Continuous Passive Motion Machine Research Articles

Design and Development of Automated Lower Limb Continuous Passive Motion (CPM) Machine

Abstract: Post-operative rehabilitation is critical in orthopedic surgery, especially for hip joint surgeries. Traditional therapies like manual exercises and resource limits in rehabilitation centers might be tough, but early mobilization and rehabilitation are critical for regaining joint function and allowing patient return to normal activities. Continuously Passive Motion (CPM) devices, primarily developed for knee joint rehabilitation, offer a non-invasive method for passive joint mobility, restoring joint range of motion and lowering post-operative stiffness risk. Their application in hip joint healing is gaining pace, offering better results and increased patient satisfaction. The research also investigates abduction mobility in the hip joint, which is necessary for daily actions like stepping to the side, getting out of bed, or exiting a car. Understanding hip joint biomechanics and range of motion parameters is vital for establishing efficient rehabilitation approaches. By merging clinical insights with technology innovations, this research intends to optimize post-surgery rehabilitation regimens, enhancing patient outcomes and quality of life. The subject of orthopedic rehabilitation continues to expand through interdisciplinary collaboration and innovation, bringing new choices for enhancing patient care and recovery trajectories.

Rotary speed control on Continuous Passive Motion (CPM) Therapy Machine Device with PI Control

Continuous Passive Motion (CPM) Machine is a therapeutic device that is used to assist the process of therapy and recovery of a patient after having joint surgeryor injury of the ankle. In this research, a CPM machine will be developed for ankle joint therapy. The rotation speed of the CPM machine will be controlled by a DC motor which is used to drive the ankle joint therapy device.Speed control for DC motor is used on a therapeutic device (CPM machine) to determine the level of the therapeutic process; therefore this device can be adjusted to the needs of the patient who will use the therapeutic device. Speed control of the DC motor that will be carried out in this research is using Proportional Integral (PI) control. With the PI control, the result of output will always be compared with the set point value. The result of this comparison will provide an error value, which later the error value will be processed by PI control.The PI values used in this research are Kp 5 and Ki 15.The test results of the CPM movement speed show that the difference between the set point and the resulting movement is 1 RPM. Where the speed tested on this tool is 3 RPM and 5 RPM. So, the output of this device will be as expected. In brief of this research, a therapeutic device that can be adjusted the rotational speed as expected.

Bony encasement of the ulnar nerve secondary to heterotopic ossification of the elbow: an evaluation of long-term outcomes

BackgroundUlnar neuropathy at the elbow caused by heterotopic ossification (HO) is a rare condition. This retrospective study aims to report on 32 consecutive cases of ulnar nerve encasement caused by elbow HO and evaluate long-term outcomes of operative management and a standardized postoperative rehabilitation regimen. MethodsA retrospective case series was conducted on 32 elbows (27 patients) that underwent operative management of bony ulnar nerve encasement. All procedures were performed in the inpatient setting at an Academic Level 1 Trauma Center from September 1999 to July 2021 by one of three fellowship-trained shoulder and elbow. Postoperatively, all patients received formal physical therapy, heterotopic ossification prophylaxis (30 received indomethacin, 2 received radiation), and a structured continuous passive motion machine regimen. Patient demographics, age, gender, type of injury, history of tobacco use, and medical comorbidities were obtained to include in the analysis. Long-term follow-up examinations were performed to evaluate elbow flexion-extension arc of motion, Mayo Elbow Performance Scores (MEPS), and visual analog scale (VAS) pain scores. ResultsThirty-two elbows with complete bony ulnar nerve encasement secondary to HO were identified (14 from burns, 15 from trauma, 3 closed head injuries). Following surgery, the mean flexion-extension arc of motion improved significantly, increasing from 21° to 100° at long-term follow-up (average 8.7 years, range 2-17 years), with statistically significant improvements in preoperative versus long-term postoperative elbow extension (p < 0.001), flexion (p < 0.001), and total arc of motion (p < 0.001). There was a statistically significant improvement in pre- vs. post-procedure ulnar nerve function, as demonstrated by a decrease in average McGowan grade (1.2 to 0.7; p = 0.002). Additionally, 63% of patients with preoperative ulnar neuropathy symptoms (20/32) had either complete resolution or subjective improvement after surgery. The mean time from injury to surgery was 518 days (range 65-943 days). Age, gender, time to surgery, and medical co-morbidities were not associated with outcomes. The complication rate was 9% (3/32). Patients had an average flexion-extension arc of motion of 97 degrees and average MEPS of 80 (“good”) at long-term follow-up. ConclusionsThe combination of operative management, postoperative heterotopic ossification prophylaxis, and a regimented rehabilitation program has proven to be a durable solution for treating and ensuring good long-term functional outcomes for patients with elbow HO and bony ulnar nerve encasement. This treatment approach leads to superior range of motion, improved or resolved ulnar neuropathy, and good to excellent long-term functional outcomes.

