The rehabilitative protocol with Fisiotek HP2 for the fracture of humerus's head

 

The fracture of humerus's head

 

Post-operative protocol with Fisiotek HP2

 

 

 

This rehabilitative protocol for the fracture of humerus's head is part of a clinical study made by Prof. Carlo Mammarella and C. Sarti, from A.S.L. S. Camillo - Forlanini in Rome (Italy), who they have analysed the clinical evidences and the rehabilitative value of Fisiotek HP2 for the rehabilitation of surgical pathologies of the shoulder.

 

The case study has been based on 16 cases  (10 women and 6 men), with an average of age aroung 54 years: these cases have been divided in two groups of 8 people each, the first one treated with Fisiotek HP2 and the other one treated with the classic mobilization.

 

GROUP A --> treatment with Fisiotek HP2

GROUP B --> treatment with classic mobilization

 

For the first 7 days after the intervention, all the people have worn a shoulder brace, in spite of the therapy which has started 9 days after the intervention.

 

As datas of reference for shoulder's mobility, it has been taken ROM values of Kapandji:
 

 

Movement	ROM
Abduction	0° à 180°
Flexion	0° à 180°
Extension	0° à 50°
External Rotation	0° à 80°
Internal Rotation	0° à 110°

 

 Initially, at the beginning of the treatment, it has been observed these values of ROM:

 

Abduction: 0° to 15°

Flexion: 20°

Extension: 20°

Rotation: 0°

 

People of the group A, have been treated in seated position (on bed and on a chair), apart from 4 people with multi-fractures, who have been rehabilitated in supine position.
 

People from group B have been treated by the physiotherapist in sessions of 15 minutes each one.

 

Here below in the chart is explained the rehabilitative program carried out for Group A:

 

Period	Treatment – modalities – timetables – R.O.M.
From 9th to 15th day	2 sessions per day (40 min. each) ; ROM: abduction 0° -> 40° / flexion 0° -> 30° / extension 0° -> 10°
From 15th to 25th day	2 sessions per day (60 min. each) ; Increase of the ROM of 10° every 4 days ; Beginning of active mobilization assisted;
From 25th to 45th day	Addition of internal rotation ( 0° -> 30°) and external rotation (0° -> 40°) ; Increase of the ROM of 10° every 5 days ;
Over 45th day	Second phase of the protocol: active exercises, resistance, stretching;

 

As results of this study, we summarize them in the chart:

Movement	Group	Periods and R.O.M. reached
Adduction		15 days	30 days	45 days
	Group A	70°	110°	140°
	Group B	50°	70°	90°
Flexion – Extension		15 days	30 days	45 days
	Group A	30°-20°	90°-30°	110°-40°
	Group B	20°-10°	60°-20°	80°-30°
Internal – External rotation		15 days	30 days	45 days
	Group A	15°-20°	30°-40°	45°-55°
	Group B	10°-15°	20°-30°	40°-35°

Surely after a first view of the chart, is easy to say that passive mobilization with a CPM device can accellerate all the rehabilitation program.

In particular, we can have a rapid recovery of the articular range and a better result in terms of R.O.M. reached: in addition, a better functional recovery and the acceleration of the following phases of the protocol.

In conclusion, compared with the classic methodology, passive rehabilitation with Fisiotek HP2 provide less anxiety and stress to the patient, who's more relaxed: this point is appreciated because patient feels without fears.

 

 

 



The rehabilitative value of Fisiotek HP2, the CPM for shoulder, elbow and wrist

Fisiotek HP2 : clinical considerations,

rehabilitative value and effectiveness for the patient

 

...not only a claim... "Fisiotek comes near the patient"

 

 

Always more clinical situations have as protagonist the shoulder, that's usually the target for traumatic pathologies or inflammations.

One of the elements for the identification of the pathology is, without doubts, joint stiffness with limitation of the R.O.M., with pain.

 

All the protocol's treatments after a pathology or after a surgical intervention, have the aim to recover the articular range, the more possible close to physiological values.

 

The recovery of the R.O.M., apart from mobilization in narcosis, is made through methodologies of passive mobilization applied in 2 ways:

 

1) manual passive mobilization provided by the physiotherapist;

 

2) continuous passive mobilization, using a mechanic mobilizer;

 

 

Now we analyse in detail both the techniques:

 

 

Manual passive mobilization: 

    

Manual passive mobilization
Advantages   -It can be modulate with reference to the opposite resistance applied   -It can be applied with adaptability to the patient	Disadvantages   -Unsettled ROM, not being measurable in the implementation step   -Inapplicable for long periods   -Unsettled as working speed

 

...and Continuous passive mobilization:

Continuous passive mobilization
Advantages   -the ROM programmed fit with the clinical frame   -Reproducibility   -Unlimited time	Disadvantages   -Not enough power   -Impossibility to be applied to patients in supine position   -Usually there’s a side of the body obligated

 

Thinking to disadvantages of Continuous passive mobilization, we would be forced to think that it could be better to leave to use CPM devices, relying the passive phase of the rehabilitation to the physiotherapist.

 

At this point, Fisiotek HP2 is the solution for all the disadvantages over mentioned:

 

- with the programming software is it possible to program a constant and measurable ROM, with a running speed and a fixed time of work, without intermediate steps or stops;

 

- no more problems for body's positioning, as Fisiotek HP2 adapt itself to a wide range of situations, depending on patient conditions.

 

Continuous passive mobilization with Fisiotek HP2 helps also to measure the progressive increase of the R.O.M., taking memory (if required) of patient's improvements, thanks to the Memory Card (if you are interested about this theme, please visit www.cpmcomparison.wordpress.com**).

 

In conclusion, Fisiotek HP2 has been recognised, during years, as an excellent device in rehabilitative protocols for shoulder rehabilitation, boasting the possibility to work over all the 3 plans of the shoulder, covering wide physiological ranges. 

