- Email: [email protected]
Suspension Frame for Home use
adjustments t o t h e machine can b e incorporated relatively easily into a daily physiotherapy programme. Doctors should b e asked t o refer t o t h e physiotherapist before making any adjustments. Nurses a n d patients should b e warned n o t t o make any alterations t o t h e machine. A CPM knee machine costs in t h e region of t h e €2,000 and there will be ongoing service and repair costs. It is, therefore, necessary t o determine i t s effectiveness in financial terms. Given that a hospital b e d costs approximately €199 per day, any regime t h a t will help t o reduce t h e length o f stay merits consideration. W e believe t h a t t h e CPM machine has been effective in reducing t h e length of hospitalisation and shortening or eliminating t h e need for any subsequent out-patient rehabilitation.
Conclusion C P M is a major advance in orthopaedic rehabilitation; however, like all 'new' ideas, it may fall into disrepute if those people utilising t h e machine d o n o t fully understand its capabilities a n d limitations. The emphasis of physiotherapy for patients w h o use t h e C P M machine will differ f r o m t h a t of patients n o t using t h e machine. Use of t h e machine helps t o maintain joint m o t i o n b e t w e e n treatment sessions, so emphasis can be placed o n muscle re-education, b o t h of the quadriceps and of t h e hamstrings. It is our opinion t h a t in t h e short term, t h e C P M knee machine allows flexion t o b e achieved and maintained with greater ease and less discomfort for t h e patient. We believe it t o be very useful as an adjunct t o t h e treatment of routine surgical procedures, and it is invaluable in t h e treatment of t h e more complicated knee conditions.
ACKNOWLEDGMENTS Our thanks must go the physiotherapy staff and patients at -the RNOH and the donators of the CPM machines. Our special thanks to Mr H Kemp FRCS, Miss F Barr MCSP and Mr J Sim BA MSc MCSP.
REFERENCES Coutts, R D, Borden, L S, Bryan, R S, Hungerford, D S, Stulberg, B, Stulberg, S 0, Thomas, W H, Turner, R H and Volz, R G (1983). 'The effect of continuous passive motion on total knee rehabilitation', Orthopaedic Transactions, 7, 3, 535- 536. Coutts, R D, Toth, C, and Kaita, J H (7984). 'The role of continuous passive motion in the rehabilitation of the total knee patient', in: Hungerford, D (ed) Total Knee Arthroplasty: A comprehensive approach, Williams and Wilkins, Baltimore. Ekholm, R (1955). 'Nutrition of articular cartilage', Acta Anatornica, 24, 329-338. Evans, P (1980). 'The healing process at cellular level: A review', Physiotherapy, 66, 8, 256-259. Gose, J 11987). 'Continuous passive motion in the post-operative treatment of patients with total knee replacement', Physicai Therapy, 67, 1, 39-42. Hamilton, H W (1982). 'Five years experience with continuous passive motion (CPM)', Journal of Bone and Joint Surgery, 648. 2, 259. James, S E and Wade, P (1987). 'Lateral popliteal nerve palsy as a complication of the use of a continuous passive motion knee machine - A case report', lnjury - The British Journal of Accident Surgery, 18, 1, 72-73. Perry, C R, Evans, L G, Rice, S, Fogarty, J and Budge, R E (1984). 'A new surgical approach to fractures of the tibia1 plateau', Journal of Bone and Joint Surgery, 66A, 8, 1236-40. Salter, R B, Simmonds, D F, Malcolm, B W, Rumble, E S, Macmichael, D and Clements, N D (1980). 'The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage', Journal of Bone and Joint Surgery, 62A. 8, 1232-51.
EQUIPMENT NOTE
Suspension Frame for Home use NOEL GANT MCSP
Community Physiotherapist, Norwich
CARING for patients in the community may often be made easier with the use of suspension frames, which can be built locally or in a hospital workshop. ,The frames are constructed of one-inch square tubular steel (or whatever rigid metal is available, eg aluminium) with steel weldmesh bars. They are made in two sections with the lower half attached with brackets and held firm to the bed frame with a bolted U-clamp. The top section can be taken off and re-assembled in seconds. Dimensions are determined by the size of the bed. The one illustrated is 3 0 inches wide and extends over the bed by 25 inches. Cost is approximately f 3 5 but as yet I have not had to pay for a frame thanks to a caring community. Uses are numerous, including all assisted active exercises. When the frame is fitted with springs, the upper limb can be balanced to enable functional activities. A 25-inch frame is effective for lower limb suspension in sitting or with the patient turned feet to bed-head.