The Development of an Interface Instrument for Collecting Electromyography Data and Controlling a Continuous Passive Motion Machine

There is a lack of research in using electromyography (EMG) signals to control a continuous passive motion (CPM) machine. This study aimed to develop an interface instrument for digitalising EMG signals and controlling a CPM machine. Methods: The proposed device was designed with the following: (1) a signal processing unit which converted the EMGs from analogue to digital for the controller; (2) a personal computer which stored and displayed the EMG signals; (3) an LCD device to display the running angle of the CPM; and (4) a microcontroller unit to control the input/output signals and process the algorithm, driving the CPM. To validate the reliability of the proposed system, a total of 600 EMG trials were collected from 10 healthy subjects by using the proposed device via the Delsys® TringoTM EMG system and simultaneously using the Vicon® motion capture system. Result: This proposed device was able to digitalise and process EMG signals from eight channels of muscles, and the signals were able to drive a CPM. The validated results showed that the digitalised EMG signals by the proposed device were statistically similar to and correlated with the signals by the Vicon system with a median correlation coefficient of 0.81, with the 25% and 75% range being 0.56–0.92 with all pairs (300 pairs of EMG trials) (p &lt; 0.001). Conclusions: This study confirmed that the developed device can digitalise EMG signals and drive a CPM as an applicable prototype that can work as an interface between EMG and CPM devices with high reliability.

A Literature Review on Pneumatic Operated CPM Machine for Knee and Ankle

bstract: Continuous passive motion (CPM) is a therapy in which a machine is used to move a joint without the patient having to exert any effort. A motorized device gently bends the joint back and forth to a set number of degrees, and the amount of movement and speed can be adjusted by the physical therapist. CPM machines are most commonly used on knee joints (after some types of knee surgery), but there are versions made for other joints as well. CPM is helpful when used according to a different principle than continuous motion. Rather than having the device flexing and extending the elbow on a continuous basis, I use the device asslow intermittent passive positioning. The day after release, my patients start slow intermittent passive placement, using the first 12 to 24 hours for rest and elevation. The machine is originally set to its most extreme acceptable extension and flexion positions. The antecubital fossa bandages must be taken off since they will prevent bending. The patient (or parent) is instructed on how to operate the machine-stopping button. The absolute minimum displacement rate is chosen. The patient is told to let the machine extend the elbow to its fullest extent, stop it, and hold it there for 20 to 30 minutes. When the button is pressed, motion is resumed up to the point of maximally tolerable flexion. Once more, the position is maintained for 20–30 minutes. The joint is kept in its most extreme position from the start of rehabilitation in this fashion, which is the intended outcome. There is no benefit to cycling the joint more frequently, and doing so could make the swelling worse. The indwelling catheter can be used to provide anaesthesia to treat pain and calm the muscular guarding if the CPM causes substantial guarding

