New York Dynamic Neuromuscular Rehabilitation - Best Physical Therapy and Therapist in NYC

Dr. Lev Kalika Wish You a Merry Christmas and a Happy New Year

Dr. Lev Kalika — Mon, 24 Dec 2012 14:39:16 +0000

Dr. Lev Kalika from Dynamic Neuromuscular Rehabilitation of New York would like to inform you that Computer Assited Rehabilitation Environment (CAREN) has received an exceptionally warm welcome from many prominent neurologist and orthopedists around the county since its succesful launch on August 2012.

Dr. Kalika has created a video greeting for you through our CAREN system and may peace and joy be yours during this wonderful season and the coming New Year!

CAREN is a breakthrough rehabilitation technology to treat:
Neurological Disorders	Balance Disorders	Walking & Running Disorders
Orthopedic & Sports Medicine Rehabilitation	Back Pain	and more

See More Information at www.nydnrehab.com, Schedule an appointment now: 1-866-311-5889

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Sciatica Treatment

Dr. Lev Kalika — Sat, 31 Mar 2012 20:56:40 +0000

Dr.Kalika uses diagnostic ultrasonography to visualize disc nerve conflicts inside the spine as well as outside the spine in the hip and pelvis area.

Sciatica is a medical term used to describe a condition characterized by the sharp pain that shoots down a lower limb through the buttock, into the upper thigh, and radiates into the the calf, and the foot. Sciatica patients may also experience tingling or burning sensation as well as numbness of the skin in the affected areas – sciatica pain.

Sciatica symptoms are regarded as the consequence of the physical damage to the Sciatic nerve

at the points where it emerges from the spine or other confined anatomical places where it could get compressed.

Video below provides brief description about causes of Sciatica:

It must be noted that there are several other conditions that resemble and are frequently confused with Sciatica nerve pain. The true radicular sciatic pain radiates below the knee into the dermatome (the skin surface area) that is known to be supplied by the Sciatic nerve. This radiation identifies Sciatica proper from sciatica like conditions( much more common) , helping to differentiate it from other conditions of similar symptomatology.

Pinching or irritation of the roots of the Sciatic nerve often triggers Sciatica by a herniated or bulging disc causing radiculopathy (the true sciatica).

However, the more common cause of the sciatic-like pain is the Piriformis syndrome – the compression and irritation of the main body of the Sciatic nerve in the pelvic cavity by the Piriformis muscle. Although not a true Sciatica, this form of the condition is quite common especially among physically active women. This condition is also common as a secondary effect in patients, which have existing L4-L5 herniated, protruded or bulged disc. Sometimes both pathologies described above coexist as a double crush syndrome .

Below is the list of all possible causes of Sciatica:

Sciatica caused by the spinal pathology affecting Sciatic Nerve roots (radiculopathy)
The spinal canal and intervertebral foraminae in the lumbar spine (lower back) are bony tunnels through which run the spinal nerves (nerve roots) respectively. When the size of these tunnels is reduced, there is less room for the spinal nerves, the consequence of which may be pressure on these structures.
Herniated/protruding or bulging disc
Ligament flava hyperthrophy
Spondilolisthesis

Sciatica caused by extra spinal factors – compression or irritation of the main body of the Sciatic nerve in the Pelvic Cavity beyond the roots’ conversion point:

Piriformis syndrome
Ischial tunnel syndrome
Obturator syndrome.

Sciatica-like conditions – not directly elated to the Sciatic Nerve although producing symptoms that resemble Sciatica:

Sacroilliac joint dysfunction
Post herniation sciatica
Multiple trigger points with referred pain down the leg

Uncommon causes:

Peroneal palsy
Intermittent claudicationThalamic stroke
Mononeuropathy Monoplex
Autoimmune disease
Infectious disease
Tumors
Ganglion cyst
Synovial cyst

SCIATICA PAIN DIAGNOSIS
Dr.Kalika uses diagnostic ultrasonography to visualize disc nerve conflicts inside the spine as well as outside the spine in the hip and pelvis area. Occasionally, nerve conduction velocity studies can be helpfull for diffferentiation of sciatica. The most important factor in sucessful treatment of sciatica is a combination of right diagnostic modality with clinical experience and the ability to match specific treatment to particulate type sciatica.

