Monthly Archives: November 2011

Our Sincerest Condolences

Former Sheltering Arms President & Board Member Mrs. Jean Dickinson has passed.  Our sincerest condolences to her family and friends. She was a wonderful part of the Sheltering Arms family, a pioneer in her field, and a strong leader in our community. She will be missed dearly.

Her full Obituary from the Times Dispatch is reprinted below:

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PAD Patients May Respond Better To Exercise Than Stents

Supervised exercise was shown to be more effective than stenting or medication for improved walking ability in patients with peripheral artery disease. The findings from a national study were reported at the 2011 American Heart Association Scientific Sessions meeting. Rhode Island Hospital is one of hospitals participating in the national CLEVER study.

Peripheral artery disease (PAD) is a condition in which plaque builds up in the arteries and impacts blood flow, especially to the legs. It is estimated that between 10 and 12 million people suffer from PAD in the United States. One symptom of PAD is known as claudication, a painful cramping of the leg muscles that limits the patient’s ability to walk. It affects nearly 2 million people who suffer from PAD, and results in a sedentary lifestyle and poor quality of life.

Current guidelines for the treatment of claudication include pharmacotherapy, supervised exercise rehabilitation and lower extremity revascularization using stents. Timothy Murphy, M.D., a radiologist who heads the vascular disease research center at Rhode Island Hospital, was the principal investigator for the Rhode Island Hospital arm of the CLEVER (Claudication: Exercise Versus. Endoluminal Revascularizaton) Study, a multi-center study sponsored by grants from the National Heart Lung and Blood Institute. It is the first multi-center clinical trial to compare the treatment strategies. He is also the lead author of the paper published in the November issue of the journal Circulation.

The research group reported that of 111 patients studied in the randomized trial, the most effective treatment proved to be supervised exercise based on the results of a treadmill test taken at baseline and again at six months. Patients who were in the supervised exercise group improved by a mean of 4.6 minutes in the treadmill test, while the group who received stents improved by a mean of 2.5 minutes. The researchers also found, however, that self-reported quality of life measurements proved to be higher in the group who received stents, even though their ability to walk did not improve as greatly as the group who received supervised exercise rehabilitation.

Murphy says, “This study demonstrates that for patients with claudication that supervised exercise provides a superior improvement in treadmill walking performance compared to both primary aortoiliac stenting and optimal medical care. This benefit is associated with an improvement in self-reported walking distance, an increase in HDL and a decrease of fibrinogen.” He adds, however, “Secondary measures of treatment efficacy such as self-reported physical function measures and pedometer measures of community walking favored primary stenting over supervised exercise.”

Alan T. Hirsch, M.D., of the Lillehei Heart Institute at the University of Minnesota Medical School, presented the findings today. Hirsch comments, “At a time when health care costs are appropriately in sharp public focus, this study provides an avenue by which we could — if we choose — achieve a major positive set of health outcomes at low risk and at lower cost.”

Murphy and the researchers believe that more studies are necessary, but also believe that supervised exercise may be an effective recommended treatment for PAD patients with claudication. Murphy comments, “The CLEVER team will be reporting further outcomes from this study based on an 18-month review.”

Hocoma launches the world’s first commercially available robotic arm exoskeleton for neurorehabilitation

After being the first to release a robotic gait orthosis in 2001, the Swiss medical technology company Hocoma now presents the world’s first commercially available robotic arm exoskeleton. As a part of the established Armeo® Therapy Concept, the ArmeoPower was designed for severely affected individuals who have suffered neurological disorders resulting in hand and arm impairment. Continue reading


Sheltering Arms Rehab (Richmond, VA) first in Country to Offer New Device to Improve Walking in Stroke Survivors and Individuals with Other Central Nervous System Disorders
Valencia, Calif. — August 29, 2011 — Bioness Inc., today announced the commercial release of its NESS L300® Plus System. Cleared by the U.S. Food and Drug Administration (FDA) earlier this year, the L300 Plus combines the award winning NESS L300® Foot Drop System with a thigh cuff to activate even more of the nerves and muscles in the leg for greater control while walking.
The L300 Plus is intended for people living with neurological conditions resulting from stroke, multiple sclerosis, traumatic brain injury and spinal cord injury. Continue reading

What’s In Your Arthritis Medicine?

There are many different names for the over-the-counter (OTC) medications that people take to relieve arthritis pain. But most products rely on just a few ingredients to ease joint pain.

Here’s what you need to know about the ingredients in OTC pain relievers, including the benefits to expect and side effects to watch for.

Aspirin for Arthritis Pain

Aspirin — acetylsalicylic acid — belongs to a family of related drugs called salicylates. It is available orally under many brand names, including Anacin, Bayer, Bufferin, Ecotrin, Excedrin, and St. Joseph. 

Aspirin relieves mild pain and fever.

Side Effects of Aspirin

The most common side effects of aspirin are stomach pain, heartburn, indigestion, nausea, and vomiting. Stomach irritation can lead to ulcers and bleeding in the stomach. Continue reading

Scientists Explore Motor Memory In Hopes Of Fostering Better Rehabilitation Techniques For Stroke Patients

For the first time, scientists at USC have unlocked a mechanism behind the way short- and long-term motor memory work together and compete against one another.