STABILITY OF 3D-PRINTED POLYE-CAPROLACTONE COLLAGEN SCAFFOLDS IN A PORCINE CADAVERIC MODEL: A PILOT STUDY

Restoration a joint's articular surface following degenerative or traumatic pathology to the osteochondral unit pose a significant challenge. Recent advances have shown the utility of collagen-based scaffolds in the regeneration of osteochondral tissue. To provide these collagen scaffolds with the appropriate superstructure novel techniques in 3D printing have been investigated. This study investigates the use of polyɛ-caprolactone (PCL) collagen scaffolds in a porcine cadaveric model to establish the stability of the biomaterial once implanted.This study was performed in a porcine cadaveric knee model. 8mm defects were created in the medial femoral trochlea and repaired with a PCL collagen scaffold. Scaffolds were secured by one of three designs; Press Fit (PF), Press Fit with Rings (PFR), Press Fit with Fibrin Glue (PFFG). Mobilisation was simulated by mounting the pig legs on a continuous passive motion (CPM) machine for either 50 or 500 cycles. Biomechanical tensile testing was performed to examine the force required to displace the scaffold.18 legs were used (6 PF, 6 PFR, 6 PFFG). Fixation remained intact in 17 of the cohort (94%). None of the PF or PFFG scaffolds displaced after CPM cycling. Mean peak forces required to displace the scaffold were highest in the PFFG group (3.173 Newtons, Standard deviation = 1.392N). The lowest peak forces were observed in the PFR group (0.871N, SD = 0.412N), while mean peak force observed in the PF group was 2.436N (SD = 0.768). There was a significant difference between PFFG and PFR (p = 0.005). There was no statistical significance in the relationship between the other groups.PCL reinforcement of collagen scaffolds provide an innovative solution for improving stiffness of the construct, allowing easier handling for the surgeon. Increasing the stiffness of the scaffold also allows press fit solutions for reliable fixation. Press fit PCL collagen scaffolds with and without fibrin glue provide dependable stability. Tensile testing provides an objective analysis of scaffold fixation. Further investigation of PCL collagen scaffolds in a live animal model to establish quality of osteochondral tissue regeneration are required.

Arthroscopic Lysis of Adhesions for the Stiff Total Knee Arthroplasty.

Arthroscopic lysis of adhesions is a treatment option for patients with painful, stiff knees as a result of arthrofibrosis following knee arthroplasty, in whom prior manipulation under anesthesia (MUA) has failed. Typically, nonoperative treatment in these patients has also failed, including aggressive physiotherapy, stretching, dynamic splinting, and various pain-management measures or medications. Range of motion in these patients is often suboptimal, and any gains in flexibility will likely have hit a plateau over many months. The goal of performing lysis of adhesions is to increase the range of motion in patients with knee stiffness following total knee arthroplasty, as well as to reduce pain and restore physiologic function of the knee, enabling activities of daily living. This is a straightforward surgical technique that can be performed in a single stage. The preoperative range of motion is documented after induction of general anesthesia. The procedure begins with the establishment of standard medial and lateral parapatellar arthroscopic portals. A blunt trocar is introduced into the knee, and blunt, manual lysis of adhesions is performed in the suprapatellar pouch and the medial and lateral gutters with use of a sweeping motion after piercing and perforating the scarred adhesive bands or capsular tissue. Next, the arthroscope is inserted into the knee, and a diagnostic arthroscopy is performed. Bands of fibrous tissue are released and resected with use of electrocautery and a 4.0-mm arthroscopic shaver. Next, the posterior cruciate ligament (PCL) is visualized in full flexion. If PCL tightness is observed, the PCL can be released from its femoral origin until the flexion gap is increased. This portion of the procedure can include either partial or full release of the PCL, as indicated. Next, the arthroscope is removed and the ipsilateral hip is flexed to 90° for a standard MUA. Gentle force is applied to the proximal aspect of the tibia, and the knee is flexed. After completing the MUA, immediate post-intervention range of motion of the knee is documented, and the patient is provided with a continuous passive motion (CPM) machine set to the maximum flexion and extension achieved in the operating room. Nonoperative treatment of a stiff knee following total knee arthroplasty is well documented in the current literature. Range of motion has been shown to increase in patients undergoing proper pain management, aggressive physical therapy, and closed MUA in the acute postoperative setting. Additionally, more severe cases of established arthrofibrosis despite prior MUA can be treated with an open lysis of adhesions1-3. Arthroscopic lysis of adhesions with PCL release versus resection has been well described previously. This procedure has been shown to benefit patients in whom initial nonoperative treatment has failed. Additionally, this procedure is not limited to the immediate acute postoperative period like standard MUA3. To our knowledge, no technique video has been published outlining arthroscopic lysis of adhesions for a stiff knee following total knee arthroplasty. This procedure has been shown to provide an immediate and lasting improvement in the flexion and extension arc of the knee, as well as improved functional outcomes. Patients should be educated that improvements gained in the operating room must be sustained through physical therapy. In a study of 32 patients who underwent arthroscopic lysis of adhesions for moderately severe arthrofibrosis following a total knee arthroplasty, Jerosch and Aldawoudy reported a mean postoperative flexion of 119° in the operating room and 97° at the time of the latest follow-up. Eight patients with extensor lag showed improvement from 27° to 4°. Average Knee Society scores improved from 70 points preoperatively to 86 points at the time of the latest follow-up4. Their article showed that arthroscopic treatment of stiffness following total knee arthroplasty is a safe and effective form of treatment. Perform manual lysis of adhesions with a trocar prior to inserting the arthroscope in order to improve visualization and access.Utilize all portals and accessory portals interchangeably in order to improve access.Prescribe physical therapy with or without CPM machine immediately following surgery in order to maintain correction.Utilize pump inflow in order to help distend the tightened capsule.Protect the prosthetic surface from scratches during portal establishment.Loss of flexion implies scarring in the suprapatellar pouch and/or intercondylar notch, or PCL tightness.Loss of extension implies a tight posterior capsule, posterior osteophytes, or scarring of the PCL stump.A motorized shaver is the best tool for treatment of dense fibrous tissue, but be sure not to scratch metal total knee components. TKA = total knee arthroplastyROM = range of motionCT = computed tomographyMRI = magnetic resonance imagingESR = erythrocyte sedimentation rateCRP = C-reactive protein.