SCIATICA PAIN TREATMENT
Sciatica pain treatment begins with the diagnosis. Structures compressing sciatic nerve must be identified through clinical examination and by diagnostic testing. The conservative treatment approach must be undertaken before any invasive intervention is considered. The conservative treatment must not focus only on identified structural factors but include the dysfunction that led to the structural damage in the first place. When dealing with Sciatica nerve pain it is important to keep in mind that the response to the sciatica treatment often varies from one patient to another. The individualized approach therefore is recommended if sciatica pain treatment id to be successful.

Shoulder Pain Treatment

Dr. Lev Kalika — Wed, 12 Oct 2011 03:35:39 +0000

Treatments for Shoulder Pain

Shoulder pain is one of the most common musculoskeletal complaints. It can occur in any age group for various reasons. Most frequently the shoulder pain results from trauma and overuse of the shoulder joint and surrounding tissues. Because of the unique anatomy, versatility and overall importance of the shoulder complex the treatment needs to be multilateral. Spanning across various medical disciplines is essential in order to achieve long-lasting positive effects.

The Shoulder Joint

The structure and functionality of the shoulder are unique for human species. The anatomy of shoulder joint is in fact the highlight of human evolution. The versatility and mechanics of the motion of the shoulder is far more complex than of any existing precision machine. Human shoulder joint is one anatomical structure that showed marked morphological changes, compared to the corresponding area in closely related animals, even before the beginning of the vertical life of the mankind.

The evolution of the shoulder anatomy is intimately connected with development of human posture and locomotion. The posture and locomotion depend on neuromuscular coordination of shoulder girdle muscles. These develop in parallel, one slightly preceding another, during the postural ontogenesis that takes place in the first months of infants life mirroring the lengthy process of the human evolution. The stability of the scapula-humeral articulation (shoulder joint complex) during this time defines future posture and locomotion. In fact, the child is not able to walk until he can lift his arm above 120 degrees.

Why is shoulder joint is so frequently a site of pain?

It is a scientific fact that anatomical structures and functions, acquired the latest during the evolution, are the most fragile and prone to failures. The human shoulder is a vivid example of that. The enhanced ability to perform complex multilateral movement has developed at the expense of diminished osteo-ligamentous stability, which is so important for all other joints in human body. At the shoulder, strong bone-and-tendon composition of the joint is replaced by an intricate, if delicate, muscular support mechanism known as the rotator cuff.

The rotator cuff is designed to reinforce the otherwise unsupported shoulder joint and hold the ball-shaped head of the shoulder bone (humerus) in the glenoid fossa, the socket of the shoulder blade (scapula). Rotator cuff is made up of four muscles that originate from the scapula surface and are connected to the upper humerus forming a tight elastic blanket of muscle tissue over the shoulder joint holding it together. Without the rotator cuff support, the head of the humerus would freely ride in and out of the shallow glenoid fossa, rendering the joint inoperable.

The function of the rotator cuff

Rotator Cuff

is not limited to the structural support. Besides keeping the joint intact, the rotator cuff assists in some shoulder and arm movements. During the throwing motion, for example, the rotator cuff muscles undergo series of rapid eccentric contractions (they are lengthened under tension) decelerating the arm and softening the impact of the exertion. Diverse functionality of the shoulder joint puts considerable stress on the tendons of the rotator cuffs muscles making them susceptible to overuse injuries. Relatively poor ability of the rotator cuff tissues to withstand excessive forces is frequently exacerbated by inadequate postural support of the shoulder girdle.

The pain due to rotator cuff tear, tendonitis, various arthritic inflictions and overuse is the price we pay for exchanging structural stability of the shoulder for mobility and motor versatility.

What are the most common shoulder pain syndromes?

