Continuous Passive Motion (CPM) is a therapy or – mobilisation passive continue (Arthromoteur CPM – kinetec), 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 home through telerehabilitation. See WWW.MEDITOUCH.CO.IL for further information.

About 300,000 people every year fracture their ribs in the U.S. 72% of these fractures occur in men although postmenopausal women are also prone to  them due to osteoporosis. Rib fractures occur as a result of trauma such as falls and sports activities  but can also come through severe coughing and even CPR treatment in older adults. A broken or fractured rib may result in internal damage to an organ, tendon or muscle. Severe damage can be done if there is a ‘flail’ chest. That is if 3 or more ribs are fractured in 2 or more places and the ribs are separated from costal cartilege or the sternum.

Earlier treatment included wrapping the chest in bandages or corsets to keep the ribs in place for healing however that is not done now as it limits proper breathing. Improper breathing can cause pneumonia and other problems.

The recommended treatment is rest, gentle exercise, pain medication and targeted physical therapy programs when the pain is less severe. Yoga and other strenuous activities are to be avoided for up to 6 weeks in most cases. Time is the main healer as the ribs heal themselves. It is recommended to take deep breathes and gentle exercises to expand the diaphragm. Sometimes even swimming 45-90 minutes per day can be helpful. Walking and moving helps to keep the airways clear and helps to prevent pneumonia and collapsed lungs.

One of the simple exercises recommended is the ”pendulum” i.e. bending forward and swinging the arms around in a circle. When ribs are sufficiently healed a larger range of motion should be attempted to increase arm flexibility.

Physical therapy is indicated in those individuals with a fractured rib who present with a compromised respiratory system, advanced age, or functional limitations associated with postural muscles .The goal of rehabilitation is to decrease pain, prevent respiratory complications and restore function. Local application of heat or cold may provide temporary relief of discomfort, in conjunction with pharmacological treatment. There is evidence to support the use of a transcutaneous electrical nerve stimulator (TENS) for pain management in patients with uncomplicated minor rib fractures (Oncel). The physical therapist should instruct patients in deep-breathing exercises to promote full lung expansion, relieve intercostal muscle spasm, and mobilize lung secretions. Finally, shoulder and trunk gentle stretching exercises may relieve discomfort and promote chest expansion, functional shoulder mobility, and improved posture.

It is noteworthy that intensive hand, arm and leg exercises would not be the treatment of choice for a rib fracture however when someone suffers from stroke, Parkinson’s disease, Brachial plexus injury, Brain/spinal cord injuries, CP, MS or other upper and lower limb semi paresis then physical therapy solutions such as the TUTOR system come into place and can be very helpful in regaining lost movement.

The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR  have become a key system in neuromuscular rehabilitation and physical therapy for interactive rehabilitation exercise. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. This training is customized by the occupational and physical therapist to ensure that the patient stays motivated to do intensive repetitive manual therapy and exercise practice.   The TUTOR system is now  part of the rehabilitation program of leading U.S. and European hospitals.  Home care patients can be supported by the occupational and physical therapist offering tele-rehabilitation. See WWW.MEDITOUCH.CO.IL for further information.

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. The TUTORs 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.

Rehabilitation medicine

One of the beautiful benefits of using music during physical rehabilitation is that one can witness the active and consistent participation of the patient which is often not the case with standard rehabilitation. The  music itself encourages participation in exercises. It can also relieve the discomfort associated with the activities. It is the goal of regular music therapy to get the participant to express himself through the music so the common goal here is to alleviate symptoms of orthopedic, pediatric and neurological conditions in order to improve range of motion, strength, communication, balance and cognition and generally the quality of life.

Occupational therapists are finding that music therapy assists clients to maximize the patient’s independence in their daily roles.

When accompanying music is used in conjunction with physical rehabilitation it would be the ultimate combination if the  physical therapy products  in use were of the highest quality and most efficient. Such would be the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. These recently created devices are comfortable ergonomically designed gloves and braces that are strategically placed on affected limbs and through sensors are connected to sophisticated software. The software consists of exclusively designed games that the patient plays. Physical therapists monitor , record and evaluate the patient’s progress and design a specific exercise program for the patient. The patient himself activates the limb rather than an external robotic device that causes movement. In that way the patient has control and can progress further independently.

