Hello, caraleen-ga!
I have found several references pointing to the positive effects of
non-electrically induced passive exercise. Though many are research
abstracts, a few require some follow-up by contacting the company that
makes the passive exercise device to pinpoint their research findings.
In terms of the NIMS AT101 Platform, I have found a definitive
reference to a clinical trial conducted on humans which was apparently
presented at the 99th International Conference of the American
Thoracic Society in May 2003. I have not been able to find the actual
research abstract, but suggest that you contact NIMS Inc. or the
company that conducted the seminar taping from the conference. You may
be able to access the original research this way.
===============================================================================
SUCCESS OF NIMS AT101 IN RELEASING NITRIC OXIDE IN HUMAN RESEARCH
PARTICIPANTS
================================================================================
"NIMS Says Trials Prove AT101's Potential in Releasing Nitric Oxide
From the Inner Lining of Blood Vessels in Humans." (5/22/2003)
http://biz.yahoo.com/prnews/030522/flth026_1.html
NORTH BAY VILLAGE, Fla., May 22 /PRNewswire-FirstCall/ -- Non-Invasive
Monitoring Systems Inc. (OTC Bulletin Board: NIMU - News; NIMS) today
announced that the
***
first human clinical study of its non-invasive Acceleration
Therapeutics AT101 passive-exercise device demonstrated its potential
to improve the quality of life for millions of people suffering from
many common, chronic and acute diseases and disorders.
****
***
The results of the study were presented at the 99th International
Conference of the American Thoracic Society, held in Seattle earlier
this month, by NIMS Chairman Dr. Marvin Sackner, who conducted the
study in collaboration with Dr. Jose Adams, chief of neonatology at
Mount Sinai Medical Center in Miami Beach.
****
****
The study found that 45-minute sessions on the AT101 caused the
release of high levels of nitric oxide from the inner lining of blood
vessels into the circulation in all nine of the subjects participating
in the trial. The levels were much greater than nitric oxide released
from nitroglycerin preparations.
*****
"This non-invasive means to increase the release of nitric oxide from
the inner lining of blood vessels within the body is important because
nitric oxide has potent anti-inflammatory actions comparable to
cortisone and other corticosteroids without the side effects of those
drugs," Dr. Sackner said.
"The miracle drug of the 20th Century, in my opinion, was cortisone
and other corticosteroids that are used to reduce excessive
inflammation in many chronic and acute diseases. And the miracle drug
of the 21st Century, in my opinion, will be nitric oxide as released
with the AT101 because of its ability to reduce the inflammatory
process with none of the negative side effects of corticosteroids."
Other clinical studies of the AT101's effects on a variety of
conditions are underway and results are expected to be released
shortly, Dr. Sackner added.
The AT101 is marketed internationally as an aid to improving
circulation and joint mobility. It is registered with the U.S. Food
and Drug Administration as a "Class I" exempt device and also has ISO
9000 certification for European use.
A comfortable platform -- mounted on a hospital-like patient gurney --
the AT101 moves repetitively in a back and forth motion from head to
foot. The forceful, repetitive movements move the diaphragm and cause
a dramatic increase of blood flow to the heart, brain, liver, kidneys
and gastrointestinal tract as well as the release of several natural
substances known to be beneficial to good health. The release of the
beneficial substances with the AT101 is also achieved through exercise
such as jogging.
The AT101 is the latest medical innovation by NIMS, which develops
products that improve quality of life without the need for drugs or
surgery.
==
* I have found a source of selected recordings from the 2003 American
Thoracic Society Seminar at https://www.csctapes.com/tapes/ats2003.htm
but cannot find the recording. Perhaps it was not taped. However,
several of the taped sessions are titled "Clinical Year in Review" and
it may be contained on one of them. Nevertheless, it is worth a call
to "Convention Seminar Cassettes at (805) 526-5436 to find out if it
was recorded.
Or, call NIMS Inc.
1666 Kennedy Causeway - Suite 400
North Bay Village, Florida 33141
Tel: +305 861 0075
for a copy of the research article!
================================================================================
PASSIVE EXERCISE CAN IMPROVE PERIPHERAL VISION IN CHILDREN WITH
MUSCULAR DYSTROPHY
================================================================================
From "Muscular Dystrophy Reviewed." ERIC Clearinghouse on Disabilities
and Gifted Education
http://ericec.org/faq/muscdyst.html
"Effects of Passive Physical Exercise on Peripheral Vision in Muscular
Dystrophic Children." Eickelberg, Warren; And Others. Perceptual and
Motor Skills, v56 n1 p167-70
(Feb 1983)
"The effects of passive exercise of the extremities on peripheral
vision of muscular dystrophic children aged 9 to 13 years was
investigated. Compared to control subjects, those who experienced six
minutes of passive exercise evidenced increased peripheral vision.
