Continuous Passive Motion

Continuous passive motion

It is a form of passive motion delivered via a motorized

device
Defined as
Motion that is uninterrupted for extended
periods of time it is usually applied by a
mechanical device that moves a desired joint
continuously trough a controlled range of
motion.
 Indication
1. Following open reduction internal fixation (ORIF)of an
intra-articular fracture when the fracture fragment is
stable/postdiaphyseal and metaphyseal fracture.
2. Capsulotomy ,arthroplasty ,
3. Ligament construction ,synovectomy, arthrotomy and
drainage of acute specific arthritis
4. Tendon reconstruction and burns
 Benefits
2. CPM is effective in lessening the negative
effect of joint immobilization in conditions
such as
-arthritis ,
-contracture ,
-intra - articular fractures
2.decreases the frequency of post operative
complication
3.Improves the recovery rate and ROM
following surgical procedure
CPM has shown to
a. Prevents development of adhesion and decrease
contracture formation
b. Decreases postoperative pain
c. Enhances nutritional status of the extremity by
improving the circulation
d. Increasing synovial fluid lubrication of the joint
e. Decreases joint effusion and wound edema and
promote healing
f. Increases the rate of intra-articular cartilage
healing and regulation
g. Provides a quicker return of range of motion
 Procedure
1. The device may be applied to the involved
extremity immediately after surgery while
patient is still under anesthesia or with in 3
days if the bulky dressings prevent early
motion
2. The size and position of the motion arc for
joint is determined
– A low arc of 20-30° may be used immediately
after surgery
1. The rate of motion is determined ; usually 1
cycle per minute or per 2 minutes is well
tolerated
2. The amount of time on CPM vary –24 hrs.
continuously or continuously 1 hour 3 times a
day
3. Active –assisstive or sling exercises is
included
4. Duration minimum 1 week or till satisfactory
ROM is reached ,active exercises is continued
until the patient attains appropriate functional
goal
 Goals
1.To maximize the biologic benefits
stimulated through CPM
• *8-24 hrs for minimum of 3weeks
2. To help relieve pain,stiffness, swelling.
 Safety Consideration
• To provide written CPM instructions to the
patient’s caretaker whenever possible.
• Verbal explanation on the purpose of using of
CPM
• instructions on all setting indication on the device
• Although demonstration and explanation on
proper limb positioning and limb relaxation
• Instructions to avoid pressure while strapping the
limb to avoid circulatory and nerve irritation
problems
ASSISTED EXERCISES

SUSPENSION THERAPY
 Types Assistance exercise

• Self assistance -patient can be taught to use the

normal extremity to move the involved extremity
through Range of motion
• Wand exercise – when the patient has voluntary
muscle control in an involved upper extremity but
needs guidance or motivation to complete the
range of motion e.g.-a dowel rod (cane , wooden
stick,t-bar)can be used to provide assistance
• Finger ladder- wall climbing is a device the
patient with objective reinforcement and
therefore motivation for performing ROM
D. Over head pulley – it can be effectively used to
assist an involved extremity in performing ROM

E. Skate board ; power board (can be used after

surgical procedure to hip to encourage ROM

F. Suspension – technique is used to free body part

from the resistance of friction while it is moving
SUSPENSION
The technique is use to free a
body part from the resistance of
friction while it is moving the part
is suspended in a sling attached to a
rope that is fix to an appropriate
point above the body segment
Guthrie Smith
BENEFITS OF SUSPENSION FOR ROM EXERCISE
b. Active participation is required thus the patient learn to
use the appropriate muscle for desired movement
c. Relaxation is promoted through secure support and
smooth rhythmic motion
d. Little work is required of stabilizing muscles because
the part is supported
e. Modification can be made to the system to provide
grades of exercise resistance
f. After instruction the patient can often work
independently of a therapist
The fixed point
 

It is made of stainless steel or plastic covered 5 cm

metal mesh around the area of a plinth,
• Its1m or 2m wide x 2m long above it,
• 2m x 2m on the wall at the side of the plinth,
• At the head of the plinth 1m or m x 2m long and
2m high.
• suspend the overhead mesh from the ceiling at a
height which will allow about 1.5m
• A free –standing frame may be used. This is a
frame big enough to take a single bed.
• Hooks on the side of the frame allow lateral fixed
points and can be used to keep the small apparatus
near at hand.
mesh

Fixed point

plinth
Storage trolley
The supporting ropes
Ropes should be 3ply hemp(will not slip)
3 types of ropes
A single rope , a pulley rope, a double rope.