The TUTOR system has been in use now for some time in leading U.S. and European hospitals and rehabilitation clinics. The TUTORs are fully certified by the FDA and CE, are available for children as well as adults and can be used at the patient’s home through the use of telerehabilitation.

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

Victoria University, New Zealand, masters student in engineering, Abigail Rajendran, 23,  designed a stroke rehabilitation device and is working to market it. Rajendran believes that stroke patients will be able to rehabilitate themselves from home with the new device.

With the device strapped on to a patient’s hand the goal is to exercise it in an opening and closing motion. A connected computer game activates at the same time and keeps both sides of the brain working.

Once the patient regains the strength and can do the motion himself, he can increase the resistance with  a special liquid contained in the device.

Rajendran says that until now, stroke patients had to rely on expensive and large rehabilitation equipment  only found in hospitals. However this  device  could be used regularly at home.

Funding for a prototype has been provided by the Science and Innovation Ministry.

Few, if any, home rehabilitation instruments are available for people recovering from strokes and new technology has to be made available according to Chief executive Sunil Vather.

Apparently New Zealand stroke patients get only a few hours of therapy if they’re lucky and this device may afford them many more hours.

Miss Rajendran will present her idea in Singapore later this month, and in Brisbane in October. The device may be ready for use in about a year.

Apparently unknown to Miss Rajendran and her associates such physical therapy solutions already exist and are being used successfully in many leading U.S. and European and other hospitals and clinics. The physical therapy products known as the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been devised to allow intensive exercises to stroke victims as well as those afflicted with disabling Parkinson’s, MS, CP, brain/spinal cord injuries  and other upper and lower limb paresis.

The TUTORs are comfortable ergonomically designed gloves and braces that are attached to the affected areas of the body and then connected to a computer that has dedicated software in the form of games. These games are played with the active initiation of the patient himself and the results are recorded and evaluated by physical therapists who then design a specific exercise program for that patient.

Since many patients have improved to the point where they no longer need hospitalization they and others who live too far from a rehabilitation clinic can avail themselves of the TUTORs at home through the use of telerehabilitation. In addition the TUTOR system is one of the most cost effective physical therapy products on the market today and they are small in relation to hospital based large equipment.

The TUTORs are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for more information.

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 TUTORs also 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.

Nineteen healthy male subjects were enrolled in the study. The study design included: a-voluntary contraction only, b-functional electrical stimulation (FES)-induced wrist extension only, and  c-simultaneous voluntary and FES-induced  movement. Brain activation was observed in all three modes.

The activated brain regions (number of voxels) of the MI, SI, cerebellum, and SMA were LARGEST DURING VOLUNTARY CONTRACTION ALONE and smallest during FES alone. SII-activated brain regions were largest during voluntary contraction combined with FES and smallest during FES contraction alone. The brain activation extent (maximum t score) of the MI, SI, and SII  was LARGEST DURING VOLUNTARY CONTRACTION ALONE and smallest during FES alone.

The conclusions drawn were that voluntary contraction combined with FES may be more effective for brain activation than  FES-only movements for rehabilitation therapy. In addition, voluntary effort is the most   important factor in the therapeutic process.

As it is this is another proof that the patient recovering from and undergoing rehabilitation for affected limbs due to Parkinson’s, CP, MS, stroke, brain or spinal injuries amongst other diseases and surgeries should be using physical therapy solutions that encourage the patient to use his own strength and efforts while exercising more than outside stimuli via robots or electrical impulses. Such physical therapy products can be found in the TUTOR system.

The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been designed for just that type of intensive exercise. Consisting of comforatble and ergonomically designed gloves or braces, The TUTORs improve fine motor, sensory and cognitive impairments through intensive exercises with augmented feedback. The exercises are challenging and motivating and allow for repetitive training tailored to the patient’s own performance. In the case of the HANDTUTOR, for example, the glove has been designed to detect finger and wrist motion and has an open palmar surface to give maximum motor and sensory input. The glove comes in different sizes to allow evaluation and treatment of patients from age 5 and up.

One of the most cost effective rehabilitation devices currently in use in leading U.S. and European hospitals the TUTORs are fully certified by the FDA and CE. They can also be used in the patient’s home via telerehabilitaion. See WWW.MEDITOUCH.CO.IL for more information.