Curriculum revisions for muscular dystrophic children indicate the
importance of activity in facilitating learning."
=================================================
BENEFITS OF EX N FLEX MACHINE IN PASSIVE EXERCISE
=================================================
Clinical Study on Positive Results for the Passive Ex N Flex Machine
http://www.selene.com/selene/exnflex/study.html
Hospital Study
Location- Arnprior & District Memorial Hospital,
350 John Street, N P.O. Box 220, Arnprior, Ontario K7S 3H4
Survey Date: Sept 7/93 to Sept 7/94
Daily log: 23 patients
Standard: The EX N'FLEX Arm/Leg machines do improve the quality of
life for the residents
Survey Results: 100% of patients have an increase in energy.
Criteria:
Increased energy level..............................................100%
Improved balance.....................................................83%
Improved Mental attitude..........................................87%
Improved Bowel control...........................................61%
Improved Bladder control.........................................61%
Improved Arm motion/Handfinger control.................48%
Improved eye-hand coordination...............................48%
Improved mobility.....................................................70%
each person improves in one of the above criteria at least 30%
(How valid is this study and who conducted it...I don't know. It is
worth calling the company for the details!)
Tecogics Scientific Limited
Unit #4, 72 Pretoria Avenue, Ottawa, Ontario K1S 1W9
Phone: (613) 238-8403 Fax: (613) 238-8789
E-mail: exnflex@pacificcoast.net
==
Details about the Ex N Flex Machine:
http://www.selene.com/selene/exnflex/features.html
(Note that it can be used in a completely passive mode for those who
have no muscle control)
The EX N'FLEX EF-250 Passive/Active Leg Exerciser has been designed
for these who have a little or no control over lower body movement; it
addresses basic principles of joint and muscle movement which help
maintain flexibility and circulation. In the Passive mode the legs
rotate in an orbital motion similar to cycling. This prevents atrophy
of joints, muscles and tendons which occurs when these elements do not
receive a minimum amount of regular movement. The Active mode can be
used if some muscle power is available in the legs. In this case the
individual can assist the orbital motion of the legs during all or
part of a revolution, thus building strength in the muscles. A
measurement of the amount of active assistance or resistance to the
motion of the EX N'FLEX is visually available at all times on the
Biofeedback Indicator.
Safe, Rhythmic, Defined Exercise for:
Multiple Sclerosis
Strokes
Alzheimer's Disease
Walking Disabilities
Parkinson's Disease
Immobilized Limbs
The Benefits of Passive Exercise:
Maintains flexibility of muscles and tendons
Nourishment of joints
Relief of pain and stiffness
Better control and function of bladder and bowels
Pleasure of movement
Security Assured:
Feet are securely attached to foot plates with velcro tipped straps
Legs are secured for rotation and guided in the plane of motion with a
neoprene strap.
Electronic Control Unit:
Biofeedback Display
Quick shut off power switch
3 Speeds
Forward and reverse
Odometer
Safety shut down mode
The EF-250 is small, light weight and can be used from a wheel chair
or a lounge chair. After 30 minutes slow (16 rotations per minute)
motor powered motion, we estimate an equivalent joint muscle and
tendon movement as would be obtained by walking 500 meters.
===
Also read "Keeping Physically Fit -- Part II: Working Your Legs."
http://www.netreach.net/~abrejcha/legs.htm
===============================
BENEFITS OF PASSIVE ARM TRAINER
===============================
"Robot-assisted arm trainer for the passive and active practice of
bilateral forearm and wrist movements in hemiparetic subjects," by
Hesse S, Schulte-Tigges G, Konrad M, Bardeleben A, Werner C. Arch Phys
Med Rehabil. 2003 Jun;84(6):915-20
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12808550&dopt=Abstract
"Robot-assisted arm trainer for the passive and active practice of
bilateral forearm and wrist movements in hemiparetic subjects.
OBJECTIVE: To determine whether use of a robotic arm trainer for
bilateral exercise in daily repetitive training for a 3-week period
reduced spasticity and improved motor control in the arm of severely
affected, chronic hemiparetic subjects. DESIGN: Before-after trial.
