Continuous Active Motion Research Articles

Early Regain of Function and Proprioceptive Improvement Following Knee Arthroplasty.

Techniques that allow early muscle activation, such as closed kinetic chain (CKC) and open kinetic chain (OKC) exercises, may play a beneficial role in the early rehabilitation of the reconstructed knee. However, current rehabilitation regimens have not been shown to reverse post-operative quadriceps activation failure and weakness. To investigate whether patients who use a continuous active motion (CAM) device that follows closed kinetic chain principles have better early post-operative functional improvements than patients who use a continuous passive motion (CPM) device that follows the principles of open kinetic chain principles. A prospective randomized controlled trial with non-blinded study staff. A tertiary care clinic at a teaching hospital. A total of 110 patients signed the consent form and 83 patients participated in the study. Patients were randomly assigned to use either the CPM device for 4 hours daily for 3 weeks (control group), or a CAM device for 3 sessions of 20 minutes for 3 weeks (intervention group), starting 24 hours after knee replacement surgery.The primary outcome measure was to identify the superiority, inferiority, or equivalence of one device at week 4 after knee arthroplasty using various functional outcome measures such as kinesthesia, quadriceps strength, coordination, general orthopaedic outcome measures and narcotic consumption. At 4 weeks, all outcome measurements were comparable between the two groups, with the exception of sit-to-stand test: in the treatment group the time was significantly shorter compared to the control group (P=0.016). Balance was significantly better in both control (P=0.001) and treatment group (P=0.032) compared to prior surgery. Most clinical centers would like to expedite functional recovery of knee arthroplasty patients without increasing the risk of falls. We observed balance and kinesthesia improvements after surgery using either device which may be important to benefit fast recovery programs. Further research is warranted to see whether additional active closed kinetic chain exercised following knee replacement surgery could improve specific functional outcomes such the observed sit-to-stand test. I.

Real-time magnetic resonance imaging (MRI) during active wrist motion--initial observations.

BackgroundNon-invasive imaging techniques such as magnetic resonance imaging (MRI) provide the ability to evaluate the complex anatomy of bone and soft tissues of the wrist without the use of ionizing radiation. Dynamic instability of wrist – occurring during joint motion – is a complex condition that has assumed increased importance in musculoskeletal medicine. The objective of this study was to develop an MRI protocol for evaluating the wrist during continuous active motion, to show that dynamic imaging of the wrist is realizable, and to demonstrate that the resulting anatomical images enable the measurement of metrics commonly evaluated for dynamic wrist instability.MethodsA 3-Tesla “active-MRI” protocol was developed using a bSSFP sequence with 475 ms temporal resolution for continuous imaging of the moving wrist. Fifteen wrists of 10 asymptomatic volunteers were scanned during active supination/pronation, radial/ulnar deviation, “clenched-fist”, and volarflexion/dorsiflexion maneuvers. Two physicians evaluated distal radioulnar joint (DRUJ) congruity, extensor carpi ulnaris (ECU) tendon translation, the scapholunate (SL) interval, and the SL, radiolunate (RL) and capitolunate (CL) angles from the resulting images.ResultsThe mean DRUJ subluxation ratio was 0.04 in supination, 0.10 in neutral, and 0.14 in pronation. The ECU tendon was subluxated or translated out of its groove in 3 wrists in pronation, 9 wrists in neutral, and 11 wrists in supination. The mean SL interval was 1.43 mm for neutral, ulnar deviation, radial deviation positions, and increased to 1.64 mm during the clenched-fist maneuver. Measurement of SL, RL and CL angles in neutral and dorsiflexion was also accomplished.ConclusionThis study demonstrates the initial performance of active-MRI, which may be useful in the investigation of dynamic wrist instability in vivo.

What Do We Really Know About Rehabilitation After ACL Reconstruction?

What Do We Really Know About Rehabilitation After ACL Reconstruction?

Implementation of CAM physiotherapy device with a virtual spring

Continuous passive motion (CPM) and continuous active motion (CAM) physiotherapy devices are commonly used to promote rehabilitation of damaged synovial joints. A CPM/CAM device with no resistive CAM-type components is presented. In the CPM mode the electric motor functions conventionally, but in the CAM mode, intelligent use of the motor simulates resistive components by driving the motor to exert a force opposing the patient's muscle activity, so as to simulate the effect of a spring load. The system easily connects to the Internet or other data links for automatic monitoring of home patients, hospital networks, research stations, or telemedicine applications.

Benefits of active motion for joint position sense

Anterior cruciate ligament (ACL) ruptures lead to a proprioceptive deficit and therefore joint position sense. This study examined whether active motion is better suited than passive motion to address this deficit. Sixty patients with ACL rupture were prospectively randomised into two groups [continuous active motion (CAM)/continuous passive motion (CPM)]. All patients had an ACL reconstruction. An angle reproduction test was used to assess the proprioceptive deficit. The relevant examinations were performed before surgery (pre-op evaluation) and after the seventh postoperative day. No preoperative difference was found between the two groups. After postoperative treatment, the deficit was reduced in both groups. Significantly better results were, however, obtained in the CAM group (CPM, 4.2+/-1.6 degrees; CAM, 1.9+/-1.2 degrees; P<0.001). During the first postoperative week, a CAM device produced a significantly greater reduction in the proprioceptive deficit and should be the first choice in immediately postoperative rehabilitation after ACL replacement.

Die krankengymnastische Nachbehandlung ausgedehnter Eingriffe bei entzündlichen und degenerativen Kniegelenksveränderungen

The authors present the treatment concept of ,,continuous active motion therapy" which consists of three parts. Besides learning the mobility exercises assisted by the physiotherapist, the patient works out and designs exercises that he himself performs independently (,,homework"). This self-programme which the patient goes through 31 times per hour represents the essential part of the treatment concept. Thirdly, exercises with equipment (pulleyblocks at the patient's bed, loop cage, pullingformer) are taught by the physiotherapist and integrated into the ,,homework" schedule.

A Case of Infection of the Knee-Joint Treated by Early and Continuous Active Motion

A Case of Infection of the Knee-Joint Treated by Early and Continuous Active Motion