CPM – Continuous Passive Motion By Tyler Moore Clinical Experience #1

History Created by Dr. Robert B. Salter in 1970 and engineered in 1978 as the CPM device.

Purpose: To keep healing joint in motion to reduce the unwanted effects of immobilization on tendons, muscle, ligaments, cartilage, blood supply, and nerve supply.

Common Indications 1. ORIF of fracture that is stable. 2. Arthroplasty 3. Ligament reconstruction 4. Tendon Reconstruction 5. Synovectomy 6. Burns Common Indications

Contra-indications 1. Unstable Fractures 2. Active Infection 3. Fused Joint 4. Hemophilia or blood-thinning medication 5. Renal Failure Contra-indications

Precautions 1. Positioning, alignment, and monitoring 2. Claustrophobia 3. External fixation devices. Precautions

Passive motion Duration/Frequency Protocols range from 24 hours per day for as long as a month, to as little as 6 hours a day for as long as a month.

Optimal time of use The first 3 weeks after surgery offer a window of time when CPM will influence biological tissue healing.

CPM Usually used along side with other agents, such as: Ice, anti- inflammatory medications, TENS, and compression stockings.

Set Up/Adjustments Measure length of pt’s thigh from ischial tuberosity to joint line. Adjust proximal end of CPM so that the end meets the bottom of the buttocks.

Set Up/Adjustments Measure length of pt’s lower leg from joint line of knee to .25’’ past the heel.

Set Up/ Adjustments Place pt’s lower extremity in unit and make sure joint line of the knee matches up with the joint of the CPM unit.

Set Up/Adjustments Adjust foot in the foot plate so foot and tibia is in neutral position. Avoid too much internal or external rotation, which can put too much stress through other supporting structures.

Set Up/Adjustments Typically pt’s are started with a low ROM and increased to full ROM as healing occurs. Ranges are determined by Doctor orders and to be progressed by the Physical Therapist.

Set Up/ Adjustments The speed should start out as slow as 1 cycle per minute and increase speed as pt can tolerate.

Set Up/ Adjustments Make sure to give the pt the interrupt control/kill switch and give instruction on how to use.

Safety Measures Injury and tissue damage from the CPM can occur from improper methods used in incorrect situations. Monitor precise ranges of protected motion, proper positioning, and monitor pt to avoid mechanical irritation or injury.

Evidence Based Articles Title: Use of inpatient continuous passive motion versus no CPM in computer-assisted total knee arthroplasty. Year: 2010 Purpose: Study was to determine whether the use of CPM following computer-assisted TKA resulted in differences in range of motion, edema/drainage, functional ability, and pain. Results: there was no statistically significant difference in flexion, edema or drainage, function, or pain between groups through the 3-month study period. Database: MEDLINE

Evidence Based Articles Title: Continuous Passive Motion (CPM) in Rehabilitation Following Total Knee Arthroplasty: A Randomized Controlled Trial. Year: 2003 Purpose: Assess whether there is additional benefit in CPM usage during acute/sub-acute rehab period. Results: The results indicate that, in addition to an improved range of motion, a protocol including CPM seems to have a favorable effect on pain and muscle strength in the first two weeks after surgery. Database: Academic Search Premier

References and Citation Alkire M, Swank M. Use of inpatient continuous passive motion versus no CPM in computer-assisted total knee arthroplasty. Orthopaedic Nursing / National Association Of Orthopaedic Nurses [serial online]. January 2010;29(1):36-40. Available from: MEDLINE, Ipswich, MA. Accessed June 10, 2012. Lenssen A, De Bie R, Bulstra S, Van Steyn M. Continuous Passive Motion (CPM) in Rehabilitation Following Total Knee Arthroplasty: A Randomised Controlled Trial. Physical Therapy Reviews [serial online]. September 2003;8(3):123-129. Available from: Academic Search Premier, Ipswich, MA. Accessed June 10, 2012. Salt Lake Community College PTA 2200 CPM lecture notes,2011, Fall Semester.

The End