Post Stroke Physical Therapy Exercise Products

Two-thirds of the 700,000 Americans who have a stroke each year survive and require rehabilitation. But fewer than one in three post-stroke patients undergoing physical therapy perform the at-home exercises their physical therapists recommend.

A team of researchers at Ohio State University is using a $653,000 grant from the Patient-Centered Outcomes Research Institute to develop a more fun and effective way for patients to work on regaining movement and mobility in their upper limbs.

Lynne Gauthier, an assistant professor of physical medicine and rehabilitation, is leading the team creating a video game for the Microsoft Kinect that the team hopes could expand access to a specific kind of rehabilitation called constraint-induced movement therapy. The game would allow patients with mild-to-moderate upper-limb impairment to perform guided CI therapy in their homes.

In standard stroke rehabilitation, patients only get a few hours of therapy each week and tend to develop what’s known as “nonuse,” in which they avoid use of the affected arm because it’s clumsy and awkward. CI therapy was designed to overcome nonuse by restraining the unaffected arm and upping the intensity of therapy to several hours a day over a period of two weeks.

Studies have demonstrated the ability of CI therapy to improve upper extremity function in patients shortly after stroke and after time has passed. Several studies have also shown changes in brain activity associated with the therapy.

Despite a body of research that suggests CI therapy is more effective than standard rehabilitation, it hasn’t become standard of care because it costs about $6,000 and isn’t typically covered by insurance, Gauthier said, so only a small number of specialty clinics offer it. Less than one percent of patients who are eligible for it are able to travel to those clinics and pay for it, she added.

Gauthier said her team’s objective is to develop and pilot a home-based program that retains the fundamental principles of CI therapy but changes the way it’s delivered, so more patients can access it for a lower cost ($500 or less). The video game the team is developing targets both subacute stroke patients who have completed inpatient rehabilitation as well as patients with chronic post-stroke impairment.

The game uses Microsoft Kinect’s motion capture technology to guide patients through a series of therapeutic exercises set in a river adventure theme, Gauthier said. Patients would visit a clinic for initial consultation and the game would act as a consultant to guide them through exercises at home. Patients would also be given a restraint mitt to encourage them to use their affected side more often in daily activities.

“A lot of these kinds of rehab games are basically about just getting the person to move a lot,” she said. “But we’re trying to make it so that the game would stimulate what the therapist would do. Just as a therapist would make a task harder when the person improves, the game would do the same thing.”

To do that, Gauthier is working with a cross-disciplinary team made up of a computer scientist, an electrical engineer, a biomechanist, two physical therapists and Gauthier, a psychologist and neuroscientist.

Eventually the team will create computer algorithms that would allow the program to track patients’ progress over time and provide performance feedback to patients and therapists. For the first year of the grant, though, it’s focused on game design.

Over the next several months, the team will work with patients and therapists to refine the game; the second year of the grant will focus on testing it in patients’ homes. “We feel it’s very important to involve stakeholders,” she said. “We don’t really know what the therapist response is going to be, but we are trying to involve them to make sure that we design a product that they would actually use.”

Kinect joins other physical therapy solutions already helping patients recover their lost mobility strengths. One such product is the TUTOR family of products. The HANDTUTOR, ARMTUTOR,LEGTUTOR and 3DTUTOR are ergonomically designed comfortable gloves and braces which are placed strategically on affected limbs and allows the patient to get intensive self initiated exercises via sensors that are connected to dedicated software.

The ARMTUTOR specifically trains the upper limb through dedicated software games such as : snowman, asteroid attack, car race and others. The exercises are designed to increase brain activity. Therapists monitor progress and then design a customized exercise program for that patient giving him appropriate feedback. The TUTORs are currently in use in leading U.S. and European hospitals and clinics and are available through telerehabilitation in the patient’s home.

The TUTORs can be used by adults as well as children from the age of 5 and up and are fully certified by the FDA and CE.

See WWW.MEDITOUCH.CO.IL for further information.

Balance Exercises to Prevent Falls–A Harvard Medical School Report

A new book published by the Harvard School of Medicine discusses ways to cope with balance. 

Many falls result in disastrous injuries such as broken hips especially for the elderly. It affects independence and other general health problems not withstanding pain and discomfort. However 90% of falls can be prevented if proper exercises are used and precautions are taken.

Prominent amongst these efforts is learning how to maintain balance through strength, agility and mobility.