SETTING: Community rehabilitation center in Germany. PARTICIPANTS:
Consecutive sample of 12 chronic hemiparetic patients; minimum stroke
interval 6 months; patients could maximally protract the affected
shoulder, hold the extended arm, or slightly flex and extend the
elbow. INTERVENTIONS: Additional daily therapy of 15 minutes with the
arm trainer for 3 weeks; the 1 degree of freedom trainer enabled the
bilateral passive and active practice of a forearm pronation and
supination and wrist dorsiflexion and volarflexion; impedance control
guaranteed a smooth movement.Main Outcome Measures: Patients'
impressions, the Modified Ashworth Scale (MAS) score (range, 0-5) to
assess spasticity, and the arm section of the Rivermead Motor
Assessment (RMA) score (range, 0-15) to assess motor control were
rated before therapy, after each 3-week interval, and at follow-up 3
months later. RESULTS: All patients had favorable impressions: the
extremity felt more vivid, and 8 subjects noticed a reduction in
spasticity, an ease of hand hygiene, and pain relief. The MAS score of
the wrist and fingers joints decreased significantly (P<.0125) from a
median of 3 (2-3) and 3 (3-4) to 2 (1-2) and 2.5 (2-3). The RMA score
minimally increased in 5 cases without improvement in functional
tasks. The median RMA score before therapy was 2.0 (1-2) and 2.0
(1-3.75) after therapy. There were no side effects. At follow-up, the
effects had waned. CONCLUSIONS: The arm trainer made possible
intensive bilateral elbow and wrist training of severely affected
stroke patients. Future studies should address the treatment effect in
subacute stroke patients and determine the optimum treatment
intensity."
PMID: 12808550 [PubMed - in process]
====================================================================
BENEFITS OF PASSIVE EXERCISE ON CEREBRAL HEMODYNAMICS AND METABOLISM
=====================================================================
(The following abstract mentions nothing about electrical stimulation)
"Effects of active and passive movement stimuli on cerebral
hemodynamics and the cerebral metabolism]," by Steuernagel B, Brix J,
Schneider B, Fischer GC, Doering TJ.
Forsch Komplementarmed Klass Naturheilkd. 2002 Dec;9(6):331-7.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12618550&dopt=Abstract
INTRODUCTION: In contrast to the well-examined cardiovascular changes
during movement stimuli, up to now changes of cerebral hemodynamics
and cerebral metabolism have rarely been studied. We investigated the
question if active and passive movement stimuli cause changes in the
cerebral hemodynamics and the cerebral metabolism. METHOD: Active and
passive repetitive movement stimuli on 14 volunteers (8 females, 6
males, age 35 +/- 8 years) were examined. As a parameter of cerebral
hemodynamics the mean and the peak blood flow velocity (mCBFV(MCA),
pCBFV(MCA)) in the middle cerebral artery (MCA) were recorded by
transcranial Doppler sonography. At the same time the noninvasive
blood pressure (Penaz method) and the CO(2) expiration concentration
were investigated on 8 volunteers of the collective. As cerebral
metabolic parameters we examined in 4 volunteers additionally the
cerebral respiratory chain enzyme cytochrome aa3 (ccytaa3) and the
cerebral oxygen saturation (cHbO(2)) by the transcranial near infrared
spectroscopy. With each volunteer 4 measurement series were carried
out with a special active and passive exercise program for the right
upper as well as the right lower extremity. Each measurement series
was formed according to the evoked flow test (R. Aaslid): Exercises
were carried out for 20 s, followed by a break of 20 s; this was
repeated 10 times for each series. RESULTS: During active exercises of
the right lower extremity we found an increase of 13.6% (p < 0.001) of
pCBFV(MCA) and an increase of 3.8% (p = 0.003) of mCBFV(MCA). During
passive exercises of the lower extremity the increases ran up to 12.3%
(p < 0.001) for pCBFV(MCA) and 3.4% (p = 0.004) for mCBFV(MCA). The
increases of pCBFV(MCA) came up to 12.5% (p < 0.001) at active
exercises of the right upper extremity, those of mCBFV(MCA) to 3.5% (p
= 0.15). During passive exercises of the upper extremity the
pCBFV(MCA) increased by 12.2% (p < 0.001) and the mCBFV(MCA) by 4.6%
(p = 0.007). Significant increases of ccytaa3 were measured during
active exercises of the upper extremity (1.6%; p = 0.04) and of the
lower extremity (2.7%, p = 0.007). We also found an increase of
ccytaa3 during passive exercises of the upper extremity (1.5%, p =
0.04). Significant changes of cHbO(2) were measured with 2.5% (p <
0.05) at active exercises of the lower extremity. CONCLUSION: These
studies show that active as well as passive clinical exercises cause
an increase of cerebral blood flow velocity. We attribute the increase
of cerebral hemodynamics and cerebral metabolism to cerebral
activation and autoregulative mechanisms.