CNC Machines for Rehabilitation: Ankle and Shoulder

Continuous passive motion (CPM) machines are used in the rehabilitation of members that have been injured to recover their range of motion and prevent stiffness. Nowadays, some CPM machines for the knee, ankle, arm, and elbow are available commercially. In this paper, ankle and shoulder rehabilitation robots, based on an X-Y table, are presented. The novelty of these rehabilitation robots is that they have a computerized numerical control system, resulting in low-cost machines. Some G-codes for basic and combined movement routines for ankle and shoulder rehabilitation are presented. In addition, the use of a robust generalized PI controller is also proposed to guarantee safe rehabilitation movements and compensate for passive stiffness in the ankle joint of stroke survivors. Some numerical simulations are included to illustrate the dynamic performance of the robust Generalized Proportional Integral (GPI) controller using the virtual prototype.

Estimation of Tibiofemoral Joint Contact Forces Using Foot Loads during Continuous Passive Motions.

Continuous passive motion (CPM) machines are commonly used after various knee surgeries, but information on tibiofemoral forces (TFFs) during CPM cycles is limited. This study aimed to explore the changing trend of TFFs during CPM cycles under various ranges of motion (ROM) and body weights (BW) by establishing a two-dimensional mathematical model. TFFs were estimated by using joint angles, foot load, and leg–foot weight. Eleven healthy male participants were tested with ROM ranging from 0° to 120°. The values of the peak TFFs during knee flexion were higher than those during knee extension, varying nonlinearly with ROM. BW had a significant main effect on the peak TFFs and tibiofemoral shear forces, while ROM had a limited effect on the peak TFFs. No significant interaction effects were observed between BW and ROM for each peak TFF, whereas a strong linear correlation existed between the peak tibiofemoral compressive forces (TFCFs) and the peak resultant TFFs (R2 = 0.971, p < 0.01). The proposed method showed promise in serving as an input for optimizing rehabilitation devices.

