ReJoyce in Singapore
We are happy to announce that the ReJoyce is now available for purchase by clinics in Singapore. It will become available in many more countries throughout 2012 as we expand our distribution network.
For information about how ReJoyce can help you recover arm, hand and shoulder mobility following a neurological injury such as stroke or spinal cord injury, please contact us.
If you are a rehabilitation professional and are interested in offering telerehabilitation services to your patients, see our for therapists page.
In-Home TeleRehabilitation Improves Hand Function
Hometelemed’s in-home telerehabilitation technology was the subject of a recently published scientific study. The article, published in the March 11, 2011 edition of the Journal of Neurorehabilitation and Neural Repair, showed exercise therapy supervised over the Internet may be effective for patients who have suffered a spinal cord injury.
The study combined Hometelemed’s telerehabilitation platform, the ReJoyce workstation, and an experimental toothclick-activated hand stimulator. A first treatment group received 6 weeks of daily at-home treatment using this apparatus, with a second group receiving conventional exercise therapy, also using the hometelemed telerehabilitation platform.
13 participants took part, 5 completing the study with both hands, such that both groups had a sample size of 9. The outcome measures included the Action Research Arm Test (ARAT), grasp and pinch force measurements, and the ReJoyce automated hand function test (RAHFT).
The results were very promising.
After ReJoyce-based exercise therapy, ARAT scores improved 13.0%, on average, and only 4.0% in the non-ReJoyce based therapy. The RAHFT scores also improved more after ReJoyce therapy, averaging a 16.9% improvement over a 3.3% improvement in the conventional therapy group.
Mary Galea, one of the researchers involved in the study, described the ReJoyce as a means of motivating patients to perform repetitive tasks.
“The ReJoyce … enables a person to do meaningful tasks, and provides the motivation to do them.” – Dr. Mary Galea, Professor of Clinical Physiotherapy and Director, Rehabilitation Sciences Research Centre.
Study participant Gabriel Moraitis was also enthusiastic about the potential of the new therapy.
“I’ve found that, in everyday tasks, I’m using my hand a lot more than before, and that I can pick things up with a firmer grip.” – Gabriel Moraitis, Study Participant
More information can be found here.
Video Games for Stroke Rehabilitation
New Canadian Study Shows Video Games May Improve Stroke Outcomes
A Canadian research group has discovered that playing video games while recovering after a stroke appears to promote arm strength and function. The new study findings were published in the April 7 online edition of the journal Stroke.
The University of Toronto group, lead by researcher Dr. Gustavo Saposnik, director of the Stroke Outcomes Research Unit at St. Michael’s Hospital says that “virtual reality may provide an affordable, enjoyable and effective alternative to intensify treatment and promote motor recovery after stroke.”
The study, a meta-analysis of studies involving video game use in upper extremity stroke rehabilitation, reviewed 12 studies that included a total of 195 patients, aged 26 to 88 years, who had suffered a mild to moderate stroke. Each study reported the effects of games on hand, arm and shoulder function and strength.
The 12 studies were broken down into the following:
Study Results
Observational Trial Results – Those stroke patients playing virtual reality games improved their upper arm strength by 14.7% and motor function by 20%.
Randomized Trials – Those stroke patients playing virtual reality games had a 4.89 times greater chance of improving arm strength compared with those who underwent standard rehabilitation.
Treatments varied between studies. The typical duration of “video game treatment”, however, lay between 20 to 30 hours over a four to six week time period. The video game systems included the following:
- Glasstron
- IREX
- Playstation Eye Toy
- Virtual Teacher
- CyberGlove
- VR Motion
- PneuGlove
- Nintendo Wii
Dr. Saposnik noted that several of the studies included combination therapy, augmenting standard therapy with video game therapy, which he claims may have skewed the results. He is, however, optimistic about this new form of treatment:
“Our study confirms the potential benefit of virtual reality in stroke rehabilitation identified in small studies. Further larger randomized trials are needed before changing practice. However, we are [going] in the right direction” – Dr. Saposnik, University of Toronto
Mechanisms of Stroke Recovery
Some studies suggest that video gaming may help stroke patients because of the brain’s unusual potential for reorganizing itself, a process called neuroplasticity, in which it creates new nerve cell connections. Recent research suggests that optimal neuroplasticity is obtained when a patient performs challenging, repetitive, task-specific, novel and motivating tasks.