PMID: 12618550 [PubMed - indexed for MEDLINE]
==========================================
EFFECTS OF PASSIVE EXERCISE ON RESPIRATION
==========================================
"The respiratory effects of two modes of passive exercise," by Bell
HJ, Ramsaroop DM, Duffin J. Department of Physiology, University of
Toronto, 1 King's College Circle, ON, M5S 1A8, Canada. Eur J Appl
Physiol. 2003 Feb;88(6):544-52. Epub 2002 Dec 24
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12560953&dopt=Abstract
We monitored gas exchange and muscle activity during two commonly used
modes of passive leg exercise as a means of assessing the degree of
passivity associated with these techniques. Additionally, we measured
the rapid changes in ventilation at the start and end of the passive
exercise to assess changes that occur in the fast exercise drive to
breathe during passive exercise. We monitored seven subjects at rest
and during 5 min of passive exercise using (1) cycling movements
performed on a tandem bicycle and (2) leg extension movements
performed in a chair apparatus. The increase in measured parameters
from rest to passive exercise were all higher while using the tandem
bicycle compared to the chair apparatus: ventilation [3.09 (0.63)
versus 0.35 (0.38) l x min(-1)], leg muscle electromyogram [8.3 (1.6)
versus 1.6 (0.6) microV], carbon dioxide production [0.092 (0.018)
versus -0.002 (0.001) l x min(-1)] and oxygen consumption [0.158
(0.046) versus -0.008 (0.007) l x min(-1)]. Passive exercise on the
tandem bicycle was also associated with a significantly larger fast
exercise drive to breathe at both the start and end of motion,
compared to the chair apparatus [start: 5.59 (0.74) versus 3.08 (0.79)
l x min(-1), end: 3.38 (0.79) versus 1.75 (0.54) l x min(-1)]. The
fast exercise drive to breathe at the end of exercise was
significantly smaller (60%) than at the start for both modes. We
conclude that passive exercise on an upright bicycle contains a
significant active component that contributes both neural and
metabolic influences toward the physiological adjustments observed.
Furthermore, we conclude that adaptation occurs in the fast exercise
drive to breathe accompanying passive limb movement.
PMID: 12560953 [PubMed - in process
===================================================
BENEFITS OF PASSIVE EXERCISE WITH THE RECK MOTO-med
===================================================
http://www.ms-society.ie/msnews/issue57/26exercise.html
(This has no research citations for back-up)
"A form of exercise which had its doubters in the past is now
converting more and more to the cause.
The idea of exercising legs or arms on an exercise machine without any
effort or without using any muscle power (i.e. passive exercising) may
seem to be a contradiction in terms. It isn’t, however, and it is an
activity which is engaged in by some hundreds of people in Ireland who
have little or no power in their limbs.
The first electrically powered exercise machine, the RECK MOTO-med
“Pico”, was introduced into Ireland in 1995 by Evans Medical Supplies
Ltd. This exerciser was designed for use by people with limited
mobility to enable them to enjoy the benefits and pleasure of physical
exercise.
The MOTO-med has the general appearance of a standard type exercise
cycle machine but there the similarity ends
The MOTO-med has the general appearance of a standard type exercise
cycle machine but there the similarity ends. An electrical motor
drives the exerciser and this, in turn, is controlled by electronics
through a remote control box which regulates speed and power.
A vital feature of the MOTO-med is its anti-spasm sensor. This is an
electronic device which will instantly detect the start of a spasm and
will immediately stop the machine and then very gently and slowly
reverse the cycle action. It will continue to do this every time it
detects a spasm. This is an important feature of the MOTO-med because
spasm is a common, and painful, side-effect for people who have very
limited leg movement.
The first MOTO-med was purchased by the Physiotherapy Department, The
Royal Hospital, Dublin, for the use by their very immobile geriatric
patients. The model chosen was the top of the range "Exercise Station"
which includes a passive arm exerciser. This proved to be so
beneficial and popular with the patients that a second unit was
subsequently ordered. The National Rehabilitation Hospital, Dun
Laoghaire has also had a unit in regular use since 1995 which is used
for treating paraplegic patients.
Subsequently MS Care Centres in Bushy Park (Dublin) Trim and Sligo
purchased units for use by MS sufferers. Since then there has been an
increasing acceptance of the benefits of MOTO-med exercise by MS
sufferers and they now constitute the largest category of users. The
MOTO-med can be of benefit to sufferers of many conditions. These
include paraplegia, muscular dystrophy, vascular disorders etc., but
by far the most common users are sufferers from multiple sclerosis.
There has been an increasing acceptance of the benefits of MOTO-med
exercise by people with MS and they now constitute the largest
category of users.
Many of the side effects of MS, such as stiffening of the joints,
spasm, circulation problems need physiotherapy treatment on a regular
basis. The great benefit of the Moto-med is that it allows the
sufferer to continue to have intensive exercise treatment in the
comfort of their own home and it is now well established that regular,
daily exercise even for short periods are more beneficial than
irregular exercise.
There is now a four-year history of MOTO-med use in Ireland and the
beneficial claims that have been made by the manufacturers have been
experienced by a wide variety of people, many of whom have sent
written testimonials of their experiences to the Irish distributor.
