cpm應(yīng)用 ppt課件

1、CPM 理論和應(yīng)用,,ObjectivesObjectivesObjectivesObjectivesObjectivesObjectivesObjectives,Present the history of CPM CPM 的歷史Explain the clinical and physiological benefits of CPM 臨床治療應(yīng)用的解釋Indications &

2、contraindications of CPM 臨床適應(yīng)癥禁忌癥Traditional therapy vs. CPM 傳統(tǒng)理論和CPM理論的比較Demonstrate types and clinical cases of CPM CPM的示范,Definition定義,« Passive joint motion is defined as any motion that is “produced

3、by an external source”»,Traditional teaching post trauma or surgery:創(chuàng)傷或手術(shù)的傳統(tǒng)教育,Enforced強(qiáng)制限制Uninterrupted不間斷Prolonged長(zhǎng)期的,,Immobilization 固定,Effects of Immobilization 制動(dòng)的影響,Inhibit the circulation of

4、Synovial Fluid 制約滑液的循環(huán) Starve joint cartilage of Nutrients 阻止關(guān)節(jié)軟骨面的營(yíng)養(yǎng)供給Promote the development of Adhesions 促進(jìn)粘連的發(fā)展Neuromuscular Degeneration肌肉神經(jīng)退化,20th Century Research 20世紀(jì)的研究,1919 WillemPreservation of sept

5、ic joints by drainage and immediatemotion1970 SalterHealing effects of CPM on rabbit joint cartilage1973 KleinertEarly Passive Motion

6、 following tendon repair 1982 Gelberman Effects on CPM on tendon healing,動(dòng)物實(shí)驗(yàn)研究,Used rabbits　用家兔 Full thickness defects　全層軟骨損傷 Intra-articular fractures　關(guān)節(jié)內(nèi)骨折 Ac

7、ute Septic arthritis　急性化膿性關(guān)節(jié)炎 Partial thickness tendon laceration部分肌腱損傷,Benefits of CPM to healing cartilageCPM對(duì)軟骨愈合的好處,Enhanced nutrition and metabolic activity 促進(jìn)營(yíng)養(yǎng)供給和代謝水平Accelerated healing of articular tissues

8、加速關(guān)節(jié)組織的愈合Regeneration of cartilage 重建軟骨面,Jama, 6 Nov. 1981Vol. 246, N°. 18,Rabbits with full thickness cartilage defects divided into three groups:兔子全層軟骨損傷分三組（Ｉ，ＩＩ，ＩＩＩ）：Immobilization with cast石膏固定組Intermitte

9、nt Active Motion (Cage activity)間歇性主動(dòng)運(yùn)動(dòng)組CPM regimen：Treatment initiated immediately post operativelyＣＰＭ組：術(shù)后馬上治療,動(dòng)物實(shí)驗(yàn)研究,動(dòng)物實(shí)驗(yàn)研究,Benefits of CPM to Healing Tendons CPM對(duì)肌腱愈合的好處,Restoration of the tendon’s gliding surface

10、 重建肌腱表面Greater mean breaking strength of the tendon Synovial diffusion may enhance intrinsic healing 滑液的擴(kuò)散增強(qiáng)康復(fù)Prevention of adhesion formation 制止粘連的產(chǎn)生,Benefits of CPM to Healing Ligaments CPM對(duì)韌帶愈合的優(yōu)點(diǎn),Maintenance of c

11、ollagen matrix organization 維持膠原蛋白組織Normalized collagen concentration 提高膠原蛋白排列整齊Maintenance and increased strength 維持和增強(qiáng)強(qiáng)度,Benefits of CPM to Skin HealingCPM對(duì)皮瓣愈合的好處,Edema reduction減少水腫 Decrease Scar formation減少疤痕

12、形成 No disruption of the graft (after 7th day) No disruption of the incision Improved elasticity改良彈性 CPM is effective in maintaining and restoring ROM有效維持和恢復(fù)關(guān)節(jié)活動(dòng)度 CPM doesn’t cause pain in excess of routine t