Unfortunately, many stroke patients don’t get into rehab programs and are never given the chance to attain any kind of significant recovery. Dr. Ralph L. Sacco, president of the American Heart Association and chair of neurology at the University of Miami Miller School of Medicine, suggests that benefit from “innovative outpatient rehab approaches.”
Sources: Stroke Journal
Publication: Spinal Cord Injury Treatment
ReJoyce was featured in the March 10, 2011 edition of the Brain Research Bulletin.
In the study, participants performed hand exercises supervised over the Internet. They were block-randomized into one of two protocols, each protocol comprising two 6-week treatments in a crossover design.
Treatment 1: conventional hand exercises for 6 weeks, 1 h/day, 5 days/week with off-the-shelf equipment including 20 min of cyclical electrical muscle stimulation.
Treatment 2: hand exercises for thesameperiods, but on a computerized exercise workstation and assisted with FES. Subjects performed FES-ET on “ReJoyce” workstations (Rehabilitation Joystick for Computerized Exercise). According to motor improvements in consecutive sessions, participants were presented with tasks of increasing difficulty. A muscle stimulator garment provided FES for hand opening and grasp, wirelessly triggered by the participant via an earpiece similar to a hearing aid that detected small tooth-clicks.
Results: Both treatments (ReJoyce + FES + teletherapy, and conventional exercise + teletherapy) resulted in functional improvements in hand function. The ReJoyce treatment produced larger gains than the conventional treatment (17.3%, easily exceeding the minimal clinically important difference of 10%).
Coffee and Stroke
A Swedish study published in the March 10, 2011 edition of Stroke claims that regular coffee consumption can reduce risk of stroke in women by up to 25%.
“Results from our study in women showed that consumption of 1 to 5 cups of coffee per day was associated with a 22 to 25 percent lower risk of stroke, compared with consumption of less than 1 cup a day,” – Susanna Larsson, lead researcher, National Institute of Environmental Medicine, Karolinska Institute in Stockholm
Larsson added that although positive, these are early findings and should not cause women to change their coffee-drinking habits.
The study was large, based on data from 34,670 women, aged 49 to 83, who took part in the Swedish Mammography Cohort, which looked for associations between diet, lifestyle and disease.
It’s Not All Roses
In a study released in the November 2, 2010 edition of Neurology, it was reported that coffee consumption increases the risk of ischemic stroke onset immediately after ingestion. The effect is magnified particularly among infrequent drinkers.
The study, led by Elizabeth Mostofsky, MPH, from Harvard Medical School in Boston, Massachusetts, provides new information that may be useful in stroke prevention and is in line with what is already known about the physiologic effects of coffee.
Mostofsky found that risk of stroke increased two-fold in the hour after drinking a cup of coffee. The increased risk returned to baseline within a 2-hour window, which investigators say strengthens the possibility of a causal relationship. The effect was most pronounced in those that consumed, on average, fewer than one cup of coffee per day. The risk of stroke in those that consume more than one cup per day was substantially less than that in infrequent drinkers.
Researchers have suggested that the increase is likely linked to the effect caffeine has on the body, including rapidly increasing epinephrine release, blood pressure, and insulin sensitivity.
Effect of Caffeine on the Body
Caffeine has systemic effects on the body. These include the following on the circulatory system:
- stimulated heart, respiratory and central nervous system
- increase in level of fatty acids in the blood which increases its viscosity
- raises blood pressure
Cola and Tea
Interestingly, the study showed that tea actually slightly reduces the incidence of stroke in the same period. Cola was shown to have no effect. The researchers speculated this was because neither beverage contained caffeine levels as high as that found in coffee.
Walking After Stroke
Body-weight supported treadmill therapy and home-based strength and balance therapy yield similar results for patients one year after having stroke, according to a new study released at the 2011 American Stroke Association’s International Stroke Conference.