Prices of the MOTO-med start at about £2,500 but the VAT element of
this (21%) is reclaimable from the Revenue Commissioners. In addition,
the cost of the equipment can be claimed against income tax provided
it is prescribed by a medical practitioner.
==
Also read "Motomed Movement Therapy." Great Lakes Medical
http://www.greatlakesmedical.com/therapy.html
For Clinical Research, try contacting the distributor:
Great Lakes Medical Systems, Ltd
851 South Kenilworth Avenue
Oak Park, Illinois 60304
1.888.843.8480
708.386.6508 fax
E-Mail: carl@interaccess.com
=====================
ADDITIONAL REFERENCES
=====================
You may be interested in reading about the following exercise device
which does not use electrodes, but guides the limb into a resistive
position. There are no research results but it is an interesting
concept.
"Development of an Upper Limb Orthotic Exercise System," by Alan
Yardley, Gianluca Parrini, David Curus and John Thorpe.
http://www.bath.ac.uk/bime/icorrproc/yardley.pdf
==========================================================
PASSIVE EXERCISE TESTING CAUSES INCREASE IN CARDIAC STRESS
===========================================================
From "Exercise Testing and Adaptation to Aerobic Exercise Training in
Neuromuscular Diseases," by William M. Fowler, Jr., MD. RehabInfo
Network.(From RRTC Newsletter, August 1995.)
http://www.rehabinfo.net/rrtc/publications/research_summaries/exercise_test.asp
Responses and Adaptations in Rapidly Progressive Neuromuscular
Diseases:
"Even a few minutes of passive exercise testing resulted in an
increase in cardiac cost (Eickelberg: Journal of Human Ergology 3:157,
1975)."
================================================
PASSIVE MOVEMENT EFFECTIVE IN TREATING NECK PAIN
=================================================
"Manual Therapy Best for Neck Pain," by Laurie Barclay, MD. BMJ.
2003;326:911-914
http://www.medscape.com/viewarticle/452968
"Manual therapy is more effective than traditional physiotherapy or
general medical care for the treatment of neck pain, according to the
results of a randomized trial published in the April 26 issue of the
British Medical Journal.
"Our findings showed manual therapy to be more cost effective than
physiotherapy and continued care provided by a general practitioner in
the treatment of nonspecific neck pain," write Ingeborg Korthals-de
Bos, from VU University Medical Centre in Amsterdam, the Netherlands,
and colleagues.
A total of 183 patients with neck pain for at least two weeks were
recruited by 42 general practitioners in the Netherlands. Age range
was 18 to 70 years. Of the 183 subjects, 60 were randomized to manual
therapy consisting of spinal mobilization, 59 to physiotherapy
consisting mainly of exercise, and 64 to standard care from a general
practitioner, including counseling, education, and medications.
"Spinal mobilization was defined as low velocity passive movements
within or at the limit of joint range of motion. Spinal manipulation
(low amplitude, high velocity techniques) was not provided," according
to the authors.
After 26 weeks, patients in the manual therapy group recovered more
quickly than did patients in the other two groups. By 52 weeks, there
were no significant differences between groups. The total average
costs of manual therapy were $402, about one third of the costs in the
other two groups (P < .01).
"Manual therapy had significantly lower costs and slightly better
effects in treating neck pain at 52 weeks compared with physiotherapy
and general practitioner care," the authors write. "The clinical
outcome measures showed that manual therapy resulted in faster
recovery."
=========
I hope the articles cited provide ample references to answer your
question. If you need additional clarification or the links do not
work, please don't hesitate to ask. I will be more than happy to help
if I can.
umiat-ga
GOOGLE SEARCH STRATEGY
+passive exercise +disabled +effects
NIMS AT-101 Platform
99th International Conference of American Thoracic Society
passive exercise
Motomed +research
+Benefits +passive exercise
+research +"passive exercise"
PUBMED SEARCH
Passive exercise |
Clarification of Answer by
umiat-ga
on
05 Jul 2003 13:10 PDT
Hello again, caraleen!
In response to your clarification:
"Is this a sample of what you have been able to find in order for me
to
confirm if you are on the right track or not? If so I wish to confirm
that this is the type of information I am seeking and if you have
access to any more I would be delighted to receive it - ".....
What I had posted was actually the answer to your question! Your
clarification came after the answer was posted. Since your original
question did not mention that you had no interest in assisted passive
exercise, I had already included some references in my answer.
I have done some additional research on the benefits of passive
exercise related strictly to passive motion machines but I must admit
that actual research references are hard to pin down. For example, the
company that makes the "Shapemaster Toning System" mentions specific
studies conducted at Carnegie Human Performance Laboratory, but I
could not find any such studies in an internet search. I recommend
that you call the Shapemaster Company if you want a copy of the actual
study. They should be able to come up with a copy or a specific
referral for you unless they want to be suspected of false
advertising.
