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
1. 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

3. The rate of motion is determined ; usually 1

cycle per minute or per 2 minutes is well
tolerated
4. The amount of time on CPM vary 24 hrs.
continuously or continuously 1 hour 3 times a
day
5. Active assisstive or sling exercises is
included
6. 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
patients 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

A. Self assistance -patient can be taught to use the
normal extremity to move the involved extremity
through Range of motion
B. 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
C. 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

a. Active participation is required thus the patient learn to
use the appropriate muscle for desired movement
b. Relaxation is promoted through secure support and
smooth rhythmic motion
c. Little work is required of stabilizing muscles because
the part is supported
d. Modification can be made to the system to provide
grades of exercise resistance
e. 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.

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

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

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.

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:
a. This occurs when all the ropes supporting a
part are attached to one S hook
b. which is fixed to a point immediately above
the centre of the joint
c. The point of attachment of the all the rope supporting
the part is above the axis of the joint to be moved
d. 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
1. Goal
2. Proper mechanism of moving segment
3. Patient comfort and safety