How Does Intensive Exercise Affect Women With Breast Cancer.

Being that breast cancer is still one of the largest causes of death amongst women in the U.S. and elsewhere solutions  are always being looked for to alleviate symptoms.  A study of the effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer have had some interesting and encouraging results.

V. Mock  et al from the Johns Hopkins Hospital in Baltimore, USA. conducted a published clinical trial to test a hypothesis that women who participate in a walking exercise program during radiation therapy treatment for breast cancer would show more adaptive responses by evidencing  higher levels of physical functioning as well as lower levels of symptom intensity than women who did not participate.

 Two groups were created  and results would be gleaned from a pretest and a post test. The testing departments  came from two university teaching hospital outpatient radiation therapy departments.  Forty six women began a six-week program of radiation therapy for early stage breast cancer.

After random assignment, subjects in the exercise group maintained an individualized, home-based, self-paced,  walking exercise program throughout the treatment while the control group received usual care.  Variables were measured before and at the end of radiation therapy. Also, symptoms were assessed at the end of three weeks of treatment.

The  variables were: Participating in the walking exercise program, physical  fatigue, emotional distress, and difficulty with sleeping.

 The exercise group scored significantly higher than the usual care group on physical functioning  and symptom intensity, particularly anxiety, fatigue,  and difficulty with sleeping. Fatigue was the most frequent and intense subjective symptom that was reported.

The conclusion that the researchers came to was that a self-paced, home-based walking exercise program can help manage symptoms and improve physical functioning during radiation therapy.

Further implications are that monitored exercise is an effective, convenient, and low-cost self-care activity that reduces symptoms and allows adaptation to breast cancer diagnosis and treatment.

Fortunately there are additional exercise programs and products that can help facilitate the management of symptoms and improve physical functioning in breast cancer patients. Specifically there is the TUTOR system. The TUTORs (which include the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR) have been designed to afford patients with a variety of limb problems to get the proper amount of exercise. The TUTORs are ergonomically designed gloves and braces that are placed on the appropriate limb and with special sensors are connected to dedicated and exclusive software. Physical and occupational therapists monitor the progress of the patient as he ”plays” certain games. The therapists then record and evaluate this information and design a customized exercise program for that patient.

The TUTORs are currently part of the physical therapy solution in leading U.S. and European hospitals and are fully certified by the FDA and CE. They are available for children as well as adults, are very cost effective and can be used in the patient’s home through telerehabilitation. See WWW.MEDITOUCH.CO.IL for further information.

Continuous Passive Motion as a Post Surgery Recovery Tool

Continuous Passive Motion (CPM) is a therapy, in the form of machines, used after surgery  that passively — without patient effort— moves a joint through a prescribed range of motion (ROM), for an extended period of time helping the healing process as quickly – and effectively – as possible. The joint is moved without the patient’s muscles being used.

 It is normal for stiffness to follow surgery or injury to a joint. It develops as a progression of four stages: bleeding, edema, granulation tissue, and fibrosis. CPM, properly applied during the first two stages of stiffness, acts to pump blood and edema fluid away from the joint and periarticular tissues. This allows maintenance of normal periarticular soft tissue compliance. CPM is therefore effective in preventing the development of stiffness providing full motion is applied immediately post surgery and continued until the swelling  is under control. This concept has been applied successfully to elbow rehabilitation and  following knee arthroplasty. 

In most patients, whether in hospital or on an  out patient basis, after extensive joint surgery, attempts at joint motion cause pain and as a result, the patient fails to move the joint. This causes the tissue around the joint to become stiff and for scar tissue to form which results in a joint which has limited range of motion and often may take months of physical therapy to retrieve that motion. By using a motorized device to very gradually move the joint, it is possible to significantly accelerate recovery time by decreasing soft tissue stiffness, increasing range of motion, promoting healing of joint surfaces and soft tissue, and preventing the development of motion-limiting adhesions (scar tissue).  

Studies have shown that patients using CPM devices require less pain medication than patients who have had the same type of surgery and are not using this device, On the other hand there was a study conducted by M.Denis etal of the, Physiotherapy Department, Centre Hospitalier Universitaire de Québec-Hôtel-Dieu de Québec, Quebec City, Quebec, Canada., to compare  the effectiveness of  in-hospital rehabilitation programs with and without CPM for range of motion (ROM) in knee flexion and knee extension, functional ability, and length of stay after primary total knee arthroplasty (TKA). The results of this study did not support adding CPM applications to conventional physical therapy  after primary TKA, as applied in this  trial, because it did not further reduce knee impairments or disability or even reduce the length of the hospital stay.