Rotator cuff tendonitis
Rotator cuff impingement
Rotator cuff tears
Subacromial bursitis
Frozen shoulder
Bicipital tendonitis
Labrum tears

What are the predisposing factors of shoulder pain?

Abnormal morphology (aberrant development of shoulder anatomy)
Poor posture
Overuse
Overhead activities
Repetitive trauma

How does poor posture create shoulder pain?

The function of shoulder joint depends not only on the integrity of rotator cuff muscles and sinews, but on the stabilization of the scapula. The ideal position of the scapula is achieved when the body is erect. Poor posture impedes scapular stability, generating excessive loads to the rotator cuff muscles.

For example: Try to lift your arm sideways after slumping your thoracic spine or protruding your chin forward and then compare the results to the range of motion of the same movement during the erect spinal position.

How is shoulder pain diagnosed?

Clinical examination allows diagnostic certainty while further radiological investigation by MRI, and/or diagnostic ultrasound allows diagnostic precision.

What are the conservative methods of dealing with shoulder pain?

The combination of physical therapy and rehabilitation exercise constitute scientifically proven and sound method for treatment of shoulder pain. Many shoulder conditions respond well to extracorporeal shock wave therapy, prolotherapy and platelet-rich plasma injections. Whatever the shoulder pain condition is at stake the combination of any of the above described methods and measured exercise brings the best results.

How often shoulder surgery is necessary for shoulder pain?

Shoulder surgery is only necessary when the conservative therapy fails or after a destructive traumatic event. It is a responsibility of a conservative care clinician to make a timely referral for the surgery.

What kind of treatment for shoulder pain is used at Dynamic Neuromuscular Rehabilitation?

At DN Rehabilitation we use combination of physical therapy exercises, DNS exercises and regenerative treatments such as extracorporeal shockwave therapy, prolotherapy and Platelet-rich Plasma injections. Depending on the diagnosis, individualized treatment plans are developed on the individual basis consisting of balanced combination of the above-listed therapies.

How different is DNS approach from the conventional Physical Therapy for the shoulder pain?

Most conventional physical therapy is based primarily on strengthening of the rotator cuff muscles. DNS approach is different in a way that the treatment begins with restoration of the motor control and muscular synergies before strengthening the rotator cuff. Doing this allows reestablishing muscular balance that is imperative for the ideal function of the shoulder. Muscle synergies that are established during the early childhood development serve as foundation of human posture and movement. During early development muscular synergies around shoulder girdle must develop first to ensure the shoulder stability, which is critical for establishment of the first point of support by the child. DNS reenacts these muscular synergies, reestablishing muscle balance, responsible for ideal function of the shoulder prior to strengthening of rotator cuff.

IS DNS treatment only useful for atheletes?

Professional athletes use DNS therapy and exercises to prevent injuries and, should an injury occur, expedite post-traumatic recovery. The general application of DNS extends far beyond sports medicine and is equally effective for all patient groups.

What is the Regenerative Shoulder Treatment?

Regenerative treatment is a form of stimulation of bodys own regenerative abilities by different physical or biological agents introduced into the injured area.

Treatments

ESWT is used for subacromial bursitis, shoulder tendinitis or calcific tendonitis. Please click here to explore our ESWT page…

Platelet-rich Plasma injections are used for moderate rotator cuff tears and frozen shoulders.

Prolotherapy is used for unstable and hyper mobile shoulders, shoulder dislocations and A-C joint suluxation.

Bulging, Protruding or Herniated Disc Treatment

Dr. Lev Kalika — Wed, 12 Oct 2011 03:34:11 +0000

In following section a detailed explanation on our unique approach to treatment of herniated disc. Depending on the patient’s symptoms, different treatment are available.

If you are reading this, you are probably looking for quick remedy of herniated, bulging or protruding disk

Herniated Disc

. Let me warn you. Magic does not exist. Over the last 50 years many therapies, commercially available devices as well as surgical and other invasive interventions – all have failed.

