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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