The book ”Better Balance” will alert you to conditions, medications, and situations that  create instability. There are  tips for fall-proofing your home.  ”Better Balance” will  lift, walk, stretch and  bend you through  workouts and exercises that will greatly increase your self-reliance, stability and confidence.

The report provides all you need to know about using exercise to improve posture, increasemuscle strength and speed, sharpen reflexes, expand flexibility, and firm your core. Filled with workouts that respect your time and budget, ”Better Balance” gives you step-by-step instructions for achieving greater static and dynamic balance.

The report also includes complete, illustrated workouts that  can be done at home —according to your own schedule and pace.  These exercises were designed in consultation with Harvard Medical School physicians. They include guidance on proper techniques, tempo and movement. They modify workouts to your own level of fitness and exercise goals. The exercises  will keep you motivated and moving.

The goal in this book is to prevent you from having a potentially devastating fall and will  protect you from instability  allowing you to enjoy the independence and peace of mind that sound balance gives you.

Achieving good balance can also be achieved by a strict exercise program through well known physical therapy solutions and products such as the TUTOR system.

With the TUTOR system a LEGTUTOR and 3DTUTOR is placed on a leg. While  standing on one leg  a computerized game is played  created specifically for the TUTOR system. In this way the legs and lower limbs strengthen their muscles and balance coordination.

Originally designed for patients recovering from a variety of limb disabling diseases or surgeries i.e. stroke, brain or spinal cord injuries, CP, MS, Parkinson’s and others theTUTORs also include the HANDTUTOR and ARMTUTOR. Currently in use by leading U.S. and European rehabilitation hospitals and clinics they are fully certified by the FDA andCE.

The TUTORs can also be used at home through telerehabilitation and are available for children from the age of 5 as well as adults.

See WWW.MEDITOUCH.CO.IL for further information.

Learning Proper Balance to Prevent Falls–Harvard Medical School

A new book published by the Harvard School of Medicine discusses ways to cope with balance. 

Many falls result in disastrous injuries such as broken hips especially for the elderly. It affects independence and other general health problems not withstanding pain and discomfort. However 90% of falls can be prevented if proper exercises are used and precautions are taken.

Prominent amongst these efforts is learning how to maintain balance through strength, agility and mobility.

The book ”Better Balance” will alert you to conditions, medications, and situations that  create instability. There are  tips for fall-proofing your home.  ”Better Balance” will  lift, walk, stretch and  bend you through  workouts and exercises that will greatly increase your self-reliance, stability and confidence.

The report provides all you need to know about using exercise to improve posture, increase muscle strength and speed, sharpen reflexes, expand flexibility, and firm your core. Filled with workouts that respect your time and budget, ”Better Balance” gives you step-by-step instructions for achieving greater static and dynamic balance.

The report also includes complete, illustrated workouts that  can be done at home —according to your own schedule and pace.  These exercises were designed in consultation with Harvard Medical School physicians. They include guidance on proper techniques, tempo and movement. They modify workouts to your own level of fitness and exercise goals. The exercises  will keep you motivated and moving.

The goal in this book is to prevent you from having a potentially devastating fall and will  protect you from instability  allowing you to enjoy the independence and peace of mind that sound balance gives you.

Achieving good balance can also be achieved by a strict exercise program through well known physical therapy solutions and products such as the TUTOR system.

With the TUTOR system a LEGTUTOR and 3DTUTOR is placed on a leg. While  standing on one leg  a computerized game is played  created specifically for the TUTOR system. In this way the legs and lower limbs strengthen their muscles and balance coordination.

Originally designed for patients recovering from a variety of limb disabling diseases or surgeries i.e. stroke, brain or spinal cord injuries, CP, MS, Parkinson’s and others theTUTORs also include the HANDTUTOR and ARMTUTOR. Currently in use by leading U.S. and European rehabilitation hospitals and clinics they are fully certified by the FDAand CE.

The TUTORs can also be used at home through telerehabilitation and are available for children from the age of 5 as well as adults.

See WWW.MEDITOUCH.CO.IL for further information.

Comorbidity of ADHD and Motor Problems in Children–Some Solutions

Up to 50% of children with ADHD have motor problems which can have a severe impact on their daily lives. It seems that little attention is placed on this comorbidity issue and it goes untreated.