13、herapy日常治療中CPM不會(huì)導(dǎo)致疼痛 “Motion gained should never be lost”,Clinical Benefits of CPM CPM的臨床好處,Maintain and Increase of ROM維持和增強(qiáng)關(guān)節(jié)活動(dòng)度Decrease pain, swelling, stiffness減少疼痛、腫脹和僵硬Increase rate of recovery增加痊愈的比例Short

14、en hospital stay減少住院時(shí)間,Physiological Benefits of CPM生理學(xué)上的好處,Reduce adhesions 減少粘連Enhance nutrition 增強(qiáng)營(yíng)養(yǎng)供給Promote wound healing 促進(jìn)傷口愈合Improve venous dynamics 增強(qiáng)血管動(dòng)力,Contra-indications 禁忌癥,Unstable fractures 不牢固的

15、骨折Active infection 感染病人Precautions防范 Vascular status 血管狀況Loss of sensation 失去感覺,Clinical Applications 臨床應(yīng)用,ORIF of intra-articular fractures 關(guān)節(jié)內(nèi)骨折切開復(fù)位內(nèi)固定ORIF of peri-articular fractures關(guān)節(jié)周圍骨折切開復(fù)位內(nèi)固定Arthroplastie

16、s關(guān)節(jié)成型術(shù)Flexor/Extensor tendon repair腱修補(bǔ)Replants, reattachments (extremities, digits)末端關(guān)節(jié)移植和重建Crush injuries關(guān)節(jié)變形損傷Capsulotomy關(guān)節(jié)囊切開術(shù)Tenolysis腱松解術(shù) Dupuytren’s contracture掌腱膜攣縮癥,Clinical Applications 臨床應(yīng)用,Colles fractu

17、res橈骨下端骨折Elbow fractures, release肘關(guān)節(jié)骨折，松解Rotator cuff repairs 肩袖縫補(bǔ)Humeral head fractures 肩部骨折Synovectomy 滑膜切除術(shù)Post removal of Heterotopic Ossification防止術(shù)后軟組織異位骨化 Surgical release of contracture攣縮的手術(shù)松解Burns燒傷病人RSD

18、反射性交感神經(jīng)營(yíng)養(yǎng)不良綜合征,CPM is an adjunct to therapyCPM是治療的輔助 It will not replace the therapist but it will enhance the Rehabilitation outcome. CPM不可能替代醫(yī)生但可以加強(qiáng)康復(fù)效果,Length of use for CPM 使用CPM的時(shí)間,Animal/Experimental models ?

19、24 hrs/day 動(dòng)物/實(shí)驗(yàn)?zāi)Ｐ?24小時(shí)/天Patient use at home ? 6-8hrs / day病人在家里使用?6-8小時(shí)/天Burns (post release) ? 4-6 weeks燒傷病人?4-6周,Patient Assessment病人評(píng)估,History and mechanism of injury and repair are vitally important 損傷和修復(fù)的歷史至關(guān)

20、重要How, where and when ?如何，哪里什么時(shí)候？Vascular status 血管狀況Neurologic status 神經(jīng)狀況Wound – location, size 傷口-地方，大小Joints and injuries above and below the affected area 關(guān)節(jié)和損傷區(qū)域,Benefit of CPM 使用CPM 的優(yōu)點(diǎn),一、Painless 無痛苦。

21、 不影響患者正常生活，患者樂于接受。CPM的“疼痛閘門學(xué)說”解釋；使用CPM裝置后，手術(shù)傷口和關(guān)節(jié)疼痛緩解或消失，尤其是術(shù)后前三天。一般在傷口愈合，關(guān)節(jié)內(nèi)創(chuàng)傷修復(fù)后停機(jī)，不會(huì)出現(xiàn)疼痛。,二、Swelling 消腫快。 CPM裝置符合生理要求，促進(jìn)手術(shù)部位血液和關(guān)節(jié)滑液的循環(huán)，利于水腫或腫脹消退。相反制動(dòng)影響血液循環(huán)，局部張力增加，進(jìn)一步限制靜脈回流，使局部腫脹呈惡性循環(huán)。,Bene