I trust the following additional references will compliment the
information I supplied in my initial answer. Some of the journal
articles are not available online, so I could not provide abstracts
for you.
umiat-ga
================================================================================
"Early Motion Gets the Worm," by Rick Hammesfahr, MD, and Mark T.
Serafino, MS, PT. Rehab Management. (March 2002)
================================================================================
http://www.rehabpub.com/features/32002/2.asp
Excerpts follow:
"Continuous passive motion following total hip arthroplasty can aid in
alleviating pain, edema, stiffness, deep vein thrombosis, and
dislocation, and in controlling costs.
For people who have had traumatic orthopedic surgery, it is probably
safe to argue that the effects of the surgery on the soft tissue are
more detrimental to patient progress and recovery than the issue
resolved by the procedure itself. Continuous passive motion (CPM) is
one of the primary methods for decreasing the deleterious effects of
immobilization and can deliver orthopedic, neurological, and even
circulatory benefits to the patient. Immobilization, in turn, can
create a negative sequelae of physiological and functional
impairments.
The effects of immobilization vs early motion, including those on the
circulatory, respiratory, and musculoskeletal systems, have long been
studied and debated, as evidence exists that rest and motion have
varied as the treatment of choice following surgery or injury for many
centuries.1,2
Orthostatic hypotension, pneumonia, and soft tissue contractures are
several of the many detrimental effects of immobilization. Others
include edema, stiffness, and pain at the affected site, many of which
correlate to the structure and function of connective tissues (CT).
....
CPM, as was developed by Robert Salter, MD, evolved over the course of
several decades, and is based on deductions that the inventor
formulated through clinical observation and practice. The first of
these is that prolonged immobilization of synovial joints causes many
problems, including persistent stiffness and pain, muscle atrophy,
disuse osteoporosis, and eventually degenerative arthritis when the
joints are actively mobilized at a later time.2 Second, beneficial
effects of early active motion were seen clinically, such as decreased
edema, decreased pain, and shorter rehabilitation time.2
Finally, observations of cardiac surgery wherein the heart muscle
heals properly in the presence of constant motion, and in the
costovertebral joints, where constant motion occurs throughout the
life of the individual, yet where degenerative arthritis is rarely
seen, led the inventor to pursue CPM development.2
Salter hypothesized that CPM would accelerate the healing of articular
cartilage and periarticular structures, such as the joint capsule,
ligaments, and tendons.2 He also believed that CPM would decrease the
likelihood of joint contractures, therefore maintaining the ROM
achieved during surgery.
A CPM device, typically used postoperatively, passively moves a joint
through a specific ROM for a predetermined period of time, depending
on the condition for which it has been prescribed.
Early CPM machines were primitive-looking devices, often composed of
noisy motors, gears, pulleys, ropes, and bars. Functionally, they were
designed to take a particular joint (initially the knee), through a
specific and limited ROM in a predictable pattern.
Though more advanced than their predecessors in design and function,
modern CPM machines adhere to the same basic principles, and have been
developed for almost every joint imaginable, including the hip.
.....
CPM vs Manual ROM
In the world of modern medicine and managed care, cost is inevitably
an issue when deciding on treatment modalities postsurgically. In a
study by Worland et al, it was found that in a group of patients who
underwent total knee arthroplasty and received only CPM upon discharge
from the hospital (as opposed to professional physical therapy), the
cost was $10,582, as opposed to $23,994 for the physical therapy
treatment group, with no statistically significant difference in ROM
achieved.11
Hip CPM Machines
Although the variety of devices designed truly for the hip is limited,
there are several devices that accommodate the need for early motion
following THA.
One such device, although applied to the knee, can take the patient's
hip through a substantial ROM keeping the lower extremity in a neutral
alignment with respect to the frontal and transverse planes, thus
avoiding the possibility of excessive motion and hip dislocation.
Additionally, the application of the device to the knee and lower leg
helps to avoid discomfort and possible irritation at the incision site
over the hip. Finally, this device can take the hip through a safe ROM
within the limits of the precautions for flexion, adduction, and
internal rotation.
Applied appropriately, CPM machines can work for the benefit of the
patient in decreasing the deleterious effects of immobilization, while
providing safe, comfortable treatment.
Reference citations:
Frank C, Akeson WH, Woo SL-Y, Amiel D, Coutts RD. Physiology and
therapeutic value of passive joint motion. Clin Orthop.
1984;185:113-125.
Salter RB. The biological concept of continuous passive motion of
synovial joints, The first eighteen years of basic research and its
clinical implications. Clin Orthop. 1989;242:12-24.
