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Continuous Passive Motion (CPM). Chapter 15. Purpose. Produce passive joint motion Effects: Enhance nutrition Increase metabolic activity Stimulate tissue remodeling and regrowth of healing tissues: Articular cartilage Tendons Ligaments. Specific to Body Area and Motion. - PowerPoint PPT Presentation
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Continuous Passive Motion(CPM)
Chapter 15
Purpose
Produce passive joint motion Effects:
Enhance nutrition Increase metabolic activity Stimulate tissue remodeling and regrowth of healing
tissues: Articular cartilage Tendons Ligaments
Specific to Body Area and Motion
Knee Flexion/Extension Wrist Flexion/Extension Wrist Radial/Ulnar Deviation
Finger Flexion/Extension
GH Flexion/Extension GH Internal/External Rotation
Types of CPM devices
Free Linkage Anatomic Nonanatomic
Free Linkage Design
Moves the limb through ROM by grasping it proximal and distal to the joint
Adjustable to patient Contraindicated for unstable joints
Anatomic Design
Mimics natural motion of involved joint and the proximal joints
Most suitable for knees
Nonanatomical Design
Does not attempt to replicate natural joint motion Compensatory movement occurs between limb
and CPM unit
Physiological Effects of CPM Encourages the remodeling of collagen along the lines of
force Reduces:
The negative effects of joint immobilization Functional shortening Cross linking of collagen Capsular adhesions
Enhances the tensile strength of Tendons Allografts Skin
Stimulate repair of articular cartilage
Physiological Effects Fluid pressures
Extension: Most joint volume Low pressure
Flexion: Least joint volume High pressure
Changes in pressure creates a pumping effect Circulates synovial fluid Assists in the removal of:
Hemarthrosis Periarticular edema Blood from tissues surrounding joint
Range of Motion
Total end range time (TERT) Delivers a low load, prolonged stress Increases ROM as TERT increases
Helps patient overcome the apprehension of moving joint after surgery
Decreases rate of atrophy Limits functional shortening of muscle No increase on cardiovascular system
Joint Nutrition
Stimulates circulation of synovial fluids Increases nutrient uptake
Meniscus Articular cartilage
Edema Reduction
Not clearly understood Varies according to:
The body part Condition being treated
The passive movement of the limb and the elevation of the body part could assist in venous and lymphatic return by milking the muscle
Pain Reduction
Movement of joint activates the gate control pain theory
Other effects such as decreased edema could also decrease pain
Not used as an acute pain-control technique
Ligament Healing
ACL does not receive the same nutritional benefits from CPM as cartilage because of its separate synovial lining
Effective in allograft-augmented medial collateral ligament reconstruction
Contraindications
Unwanted joint motion and overstressing Unstable fractures Spastic paralyses Uncontrolled infection Deep Vein Thrombosis
Clinical Applications
A CPM technician will use the manufacturers protocol to administer treatment following surgery
Precaution: CPM devices should not
be used in the presence of flammable gases
Treatment Duration
Long term bouts: patient continuously attached 1-hour 3 times per day 6 to 8 hours a day post-surgery In home treatments with home visits by physical
therapist