Occasionally some success is reported when by accident an applied intervention happens to match the exact anatomical configuration of the pathology bringing relief to the sufferer. Mostly however patients are destined to wander in circles from specialist to specialist in the eternal quest for the healthy back. Until they come to realize the fact that there is no easy way out and it is necessary for them to put their full trust in the hands of specialists who base their treatment on the latest scientific findings and technological advancements. Who do not sugarcoat the issue with promises of some “miraculous cures”, but approach the problem energetically and realistically providing the patients with what is best for them.

There is no evidence or consensus to this day as to what type of herniation should be treated with what method. Every attempt to match a specific therapy to a specific type of herniation has failed. The extensive variability of the degree, shape and position of intervertebral disc herniation make intervention targeting next to impossible. The obvious question is – why?
I am not going to go into the intricacies of the spinal anatomy for it will only shift your attention away from the actual problem. Just like over-reliance on the most popular imaging modality – MRI – that has done exactly that. The radiological evidence of disc displacement and compression of the nerve by the bulged material of the disc is only a radiological fact, a mere outcome of the disease. It is simply not the cause. Recently I see an increase in awareness of this by radiologists, who now are much more careful in their interpretation of MRI imagery. What they would have called a disc prolapse (herniation) a few years ago, for example, is now classified as a disc protrusion.

Another example of this controversy is the Failed Back Surgery syndrome. In this condition the patient continues to have the same pain after the discectomy (disc prolapse removal). The fact is that the surgery could have been avoided altogether and pain successfully eliminated by other conservative methods, even thought there was a herniated disc present on the MRI images, for it obviously was not the cause of the pain.

It is a known and scientifically proven fact that there are just as many patients with disc herniations that do not have pain than there are those that have pain. So what makes some patients with herniated discs to be in extreme pain while others with the same herniation have either very little or no pain at all?
The source of pain lies within the contents of the corresponding intervertebral unit. Pain occurs either due to direct mechanical pressure on the nerve root by the bulging disc tissue or triggered by the inflammatory process, to which the nerve responds when it is exposed to the foreign tissue of the disc material.

The cause of the disease however lies outside of the intervertebral unit. Herniation of the disc occurs due to variety of abnormal neuromuscular interactions in the whole body (not just a spine) that lead to repetitive overloading and resulting shearing forces that impact spinal discs. The causes of those abnormal forces are numerous. To name a few:

1. Failed load transfer through LPH lumbopelvic hip complex;
1. Suboptimal structural architecture of human skeleton;
2. Poor neuromuscular development;
3. Decrease in spinal stability;
4. Poor body mechanics;
5. Misalignment;
6. Poor kinesthetic awareness;
7. Overuse;
8. Poor exercise or sport technique;
9. Improper lifting technique;
10. Poor balance;
11. Poor gait (walking) mechanics;
12. General joint laxity or hyper mobility.

In most patients with herniated discs those factors coexist and interact.
There is a variety of other factors that may contribute to the chronic pain caused by the herniated disc, such as improper medical treatment in the very beginning of the disease, negative attitude and reckless behavior patterns, non-compliance with treatment protocols, depression, poor coping strategies, etc…

Treatment of Herniated Disc
As it is so logical that treatment of the symptom and not the cause will fail, the treatment of the herniated disc must address the causes of the spinal overload which lead to pain and to the herniation.

Based on scientific studies and clinical experience, we know that some types of disc herniations dissolve with time. Symptoms from herniations, which do not dissolve, can be successfully eliminated if axial (vertical) compression on the spine is decreased.
The effect of decreasing axial compression of the spine would be the drastic reduction of pressure on intervertebral discs and spinal nerves, and normalization of biomechanics of the spinal joints and muscles of the affected segment. This allows for cessation of the inflammatory reaction around the nerve pinched by the herniated material of the disc.

Eventually, when spinal loads are properly redistributed by rehabilitative exercises, soft tissue physical therapy techniques, joint mobilizations/manipulations and variety of other conservative methods, the inflammation around the nerve is further decreased, the nerve root finds its way around herniated or protruded disc material and the pain disappears.

Treatment of herniated discs should be based on careful clinical evaluation of all causative factors and their interactions. As all of the above-mentioned factors come from variety of structures and control systems within the neuromuscular complex, it requires a clinician who is intimately familiar with how different structures and control systems interact within human body.