 Recently developed for the rehabilitation of joint or limb movement is the TUTOR system. Consisting of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR these physical therapy products provide  intensive exercise for patients who have had knee or hip  replacement, partial paresis resulting from stroke, Parkinson’s disease,
CP, MS, brain/spinal cord injury and other upper and lower limb disabilities. The TUTORS consist of ergonomically designed gloves and braces with sensors connected to powerful evaluation software in the form of specially designed games. Physical therapists evaluate the patient’s ability and then design a customized exercise program for that particular patient. The TUTOR system operates through the initiative of the patient (and not an outside stimulus like a robot) and thereby allows maximum success to the patient’s movement recovery.

 Already in use in leading U.S. and European hospitals and rehabilitation clinics the TUTORs are fully certified by the FDA and CE. They are available for use by the patient in his ho

Active Robotic Training and the Legtutor

Many robot type inventions have appeared on the market in recent years to assist patientsthat have suffered some level of paresis due to accidents or disease. These devices have proven to be helpful in some cases. In general they are large and cumbersome and therefore  based in hospitals and rehabilitation centers. They are, of course, quite expensive as well. The gear that is necessary for the patient to wear sometimes gives the patient the look of an astronaut out on a spacewalk.

In a recent study published in  the Journal ofNeuroEngineering and Rehabilitation on 20 August 2012 Dr. C. Krishnan and his team from the Department ofPhysical Medicine and Rehabilitation, University of Michigan Medical School discuss the fact that clinical outcomes after robotic training are often not necessarily superior to conventional therapy. One  factor that is responsible for this is that the device provides most of the guidance. This strategy  leads to a reduction in voluntary physical effort and and also interferes with motor relearning.

The team tested the suitability of a different training approach (active robotic training) which uses a powered gait orthosis (Lokomat) in reducing the severity of  post-stroke gait impairments of a 52-year-old male stroke survivor. This gait training paradigm combined patient-cooperative robot-aided walking with a target-tracking task. The training lasted for 4 weeks with  12 visits of  3  per week. The patient’s  performance and recovery were evaluated by using neuromuscular, biomechanical  and clinical measures recorded at various points in time such as pre-training, post-training, and 6-weeks after training.

Active robotic training resulted in a considerable increase in target-tracking accuracy and a reduction in the kinematic variability of the ankle trajectory during  treadmill walking while robot-aided. Larger propulsive forces and more symmetric ground reaction forces were also transferred to overground walking. There were also  improvements in muscle coordination, similar to patterns observed in healthy controls.  Importantly, active robotic training showed results in  improvements in several standard clinical and functional parameters. These improvements were also prevalent during the follow-up evaluation which took place at 6 weeks.

The conclusion drawn indicates that active robotic training seems to be a promising way of improving gait and physical function in moderately severe  stroke survivors.

In addition to the active robotic training the recently developed LEGTUTOR  motivates the patient to undertake intensive and repetitive active exercise practice of the impaired leg by himself and not prompted by a robot. However it can be used in conjunction with powered gait orthosis in stroke, brain injury, CP and spinal cord injury patients. The LEGTUTOR is part of the TUTOR system which together with its sister physical therapy products (HANDTUTOR, ARMTUTOR, 3DTUTOR)

is an ergonomic wearable leg brace with dedicated rehabilitation software.  The cost effective LEGTUTOR rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. This means that the LEGTUTOR system, for example, allows thephysical therapist to prescribe a leg rehabilitation program customized to the patient’s knee and hip movement ability at their stage of rehabilitation. The LEGTUTOR uses biofeedback to keep the patient motivated to do the exercise practice with those that were designed in the form of challenging games. They are suitable for a wide variety of other neurological and orthopedic injuries and diseases as well as post trauma and orthopedic surgery.

 The LEGTUTOR is also used by physical and occupational therapists for upper and lower extremity rehabilitation. The TUTOR system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. It is designed for children and adults and can be used at home supported by telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

Mental Health and Physical Therapy–a Team

Mental disorders can be of major public health significance.  Studies from the U.N.’s WHO organization in 2010 show that long lasting musculoskeletal disorders, depression, anxiety and stress-related conditions  affect millions of people worldwide often causing negative consequences in their ability to work and their quality of life . Mental health disorders include a broad range of problems with several different symptoms. People with  mental health problems very often have bodily oriented symptoms. They represent a major group of patients seeking help from physical therapists all over the world.