22、fit of CPM 使用CPM 的優(yōu)點(diǎn),三、Heal up wound 傷口愈合快。 縫合時(shí)注意克服切口張力，CPM裝置活動(dòng)時(shí)不增加手術(shù)切口的張力，血液循環(huán)增加，處于切口早期愈合。切口的抗張力和修復(fù)肌健的抗拉力明顯優(yōu)于制動(dòng)處理。,Benefit of CPM 使用CPM 的優(yōu)點(diǎn),四、Improve ROM 消除關(guān)節(jié)粘連，改善ROM。 CPM裝置克服關(guān)節(jié)手術(shù)和肢體制動(dòng)造成的關(guān)節(jié)粘連、關(guān)節(jié)僵硬、肌肉萎縮、退

23、行性和創(chuàng)傷性關(guān)節(jié)炎的發(fā)生，并可縮短住院時(shí)間。,Benefit of CPM 使用CPM 的優(yōu)點(diǎn),五、Scar down Tendons and Ligaments 促進(jìn)關(guān)節(jié)軟骨損傷的自身修復(fù)。 關(guān)節(jié)骨折或小的關(guān)節(jié)軟骨損傷，通過CPM裝置的活動(dòng)，刺激關(guān)節(jié)軟骨的細(xì)胞增生，分泌和合成軟骨基質(zhì)，也可使軟骨下骨組織中血液未分化細(xì)胞發(fā)生軟骨樣改變，避免或減輕創(chuàng)傷性關(guān)節(jié)炎的發(fā)生。,Benefit of CPM 使用CPM 的優(yōu)點(diǎn),MO

24、VEMENT OF THE ANATOMY:解剖運(yùn)動(dòng)方式 the movement of the unit should be very similar tothe natural movement of the leg; if not, it can be veryuncomfortable for the patient and there is adistortion between the feedback me

25、asured on theunit and the real movement of the leg. 運(yùn)動(dòng)方式必須完全符合生理曲線，否則病人將會(huì)十分 不適，而且導(dǎo)致關(guān)節(jié)損傷。,Non-anatomical不符合生理曲線,Semi-anatomical半不符合生理曲線,Anatomical符合生理曲線,ANATOMY & MOVEMENTS解剖和運(yùn)動(dòng),The

26、re are some basic things to know…,KNEE 膝關(guān)節(jié)的運(yùn)動(dòng)方式,FLEXION 彎曲EXTENSION 伸展MEDIALROTATION內(nèi)旋LATERALROTATION外旋,,HIP髖關(guān)節(jié)的運(yùn)動(dòng),FLEXION 彎曲EXTENSION 伸展ABDUCTION 外展ADDUCTION 內(nèi)收EXTERNAL ROTATION 外旋INTERNAL ROTATION內(nèi)旋,,ANKLE

27、 踝關(guān)節(jié)的運(yùn)動(dòng),FLEXION 背伸 EXTENSION 跖屈 PRONATION 外翻SUPINATION 內(nèi)翻EVERSION 外展INVERSION 內(nèi)收,,SHOULDER,,FLEXION 彎曲EXTENSION 伸展ABDUCTION 外展ADDUCTION 內(nèi)斂EXTERNAL ROTATION 外旋INTERNAL ROTATION 內(nèi)旋HORIZONTAL ABD/ADD 水平內(nèi)/外斂

28、CIRCUMDUCTION 環(huán)行運(yùn)動(dòng),and the others 其他,PRONATION 正掌SUPINATION 反掌…. 等等...,,,Semi anatomical半解剖- ROM : -5°/115°- Patient size : 1,4 to 1,9 m- Electronic adjustments- Adjustable load,- Anatomical

