November 6, 2009
ReJoyce and Functional Electrical Stimulation (FES)
Several studies have investigated the combined effect of various hand FES systems and ReJoyce for stroke and spinal cord injury rehabilitation. Here’s some background:
Functional electrical stimulation (FES) is a technique that uses small electrical pulses to activate nerves affected by paralysis resulting from spinal cord injury (SCI), stroke, head injury or other neurological disorders. FES can restore a certain amount of function in people with these injuries. Electrical stimulation of nerves is also used in many other applications including pain suppression, epilepsy, bladder control and bedsore prevention.
Hand and leg stimulators are the most common applications of FES in cases of stroke and SCI. The Bioness H200 and Bioness L300 are examples of such systems.
ReJoyce (Rehabilitation Joystick for Computer Exercise) is a hand, arm and shoulder rehabilitation workstation for improving function and range of motion. It is an affordable, passive device (no powered joints or actuators), and requires users to perform dexterous movements that are used in many common tasks of daily life. ReJoyce’s software adapts itself to a user’s abilities, adjusting its sensitivity to adapt to a wide range of abilities.
ReJoyce is used in clinics and in homes (in some countries), both under clinician supervision. The following video shows a person with SCI using the ReJoyce in combination with a hand stimulator. She is being supervised by a remote therapist using the ReJoyce Telerehabilitation system:
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Optimal rehabilitation outcome is achieved after intensive active movement practice. Traditionally, Occupational and Physical therapists use task orientated training (TOT), a program focusing on intensive repetition of everyday functional tasks. Plasticity in the central nervous system influenced by the intrinsic motor and sensory feedback from the result of the tasks gradually improves planning, initialization and performance of the task. This is the essence of modern rehabilitation of central nervous system injuries and disorders.
My company, Meditouch, produces the HandTutor, a rehabilitation glove and software which offers impairment oriented training and augmented feedback or biofeedback. Instead of TOT, the system uses Impairment Oriented Training (IOT). IOT relies on an objective evaluation of a patient’s sensory motor and cognitive ability. A deficit in such abilities is known as an impairment. IOT focuses on providing customized exercises for each impairment, or exercises a group of impairments together.
The HandTutor provides repetitive customized isolated or inter-joint coordinated finger and wrist hand exercises. HandTutor is designed to rehabilitate fine movements of the hand and wrist. HandTutor’s dedicated rehabilitation software motivates the patient to continue intensive repetitive exercises by providing challenging games that have been designed around both neurological and Orthopedic conditions. Research with the HandTutor confirms that Task Oriented Training (TOT) should be combined with Impairment Oriented Training (IOT) to achieve enhanced functional recovery. The HandTutor is used in hospitals and community clinics as well as through tele rehabilitation. Examples of patients that are treated include Stroke, TBI, spinal cord injury CP, Orthopedic hand and arm surgery, development co-ordination disorders in children etc. Please note we are currently using the HandTutor system for tele-rehabilitation and we have patients in USA, Greece and Israel. We use off the shelf team viewer for video and skype for audio in addition to our dedicated rehabilitation windows based software.
Comment by Alan Waterman — March 17, 2010 @ 6:42 am
Thanks for your comment Alan.
Perhaps in contrast to your HandTutor system, ReJoyce therapy can be used for either TOT or IOT rehabilitation regimens, as you have defined them. ReJoyce has a similar system of games that are designed to motivated patients, as well as an objective hand function test that characterizes a patient’s movement deficits.
Your device reminds me of the HandMentor. It is essentially an active version of your device that uses air pressure to move the hand.
Unlike the skype/team viewer combination, we have a proprietary telerehabilitation system that is built with HIPA and other health privacy guidelines in mind.
Can you post another comment with links to the studies you mention in your comment?
Andy P.
Comment by admin — March 18, 2010 @ 1:12 pm