Clinical evaluation of usefulness and effectiveness of sitting type continuous passive motion machines in patients with total knee arthroplasty: a study protocol for a single-blinded randomized controlled trial

BackgroundTotal knee arthroplasty (TKA) is an important management strategy for patients with knee osteoarthritis (OA) refractory to conservative management. Postoperative range of motion (ROM) exercise is important to recover patients’ activities of daily living. Continuous passive motion (CPM) is a machine that provides passive ROM exercises of the knee joint in a pre-defined arc of motion. The short- and long-term effects of CPM exercise are controversial. We hypothesized that the inconsistent results of the CPM exercise are due to poor fitting of CPM machines and measurement errors. This study aims to present a protocol for investigating a new type of CPM machine that could be applied in a sitting position in comparison with the conventional type of CPM machine for patients with unilateral TKAs.MethodsThis study presents the protocol of a prospective, multicenter, single-blinded, three-armed randomized controlled trial (RCT). One hundred and twenty-six patients receiving unilateral TKAs will be recruited at the physical medicine and rehabilitation clinics of two urban tertiary medical hospitals. The patients were randomly divided into three groups with a 1:1:1 allocation. The intervention group will receive two weeks of post-operative rehabilitation using a new type of CPM machine. The control group will receive 2 weeks of post-operative rehabilitation using conventional CPM machines. The third group will receive post-operative rehabilitation with both types of CPM machines. The primary outcome will be the change in the passive ROM of the affected knee joint from baseline to 2 weeks after baseline assessment. The secondary outcomes will be pain and functional measurements, and will include patient-reported outcomes and performance tests surveyed at multiple time points up to 3 months after TKA.DiscussionThis is the first RCT to investigate the effect of a new type of CPM machine. The results of this RCT will determine whether the position of the patients during CPM exercise is important in post-operative rehabilitation protocols after TKAs and will provide evidence for the development of proper rehabilitation guidelines after TKAs.Trial registrationClinical Research Information Service of Republic of Korea, KCT0005520, Registered on 21 October 2020, https://cris.nih.go.kr/cris/search/detailSearch.do/21750

Capsulolabral Adhesions After Hip Arthroscopy for the Treatment of Femoroacetabular Impingement: Strategies During Rehabilitation and Return to Sport to Reduce the Risk of Revision

AbstractThis article will review various strategies such as passive range of motion modalities, active range of motion movements, and pharmacological interventions for the prevention of adhesion formation after hip arthroscopy. Capsulolabral adhesions are a common cause of revision hip arthroscopy for which treatment methods are still evolving. Efforts to prevent and limit their formation postoperatively, including adjuncts such as losartan, as well as the use of consistent passive and active, multiplanar movements, both therapist and continuous passive motion machine assisted, should be considered.

Continuous Passive Motion Machine for Elbow Rehabilitation

Continuous Passive Machines (CPM) facilitate patients in eliminating joint stiffness after surgery and lead to a faster and more efficient recovery. However, many previous CPM machined are mechanically complicated, expensive, and lack a user interface. This paper presents a new CPM machine for elbow flexion-extension and forearm pronation-supination. The machine is simple, low-cost, and equipped with Graphical User Interface (GUI). Its mechanism is designed so that it can be used on the left or right arms interchangeably. It is developed using aluminum, perspex, and steel rods. The electrical part of the machine consists of Arduino Uno to drive the motors and a potentiometer to measure the patients’ Range of Motion (ROM). The GUI for setting the exercise parameters and monitoring the patients’ progress has been developed using MATLAB software. The experimental results show that the machine has successfully provided the repetitive desired motions. The machine realizes elbow flexion-extension and forearm pronation-supination movements with 0ᵒ-135ᵒ and 0ᵒ-90ᵒ ranges of motion (ROM), respectively. The machine is also capable of increasing the elbow joint’s ROM by 5ᵒ increments for the therapy. The results show that the machine has the potential to be used in hospitals and rehabilitation centers.

Uneven Playing Field: Insurance Status Adversely Affects Children with Tibial Spine Fractures (181)