29、ly perfect- ROM : -10°/120°- Patient size : 1,4 to 2mWarm-upModulationBy passProgram,- Anatomically perfect- ROM : -3°/130°- Patient size : 1,1 to 2,1m - Electronic adjustments

30、- Adjustable loadActive work 主動(dòng)方式,KNEE CPM MACHINES膝關(guān)節(jié),Optima,Performa,Spectra,ADJUSTMENT調(diào)節(jié),SPEED速度,LOAD負(fù)荷,PAUSE暫停,TIMER定時(shí),STIM刺激,FEED BACK反饋,SET UP設(shè)置,,,,,,,,,C.P.M. Optima,Semi-anatomical半解剖,Transformer inside隔離變壓

31、器,-5/115°,1m40/1m90,1m01,13 kg,,,,,,,C.P.M. Spectra,Anatomical解剖,Electronic hand control,30° to 160° per min,Pauseext, flex,Timer,Synchronized stim刺激,Big Screen,Transformer inside,-10/120°,1m4/2

32、m,71-104cm,11 kg,Manual mode手動(dòng),,,,,,,,,,,,,,,Warm-up/Modulation/Program,Anatomical解剖,Electronic hand control,50° to 220° per min,Active work,Pauseext, flex,Timer,Synchronized stim刺激,Screen,Transformer ins

33、ide,-3/130°,1m12/2m06,1m09,15 kg,Manual mode手動(dòng),,,,,,,,,,,,,,,C.P.M. Performa,肩關(guān)節(jié)CPM,FUNCTIONS 肩CPM功能,Frontal Flexion-Extension前伸展/屈曲20- 180 DegreesAbduction-Adduction 側(cè)外展/內(nèi)收20- 160 DegreesScapular Sliding Access

34、ed Past 90-100 Degrees Abduction Rotation- Isolated Motion內(nèi)/外旋 60 Internal to 90 ExternalSynchronized Abduction & Rotation 側(cè)外展/內(nèi)收與內(nèi)旋/外旋同步Combined Range 20-160 of Abduction with 30-90 Rotation,CENTURA HAND CONTRO

35、LLER肩CPM手控開關(guān),Digitally Precise Adjustments精確數(shù)字調(diào)節(jié)Real Time Feedback of Current Angle of Unit 實(shí)時(shí)反饋Adjustable Parameters可調(diào)參數(shù)Movement, ROM LimitsSpeed, Load, Pauses, TimerFunctions 功能Manual Mode- Initial Set Up to Pt’

36、s Pain Tolerance 手動(dòng)模式By- Pass Mode- In Use Tolerance Adjustments 旁路模式Programme Options- Set 16 Pt’s. Or 16 Protocols 16種運(yùn)動(dòng)組合程序,Centura B&W 肩關(guān)節(jié)CPM,UPPER LIMB CPM RANGE 上肢CPM,Meastra 手指手腕CPM,Meastra Portable 便攜手指CP

37、M,Meastra手指和腕關(guān)節(jié)CPM,Meastra手指和腕關(guān)節(jié)CPM,手指手腕9種運(yùn)動(dòng)方式 1、復(fù)合握拳 -30度到225度,2、尺骨背離 -30度到60度 3、手腕彎曲伸展 -30度到60度4、手腕和掌指關(guān)節(jié)彎曲伸展 -50度到140度5、手掌向下/手掌向上 -90度到90度,6、拇指對(duì)指 0度到180度,7、掌指關(guān)節(jié)復(fù)合運(yùn)動(dòng) 0度到90度8、指間關(guān)節(jié)和遠(yuǎn)端指間關(guān)節(jié)一起運(yùn)動(dòng) 0度到180度9、單獨(dú)運(yùn)動(dòng)遠(yuǎn)端指間關(guān)節(jié)