The research – from a team led by Nicolas Schweighofer of the Division of Biokinesiology and Physical Therapy at USC – could potentially pave the way to more effective rehabilitation for stroke patients.

It turns out that the phenomenon of motor memory is actually the product of two processes: short-term and long-term memory.

If you focus on learning motor skills sequentially – for example, two overhand ball throws – you will acquire each fairly quickly, but are more likely to forget them later. However, if you split your time up between learning multiple motor skills – say, learning two different throws – you will learn them more slowly but be more likely to remember them both later.

This phenomenon, called the “contextual interference effect,” is the result of a showdown between your short-term and long-term motor memory, Schweighofer said. Though scientists have long been aware of the effect’s existence, Schweighofer’s research is the first to explain the mechanism behind it.

“Continually wiping out motor short-term memory helps update long-term memory,” he said.

In short, if your brain can rely on your short-term motor memory to handle memorizing a single motor task, then it will do so, failing to engage your long-term memory in the process. If you deny your brain that option by continually switching from learning one task to the other, your long-term memory will kick in instead. It will take longer to learn both, but you won’t forget them later.

“It is much more difficult for people to learn two tasks,” he said. “But in the random training there was no significant forgetting.”

Schweighofer uncovered the mechanism while exploring the puzzling results of spatial working memory tests in individuals who had suffered a brain stroke.

Those individuals, whose short-term memory is damaged from the stroke, show better long-term retention because they are forced to rely on their long-term memories.

Schweighofer’s paper appears in the August issue of Journal of Neurophysiology.

In the long term, he said he hopes this research could help lead to computer programs that optimize rehabilitation for stroke patients, determining what method of training will work best for each individual.

This research was funded by the National Institutes of Health and the National Science Foundation.

Robot-Assisted Therapy Helps Stroke Victims Enhance Arm Function

According to a new study featured in the journal Clinical Rehabilitation, published by SAGE, robot-assisted therapy had considerable benefits for patients with a weaker arm following a stroke.

The investigation authors, Keh-chung Lin, Yu-wei Hsieh, Wan-wen Liao – National Taiwan University, Ching-yi Wu – Chang Gung University, and Wan-ying Chang, Department of Physical Medicine and Rehabilitation, Taipei Hospital, researched how robot-assisted therapy helps enhance arm function after a stroke. 20 patients were enrolled in the investigation comparing robot-assisted therapy together with functional training against an active control treatment group.

Due to cognitive deficits, stroke patients often have difficulties transferring motor skills learned in therapy to their daily living environment. Researchers included real-world arm activity in the investigation by getting patients to wear accelerometers on both arms daily as they went about their normal routines.

One of the major discoveries of the investigation was that robot-assisted therapy, when incorporated with functional task training, helps functional arm use and improves bimanual arm activity in daily life. Following a stroke, patients usually have weakness on one side of the upper body (hemiparesis), which can increase the difficulty in everyday life. Robotic rehabilitation is becoming increasingly more accessible, and shows promise for improving traditional post-stroke interventions. As they never tire, robots can provide immense and intensive training in a consistent manner without fatigue, and can be programmed precisely to tailor each patient’s needs.

The robots provide sensorimotor feedback through visual and auditory feedback during training sessions, to help patient’s motor learning. Although arm motor function and muscle strength have shown to improve when robot-assisted therapy was used in rehabilitation, previous investigations indicated that these improvements did not carry through to the patient’s daily lives. A few explanations for this may include a need for improved measurement scales for patients real life daily functions, in addition to the fact several people compensate by using their non-impaired arm instead. This study addressed those issues, by measuring both arms and following patients with the accelerometers at home.

Accelerometers are appropriate tools to measure real-world arm activity in stroke patients, when used together with traditional clinical measurements; it can improve holistic understanding of a patient’s life performance.

The portable accelerometers can be easily worn like a wristwatch on each arm, and by measuring the acceleration of body movements; they give objective data about physical activity. Researchers now have the accurate information they need to verify the intensity and amount of physical activity the patients really do in their daily life.

Throughout the investigation, both groups had intensive training by certified occupational therapists for 90 to 105 minutes per session, five days a week for four weeks, while all other routine interdisciplinary stroke rehabilitation continued as usual. In the control group, therapy was designed to match the robot-assisted therapy in the amount of therapy hours, and these participants served as a dose-matched comparison group. Based on neurodevelopmental techniques and contemporary rehabilitative models, like task-oriented training and motor learning theory, occupational therapists created activities for the group.

In the robot-assisted therapy group the mean ratio change was 0.047± 0.047, beating the 0.007 ± 0.026 ratio of the control group. Compared to the control group the robot-assisted therapy group also handled more daily tasks with their impaired arm.

