When to start using cpm machine
Kinetec CPM Machine
my name is Shawn Willis a
physiotherapist at University Hospital
London Health Sciences Centre and today
we're going to go over how to adjust and
put on a CPM machine this particular CPM
machine is manufactured by kinetech so
some of the instruction in terms of the
remote and the electronics will be
specific to this unit but for the most
part fairly generic to most CPM machines
the key components to the CPM machine
are the remote which will allow you to
set the flexion extension for the
individual generally speaking it's
fairly straightforward in terms of
setting the amount of movement that you
would like to happen there are basically
four most remotes they have a flexion
limit and extension limit generally when
you press that button the limit will
start to flash and then you use the up
or down keys to set the amount of range
of motion that's desired by the surgeon
to be achieved by the machine the same
with extension you can limit the amount
of extension or increase the amount of
extension based on what the surgeon is
as requested for that individual and as
you can see on the remote itself you can
see that there's a start and stop button
so that the patient themselves can
initiate or stop the device at any time
depending on how things are going on or
what's happening if they have to use the
bathroom and that type of thing
generally speaking the CPMs we most
often see them here at University
Hospitals post manipulation there for a
stiff total knee replacement to stiff
ACL those types of things we may see
them on occasion for individuals who
have had some type of knee surgery that
require an epidural to be in situ and as
a result can't bend their knee on their
own so they'll need some type of
assistance but generally speaking those
are the most common reasons as to why
we'd see the CPM in terms of adjustment
a couple of finer points that just to
see on the machine itself there are
generally three adjustments that that
need to be made one the most distally
there's two adjustments or two knobs
here that can be adjusted to allow for
dorsiflexion and plantarflexion of the
ankle for comfort next more proximal is
the distance for the tibia to lengthen
Elfi CPM machine and then for the thigh
itself is the
most proximal component here and that
will allow the CPI machine to be
extended to accommodate a longer leg
what you want to be aware of is when we
go to set up the machine is that the you
want the Machine basically to be bending
and extending at the knee joint itself
all right if it's the knee joint is too
far up or too far or too low you're
going to have to readjust the length of
it so we want to make sure that it's in
the appropriate spot so that we can be
as accurate as possible in terms of how
the machine itself is working in that
type of thing for application of the CPM
you want to make sure that we're looking
at the patient's length of their leg
these generally are one-size-fits-all so
we're going to be making sure that we
try and adjust it and as best as we can
to fit the patient's length of their leg
with Carolyn's leg her leg is fairly
long so we want to make sure that we
kind of get a rough estimate in terms of
how much we're going to have to adjust
this CPM so what we'll do is we'll just
adjust the the most distal component
first and we'll lengthen it out to a
certain degree there now once we start
to lengthen it out if you can see that
there are three straps here already if
this was quite short we wouldn't need to
have another strap because there's such
a gap here now between the foot pedal
and the the last strap would you want to
add a fourth strap on here to make sure
that we have adequate support for the
patient's leg while they're in the CPM
itself so we add that in and generally
speaking you don't have to adjust these
once the CPM has been set to be to be
used it no further adjustment of the
straps for underneath the leg need to be
done then when we have here is another
strap and basically just as the cushion
here just to keep the leg comfortable on
the CPM machine what we'll do is we'll
get Caroline to slip her leg into the
CPM machine and as I have mentioned when
we're looking at adjusting the CPM
machine we want to make sure that the
machine itself basically bends where the
knee would normally Bend so for her
lower leg it looks like we've got the
distance approximately correct we'll
just to quickly adjust the foot pedal
here the last adjustment is usually
looking at adjusting the thigh component
of it so to get an accurate read in
terms of the length of the thigh what we
do is I do like to get the knee bending
so starting up the Machine allowing it
to run a little bit and getting it up to
a certain amount of flexion to make sure
that we've got the CPM adjusted
correctly we won't put any straps in yet
because we're not quite ready quite
ready to be going to that point so at
the moment the dials don't look too bad
they are approximately where that knee
would Bend heel is into the foot well
there which is good enough against the
foot pedal
so far that pretty good here it's going
to lengthen oh just a tad bit more just
on the thigh just to get it up towards
the knee just a little bit more and
we'll tighten the knobs there I'm going
to start the machine again just to run
it out a little bit further just to make
sure that when we reach our upper limit
that it will be appropriate
looks to be fairly accurate with the
amount of knee bend that it's reporting
so about 110 on the machine and that's
definitely greater than 90 so that's
good
so once we've got the machine set in
terms of the correct length we want to
make sure that the patient stays within
the screen itself so we're using these
straps to help lock the leg into place
so you usually have one around the shin
and we're looking at applying another
one on the thigh again to help lock the
leg in place there is a strap built onto
the machine for the foot and help lock
that in and again depending on the
individuals length you may need a third
strap in around the ankle area just to
make sure that the leg stays where it
needs to be while the machine is running
finish the pause and then it should
start to go back into extension
yeah and that looks good there
and then you can adjust the the speed as
well as the force required to get the
knee moving depending on how the patient
is doing with their range of motion
while in the machine