Since disc herniations always result from multilayered pathology, the treatment and rehabilitation of patients should be either done by a multi-factorial group of physicians and therapists who understand each other’s language and practice within the same facility, or by a clinician who is familiar with structural and functional diagnostics and has proficiency in a variety of treatment techniques.

Motion Equilibrium Reprocessing Therapy (MERT) with Computer Assisted Rehabilitation Environment (Caren)

Dr. Lev Kalika — Thu, 24 Jan 2013 19:15:57 +0000

Motion Equilibrium Reprocessing Therapy (MERT) can be used in all patients who need to be treated for maintainance of balance like appears in non- progressive vestibular , motor and neurological conditions.
MERT is the most advanced habituation therapy for patients with non- progressive vestibular disease.

We are proud to be the first private facility in the US providing MOTION BASED EQUILIBRIUM REPROCESSING THERAPY, which has been successfully used by the military to treat pilots suffering from motion sickness.

ALL THERAPIES ARE CONDUCTED WITHIN CAREN’S IMMERSIVE ENVIRONMENT.

SPECIALIZED OBJECTIVE TESTING IS CONDUCTED TO DEFINE TREATMENT PROTOCOLS

The results achieved with CAREN are not attainable by conventional physical

therapy. CAREN treatment combines sensory motor training, visual exercises and habituation treatment.

Vestibular disease can handicap people physically, emotionally and socially.

Unilateral peripheral vestibular loss results in gait and balance impairment, dizziness and oscillopsia.

Conventional treatment with Betahistine, Carbamazepine and oral steroids as well as head rotation exercises by Cawthorne and Cooksey have limited indication and varying response rates.

Patients affected with peripheral vestibulopathies are usually frustrated with inability to find the right treatment.

Virtual reality rehabilitation is a new method which has shown results superior to conventional treatment options.

At DNR we specialize in treatment of balance and vestibular disorders
with the help of CAREN (computer assisted rehabilitation
environment) – the most advanced technology for treatment of balance
and vestibular disorders that is available for the first time in the NYC.

TREATMENT METHOD

MERT is based on military desensitization principles within Virtual Environment.

The 6 DoF ( Degrees of Freedom) virtual reality motion base of CAREN is used to expose patient to sinusoidal vertical passive whole body motion in gradually increasing intensity while fixating the eye site on rolldome and/or optokinetic drum through virtual reality 180 degrees screen.

TREATMENT FREQUENCY

3-5 times a week for two consecutive weeks

MERT is based on military desensitization principles within Virtual
Environment.

Back Pain Treatment With Computer Assisted Rehabilitation Environment (Caren)

Dr. Lev Kalika — Wed, 16 Jan 2013 15:52:35 +0000

Computer Assisted Rehabilitation Environment (CAREN) System was originally developed to rehabilitate patients with traumatic brain damage and other neurologically induced disorders, which affect locomotion. We discovered that as locomotion and balance control in CAREN patients improved, their back pain also disappeared. Later it was revealed that patients with chronic low back pain also improved by CAREN intervention.

Balance depends upon multiple inputs from various structural systems of the body and their intricate relationships.
Human capacity to walk and function in an upright posture came with the progressive acquisition of the sense of vertical balance.

There is countless significant evidence that people with back pain have poor balance.

HOW DOES CAREN TREATMENT HELP PEOPLE WITH CHRONIC LOW BACK PAIN?
CAREN system provides a truly integrative treatment due to its multimodal set up and multi-sensory environment.

WHY CAREN IS THE TREATMENT OF CHOICE AND/OR AN INTEGRAL COMPONENT OF TREATMENT OF PATIENTS WITH CHRONIC BACK PAIN
Muscle and joint elasticity are all affected by chronic back pain and ageing. However spine and musculoskeletal balance
may be maintained keeping all motor and sensory inputs in good functional condition as well as insuring the integrity of
proprioception. CAREN intervention delivers multiple sensory input, sensorymotor
training and enriched immersive environment thereby creating an increased opportunity for learning new, more
optimal movement strategies.