There are claims that powerful physical activity has positive effects on mental health  both in clinical and nonclinical populations.   The strongest evidence  suggests that physical activity and rigorous exercise probably alleviate some symptoms associated with mild and moderate depression. The evidence also suggests that physical activity and exercise can provide a beneficial addition for alcoholism and substance abuse programs, social skills, reduce the symptoms of anxiety, improve self-image,  and cognitive functioning.  It could also possibly alter aspects of  Type A behavior and physiological response to stressors. However the effects of physical activity and of exercise on some mental disorders, such as schizophrenia, and other aspects of mental health are not exactly known.  Further research on the effects of physical activity and exercise on mental health is recommended.

The International Organization of Physical Therapy in Mental Health, IOPTMH, an international network of physical therapists working in the field of psychiatry and mental health, was created in Amsterdam, June 2011.  Several nations in Europe have organized subsections of physical therapy in mental health for several decades.

Many mental health facilities incorporate physical training and exercise into their daily routine. Therefore when physical exercise is recommended for improving mental health, patients should take advantage of physical therapy products such as  the TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR were created to provide intensive exercises to those suffering from limb disabilities resulting from stroke, brain or spinal cord injury, Parkinson’s disease and a host of other upper or lower limb injuries or surgeries. However the TUTOR system can be used  to alleviate mental disorder symptoms as well. TheTUTORs include comfortable ergonomically designed gloves or braces that contain sensors connected to exclusive integrated software in the form of games. In addition to the enjoyable results afforded by the games the physical therapist is able to record and evaluate the patient’s progress and design a customized exercise program for the patient.

The TUTOR system is currently in use in leading U.S. and European hospitals and rehabilitation clinics. They are available for use by children as young as 5 as well as for adults and are fully certified by the FDA and CE. The TUTORs can also be used in the patient’s home through the use of telerehabilitation. See WWW.MEDITOUCH.CO.IL for further information.

Pinless Navigation for Knee Surgery–Less Pain

Published in “Daily News and Analysis” (DNA) on Aug 9, 2012 by one of their correspondents, it was announced that Dr Vijay Allahbadia, consultant joint replacement surgeon at  Hinduja Healthcare, Mumbai, India established a new  procedure for  knee replacement surgery, which normally includes getting holes drilled into your knee and then having pins inserted into them. This is both complicated and painful during recovery. However, a new technological innovation-the pinless navigation system-will make the surgery a safer and a less painful option.

Using  infrared cameras and tracking software to conduct the knee  surgeries without using the traditional pins the system will hopefully set a trend in future knee replacements. Dr Vijay Allahbadia states that the surgery is less invasive and is a shorter surgical procedure than the traditional one.

Because extensive training is needed  there are very few orthopedic surgeons that can perform this surgery. In Mumbai Dr. Allahbadia is the only one.

Normally, following the initial recovery period of knee replacement surgery, there is a longer period of  rehabilitation. One of the most recent and cost effective physical therapy solutions is found in the LEGTUTOR.

  The LEGTUTOR is an ergonomic wearable leg brace with dedicated rehabilitation software.  The LEGTUTOR rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. This means that the LEGTUTOR system allows the physical therapist to prescribe a leg rehabilitation program customized to the patient’s knee and hip movement ability at their own stage of rehabilitation. The LEGTUTOR uses biofeedback to keep the patient motivated to do the exercise practice with those that were designed in the form of challenging games. They are suitable for a wide variety of other neurological and orthopedic injuries and diseases as well as post trauma and orthopedic surgery.

 The LEGTUTOR is also used by physical and occupational therapists in combination with the HANDTUTOR, LEGTUTOR and 3DTUTOR for upper and lower extremity rehabilitation. The TUTORs are used in rehabilitation therapy as well after brain or spinal cord injuries, Parkinson’s disease, MS, CP, Radial, Ulnar nerve and Brachial Plexus injuries. The TUTOR system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. It is designed for children and adults and can be used at home through telerehabilitation. See WWW.HANDTUTOR.COM for more information.

Maintenance Care for Arthritis Sufferers

According to the U.S. Center of Disease Control and Prevention (CDC) arthritis contributes to physical inactivity in the general population. Even though arthritis may prevent adults from engaging in physical activity there are some interventions that can benefit those people. Statistically, more than 30% of adults with arthritis (in 23 states) have no leisure time physical activity. The reasons for inactivity among arthritis sufferers include pain, fear of worsening the arthritis, ignorance of what the best type of exercise is beneficial for them and fear of being injured.