A study was conducted by interviews and questionnaire in The Netherlands with 235 children with ADHD and 108 controls showing that half of motor-affected children had received physiotherapy. Children that were treated had more severe motor problems but less frequently presented with comorbid anxiety and conduct disorder. Both groups (treated and untreated) were of the same general age, and rated similarly on ADHD testing scales and parental socio-economic status.

Apparently at the time of the survey undertreatment of motor problems in ADHD children occurs and behavioral factors play a role in referral and intervention.

Health workers should be aware of the impact of motor problems on the daily life of children with ADHD

 In clinical practice there seems to be less attention given to motor problems. Motor problems are usually not part of assessments for ADHD and are typically not included in intervention programs. A  child’s popularity and self-esteem is usually affected. Motor problems can cause difficulties in, for example, riding a bicycle, dressing, tying shoelaces or causing poor handwriting and sports abilities and can  further reduce children’s social participation and make them even more disadvantaged.

There are studies that have conclusively shown that physiotherapy of motor problems, especially child–centered, task-oriented approaches, can ameliorate motor disability and thus quality of life. Physical therapists  or occupational therapists can deliver interventions.  Parents and teachers can be instructed to manage motor problems as well, which may be helpful in case there are limited professional resources.

In the current study, the researchers examined if they could substantiate the clinical impression that motor problems don’t receive enough attention in the treatment of ADHD comorbid disorders. The main goal was to investigate in a well-diagnosed sample of children that had combined subtype ADHD, how many and which children were treated for motor problems. The investigation determined if treated and untreated children differed in age, gender, ADHD inattentive and hyperactive-impulsive symptoms scores, motor scores,  comorbidity with other conditions  such as: mood disorders, anxiety disorders,  conduct disorder, defiant disorder and socio-economic status of parents.This was done in order to predict actual treatment administration.

To detect  motor difficulties the Developmental Coordination Disorder Questionnaire  was completed by parents, and the Groningen Motor Observation scale was completed by teachers.

The parental socio-economic status was based on information concerning parents’ professions, gathered during the PACS interview. Professions were categorised into five levels, from manual labor to academic work.

A questionnaire concerning physical domains was designed for this study. This questionnaire was completed by parents and contained 36 questions about  motor milestones, sleep habits, development, infections, hospital admissions, medication and use of physiotherapy. The question that was evaluated in this study was : ‘Has your child ever been treated for motor problems by a physiotherapist?’

The study confirmed the impression that motor problems of children with ADHD are a neglected area of clinical attention. Roughly only half of the children with ADHD and motor problems in the study had received physiotherapy.

Apparently parents seek help earlier than teachers for children that are ADHD  This finding may point to a lack of communication on this subject between teacher and parents.

Physiotherapy or occupational therapy has been proven effective for treating motor problems.  Modern intervention methods are child-focused and help children  acquire important skills for daily activities, which can increase their quality of life.

When a child from the age of 5 and up develops motor problems due to ADHD there is a physical therapy solution that can be very helpful. Referred to as the TUTOR system it consists of a HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. Originally designed for patients that are recovering from a stroke, brain or spinal cord injury, CP, MS or many other upper or lower limb disabilities the TUTORs incorporate exclusive and challenging games into sensor-containing gloves and braces that allow the user to get intensive exercises. The ADHD child will actually enjoy using these devices at the same time that they are alleviating his motor problems.

Currently in use leading rehabilitation facilities around the world the TUTORs are fully certified by the FDA and CE.

For further information see WWW.MEDITOUCH.CO.IL

Step By Step Osteoarthritis Exercise Program

Always consult with your doctor before beginning an exercise program if you have osteoarthritis.

 

Stretching the Hamstring

 Walk for 5 minutes as a warmup.  Stretch. Lie down. Put a  bed sheet around your right foot and use it to help pull and stretch your leg up. Hold that position for 20 seconds. Repeat this twice, then switch legs. There are 3  important types of exercises for knee OA. Range of motion or stretching exercises which keep you limber. Strengthening exercises which build muscle strength in order to stabilize weak joints. Aerobic exercises, like walking, which help the lung and heart.

Stretching exercises help loosen muscles and improve flexibility. They also help prevent pain and injury.

While using a chair for balance, bend your right leg then step back with your left leg, slowly straightening it behind you. Press your left heel towards the floor. You will now feel the stretch in your back leg.

If you want more of a stretch then lean forward while bending the right knee deeper. However don’t let the right knee go past your toes. Hold this position for 20 seconds. Do it twice and then switch legs.