Objectives:Previous studies have reported disparities in medical and surgical care resulting from demographic factors, including insurance status. Tibial spine fractures are uncommon injuries, which may exacerbate potential disparities in care. The purpose of this study is to assess the impact of insurance status on the treatment of tibial spine fractures in children and adolescents.Methods:We performed a retrospective cohort study of tibial spine fractures treated at 10 institutions between 2000 and 2019. Polytraumas and patients older than 18 years were excluded. Demographic data was collected as was information regarding pre-operative, intra-operative, and post-operative treatment, with attention to delays in management and differences in care. Both surgical and non-surgical fractures were included, but a separate analysis of operative patients was performed subsequently. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors.Results:Data was collected on a total of 434 subjects with a mean age of 11.7±3.0. Of these, 61.1% had commercial insurance and 38.9% had public insurance. Publicly insured children were more likely to be injured in a motor vehicle accident. Among athletes, those with public insurance were injured more frequently during football while commercially insured patients were more likely to be injured while skiing. When analyzing the overall cohort of surgical and non-surgical fractures in multivariate analysis, those with magnetic resonance imaging (MRI) performed 21 or more days after injury were 5.3 times more likely to have public insurance (95% CI 1.3-21.7, p=0.02). Similar results were found with the 365 patients that required surgery. In this cohort, those with MRI delayed ≥21 days from injury were 4.8 times more likely to have public insurance (95% CI 1.2-19.6, p=0.03). Children that underwent surgery ≥21 days after injury were 2.2 times more likely to have public insurance (95% CI 1.1-4.1, p=0.02). Those that were publicly insured had 2.5 times higher odds of undergoing open surgery rather than arthroscopic (95% CI 1.1-6.1, p=0.04). These children also had 4.5 times lower odds of receiving a continuous passive motion machine (CPM) after surgery (95% CI 1.7-11.7, p=0.002) and were 4.0 times more likely to be immobilized in a cast rather than a brace post-operatively (95% CI 2.0-8.2, p<0.001).Conclusions:Children with public insurance and a tibial spine fracture were more likely to experience delays with MRI and surgical treatment than those with commercial insurance. Additionally, these patients were more likely to undergo open surgery and post-operative casting and less likely to receive a CPM machine.

UNEVEN PLAYING FIELD: INSURANCE STATUS ADVERSELY AFFECTS CHILDREN WITH TIBIAL SPINE FRACTURES

Background:Previous studies have reported disparities in medical and surgical care resulting from demographic factors, including insurance status. Hypothesis/Purpose: The purpose of this study is to assess the impact of insurance status on the treatment of tibial spine fractures in children and adolescents.Methods:We performed a retrospective cohort study of tibial spine fractures treated at 10 institutions between 2000 and 2019. Polytraumas and patients older than 18 years were excluded. Demographic data was collected as was information regarding pre-operative, intra-operative, and post-operative treatment, with attention to delays in management and differences in care. Both surgical and non-surgical fractures were included, but a separate analysis of operative patients was performed subsequently. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors.Results:Data was collected on a total of 434 subjects with a mean age of 11.7±3.0. Of these, 61.1% had commercial insurance and 38.9% had public insurance. Publicly insured children were more likely to be injured in a motor vehicle accident. Among athletes, those with public insurance were injured more frequently during football while commercially insured patients were more likely to be injured while skiing. When analyzing the overall cohort of surgical and non-surgical fractures in multivariate analysis, those with magnetic resonance imaging (MRI) performed 21 or more days after injury were 5.3 times more likely to have public insurance (95% CI 1.3-21.7, p=0.02). Similar results were found with the 365 patients that required surgery. In this cohort, those with MRI delayed ≥21 days from injury were 4.8 times more likely to have public insurance (95% CI 1.2-19.6, p=0.03). Children that underwent surgery ≥21 days after injury were 2.2 times more likely to have public insurance (95% CI 1.1-4.1, p=0.02). Those that were publicly insured had 2.5 times higher odds of undergoing open surgery rather than arthroscopic (95% CI 1.1-6.1, p=0.04). These children also had 4.5 times lower odds of receiving a continuous passive motion machine (CPM) after surgery (95% CI 1.7-11.7, p=0.002) and were 4.0 times more likely to be immobilized in a cast rather than a brace post-operatively (95% CI 2.0-8.2, p<0.001).Conclusion:Children with public insurance and a tibial spine fracture were more likely to experience delays with MRI and surgical treatment than those with commercial insurance. Additionally, these patients were more likely to undergo open surgery and post-operative casting and less likely to receive a CPM machine.

The Utility of Continuous Passive Motion After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Comparative Studies.