=============================================================================
"Keep It Moving," by Jeff Yip. Orthpedic Technology Review. (Sept/Oct
2001)
==============================================================================
http://www.orthopedictechreview.com/issues/sepoct01/pg36.htm
This article highlights the pros and cons of Continuous Passive
Motion, as well as the right and wrong way to go about the use of CPM
machines.
Some excerpts:
=============
"Salter reports that an industry survey in 1998 found that more than 5
million people have been treated with continuous passive motion in
17,000 hospitals in 57 countries."
"Jensen is a believer. "CPM has been shown to improve range of motion,
lessen pain and scar tissue, and there's less stiffness so therapy can
work on regaining strength quicker," he says. "There's also reduced
costs."
The key to using CPM effectively, Jensen says, is to begin it
immediately after surgery. "If the patient has outpatient surgery,
therapy should start that day. If it's an inpatient procedure-like a
total knee replacement-same thing. We also will use it with some
ligamentous injuries. We'll give the patient CPM prior to operating.
"Our rule of thumb is that we like to use continuous passive motion 6
hours a day. If it's a knee CPM, I tell people if they can sleep with
a device on at night-let it go all night long."
==
Jenson says that once a patient's range of motion reaches above 110,
there is no longer a need for CPM. This usually occurs within a couple
of days. For example, the recovery period when using CPM following an
allograft implant procedure for an injured anterior cruciate ligament
(ACL) is about a week.
Although Jenson believes that CPM use and development will continue,
he does acknowledge that there are still shortcomings in the
technology. "The shoulder CPMs don't quite get all the motion that
we'd like. The movements required are so multi-planar."
==
Donald A. Chu, PhD, PT, ATC, CSCS, was another CPM pioneer.
"As a physical therapist, continuous passive motion made sense from a
physiological and a practical standpoint to me," says Chu, director of
Athletic Training & Rehabilitation at Stanford University in Palo
Alto, Calif. "We were coming to the conclusion that early
mobili-zation yielded better results. It's about muscle concentration,
muscle stimulation. The muscles need to be passively worked, and not
subjected to high velocity activity.
"With CPM you need to go slowly. There should be no voluntary
contractions. You don't want people to fight it. You would like them
to attend to other things. CPM is most effective with ligamentous
repair such as ACL surgery. By employing CPM, you tend to avoid some
of the shutdown of the muscle. You can avoid extensor lag and
alleviate pain. I'd say that nowadays ACL patients regain 90% to 95%
function."
"Chu, who is also president of California's State Board of Physical
Therapy, warns that close attention must be paid to ensure that the
patient achieves maximum range of motion. "It's easy for people to be
using CPM and the gear comes out of alignment," he says. "The
professional needs to pay careful attention to how it's fitted. Fit
and monitoring are crucial. This can be done either in the doctor's
office or at the patient's home by the physical therapist."
=======================
Passive motion machines
=======================
Westons carries several active/passive exercise trainers for the upper
and lower body. They can be viewed in the Weston's online catalog at
http://www.westons.com/acatalog/Online_Catalogue_Active_Passive_Exercise_Equipment_971.html
The machines, which can be used by those with no active control,
purport to increase muscle tone, strength, flexibility and joint
mobility. (However, I could find no research backup)
==
Additional Information about the APT-5:
From "Giving the Intellectually Disabled a Chance," by Joav Merrick,
MD, DMSc, and Carmit Cahana, BPT. Rehab Management.
http://www.rehabinternationalpub.com/issues/fall2000/5.asp
"The APT (Active-Passive-Trainer) was developed in Israel as an
exercise machine to provide both active resistance and passive motion.
Active exercise against some form of variable resistance promotes
circulation, revives and strengthens muscles, and increases endurance.
The passive movement of joints, tissue, and muscles can prevent
immobility and muscle waste. We have used the APT with the severe ID
population and are now conducting a project to evaluate its ability to
prevent and treat lower limb edema.
====
Shapemaster "Motorized Repetitive Motion Exercise"
http://www.shapemasterusa.com/index.html
Shapemaster Toning System
http://www.shapemasterusa.com/medical.html
"ShapeMaster Assisted Exercise Systems and Toning
Tables work through repetitive isometric and isokenetic
exercises to different muscle groups, gently toning and
firming figures into shape and helping to trim away inches.
The equipment enhances mobility and flexibility and
improves blood and lymphatic circulation. While the
machines are contouring your new figure, the relaxing
movement alleviates tension and stress and generates a
feeling of well-being.
In just seven to eight minutes on a ShapeMaster Toning
Table, the muscles contract (concentric contraction) in
excess of 100 times, forcing a corresponding relaxation
(eccentric contraction) in the opposing muscles. It is no
surprise that muscles are toned and tightened quickly and
effectively with regular use of the equipment.