 Straight Leg Raise

 Lie on the floor and prop your back up on your elbows. Bend your left knee while keeping your foot on the floor. Keep the right leg straight with your toes pointed up. Tighten the thigh muscles of your right leg. Smoothly and slowly  use your thigh muscles — but not your back — to raise your leg.

Pause for five seconds. While your thigh is still tight, slowly lower your leg to the ground. Relax. Repeat this 10 times. Rest. Do another 10 sets; then switch legs.

Quad Set

If the straight leg raise is too tough then do quad sets instead. With these you don’t have to raise your leg. Just tighten the thigh muscles (quadriceps) of one leg at a time.

Begin by lying on the floor keeping both legs on the ground, relaxed. Flex and hold your left leg tense for five seconds and then  relax. Do 2 sets of 10. Then, switch to the other leg.

Seated Hip March

Doing this can strengthen hips and thigh muscles to help you with daily activities, like walking or getting up  from a chair.

Sit up straight in the chair.  Kick back your left foot but keep your toes on the floor. Lift your right foot off the floor while keeping your knee bent. Hold your right leg in the air for five seconds. Slowly lower your foot to the ground. Repeat this 10 times. Then rest and do another 10 after which you should  switch legs. If this is too hard use your hands to help raise your leg.

Pillow Squeeze

This will help strengthen the inside of your legs to give support to your knee. Lie on your back with both knees bent. Put a pillow between your knees.

Squeeze your knees together, squishing the pillow between them. Hold this for five seconds then relax. Repeat the set 10 times. Rest, then do another set of 10.

If this is too hard you can  do this exercise while seated.

Heel Raise

Hold the back of a chair for support. Stand straight and tall. Lift your heels off the ground and rise up on the toes of both feet. Hold it there for five seconds. Slowly lower both heels to the ground. Repeat this 10 times then rest and do another 10.

If this is too hard do the same exercise while sitting in a chair.

Side Leg Raise

Hold the back of a chair for balance. Place your body’s weight on your left leg. Lift the right leg outwards to the side. Keep your right leg straight. Keep your outer leg muscles tensed. Try not to slouch. Lower your right leg and relax. Repeat this 10 times. Rest. Do another 10 sets, then repeat  it with your left leg.

If this is too hard increase the leg height over time. Following a few workouts, you’ll be able to raise your leg higher.

Sit to Stand

Practice this move in order to make standing easier. Put two pillows on a chair. Sit on top of them, with your back straight and feet flat on the floor. While using your leg muscles, slowly and smoothly stand up tall. Then, slowly lower yourself back down to a sitting position. Make sure your bent knees don’t move in front  of your toes. Try this also with arms crossed  or loose to your side.

If this is too hard  add pillows or use a chair with armrests and then  help push up with your arms.

One Leg Balance

Try doing this hands-free or steady yourself on a chair, if necessary. Now, shift your body weight to one leg but don’t lock your knee straight. Then slowly raise the other foot off the ground, balancing on your standing leg. Hold that for 20 seconds then lower your  raised foot to the ground. Do this twice, then switch legs. This move helps you when getting out of cars or bending.

If you find this too easy, balance for a longer time. Or do it with your eyes closed.

Step Ups

This move can help you strengthen your legs for stair climbing. Face a stable step with both feet on the ground. First, step up with your left foot then follow with your right foot. Now, stand on top, tall and while both feet are flat. Climb down in the reverse order: Right foot down first, then left. Do this 10 times then rest and  repeat another 10 times. Now do it starting with your right leg first. If this is too  hard try using a railing, wall, a lower step or lamppost for balance.

Walking

If you have  stiff or sore knees you may not think that walking is a great idea but it actually is one of the best exercises for knee arthritis. Not only  can it reduce joint pain but it can also strengthen your leg muscles and improve flexibility. It’s also good for your heart and the best part is that there are no gym membership fees needed.

Having a good form is key: Look forward, keep your arms and legs moving, relaxed and walk tall.

Low-Impact Activities

Losing weight is a side benefit of being active and exercising. It also takes pressure off your joints. Other exercises that are easy on the knees are  swimming, biking and water aerobics. Water exercise can take weight off painful joints.

It isn’t necessary to give up your favorite activities, like golf. Discuss with  your doctor or physical therapist about modifying painful moves.

How Much Exercise?

Start with just a little. If there is no pain, do more next time. Try to aim for 30 minutes a day.