Background:The application of continuous passive motion (CPM) after anterior cruciate ligament reconstruction (ACLR) was popularized in the 1990s, but advancements in the understanding of ACLR rehabilitation have made the application of CPM controversial. Many sports medicine fellowship–trained surgeons report using CPM machines postoperatively.Purpose:To determine the efficacy of CPM use for recovery after ACLR with respect to knee range of motion (ROM), knee swelling, postoperative pain, and postoperative complications.Study Design:Systematic review; Level of evidence, 3.Methods:The PubMed (MEDLINE), EMBASE, Cochrane, Cumulative Index of Nursing, and Allied Health Literature databases were searched from inception to January 1, 2020, for studies with evidence levels 1 to 3 on the use of CPM for ACLR rehabilitation. Included studies were those that comparatively evaluated postoperative outcomes after ACLR between at least 2 groups of patients, with 1 having received CPM rehabilitation and the other not having received CPM.Results:A total of 12 studies from 1989 to 2019 met the inclusion criteria. These studies included 808 patients who underwent ACLR. There was no evidence of CPM improving knee stability, final postoperative ROM, or subjective pain scores. Additionally, CPM did not lead to decreased muscle atrophy or improved International Knee Documentation Committee scores. Regarding pain medication intake during postoperative hospitalization, 2 studies found that the CPM group used less pain medication, 1 study found the CPM group used more pain medication, and 1 study found that there was no difference between the 2 groups. Complications varied widely, with 2 of 12 studies reporting complications that required a return to the operating room.Conclusion:A clinical benefit of postoperative CPM use after ACLR was not identified in this review. While our systematic review identified a number of studies that suggest CPM use may be associated with lower usage of pain medication in hospitalized patients, this cannot be confirmed without further investigation with standardized CPM protocols and larger sample sizes. Routine CPM use after ACLR was not supported by this systematic review.

Design of a Continuous Passive Motion (CPM) Machine for Wrist Joint Therapy

Patients after joint surgery require passive movements that are carried out continuously. The movement is given to the patient to reduce the stiffness that occurs in the joints after joint surgery. Joint stiffness is characterized by pain and limited motion of the joint, which is caused due to reduced synovial fluid. Synovial fluid in the joints can be reduced if the joint is not moved for a long time. This research will design a wrist joint therapy machine that can be moved flexion, extension, ulnar, and radial. Besides that, the device to be designed can be adjusted the angle of movement of the tool and the speed of movement of the tool. The angles of movement that can be reached are (1) flexion movement: 80 ° movement angle, (2) extension movement: 75 ° movement angle, (3) radial movement: 25 ° movement angle, and (4) ulnar movement: movement angle 39 °. Adjustable speeds include 1 RPM, 2 RPM, and 3 RPM. In the result of the testing device, we find the maximum difference of movement in 2° and the speed of rotation we have the difference in 0.5 seconds. Based on experiments that have been done, the tool can be controlled in accordance with the desired movement settings.

EFFECTS OF FULL IMMERSION VIRTUAL REALITY TRAINING ON BALANCE AND KNEE FUNCTION IN TOTAL KNEE REPLACEMENT PATIENTS: A RANDOMIZED CONTROLLED STUDY

Background: Recently, new methods have emerged that encourage voluntary participation by allowing patients to perform tasks, including exercises or treatments, in a virtual reality (VR) environment. Aim: This study aimed to examine the effects of full immersion virtual reality training on balance and knee function in patients who had undergone total knee replacement. Design: Single blind randomized controlled trial. Setting: Department of Physical Therapy in a rehabilitation center. Population: A total of 30 elderly patients ([Formula: see text]65 years old) who had undergone total knee replacement. Methods: Participants were randomly allocated to an experimental group ([Formula: see text]) and a control group ([Formula: see text]). The experimental group received with a continuous passive motion machine, exercise therapy, and a full immersion VR training program; the control group received only with a continuous passive motion machine and exercise therapy. Biorescue was used to test static and dynamic balance ability, and the Timed Up and Go and Western Ontario and McMaster Universities tests were used to assess knee function. Paired [Formula: see text]-tests were used to examine differences by time in each group, and independent [Formula: see text]-tests were used to examine differences between the groups. Results: In terms of within-group differences by time, both the experimental group and the control group showed significant changes in the anterior, and posterior limits of stability in both sides; static balance; and knee function. In the between-groups comparison, among static balance tests, there was a significant difference in center of mass path length in the standing position with eyes open ([Formula: see text]); among dynamic balance tests, there were significant differences in left, right, anterior, and posterior limits of stability ([Formula: see text]). Conclusions: VR training produced better early balance ability and knee function than what was seen in the control group. We believe that VR training in initial post-operative rehabilitation of total knee replacement patients may increase the rate of recovery. Clinical Rehabilitation Impact: VR exercise programs are effective in early rehabilitation after total knee replacement, and have clinical value as inexpensive methods that can promote active participation.