The study showed the 52% of people who participated in either home-based progressive strength and balance exercises or a clinic-based body-weight supported treadmill demonstrated functional improvement in walking. The Locomotor Experience Applied Post-stroke (LEAPS) trial involved 408 participants who recently suffered stroke.
The investigators has hypothesized that the body-weight supported treadmill program would be superior to a home exercise program. One-year post stroke, however, the gains in walking speed, balance, and quality of life were similar in both groups.
In both groups, the largest functional gains were made during the first 12 sessions of therapy. 13% of subjects continued to improved after the first 12 sessions, but only 7% improved after between sessions 30 to 36.
A secondary finding of the study shows that at six months post-stroke, a group who had not yet received any therapy beyond usual care showed improved walking speed, but only about half as much as the participants who received either the weight-supported walking or home-based program at two months.
According to the researchers, the findings suggest that both home-based and weight support programs are effective forms of physical therapy and are superior to usual care provided according to current standards of practice.
Stroke Rates Increase in Young People
Alarming figures showing an upward trend in stroke-related hospitalizations of young people were released at the American Stroke Association conference in Los Angeles.
The study, prepared by the US Centers for Disease Control and Prevention, comparing figures from 1994 and 1995 with those in 2006 and 2007 break down stroke hospitalizations by age. The figures are as follows:
- 51% increase in stroke-related hospitalizations for men under the age of 35
- 17% increase in stroke-related hospitalizations for women under the age of 35
A 2010 report from Canada indicated similar trends. These figures, published in the Canadian Heart and Stroke Foundation’s 2010 annual report, compared 1994 and 2005, and are as follows:
- 77% increase in high blood pressure
- 45% increase in diabetes
- 18% increase in obesity
- 250,000 Canadians in their 20s and 30s had high blood pressure in 2005
- 127% increase in high blood pressure in people aged 35-49
Meanwhile, the American study showed some positive news as well – an opposite trend appeared in older people.
- 25% decrease in stroke-related hospitalizations for men 65 and older
- 28% decrease in stroke-related hospitalizations for women 65 and older
The study suggests that better prevention and treatment of conditions such as high blood pressure in older people may be contributing to the decline.
Stroke and Medicare – Study
A recent study, published in the December 16, 2010 issue of Stroke, close to 2/3 medicare patients discharged from the hospital after suffering an ischemic stroke are readmitted, or die, within a year. The study also found that such post-discharge mortality and rehospitalization rates varied considerably between hospitals. The study showed that such variance was not dependent on the size of the institution or the size of its stroke center designation.
“The very high rates of death and rehospitalization are in a sense staggering, and despite some advances, stroke continues to place a burden on this patient population, which is fee-for-service Medicare beneficiaries. Also striking is the very substantial variation in clinical outcomes by hospitals.” – Dr Gregg Fonarow, Lead Author of the study, UCKA
The following lists some important details of the stroke treatment study:
- Study based on data from 91,134 Medicare beneficiaries between April 1, 2003 and December 31, 2006
- Median Age: 79.3 years
- Overall rate of death or rehospitalization within 12 months: 61.9%
- Difference in 30-day post-stroke mortality between 2003 and 2006: 0.1% (14.1% in 2003 vs. 14.2% in 2006)
- Academic hospitals performed marginally better than their nonacademic equivalents (variation of 2%-5%)
- Significant mortality and readmission variation between hospitals was discovered
Dr. Fonarow was unable to offer insight into why there was such great variance in outcomes between different hospitals
“Understanding what it is about what they’re doing is an important next step. It wasn’t something as simple as where the hospital was located or the number of beds they had; it was more around the processes they had and the systems they had in place, and those were variables we didn’t have access to in this study.”
The authors suggest that several areas of potential improvement exist in post-acute stroke care. These include:
- stroke severity measurements only documented in 37% of patients – possibly due to the the fact that they arrived by private transport rather than through emergency medical services
- more than half of the rehospitalizations were related to noncardiovascular causes, which leaves room for significant secondary prevention efforts
Spinal Cord Injury Rehabilitation with ReJoyce
ReJoyce has been the subject of a spinal cord injury rehabilitation research study in Vancouver since late 2009. Here’s a recent video about the study, published by the Rick Hansen Institute.