The way to counteract these problems is by having advertising campaigns through health and community organizations. Exercising methods that are safe and effective should be described for arthritis sufferers. The CDC has two such programs  currently in use. One is  ”Physical Activity. The Arthritis Pain Reliever” for English speakers and ”Buenos Dias Arthritis” for Spanish speakers. These programs increase knowledge about and initiate physical activity. Much of the programming is free. Adults with arthritis can become physically active by engaging in safe and effective group exercises. In addition the group provides social support. The venues for these activities are senior centers, Area Agencies on Aging, YMCAs, parks and recreation departments, churches and others.

Although there is no known cure for arthritis there are ways to maintain current strength and that is by having an intensive and customized exercise program. One of the most sophisticated and effective physical therapy solutions available today for that purpose is the HANDTUTOR, ARMTUTOR and LEGTUTOR. These are products that have been designed for patients who have lost  some limb mobility due to stroke, brain or spinal cord injury or upper and lower limb surgeries. However the same device that assists the latter issues can also be effectively used to provide maintenance exercise for arthritis sufferers.

The TUTORs (which also include the 3DTUTOR) are comfortable ergonomically designed gloves or braces that, through the use of sensors connected to dedicated software in the form of games, allow for intensive exercises of affected wrists, fingers, hands, knees and other joints. Physical therapists adjust the exercise program to the ability of the patient and therby customize an individual program.

The TUTOR system is currently in use in leading rehabilitation hospitals and clinics in the U.S. and Europe. It is available at home through telerehabilitation and certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for more information.

2012 London Olympics Injury List

What do Liu Xiang, Goldie Sayers, Lawrence Clarke, Andrew Pozzi, Asafa Powell and Philips Idowu have in common? These brave and talented individuals are all athletes that have trained for a considerable amount of time in their respective countries and are in London to compete for a gold, silver or bronze medal by winning a race or sportsmanship achievement however unfortunately have been eliminated because of an injurythat occurred just before or during the games.

Despite years of preparation and investment of time and money a simple (or complicated) injury has dashed their hopes and those of their respective countries. It may be a misstep, lack of coordination or forgetfulness that has put an end to their hopes for success. As tragic as this may be for the athlete and his trainers, family and country ”it isn’t the end of the world” for them. They can continue to train and improve and compete again. Many of them will also be able to train others or even just be poster people for sports products.

The tragedy is compounded by the fact that some of the injuries may have been prevented if better preparation was in place. There are exercises and physical therapy products that are usually used post injury  but  that can also be incorporated to strengthen muscles and limbs as a precautionary measure. One such set of physical therapy products is the TUTOR system. Consisting of the HANDTUTOR, ARMTUTOR, LEGTUTOR and  3DTUTOR these recently created medical devices are comfortable and ergonomically designed gloves and braces that together with dedicated software  are designed to strengthen head, trunk and upper and lower limbs. Controlled exercise practice helps to prevent the development of compensatory movement patterns for injuries suffered by accident or disease. The TUTORsalso optimize the user’s motor, sensory and cognitive abilities.

Currently in use in major  hospitals and clinics in the U.S. and Europe the TUTORs are available via telerehabilitation and are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for further information.

When did Physical Therapy Start– a Timeline History

Physical therapy not only cures various ailments of joints and bones by restoring and maintaining maximum movement and functionability it also contributes to the psychological, physical, emotional and social health of a person. But when and where did it start?

460 BC–The philosophers Hippocrates and Hector used water therapy (hydrotherapy) and massage to treat their patients.Now, fast forward to:

1984–Four British nurses formulated the Chartered Society of Physiotherapy soon emulated by other countries.

1913,4–The School of Physiotherapy of the University of Otago in New Zealand and Reed College in Portland, Oregon, USA were established. These were the  first higher education facilities that taught physical therapy.

1917-8–World War I produced many injured soldiers who benefited from this treatment so the industry grew. The system was then called ”rehabilitation therapy” and the people employed to administer it were called ”reconstruction aides”.Basically they were nurses who had additional training in physical education and massage therapy.

1921–A journal called ”PT Review” featured an article on physical therapy. Another organization called the ”American Women’s Physical Therapeutic Association” (later changed to American Physical Therapy Association–APTA) was established by Mary McMillan, a physical therapy aide. She became known as ”the mother of physical therapy”.

 1924–The Geogia Warm Springs Foundation suggested that physical therapy be used in the treatment of polio. U.S. President F.D.Roosevelt was a polio victim and spent a lot of time in Warm Springs.