In the course of time you’ll build your leg muscles which will support your knee and increase flexibility.

It is normal to have some  muscle soreness  but hurting or swollen joints should have rest. Take a break and ask your doctor for advice. Ice painful joints and take ibuprofen, naproxen  or acetaminophen as a pain reliever.

Using physical therapy solutions and products is also an effective way to strengthen leg muscles which can alleviate osteoarthritis pain. The LEGTUTOR is one such device that can be used.

 The LEGTUTOR system is a key component of physical therapy usually used after total knee or hip  replacement. 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 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, ARMTUTOR and 3DTUTOR 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.

Disability, Depression and Rehabilitation

Disabilities make it harder to take part in normal daily activities. They may limit what you can do physically or mentally, or they can affect your senses. Disability doesn’t necessarily mean unable, and it isn’t a sickness. Most people with disabilities can – and do - learn, work, play,  and enjoy full healthy lives. Mobility aids and assistive devices can sometimes make all the difference., About one in every five people in the United States has some kind of a disability. Some people are born with a disability. Some get sick or have an accident that results in a disability. Some people develop disabilities as they age. Almost all of us will have a disability at some point.

 Disabilities can lead to depression. Depression is a serious medical illness that involves the brain. Being “down in the dumps” or “blue” for a few days is not what depression is about.   If you are one of the more than 20 million people in the United States who have depression, the feelings do not always go away. They persist and can interfere with your everyday life.

Symptoms can include:

Loss of interest or pleasure in activities you used to enjoy,

Sadness,

Difficulty sleeping or oversleeping,

Change in weight,

Feelings of worthlessness,

Energy loss,  and even

Thoughts of death or suicide

Depression is a disorder of the brain. There are a variety of causes, including environmental, genetic, psychological, and biochemical factors. Depression can start between the ages of 15 and 30, and is much more common in women. Postpartum depression after the birth of a baby can also cause major depression. Some people get an affective disorder in the winter or around the holidays especially if they are separated from family and friends. Depression is one part of bipolar disorder.

There are effective treatments for depression, including antidepressants, talk therapy andphysical rehabilitation for a disability. When the disability is a result of a stroke, brain or spinal cord injury, Parkinson’s disease, MS, CP or any other upper or lower limb surgery or disease efforts should be made to employ the most effective physical, solution available. This may encourage the best way to return to the pre event emotional status. One of the most efficient physical therapy products available today is the TUTOR system by MEDITOUCH. The MEDITOUCH rehabilitation system consists of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. These are ergonomic wearable devices together with powerful dedicated rehabilitation software. The system is indicated for patients in rehabilitation centers, private clinics and the home and can be supported by telerehabilitation. It is designed for those that have head, trunk, upper and lower extremity movement dysfunction.

The system consists of motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises. The dedicated software allows the therapist to fully customize the exercises to the patient’s ability. Most important is that the TUTOR system optimizes the patient’s motor, sensory and cognitive performance allowing him to better perform everyday functions again and thereby to reduce depression.

Currently in use in leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE.

See WWW.MEDITOUCH.CO.IL for further information.

More Efficient System for Therapeutic Arm and Hand Movement

Recently, interest in virtual-reality technology as used in physical rehabilitation has risen drastically. The applications in this field are varied. They range from simulations that address various phobias, to physical interfaces that help to improve and analyze   fine motor control. In  Physical Therapy, the majority of virtual-reality applications focus on hand and arm movements. This is because of the variety of available hand interfaces developed by the gaming industry. However, when used within the context of VR therapy, these hand interfaces only provide limited sensory information, which often yields unreliable results. For example, if an application requires the patient to move their arm in a certain manner, and the patient is unable to do this satisfactorily, he may compensate for  the action by adjusting his posture or his shoulders. In that case,  the patient fails in accomplishing the intended therapeutic objectives but the application  may still register the action as a ‘success’.

Researchers note that typically, the patient compensates for a reach task mostly through moving the trunk forward  and to a lesser extent, shoulder flexion. This movement compensation is used instead of the natural reach pattern, which involves interjoint co-ordination of shoulder, elbow and hand.  Technologies that  are available do  address shoulder and posture control with the precision required by researchers but   are cost-prohibitive and  bulky. These include camera based motion-capture systems, which require high  setup and maintenance costs. However physical and occupational therapists can now use the HANDTUTOR, ARMTUTOR and 3DTUTOR to allow their patients to practice intensive reaching and gripping exercises and receive feedback on the position of the trunk as they are performing the reaching task.  The software also shows the patient how to reposition the trunk in the correct way. Being aware of the trunk position during reaching exercises  using the ARMTUTOR and or HANDTUTOR will allow the patient to practice active trunk constraint.

