Continuous Passive Motion as a Post Surgery Recovery Tool

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.

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