1940s–massage, exercise and traction became common treatments in the field of physiotherapy

1950s–British Commonweath countries began the practice of manipulative therapy for people suffering from spine and joint ailments and pain. It was during this decade that physical therapy began to be administered outside hospitals. Schools, universities, skilled nursing facilities and rehabilitation centers also administered these treatments.

 1974–doctors began specializing in physical therapy. APTA formed an Orthopedic Section for those specializing in Orthopedics. A new organization called  the ”International Federation of Orthopedic Manipulative Therapy” popularized manual therapy.

1980s–Medical science began using computers in the field of physiotherapy. Devices such as electrical stimulators were introduced which enhanced the treatment.

2008–The HANDTUTOR was created for hand, wrist and upper limb injury rehabilitation.

2011– additional TUTOR physical therapy products called the ARMTUTOR, LEGTUTOR and 3DTUTOR were devised to allow patient rehabilitation for other parts of the body affected by stroke, brain/spinal cord injuries, Parkinson’s, CP, MS and other upper and lower limb malfunctions.

These latest physical therapy products brought amazing results to the field of physiotherapy to help cure

 a number of disorders and injuries, ranging from  musculoskeletal and sports injuries to rehabilitation from hand, wrist, elbow, knee surgeries and Ulnar fractures in addition to other head, trunk, upper and lower extremity movement dysfunction.

The TUTOR system uses comfortable and ergonomically designed gloves and braces strategically placed on various limbs together with powerful dedicated software. The system consists of motivating and challenging games that allow the patient  to practice isolated and/or interjoint coordination exercises. These exercises are monitored by physical therapists who record and evaluate the patent’s progress and customize an exercise program for that particular patient.

The TUTORs are currently in use in leading U.S. and European hospitals and clinics and are available for home use through telerehabilitation. Designed to be used for children from the age of 5 and up as well as adults, the TUTORs are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for more information.

A Researchers Suggestion Already Answered

Dr. Ananda Hochstenbach-Waelen etal from Adelante Centre of Expertise in Rehabilitationand Audiology, Zandbergsweg,  Hoensbroek, Holland published  their findings of research in the September 2012 edition of “Journal of Neuro Engineering and Rehabilitation” wherein they  discuss ”Embracing change: practical and theoretical  considerations for successful rehabilitation for upper limb training of strokepatients”.

 Dr. Ananda Hochstenbach-Waelen feels that rehabilitation technology is the tool of the future for upper limb training for stroke patients because of an increasing demand and because there is limited implementation of this technology.

Dr. Ananda Hochstenbach-Waelen did a search of PubMed and IEEE databases and discussed the issue with therapists to identify criteria and conditions to implement such skills training for stroke patients. The steps they recommended were that the technology should be tailored to the patient’s needs and goals; that there should be increasing levels of difficulty in the exercises; that the hardware and software should allow for quick familiarization and adjustability to individual patients; that the system should make itself adaptable to the patient and that the technology should provide instructions and feedback to the patient’s progression.

Apparently overlooked by the researchers is the fact that such technology already exists in the form of the widely acclaimed HANDTUTOR and ARMTUTOR. The HANDTUTOR and ARMTUTOR together with their sister devices (LEGTUTOR and 3DTUTOR) are ergonomic wearable devices that together with powerful dedicated software are  physical therapy products that have been created to serve as the exercise vehicle for stroke patients as well as for Parkinson’s, CP, MS, brain/spinal cord, Radial and Ulnar nerve and Brachial Plexus injuries as well as  other head, trunk or upper and lower limb movement dysfunction.

The TUTOR system consists of motivating and challenging games that allow the patient to practice increasing levels of difficulty and isolated and/or interjoint coordination exercises as well as  to experience repetition of the task related movements. Controlled exercise practice will help to prevent the development of compensatory movement patterns. The dedicated software allows the physical therapist to fully customize the exercises to the patient’s movement ability. In addition the therapist can objectively and quantitavely evaluate, offer feedback and provide documentation so as to report on the treatment progress In this way the therapist can tailor the program to the patient’s personal goals. The rehabilitation system optimizes the patient’s motor, sensory and cognitive performance and allows the patient to better perform everyday functional tasks to improve his quality of life. The TUTOR system has been designed to allow for quick familiarity and easy adaptibility on the part of the patient.

Already in use in leading U.S. and European hospitals and clinics the TUTOR system is fully certified by the FDA and CE and is available for children as well as adults and can also be used at the patient’s home through telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information about this most cost effective physical therapy solution.