CAREN helps CNS to learn the dynamics (balance) of the spine system. This neuromuscular retraining is valuable to help “reset” the control to a more desirable strategy.

OTHER EFFECTS OF CAREN ON LOW BACK PAIN
It is a relatively new vision in science that pain in the low back is caused by motor dysfunction above and below the area of complaint.

What does it mean and how does it relate to CAREN?
Not every patient who complains of chronic low back pain admits that the pain appears during walking.
However, latest studies confirm that it is abnormality of the gait, which creates problems in low back.

CAREN is all about maximizing the brain’s potential to compensate and promote optimal movement patterns so that
loads could be redistributed and tissues can heal. This, in fact, allows the chance for other therapies to work.

Other Popular CAREN Topics:
Computer Assisted Rehabilitation Environment (CAREN)	The Effect of Computer Assisted Rehabilitation Environment (CAREN)	How Computer Assisted Rehabilitation Environment Works
Computer Assisted Rehabilitation Environment (CAREN) and Human Body Model (HBM) Software	Caren treatment for inner ear/ vestibular disorders	Post Cancer, Post Chemo, Post Radiation Rehabilitation

Balance Retraining Therapy On Computer Assisted Rehabilitation Environment (Caren)

Dr. Lev Kalika — Mon, 14 Jan 2013 15:08:20 +0000

At Dynamic Neuromuscular Rehabilitation of New York, we specialize in treatment of balance and vestibular disorders
with the help of Computer Assisted Rehabilitation Environment (CAREN)- the most advanced technology for treatment of balance and vestibular disorders that is available for the first time in the NYC.

Lost Of Balance Is Not Only Disease Of The Elderly Population. In Fact Balance Training Is Now Very Successfully Used In Sports Medicine And Training Of Professional Athletes At Dynamic Neuromuscular Rehabilitation We Have Developed Special Protocols Based On Carens Unique Environment To Train Sport Specific Balance Deficiencies.

WHAT IS BALANCE ?
Balance is an ability to maintain the human body upright and in equilibrium in relation to gravitational field. Balance is one of the senses which requires the integrity of all the other senses. One of the most complex true marvels of brain coordination is the permanent control of the human body and all of its body parts in the three dimensions of space. This ability is the sense of “BALANCE”.

BALANCE DEFINES PERFORMANCE

Normal balance requires the integration of three sensory systems; visual, vestibular (inner ear), and somatosensory (skin, muscle, tendon, and joint sensations). Balance is maintained through a complex process involving sensory detection of body movement, integration of sensorimotor information within the central nervous system (CNS), and execution of appropriate musculoskeletal responses.

BALANCE DEFINES PERFORMANCE

The way, in which sensory systems are normally used, depends upon the environment in which they are functioning. Patients with sensory deficits rely on sensory systems differently than healthy individuals.

When one or more of sensory systems is not functioning well, individuals may experience the symptoms of balance disorders.
Common symptoms may include:

Episodes of spinning or dizziness (vertigo)
Periods of lightheadedness
Feelings of faintness (syncope)
Problems with eye-head coordination
Poor balance (disequilibrium);
Difficulty in sitting, standing, bending, walking, back pain

We are proud to be the first private facility in the US providing most advanced treatment for balance disorders of different
sources. CAREN treatment has been successfully used by the military to treat soldiers with severe balance disorders.

ALL THERAPIES ARE CONDUCTED WITHIN CAREN’S IMMERSIVE ENVIRONMENT. SPECIALIZED OBJECTIVE TESTING IS CONDUCTED TO DEFINE TREATMENT PROTOCOLS

The results achieved with CAREN are not attainable by conventional physical therapy. CAREN treatment combines sensory motor training, visual exercises and habituation treatment. CAREN STABLE SUIT CAREN offers an integrated solution for stability and balance related disorders. CAREN supports the use of therapeutically constructed Virtual Reality
(VR) applications using real-time feedback. Dedicated assessment applications are used for objective and
quantitative measurements, while motivating exercise activities help to train impaired balance control and stability.