Application of continuous passive motion in patients with distal radius fractures: A randomized clinical trial

The aim of this study was to know if applying continuous passive motion (CPM) in addition to routine exercises is more effective than routine exercises alone in pain reduction, range of motion (ROM) and function improvement after distal radius fractures (DRFs). In this randomized controlled trial, 21 patients with non-stabilized DRF after pin removal were randomly assigned to experimental and control groups. The experimental group received stretching exercises with CPM machine for 2×15min per session. Both groups received routine exercises for 1h, three times a week for 4 weeks. The primary outcome measure was pain evaluated on a visual analog scale (VAS), and the secondary outcome measures were disability evaluated by the patient-rated wrist/hand evaluation and ROM (goniometry) at 4, 6, and 12 weeks. Univariate analysis of covariance (ANCOVA) and a one-way repeated measure mixed model analysis of variance (ANOVA) were used for data analysis. Twenty-one participants completed the 12-week follow-up. Pain relief, ROM and functional improvement revealed that the treatment was successful in both groups. We detected no significant differences (p>0.05) between the two groups at the end of the follow-up period regarding pain, ROM, and function. Using a CPM machine had no additional effect on pain reduction, ROM and function improvement compared with routine exercises in patients with DRF.

Synovitis and synovectomy in haemophilia.

Joint bleeds cause major morbidity in haemophilia patients. The synovial tissue is responsible for removal of blood remnants from the joint cavity. But blood components, especially iron, lead to a series of changes in the synovial tissue: inflammation, proliferation and neovascularization. These changes make the synovium vulnerable to subsequent bleeding and as such a vicious cycle of bleeding‐synovitis‐bleeding may develop leading to chronic synovitis. The initial step in the treatment is adequate clotting factor supplementation and immediate physiotherapeutic involvement. If these measures fail, synovectomy may be indicated. Non‐surgical options are chemical and radioactive synovectomy. This is a relatively non‐invasive procedure to do synovectomy, leading to a reduction in pain and joint bleeds. Radioactive synovectomy seems more effective than chemical synovectomy in larger joints. Surgical options are open and arthroscopic synovectomy. Open synovectomy has been found to decrease the incidence of breakthrough bleeds but at the cost of loss of joint motion. Use of arthroscopic synovectomy has been advocated to reduce bleeding episodes with less morbidity to extra‐articular tissue and preservation of joint motion. Use of a continuous passive motion (CPM) machine and early mobilization can decrease the postoperative stiffness and promote early recovery. This review addresses the current understanding of synovitis and its treatment options with specific emphasis on chemical and radioactive synovectomy and surgical options.

Controlling a knee CPM machine using PID and iterative learning control algorithm

A conventional continuous passive motion (CPM) machine uses simple controller such as On/Off controller. Some better CPMs use PID controller. These kind of CPMs can not distinguish load different due to the different size of the patient leg. This may cause the CPM no longer follow the trajectory or the angle commands. Meanwhile, each patient may have different scenario of therapy from the others. When progress on the patient exists, the range of the flexion may be increased step by step. Therefore, the treatment can be different in term of the range of flexion from time to time. This paper proposes CPM with hybrid proportional integral derivative (PID) and iterative learning controller (ILC). The system has capability in learning the trajectory tracking. Therefore, the CPM will be able to follow any load or trajectory changes applied to it. The more accurate CPM machine can follow the trajectory command, the better its performance for the treatment. The experiment showed that the system was stable due to the PID controller. The tracking performance also improved with the ILC even there exist some disturbances .