Keh-chung Lin explained,

“In this study of rehabilitation approaches for patients with mild-to-moderate upper limb impairment six months after a stroke, we found significantly greater benefits of robot-assisted therapy compared with the active control group on the amount and quality of functional arm activity for the hemiplegic hand in the living environment.

Moreover, robot-assisted therapy had superior benefits on improving bimanual arm activity.”

To make the most of robots for stroke patients rehabilitation in the future, larger investigations together with follow up research to see whether these improvements are lasting are the next steps.

Written by Grace Rattue

Physical Therapy Computer Games Benefit People With Parkinson’s Disease

Playing computer-based physical therapy games can help people with Parkinson’s disease improve their gait and balance, according to a new pilot study led by the UCSF School of Nursing and Red Hill Studios, a California serious games developer.

More than half the subjects in the three-month research project showed small improvements in walking speed, balance and stride length.

UCSF and Red Hill were the first research team in the United States to receive federal funding in the burgeoning field of low-cost computerized physical therapy games. Unlike off-the-shelf computer games, these specialized games encourage scientifically tested specific physical movements to help people with functional impairments and diseases.

Teams at Red Hill and UCSF collaborated to produce nine “clinically inspired” games that were designed to improve coordination in people with Parkinson’s disease, a chronic, progressive neuromuscular disease characterized by shaking, slowness of movement, limb and trunk rigidity. The clinical team members at UCSF focused on specific body movements and gestures that their previous research had shown to be beneficial for staving off the physical declines of Parkinson’s.

The UCSF team was led by Glenna Dowling, RN, PhD, professor and chair of the UCSF Department of Physiological Nursing, and Marsha Melnick, PT, PhD, a clinical professor in the UCSF School of Medicine’s Department of Physical Therapy and Rehabilitation Science and professor emerita of the Department of Physical Therapy at San Francisco State University.

The Red Hill team then designed physical games, similar to Wii and Kinect games, in which subjects win points by moving their bodies in certain ways. Each game has multiple difficulty levels so that the clinical team could customize the therapeutic games for each subject’s particular abilities.

“Each subject found his or her own gaming ‘sweet spot’ – the spot where the physical challenge was not too hard, not too easy, just right,” said Bob Hone, creative director of Red Hill Studios and the lead principal investigator of the study. “And when subjects mastered one game level, they often moved on to harder levels for more beneficial effect. The subjects improved their games scores while improving their gait and balance.”

Red Hill developed a custom sensor suit with nine tracking sensors to analyze subjects’ movements with higher resolution and accuracy than is possible with consumer gaming platforms. The PC-based system sent encrypted data to a secure database allowing the research teams to track the subjects’ performance daily.

“From the data tracking we could see that there were some subjects who were playing the games more than the specified three times a week,” Hone said. “Because this was a highly structured research study, we actually had to ask them to play less than they wanted.”

The trial involved 20 participants in northern California with moderate levels of Parkinson’s disease. After playing the games for 12 weeks, 65 percent of game players demonstrated longer stride length, 55 percent increased gait velocity, and 55 percent reported improved balance confidence.

“These initial studies show the promise of custom-designed physical therapy games promoting specific movements and gestures that can help patients get better,” Dowling said. “Now that we have this preliminary positive result, we want to conduct a longer term clinical trial with more subjects to confirm these initial findings.”

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Wellness Zone – Cranberry Bean Pasta Fagioli Recipe

Cranberry Bean Pasta Fagioli Recipe

courtesy of Food Network Magazine

5 tablespoons extra-virgin olive oil, plus more for drizzling
5 cloves garlic, smashed
1 small onion, roughly chopped
1/4 teaspoon red pepper flakes, or more to taste
1 teaspoon finely chopped fresh rosemary
1 2-ounce piece pancetta (optional)
5 canned whole San Marzano tomatoes, crushed by hand
Kosher salt
3 pounds fresh cranberry beans in pods, shelled (or 1 cup dried cranberry beans, soaked overnight)
2 bay leaves
1 piece parmesan cheese rind, plus 1/2 cup grated parmesan, and more for topping
2 cups small pasta, such as shells or ditalini
1 bunch kale, stems and ribs discarded, leaves chopped
1/4 cup roughly chopped fresh parsley
Freshly ground pepper


Heat 3 tablespoons olive oil in a large pot over medium heat. Add the garlic, onion, red pepper flakes, rosemary and pancetta, if using, and cook 2 minutes. Stir in the tomatoes and cook 2 more minutes; season with salt. Add the beans, 3 quarts water, the bay leaves and parmesan rind. Cover and bring to a boil, then reduce the heat to low and simmer until the beans are tender, 1 hour 30 minutes to 2 hours.

Uncover the pot and bring the mixture to a boil over high heat. Add the pasta and cook until al dente, about 8 minutes. Add the kale and cook, stirring occasionally, until tender, 5 to 6 more minutes. (The soup should be thick and creamy; thin with water, if necessary.)

Remove the bay leaves, parmesan rind and pancetta, if used. Add the grated parmesan, parsley, the remaining 2 tablespoons olive oil, and salt and pepper to taste. Top with more olive oil and parmesan.