The TUTOR system (which also includes a LEGTUTOR) was originally designed to assist patients recovering from stroke, brain/spinal cord injuries and other upper and lower limb disabilities. The TUTOR system consists of ergonomically designed gloves and braces which include sensors connected to dedicated exercise software. The patient uses his own power to move objects on the screen. Physical and occupational therapists record and evaluate the patient’s progress and then design a customized exercise program for the patient.

Operating now in leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE. They are also available at the patient’s home through the use of telerehabilitation.

See WWW.MEDITOUCH.CO.IL for further information.

Trunk Restraint and the TUTOR As Tools for Reach and Grasp

Since the goal in physical rehabilitation is to return the patient‘s functional ability to as near as possible to the pre event state it is necessary for the patient to become as independent as possible and  to relearn basic skills like eating, dressing, walking and grasping. This will preserve the patient’s dignity and reduce the burden on family.

A study was performed by Stella M. Michaelsen, PhD etal from the School of Rehabilitation, University of Montreal and the Centre for Interdisciplinary Research in Rehabilitation, Rehabilitation Institute of Montreal, Quebec, Canada. The Purpose of the study was to discover the advantages of trunk movement restriction when attempting to reach an item placed within arm’s reach by patients with hemiparesis caused by stroke. Compensatory trunk movements may improve motor function in the short term but may limit arm recovery in the long term. Previous studies showed that restriction of trunk movements during reach-to-grasp movements results in immediate increases in active arm joint ranges and improvement in interjoint coordination. To evaluate the potential of this technique as atherapeutic intervention, a comparison was made as to the effects of short-term reach-to-grasp training with a 60 session trial with and without physical trunk restraint on arm movement.

 A total of 28 patients with hemiparesis were divided into 2 groups: One group practiced reach-to-grasp movements during which compensatory movement of the trunk was prevented by a harness as a trunk restraint, and the second group practiced the identical task but they were verbally instructed not to move the trunk (control group). Before, immediately after and 24 hours after training, Kinematics of reaching and grasping an object placed within arm’s length were recorded.

 The results showed that the trunk restraint group used more elbow extension, less anterior trunk displacement and had better interjoint coordination than the control group after training. In addition range of motion was maintained 24 hours later in only the trunk restraint group.

Therefore it was concluded that restriction of compensatory trunk movements during practice may lead to greater improvements in reach-to-grasp movements by chronic strokepatients than practice alone.

Also, in order to train grasp through hand therapy, the occupational and physical therapists have to improve both the patient’s finger range of motion and movement. This means that the OT and PT have to work on the patient’s motor movement in terms of strength, accuracy and balance of antagonistic muscle movements as well as pattern of joint movements.

In addition to hand therapy the OT and PT will have to work on the patient’s shoulder, elbow and wrist movement ability as these joints are also used during a reach, grab and grasp task.

Proper exercise practice using the TUTOR system will allow the patient to implement the correct pattern of multijoint movements in order to perform the functional grasp task. Therefore the OT and the PT will use the ARMTUTOR for shoulder and elbow intensive exercise practice and the HANDTUTOR for wrist and finger movement practice.

The dedicated rehabilitation software of the TUTOR system allows the occupational and physical therapists to  work on the correct pattern of joint movement with feedback from the shoulder and the elbow. Together with the accompanying motion feedback from the HANDTUTOR the patient will learn how to perform the grasp task through repetitive exercise practice.

The TUTOR system is used extensively in rehabilitation hospitals and clinics in the U.S.and Europe and are fully certified by the FDA and CE.

Telerehabilitation allows the patient to continue his exercise program at home or if he is located too far from a rehabilitation facility.

See WWW.MEDITOUCH.CO.IL for further information.

Using Contextually Based Technology in Occupational Therapy

Robert Ferguson, OTRL, and Douglas Rakoski, MA, OTR/L, ATP feel that when we consider technology, our ideas of it can range from using a computer to robotics. Working with stroke survivors, they wantoccupational therapy practitioners to be aware that even the simplest technology can help clients achieve their therapeutic goals.