Single rope

A single rope has a ring fixed at one end, by

which it is hung up
The other end of the rope passes through one
end of a wooden cleat,
Then through the ring of a dog clip
And through other end of the cleat and is then
knotted with a half-hitch.
The cleat is for altering the length of the rope
And should be held horizontally for movement
Should be pulled oblique when supporting
 The rope then ‘holds’ on the cleat by frictional
resistance
The total length of rope required is 1.5m
Further shortening of the rope may be brought
about by knotting is about the cleat.
Pulley rope
A pulley rope has a dog clip attached to one end of the
rope
which then passes over the wheel of a pulley
The rope then passes through the cleat and a second
dog clip.
This rope is 1.5m long.
This arrangement is used for reciprocal pulley
circuits:
with one sling supporting a limb, and the ends of
the sling attached to the two dog clips, it is used for
three-dimensional movements of a limb,
 i.e. abduction or adduction with flexion or
extension and medial or lateral rotation (combined,
oblique, rotatory movements).
Double rope
A double rope consists of a ring and clip from which
the rope is hung to create a compensating device
permitting a certain amount of swivel on the rope.

The rope then passes through one side of a cleat,

around a pulley wheel at the lower end, to the case

of which is attached to a dog clip,

Through the other end of the cleat and over the

wheel of an upper pulley which is attached to the
compensating device.

 
The rope then passes down again through a
centre hole in the cleat where it is knotted
 This device gives a mechanical advantage
Such a rope is used to suspend the heavy parts of
the body – the pelvis, thorax or heavy thighs when
these are to be supported together
 Slings

Single slings
•Single slings are made of canvas
bound with soft webbing and with
a D ring at each end.

•Used open to support the limbs

•Can be folded in two, and as a

figure of eight to support the hand
or foot.

•They measure 68 cm long by 17

cm wide
Double slings
Double slings are broad slings measuring 68 cm
long by 29 cm] wide with D rings at each end
Used to support the pelvis or thorax or the thighs
together,
Three-ring slings
Three ring slings are webbing slings 71 cm long by
3-4 cm wide with three D rings one fastened at each
end and one free in the middle
 The center ring is for attachment to the dog clip
 The webbing is slipped through the end D rings to
make two loops.
 These slings are used to support the wrist and hand
or ankle and foot.
Head sling
A head sling is a short,
split sling with its two halves stitched together at
an angle to create a central slit.
This allows the head to rest supported at the back
under the lower and upper parts of the skull,
in the side lying position leaves the ear free

Clips
Karabiner hooks of 70 mm or 100 mm provide a
convenient alternative means of clipping two
pieces of equipment together.
 
 TYPES OF SUSPENSION
. Vertical fixation :
• vertical fixation the rope is fixed so that it hangs
vertically above the centre of gravity of the part to be
suspended
• The centre of gravity of each part of the body is, at the
junction of the upper and middle third.
• The point of attachment of the rope is over the center
of gravity of the moving segment.
• The part can then move like a pendulum,
• The movement is small range,
•
Axial fixation:
• This occurs when all the ropes supporting a part
are attached to one ‘S’ hook
• which is fixed to a point immediately above the
centre of the joint
• The point of attachment of the all the rope supporting
the part is above the axis of the joint to be moved
• The part will move on a flat plan parallel to the floor
this type of fixation allows for maximum movement of
the joint.
If some resistance to the muscle work is required

The whole fixed point is moved away from the

muscles which require resistance.
For e.g. If abduction is to be resisted the fixed point
is moved towards the adductors.
 On effort the limb will now rise into abduction
brought about by isotonic shortening of the
abductors, resistance being offered by gravity.
Slow lowering into the resting position is controlled
by isotonic lengthening of the abductors
1. Suspension therapy is a form of assisted exercise
2. Suspension therapy used in case of muscle power 2

Applications:
Whenever using equipment the primary concerns must be
6. Goal
7. Proper mechanism of moving segment
8. Patient comfort and safety