Right: The frame in use
Physiotherapy, July 1989, vol75, no 7
43 1
Conclusion C P M is a major advance in orthopaedic rehabilitation; however, like all 'new' ideas, it may fall into disrepute if those people utilising t h e machine d o n o t fully understand its capabilities a n d limitations. The emphasis of physiotherapy for patients w h o use t h e C P M machine will differ f r o m t h a t of patients n o t using t h e machine. Use of t h e machine helps t o maintain joint m o t i o n b e t w e e n treatment sessions, so emphasis can be placed o n muscle re-education, b o t h of the quadriceps and of t h e hamstrings. It is our opinion t h a t in t h e short term, t h e C P M knee machine allows flexion t o b e achieved and maintained with greater ease and less discomfort for t h e patient. We believe it t o be very useful as an adjunct t o t h e treatment of routine surgical procedures, and it is invaluable in t h e treatment of t h e more complicated knee conditions.
ACKNOWLEDGMENTS Our thanks must go the physiotherapy staff and patients at -the RNOH and the donators of the CPM machines. Our special thanks to Mr H Kemp FRCS, Miss F Barr MCSP and Mr J Sim BA MSc MCSP.
REFERENCES Coutts, R D, Borden, L S, Bryan, R S, Hungerford, D S, Stulberg, B, Stulberg, S 0, Thomas, W H, Turner, R H and Volz, R G (1983). 'The effect of continuous passive motion on total knee rehabilitation', Orthopaedic Transactions, 7, 3, 535- 536. Coutts, R D, Toth, C, and Kaita, J H (7984). 'The role of continuous passive motion in the rehabilitation of the total knee patient', in: Hungerford, D (ed) Total Knee Arthroplasty: A comprehensive approach, Williams and Wilkins, Baltimore. Ekholm, R (1955). 'Nutrition of articular cartilage', Acta Anatornica, 24, 329-338. Evans, P (1980). 'The healing process at cellular level: A review', Physiotherapy, 66, 8, 256-259. Gose, J 11987). 'Continuous passive motion in the post-operative treatment of patients with total knee replacement', Physicai Therapy, 67, 1, 39-42. Hamilton, H W (1982). 'Five years experience with continuous passive motion (CPM)', Journal of Bone and Joint Surgery, 648. 2, 259. James, S E and Wade, P (1987). 'Lateral popliteal nerve palsy as a complication of the use of a continuous passive motion knee machine - A case report', lnjury - The British Journal of Accident Surgery, 18, 1, 72-73. Perry, C R, Evans, L G, Rice, S, Fogarty, J and Budge, R E (1984). 'A new surgical approach to fractures of the tibia1 plateau', Journal of Bone and Joint Surgery, 66A, 8, 1236-40. Salter, R B, Simmonds, D F, Malcolm, B W, Rumble, E S, Macmichael, D and Clements, N D (1980). 'The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage', Journal of Bone and Joint Surgery, 62A. 8, 1232-51.
EQUIPMENT NOTE
Suspension Frame for Home use NOEL GANT MCSP
Community Physiotherapist, Norwich
CARING for patients in the community may often be made easier with the use of suspension frames, which can be built locally or in a hospital workshop. ,The frames are constructed of one-inch square tubular steel (or whatever rigid metal is available, eg aluminium) with steel weldmesh bars. They are made in two sections with the lower half attached with brackets and held firm to the bed frame with a bolted U-clamp. The top section can be taken off and re-assembled in seconds. Dimensions are determined by the size of the bed. The one illustrated is 3 0 inches wide and extends over the bed by 25 inches. Cost is approximately f 3 5 but as yet I have not had to pay for a frame thanks to a caring community. Uses are numerous, including all assisted active exercises. When the frame is fitted with springs, the upper limb can be balanced to enable functional activities. A 25-inch frame is effective for lower limb suspension in sitting or with the patient turned feet to bed-head.
Right: The frame in use
Physiotherapy, July 1989, vol75, no 7
43 1