38、0度到70度,Meastra手指和腕關(guān)節(jié)CPM,唯一能夠形成正確復(fù)合握拳的CPM 所有手指關(guān)節(jié)都可以運(yùn)動(dòng)（MCP-PIP-DIP） 可使3個(gè)指骨同步運(yùn)動(dòng)特有的拇指對(duì)指功能能做手腕所有動(dòng)作 運(yùn)動(dòng)軌跡與屈曲的生理螺旋相匹配 適用于手指、大拇指和腕關(guān)節(jié),Meastra Portable便攜手指CPM,Meastra Portable便攜手指CPM三種運(yùn)動(dòng)方式：,1、復(fù)合握拳 -15度到270度,2、指間關(guān)節(jié)和遠(yuǎn)端指間關(guān)節(jié)一起運(yùn)

39、動(dòng) 0度到180度,3、掌指關(guān)節(jié)復(fù)合運(yùn)動(dòng) 0度到90度,便攜手指CPM,關(guān)節(jié)運(yùn)動(dòng)幅度 150度—270度總重量： 僅541克速度：一次循環(huán)0度—270度—0度從27—135秒可調(diào)伸展/屈曲轉(zhuǎn)換暫停：0—900秒可調(diào),肘關(guān)節(jié)CPM 6080,肘關(guān)節(jié)CPM 6080,關(guān)節(jié)活動(dòng)度ROM 屈曲：135度 伸展：0度 伸展到屈曲進(jìn)程中掌心翻轉(zhuǎn)。 病人高度 1.4m-1.9m 速度：一次循環(huán)由3’50—

40、1’,LOWER LIMB CPM RANGE 下肢CPM,5190踝關(guān)節(jié)CPM,5190踝關(guān)節(jié)CPM,適應(yīng)癥 腿部骨折內(nèi)固定后 跟腱損傷 外側(cè)韌帶損傷 內(nèi)側(cè)韌帶損傷 關(guān)節(jié)運(yùn)動(dòng)幅度 踝：腳背伸：40度 腳背屈：30度 上踝部：外翻：25度 內(nèi)翻：25度 外展：25度 內(nèi)收：25度,5090小兒畸形足（馬蹄足）CPM,5090

41、小兒畸形足（馬蹄足）CPM,臨床好處：專為馬蹄足設(shè)計(jì)重建踝關(guān)節(jié)和距下關(guān)節(jié)的活動(dòng)防止關(guān)節(jié)粘連和軟組織纖維化對(duì)有些病例無需手術(shù)治療術(shù)前使用可使手術(shù)更方便可用于術(shù)后恢復(fù)適應(yīng)證：： 適用于任何足部僵硬，無論先天或獲得。,5090小兒畸形足（馬蹄足）CPM,9081 髖關(guān)節(jié)CPM,打破損傷－炎癥－喪失活動(dòng)度的循環(huán)防止髖關(guān)節(jié)僵硬加速術(shù)后關(guān)節(jié)活動(dòng)度的回復(fù)保持關(guān)節(jié)面的質(zhì)量減少疼痛和水腫防止靜脈血栓形成提供術(shù)后馬上持續(xù)被動(dòng)

42、運(yùn)到減少住院時(shí)間減少止痛藥的使用提供屈、伸、外展、外旋的運(yùn)動(dòng)振動(dòng)吸收裝置可以減少下肢重量髖關(guān)節(jié)的影響,9081 髖關(guān)節(jié)CPM臨床好處,截骨術(shù)髖關(guān)節(jié)翻修全髖置換術(shù)骨盆和股骨遠(yuǎn)端骨折股骨上端骨折切開復(fù)位內(nèi)固定異位骨化的髖關(guān)節(jié)松解術(shù)半月板切除術(shù)膝關(guān)節(jié)融合術(shù),9081 髖關(guān)節(jié)CPM適應(yīng)證,,,,循序漸進(jìn)的康復(fù)方式,,,,,,,Acute period急性圍床期,Convalescent period康復(fù)期,Chroni

43、c period慢性期,Bed 病床,Wheelchair輪椅,,Stability in sitting position座姿,Stability in standing position座姿,,,CPM,KAM Pedala,KPT CyclaKAM TonikaKAM Vitaglide,KAM TonikaKAM Vitaglide,In 1845, French surgeon A. Bonnet was