For others who are not so lucky and are suffering from Cerebral Palsy and other disabling diseases  getting the right type of physical therapy solution is critical in order to restore normal movement in the affected limb. Such a solution can be found in the TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been included in physical therapy programs at leading U.S. and European hospitals and rehabilitation facilities. These devices are ergonomically designed gloves and braces that have sensors to detect even the slightest movement on dedicated software they are connected to. The physical therapists then record and quantify this information and design a customized intensive exercise program with augmented feedback leading to enhanced rehabilitation for the patient.

The TUTOR system is suitable for children as well as adults and can be used at the patient’s home through telerehabilitation. The TUTORs are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for more information.

What they discovered could lead to new treatments for stroke,  autism, tinnitus, and other disorders.

The researchers looked at whether by repeatedly pairing vagus nerve stimulation with a specific movement it would change neural activity in laboratory rats’ primary motor cortex. They paired the vagus nerve stimulation with movements of the front limbs in two groups of rats.

After a period of five days of this stimulation and movement pairing, the researchers examined the brain activity of the rats. Those who received the training together with the stimulation displayed large changes in the organization of the brain’s  control system. Those animals receiving identical motor training without stimulation pairing didn’t exhibit any brain changes, known as plasticity.

Patients suffering from strokes or other brain trauma often have rehabilitation that includes repeated movement of the affected limb in order to regain motor skills. It is surmised that repeated use of the affected limb will cause reorganization of the brain which is essential to recovery.

Dr. Rennaker stated that there  was a suggestion from the research that pairing vagus nerve stimulation with standard therapy could result in a more rapid and extensive brain reorganization. This would offer the potential for speeding  recovery following a stroke.

He further stated “Our studies in sensory and motor cortex suggest that the technique has the potential to enhance treatments for neurological conditions ranging from chronic pain to motor disorders. Future studies will investigate its effectiveness in treating cognitive impairments”.

Vagus nerve stimulation has an excellent safety record in human patients that suffer from  epilepsy. Therefore the technique researched provides a new method to treat brain conditions such as dyslexia and schizophrenia.

Future human patients may have access to more efficient therapies that are minimally invasive and avoid long-term use of drugs if the studies are confirmed.

To provide repeated movement of a stroke affected limb the TUTOR system has been in the forefront of physical therapy products. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been developed to provide intensive and active movement of  disabled legs, hands, wrists, elbows and other upper and lower limbs. The ergonomic gloves and braces that make up the TUTOR system are connected to dedicated software that allows the therapist to fully customize the exercises to the patient’s movement ability. In addition the therapist can objectively and quantitatively evaluate and report on the treatment progress. The TUTOR rehabilitation system optimizes the patient’s motor, sensory and cognitive performance and allows him to better perform everyday functional tasks to improve their quality of life.

The TUTOR system is currently in use in leading U.S. and European hospital and clinics. They are fully certified by the FDA and CE and can be used at the patient’s home via telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

To explain it further  there are two areas of rehabilitation:

a) Prehabilitation: which is  exercise therapy undertaken by athletes and others to try to  reduce the risk of injury.

b) Rehabilitation:  is exercise therapy which is used to strengthen muscles around limbs and thereby attempt to return the use of an affected limb to its previous healthy state and also to prevent the injury from recurring. This method can be used to build up muscles and reduce injury around the shoulder, arm, leg and other upper and lower limbs of the body. Players of contact sports such as Rugby in the UK or football in the U.S., as an example, can be the beneficiaries of such prehabilitation.

Using the best physical therapy solutions for prehabilitation would add to the success of prevention of severe injuries. Such physical therapy products as the TUTOR system afford the athlete and others to accomplish controled exercise practice allowing for muscle toning and strengthening. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been introduced to provide intensive exercises for disabilities arising from stroke, CP, MS, brain/spinal cord injuries and other upper and lower limb injuries or diseases or orthopedic injury and disease. The TUTORs are ergonomically designed gloves and braces that are attached to various parts of the body and through powerful evaluation software accessed by sensors in the braces that allow the patient to perform intensive exercises. The exercises are monitored by physical therapists who then design a custom made program appropriate for that patient’s ability level.

The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are fully certified by the FDA and CE. They are available for children as well as adults and can be used in the patient’s home through telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

Rehabilitation helps return abilities impaired by a stroke. How much progress one makes and how quickly it occurs will depend on how severe the stroke was and the part of the brain that was affected.