BALANCE RETRAINING THERAPY ON CAREN

CAREN measures and improves postural stability and balance control. Assessment applications provide doctors and therapist with objective measures to define a base level, to monitor treatment progression and to set the level of personalized training applications. Immersing patients in a challenging environment with real time feedback is beneficial for balance restoration .
Exercise games for training are specifically developed for stability and balance enhancement in immersive and motivating therapy
environment. CAREN contains a carefully selected set of applications for both the assessment and subsequent training of balance and stability. Proven, precise therapeutic protocols are implemented in challenging VR (virtual reality) environment.

Call now for a free consultation! Talk to Dr. Kalika on how CAREN can helps you recover! 1-866-311-5889

Caren Stable Suit With Computer Assisted Rehabilitation Environment (Caren)

Dr. Lev Kalika — Mon, 10 Dec 2012 15:59:31 +0000

CAREN offers an integrated solution for stability and balance related disorders. CAREN supports the use of therapeutically constructed Virtual Reality (VR) applications using real-time feedback. Dedicated assessment applications are used for objective and quantitative measurements, while motivating exercise activities help to train impaired balance control and stability. Balance (or static postural stability) and dynamic stability are key features in many therapeutic programs. Many patients with neurological disorders experience difficulties in balance and stability control, potentially restricting a healthy active lifestyle. Impaired balance and stability is often also the cause of falls, with devastating consequences like extensive rehabilitation programs or even hospitalization. Caren can measure and improve postural stability and balance control.

Assessment applications provide doctors and therapist with objective measures to define a base level, to monitor treatment progression and to set the level of personalized training applications. Immersing patients in a challenging environment with real time feedback is beneficial for balance restoration . The available exercise games for training are specifically developed for stability and balance enhancement in immersive and motivating therapy environment. CAREN contains a carefully selected set of applications for both the assessment and subsequent training of balance and stability. Proven, precise therapeutic protocols are implemented in challenging VR (virtual reality) environment.

ASSESMENT

Unambiguous and dedicated assessment applications are used to obtain quantitative and objective outcome measures, which helps the therapists to identify stability and balance related issues. The applications are used to define a base-level of the patient and monitor therapy progression.

THE STABLE ASSESMENT APLICATIONS INCLUDE:
1. Limit of stability.
2. Measures the maximal Center-of-Pressure (CoP)
3. Mediolateral displacement

Training
Fun, motivating and engaging exercise sessions are supported by a set of training applications with immersive VR environments and game-play. Exercise applications are driven by therapeutically relevant parameters. Training intensities are set automatically by the patient specific assessment application outcomes. However,the therapist is always in control to decrease or increase the intensity of the training.
The CAREN balance stability training applications include:

-THE CITY RIDE.
Improves ML( medio-lateral) and AP ( anterio-posterior) stability by maneuvering a CoP( center of pressure) driven car through the city while avoiding approaching traffic.

-The MAZE.
ML and AP stability is challenged when the patient needs to use its CoP to steer a ball through mazes of increasing difficulty levels.

-REACH THE SKIES .
Visual balance is trained in this application where the patient mimics a wobbling tower while blocks that fall from the sky need to be caught to build a higher tower.

-THE BOAT.
Dynamic stability is required to successfully steer a boat through a challenging track without hitting buoys or sharks. The goal is to complete the track as fast as possible.

-ROAD ENCOUNTERS.
In this dual-task application the road visually passes while stepping on the spot. Objects flying by need to be hit with the arms.

-HIT!
Reaction time and muscle force training. Hit the targets as quick as
possible after they appear by making knee bends.

-HIT THE MOLE.
Dynamic stability improves while stamping a mole back underground the moment he shows his head. Watch out, he’ll appear at different locations.

-TRAFFIC JAM.
Don’t cause a traffic jam by alternately re-locating your feet at the right time to let cars pass. Be careful not to stop the police.

