Download CPM - Therapeutic Modalities

Continuous Passive Motion
(CPM)
Chapter 15
Purposes
• Produce passive joint motion
• Effects:
– Enhance nutrition
– Increase metabolic activity
– Stimulate tissue remodeling and regrowth of
healing tissues:
• Articular cartilage
• Tendons
• Ligaments
Types of CPM devices
• Free Linkage
• Anatomic
• Nonanatomic
Free Linkage
• 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
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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
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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