Older and arthritic clients/patients will benefit from the
increased mobility that the continuous passive motion
produces in the joints. Osteo-arthritis inhibits the
production of synoval fluid, (the joints natural lubricant)
and it is essential that affected joints be exercised
regularly if production is to be stimulated. That exercise
must always be resistance free however, and the Shape
Master Toning Tables provides the passive movement that
doctors prefer.
Medical testimony: (I could find no citation for the study mentioned
below)
=================
A study conducted by Carnegie Human Performance Laboratory for
ShapeMaster Toning Tables,
England, showed that joint mobility increased by an astonishing 23%
during a six-week program of continuous passive motion using the
Toning Table equipment.
Further benefits included improved posture and re-alignment of the
spine and pelvis. 70% of long term sufferers of lower back pain
reported total relief of pain within weeks of commencement. A further
20% showed considerable improvement, while only 10% achieved no relief
at all.
Localized blood and lymphatic circulation is stimulated by regular
Assisted Exercise with toning tables. Cardiac output is not increased
during continuous passive motion, which makes it a safe activity for
clients/patients with a history of angina, cardiac problems,
hypertension, etc. (obviously the client/patient's doctor must always
be consulted before commencement).
Testimony from Dr.Pedro Gismondi
================================
(Trained in Internal Medicine at the Mayo Clinic, completed a
Fellowship in Rheumatology at Indiana University and Emory Clinic in
Georgia and currently maintains a full time Rheumatology practice in
Oklahoma City.)
"Patients with chronic pain, unfortunately, prefer not to exercise. It
hurts too much. In fact, it is not uncommon to hear these patients
complain that physical therapy makes them worse! Deconditioning and
progressive weakness contribute to the chronic problems of these most
unfortunate patients. We all would like to have some gentle,
progressive toning up of muscle. Someone has called this a "kinder,
gentler" type of exercise. In fact, this kind of exercise is now
possible in the new equipment "Assisted Exercise" marketed by
ShapeMaster USA. These new machines are capable of slowing the rate of
muscle
contraction to a more comfortable slower pace. No more of the shaking
machines of the 80's. The principles of muscle toning dictate that the
muscle be allowed to maintain isometric or isotonic contraction for
several seconds to obtain maximum benefit on strength and, as side
benefit, calorie expenditure and weight loss. Some of the ShapeMaster
equipment can also be used for aerobic purposes, and thus to foster
the production of endorphins sorely needed for chronic fatigue and
pain. In general "Assisted Exercise" can contribute to the sense of
well-being and help to overcome the depression that afflicts some
patients. Some types of exercise, with the ShapeMaster systems, can be
modified as well to include stretching of myofascial bands of muscle
(i.e., painful chronic spasm). Patients with new prosthetic knees or
hips can "graduate" from their C. P. M. (Constant Passive Motion)
machines to these to continue, not only mobilization, but beyond this,
strengthening of the affected limb."
Respectfully submitted,
Pedro A. Gismondi, M.D.
===
Some other passive/active exercise machines:
http://www.ucpa.org/ucp_channeldoc.cfm/1/15/11500/11500-11500/3177
Benefits of Exercise Using an Ergometer:
Increases and maintains heart and lung efficiency.
Increases and maintains strength, flexibility, mobility and
coordination.
Improves and maintains bone structure and strength.
Reduces risk of high blood pressure and cholesterol.
Increases energy, endurance, and stamina.
Lower Extremity Ergometers - The MotoMed Viva allows individuals to
work their lower extremities. It is a motorized movement trainer that
allows passive, active and active-assist exercise.
Dual Extremity Ergometers - The SCIFIT Power Trainer provides an upper
and lower extremity workout. While the upper extremities are at work,
the lower extremities are stabilized by support boots and are moving
passively at the same ratio.
======================================================
Additional Research References that may be of interest:
=======================================================
Fronek J, Frank C, Amiel D, Woo S I-Y, Coutts R D, Akeson W H 1983 The
effect of intermittent passive motion (IMP) in the healing of medial
collateral ligament. Proceedings of the Orthopaedic Research Society
8:31 (abstract).
Cautilli, G., Hozack, W.J.: Late Peroneal Nerve Palsy: A Complication
of Continuous Passive Motion Machines. Journal of Knee Surgery, 6:3
1115 117, 1993.
Ververeli, P.A., Sutton, D.C., Hearn, S.L., Booth, R.E., Hozack, W.J.,
Rothman, R.H.: Continuous Passive Motion After Total Knee
Arthroplasty: Analysis of Cost and Benefits. Clinical Orthopaedics and
Related Research, 321:208 215, 1995.
Laughlin M H 1987 Skeletal muscle blood flow capacity: role of muscle
pump in exercise hyperemia. American Journal of Physiology 253(22):
993-1004.
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