Other Popular CAREN Topics:
Computer Assisted Rehabilitation Environment (CAREN)	The Effect of Computer Assisted Rehabilitation Environment (CAREN)	How Computer Assisted Rehabilitation Environment Works
Computer Assisted Rehabilitation Environment (CAREN) and Human Body Model (HBM) Software	Caren treatment for inner ear/ vestibular disorders	Post Cancer, Post Chemo, Post Radiation Rehabilitation

Balance And Vestibular Rehabilitation With Computer Assisted Rehabilitation Environment (Caren)

Dr. Lev Kalika — Mon, 10 Dec 2012 15:54:43 +0000

When one or more of these systems is not functioning well, individuals may experience the symptoms of balance disorders. Common symptoms may include:

Episodes of spinning or dizziness (vertigo)
Periods of lightheadedness
Feelings of faintness (syncope)
Problems with eye-head coordination
Poor balance (disequilibrium); difficulty in sitting, standing, bending, and walking.

The way in which normal individuals weigh or use each system is dependent upon the environment in which they are functioning. To maintain upright balance, patient populations with sensory deficits rely on sensory systems differently than normal individuals.

At DNR we specialize in treatment of balance and vestibular disorders with the help of CAREN ( computer assisted rehabilitation environment) , the most advanced technology for treatment of balance and vestibular disorders ,available for the first time in NYC.

ALL THERAPIES ARE CONDUCTED WITHIN CARENS IMMERSIVE ENVIRONMENT.
SPECIALIZED OBJECTIVE TESTING IS CONDUCTED TO DEFINE TREATMENT PROTOCOLS
The results achieved with CAREN are not achievable by conventional physical therapy.
CAREN treatment combines sensory motor training, visual exercises and habituation treatment.
We are proudly the first private facility in US providing MOTION BASED EQUILIBRIUM REPROCESSING THERAPY which has been successfully used in military for pilots suffering from motion sickness.

MOTION BASED EQUILIBRIUM REPROCESSING THERAPY (MERT)

Vestibular disease can handicap people physically, emotionally and socially.

Unilateral peripheral vestibular loss results in gait and balance impairment , dizziness and oscillopsia.
Conventional treatment with betahistine, carbamazepine and oral steroids as well as head rotation exercises by Cawthorne and Cooksey have limited indication and varying response rates.
Patients affected with peripheral vestibulopathies are usually frustrated with inability to find the right treatment.

Virtual reality rehabilitation is a new method which has shown results superior to conventional treatment options.

MERT ( motion based equilibrium reprocessing therapy) – is a novel treatment method for chronic peripheral vestibulopathies.

TREATMENT METHOD
MERT is based on military desensitization principles within Virtual Environment.
The 6 DoF ( degrees of freedom) virtual reality motion base CAREN is used to expose patient to sinusoidal vertical passive whole body motion in gradually increasing intensity while fixating the eye site on rolldome and/or optokinetic drum through virtual reality 180 degrees screen.

TREATMENT FREQUENCY
3-5 times a week during two consecutive weeks

CAREN STABLE SUIT

CAERN offers an integrated solution for stability and balance related disorders. CAREN supports the use of therapeutically constructed Virtual Reality (VR) applications using real-time feedback. Dedicated assessment applications are used for objective and quantitative measurements, while motivating exercise activities help to train impaired balance control and stability. Balance (or static postural stability) and dynamic stability are key features in many therapeutic programs. Many patients with neurological disorders experience difficulties in balance and stability control, potentially restricting a healthy active lifestyle. Impaired balance and stability is often also the cause of falls, with devastating consequences like extensive rehabilitation programs or even hospitalization. Caren can measure and improve postural stability and balance control. Assessment applications provide doctors and therapist with objective measures to define a base level, to monitor treatment progression and to set the level of personalized training applications. Immersing patients in a challenging environment with real time feedback is beneficial for balance restoration . The available exercise games for training are specifically developed for stability and balance enhancement in immersive and motivating therapy environment. CAREN contains a carefully selected set of applications for both the assessment and subsequent training of balance and stability. Proven, precise therapeutic protocols are implemented in challenging VR (virtual reality) environment.