Ferguson and Rakoski prefer using technology instroke rehabilitation by breaking down tasks and incorporating them into therapeutic interventions and that occupational therapy should be the driving force in using technology in rehabilitation.

 ”Technology is pervasive in our daily lives”, say Ferguson and Rakoski. It’s used daily from young children to  74-year-old women who never used a computer  and now are on it every day.  Most people don’t realize how many repetitions are required to access and use  user-friendly and intuitive technology such as smartphones, computers and tablets.  This fact allows therapists an opportunity to provide an occupationally based treatment which can be modified and adapted  to facilitate cognitive, motor  and perceptual abilities.

Using technology with a stroke survivor as an example.

One patient had a hard time being able to reach behind to do toilet hygiene. Rakoski and Ferguson said “we can use the computer to do that,” and of course everyone laughed at him. But if the task is broken down the client has to be able to internally rotate and reach behind. They brought up a card game on the computer that the client liked, where he touched the screen to move the cursor, but to do a left click, they took a switch and  safety-pinned it to the back of his pants. So he’s doing the same motion, but he’s doing a high number of repetitions so he can practice the movement to be able to reach. They broke down the functional task into components and utilized the same tasks while the client is playing a game or doing an activity.

Ferguson continues: While the client was doing that, I’m using the same hands-on handling techniques that I would normally use in the clinic, but  with the technology to facilitate that movement. It gives us hundreds of repetitions and we’re able to replicate it.

Ferguson was asked why he thinks occupational therapy practitioners struggle to find ways that link stroke intervention approaches to the client’s participation in meaningful occupations?

He responded that many common everyday activities don’t normally have enough repetitions inherent to the demands of the activities. As a result, therapists  tend to use  objects like rings or blocks   that can provide repetition, but they lack context. Unfortunately even when a treatment approach uses  contextually appropriate objects for the activities, when the treatment occurs outside of a natural environment they are still practiced out of context. We normally work in a hospital and it therefore makes it difficult to  link many activities contextually. Some people have tried to use functional kits, which are more appropriate, but they are difficult to adapt to challenge the patient as they continue to progress. Technology can contextually be used  anywhere. You can decide how the technology interaction is to be completed and it becomes an intricate part of the activity. Patients seem love it and they find it easy to relate it to their  goals.

Rakoski describes his favorite technology that helps with post stroke interventions.

He likes an ”emerging movement”—whether it’s finger extension, wrist or elbow —it’s such a small movement that it’s not really functional. You aren’t able to get dressed or  take care of yourself, but it’s still an emerging movement.  The client can see that, “Wow, I’m moving my finger, even if just by a few degrees, but I’m activating that switch, which is driving the computer to do an activity or  play a game.” Even though it’s not completely functional, the patient begins to get  to see that there is some movement. The stronger they get the more they can be challenged. So even though it’s not  a favorite piece of equipment, it gets the client who functionally cannot use that movement, to   see that it translates into some  activity.

Rakoski was asked what he would want all occupational therapists to know about using technology in stroke rehabilitation?

He answered that it isn’t necessary to have a large expensive piece of equipment. Sometimes it’s just a simple touch screen or  switch. A lot of it boils down to  creativity.  Basically it’s setting up the computer to allow the client to interact in a meaningful occupation—it could be a hunting  or fishing card game—but you’re working on a high number of movements and repetitions. You’re engaging the patient which makes him work harder and longer. He will also  have less fatigue and less pain. It basically depends on the therapist‘s creativity.

Ferguson stated that technology is all over the place today and is so much a part of everyone’s lives. Almost everyone uses some technology every day. However, even folks who don’t use a lot of technology like to come into the computer lab. They are interested in seeing  what they can do and what the connection is to  what they want to be able to do.

The TUTOR system (HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR) is a recently developed state of the art technological advance in rebuilding muscles and limb movement following stroke, head/brain injuries, Parkinson’s disease, CP, MS and other upper or lower limb surgeries or diseases. Physical as well as occupational therapists administer intensive exercises through this innovative physical therapy product.

Consisting of ergonomically designed and comfortable gloves and braces the TUTORscontain sensors  connected to exclusive computerized games. The therapists then monitor the results and customize an exercise program for that particular patient. The TUTOR system implements an impairment based rehabilitation program with augmented feedback and encourages motor learning.

Currently in use in leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE.

They are available for children from the age of 5 as well as adults and can be used in the patient’s home through telerehabilitation.

See WWW.MEDITOUCH.CO.IL for further information.