Strokes can affect muscle strength, senses (like pain), one’s ability to speak and to understand speech, vision, emotions, thinking and level of consciousness. Some people only suffer mild unilateral weakness with nothing else wrong. Other people lie in a coma.

New techniques have been learned in recent years that sometimes lead to recovery that at one time were not possible.

Rehabilitation may occur in the hospital, a rehab facility or at home. One or more specialists may be involved. These may include a physiatrist, rehab nurse, physical or occupational therapist, speech-language pathologist or a recreational therapist.

The strategies used will depend on the patient’s goals for therapy. Some common goals include rebuilding strength, relearning to walk, improving speech and recovering memory. On the other hand rehab can also help a person adapt to a permanent disability, if necessary.

Physical rehab may include walking up or down stairs, walking on a treadmill and using hand or leg weights. Even if the patient can’t bear weight on his legs exercise may still be possible. This may have to be done while partially supported by a harness. Many patients exercise in a swimming pool, where water can support some of the weight.

The therapist may also stimulate natural movements in the arms and legs. This can help restore neurological pathways at the same time as it strengthens muscles and improves circulation.

Regaining skills for regular everyday living is another important goal. The patient will learn practical techniques to make washing, dressing, driving and other routine activities more manageable.

The therapist may teach speech and language skills and may include exercises to improve comprehension, speaking, reading and writing. It may also help restore the ability to swallow safely which is often impaired by a stroke.

Then there is cognitive rehab that teaches strategies to compensate for problems with learning, memory, and awareness.

Rehab usually takes time and hard work. patients sometimes get discouraged but rehab can make the crucial difference between regaining previous ability to function or remaining impaired.

Some patients make little progress after a month of work, every day, with rehabilitation therapy. Then, they suddenly seem to make considerable progress. They should not give up. Stroke rehab really can make a difference.

Finding and using the best physical therapy solutions often includes products like the TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been developed to assist in exercising stroke affected limbs.

The TUTORs have become a key system in neuromuscular rehabilitation and physical therapy for interactive rehabilitation exercise. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. The training is customized by the occupational and physical therapist to ensure that the patient stays motivated to do intensive repetitive manual therapy and exercise practice. The TUTORs are now part of the rehabilitation program of leading U.S. and European hospitals with the TUTORs being used in clinics and in the patient’s home. Home care patients can be supported by the occupational and physical therapist offering tele-rehabilitation. The TUTORs are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for more information.

A questionaire was sent to 300 Dutch physical therapists. More than two thirds responded. The results showed that there were 3 main factors to noncompliance on the part of patients to physical therapy. First, and the strongest reason, was the perception of the barriers to the therapy and encountering those perceptions. Second, was the lack of feedback they received and third, the feeling of helplessness they felt. The results also showed that non compliance with physical therapy was because of the characteristics of the illness rather than the illness itself. If the patient received a negative prognosis it would produce more non compliance.

No differences were seen between male and female noncompliance but there was a difference between more or less educated patients with the less educated being more compliant than the highly educated.

The conclusion of the study seems to be that physical therapists should investigate more thoroughly problems that patients encounter with compliance and to seek the solutions to those problems before proceeding so that there can be mutual cooperation between patient and therapist.

A significant part of compliance can be the method(s) used in the physical treatment itself. If the treatment is enjoyable, shows results and is set at at the patient’s level he will tend to be more compliant than if it is just routine and there is no feedback on progress. Such is the goal of the TUTOR program. The TUTORS (HANDTUTOR, ARMTUTOR, LEGTUTOR, 3DTUTOR) are physical therapy products that allow the patient to receive intensive exercises in a fun way–through the use of games created exclusively for the TUTORs. Physical therapists monitor the exercises, record and evaluate the results and then customize a program for that particular patient. This in turn gives the patient satisfaction as he sees steady improvement in rehabilitating his affected limb after a stroke or other medical incident that he experienced.

The TUTORs are fully certified with the FDA and CE and are currently in use in U.S. and European hospitals and clinics. The TUTORs are available for children as well as adults and also at home through the use of telerehabilitation. More information on these cost effective devices can be seen on WWW.MEDITOUCH.CO.IL