44、 the first to recognize the significance of motion in treating joint illnesses:“Functional activity should only be temporarily repressed. The intermediate stage is to partially exercise the function.”,Bonnet: Trait&#

45、233; de Therapeutique des Maladies articulaires. Paris 1853,1845,Not a New Idea,In 1904 the Swiss doctor Charles Scholder developed the “arthromotor“, the predecessor to today‘s motion supports.,The Swedish doctor Gustav

46、 Zander introduced the “medico-mechanical therapy“ in,1865. His Zander apparatus enables mechanically supported active and passive exercises for improving motion and muscle strength with regular resistance.,1865,1904,Not

47、 a New Idea,可以被動(dòng)或者主動(dòng)運(yùn)動(dòng)患側(cè)患者自己決定運(yùn)動(dòng)速度患者自己為患側(cè)關(guān)節(jié)的康復(fù)負(fù)責(zé) 運(yùn)動(dòng)阻抗可以隨意調(diào)節(jié),KAM Pedala,患者積極參與康復(fù)進(jìn)程主動(dòng)運(yùn)動(dòng)后產(chǎn)生被動(dòng)運(yùn)動(dòng)，可控的運(yùn)動(dòng)早期的神經(jīng)肌肉控制關(guān)節(jié)，有利于本體感覺的重建 雙側(cè)協(xié)調(diào)運(yùn)動(dòng)患者自己決定運(yùn)動(dòng)速度,和CPM的主要差別,膝關(guān)節(jié)置換術(shù)骨折（包括膝蓋骨，脛骨平臺(tái)，股骨等）關(guān)節(jié)松解術(shù)髖部手術(shù)（包括髖關(guān)節(jié)置換，髖部釘內(nèi)固定，骨切除術(shù)等）

48、韌帶修復(fù)關(guān)節(jié)內(nèi)窺鏡檢查手術(shù)（如半月板切除術(shù)，膝蓋骨切除術(shù)等）燒傷，關(guān)節(jié)膿毒癥等,適應(yīng)癥,運(yùn)動(dòng)阻力調(diào)節(jié),防滑動(dòng)部件,控制關(guān)節(jié)活動(dòng)度,設(shè)置,數(shù)字記數(shù)器,,循序漸進(jìn)的主動(dòng)康復(fù)進(jìn)程,,,,,階段,患側(cè),健側(cè),1 被動(dòng)運(yùn)動(dòng) 主動(dòng)運(yùn)動(dòng),2 主動(dòng)運(yùn)動(dòng) 主動(dòng)運(yùn)動(dòng),3 主動(dòng)運(yùn)動(dòng) 被動(dòng)運(yùn)動(dòng),,,1、雙側(cè)的同時(shí)運(yùn)動(dòng)可以使得病人運(yùn)動(dòng)協(xié)

49、調(diào)性得到很好的恢復(fù);     在關(guān)節(jié)置換和其他關(guān)節(jié)手術(shù)中，恢復(fù)病人運(yùn)動(dòng)協(xié)調(diào)性是康復(fù)的要點(diǎn)之一。,主要優(yōu)點(diǎn),2、雙側(cè)的運(yùn)動(dòng)使得病人的本體感覺得到充分的重建關(guān)節(jié)不穩(wěn)的本體感覺缺失和重建不僅應(yīng)包括關(guān)節(jié)生物力學(xué)的重建，而且還應(yīng)有健全的神經(jīng)肌肉反饋機(jī)制的重建。我們的設(shè)備就是通過雙腿的協(xié)調(diào)運(yùn)動(dòng)對(duì)患者的神經(jīng)肌肉反饋機(jī)制進(jìn)行重建，從而恢復(fù)患者的本體感覺。,主要優(yōu)點(diǎn),3、在一些如髕骨脫位的患者，往往是雙側(cè)都有損