 

 

 

(**) www.cpmcomparison.wordpress.com is a blog for the comparison of the main important models of CPM devices for shoulder rehabilitation from the main  famous manufacturers of all over the world.

In this case, our attention is focused on an article which take into consideration different systems and phylosophies for data storage of patient parameters.

 

 

 

 

 

 

 

 

 

A cost-effective rehabilitation: the CPM therapy as first step for knee and shoulder rehabilitation

Economic and physical benefits of CPM therapy for lower and upper limbs

 

"Concrete" usefulness of continuos passive motion methodology

 

After joint surgery, the range of motion is the first function to regain, according. Generally surgeons prescribe continuous passive motion (CPM) because enable patients to get back quickly-or never lose-good motion, for example for outpatients shoulder surgeries and instability cases: it is also used CPM following distal clavicle excisions and acromioplasties, if a rotator cuff repair is not done.

Generally, procedures that are high risk for developping stiffness are recommended to be treated prescribing CPM following total knee replacements, ligament reconstructions, and fractures. CPM has also produced significant benefits following newer articular cartilage resurfacing procedures that result from isolated chip fractures on the ends of bone. CPM not only helps prevent stiffness, but promotes nutrition of the articular cartilage that you are trying to heal.

The benefits of CPM are recognized, although quantifying its value has been difficult. Its use early in recovery, has a significant impact overall. People who use CPM very early versus those who do not, can verify theirselves a quicker, less costly rehab process.

CPM keeps the joint region stretched and warm, increasing blood flow and elasticity. It has been verified that patients get their motion back faster, and they are off crutches sooner. They also find that it relaxes the area and provides pain relief. Patients are recommended to spend 4 to 6 hours a day in the machine

Additional increased motion and stretching exercises are demonstrated to patients during visits in the first and third weeks following surgery. With good motion after the first 3 weeks following the procedure, patients are well ahead in the healing curve when they begin physical therapy. Up until that time, patients should not be doing any active motion, just passive motion and stretching.

Studies have also been unreliable in determining CPM's impact on healing the joint.

Most have looked at patients 1 or 2 years after surgery, another mistake according to these physicians. Accurate short-term studies require testing a single surgical procedure, as well as splitting patients into those who receive and those who do not receive CPM. Studies have shown CPM's value in pain reduction and its benefits after certain procedures: in fact they have showed that CPM therapy is beneficial for articular cartilage healing.

Economics reasons to support CPM therapy

The ability to shorten recovery time by 2 months is significant in return-to-work claims. Getting a patient back to work in 3 months rather than 4 to 6 months is important to everyone:

1)      there is a huge amount of money saved;

2)      the patient is back and healthy

The end costs in time, pain management, and physical therapy are reduced. Some patients require very little or no physical therapy, just stretching and time in the CPM machine. Fighting that stiffness early also eliminates a setback in what PTs are trying to do-strengthen muscle around the joint. The result, benefits everyone.

Patients benefit because they are active in less time, payers pay less, and therapists end up with a patient at 6 to 8 weeks who has good passive motion.

 

In the past, managed care companies eyed CPM with cost-cutting scrutiny. The mistake, was thinking money saved by eliminating CPM would outweigh money saved in the duration of physical therapy or additional surgeries if scar tissue developed. Attaining 110° to 120° of motion prior to physical therapy is usually the goal, and while many procedures have become more packaged, CPM's use varies.

 

 

 

 

 

The correct positioning of the limb for Fisiotek HP2, the shoulder CPM from Rimec

The correct positioning of the limb is the preface for an effective rehabilitation

 

Positioning of the arm on Fisiotek HP2

 

 

 

The prerequisite of a correct rehabilitation is surely the positioning of the limb. In this case, we analyse passive rehabilitation of the shoulder with Fisiotek HP2.

 

In order to provide a correct positioning of the limb, firstly it's necessary  to measure the arm from the shoulder to the elbow, and report the lenght on the scale of the mechanical arm (the maximum lenght accepted is 38 cm).
After the programming of the device through the consolle, it's possible to positionate the limb: as Fisiotek devices have been developed in order to "come near the patient", a correct alignement close to patient body is required, even for a more comfortable position.

This is possible thanks to simple but smart details :

1) adjustment of the grade (see picture 1)
2) adjustment of the height (see picture 1)
3) laser pointer (see picture 2)






1) system for bend the
    device

2) system for the adjust
     of the height








                        3) laser pointer







            Picture 1                                                                                                    Picture 2



Grade is fondamental in Fisiotek HP2, because it's necessary for the correctness of the movement.
In fact, bending the device permits to modify the work of field and choose the one we need: so, if we have a patient in supine position, we have to bend the device horizontally with respect to his body (like for elevation movement).
As result, patient feel a comfortable position, providing muscle relaxing.

Height have to be adjusted with reference to the distance between patient's shoulder and the floor (in centimeters). The control knob raise or lower the device up to the requested height

Laser pointer is generally employed in couple with the system for the adjustment of the height, because in the same time it's necessary also to center the rotation's point of the shoulder.

After a correct review of all this point, we can positionate patient's limb and start the session; before it, it's always compulsory to tighten the straps of the accessories and ask to the patient if he feel well all the grips and the arm support.

Picture 3

In picture 3 is shown the external rotation movement in supine position.

The body of Fisiotek HP2 is bent up to 60°, near the patient, allowing to work on an horizontal scapular plan, which relax shoulder's muscle.

Picture 4

 

 

In picture 4 we see the elevation movement in supine position.

 

 

The ROM  5° - 180° covered by Fisiotek HP2 for shoulder's elevation can be reproduced also in supine position: obviously, changing the degrees of bending, we modify the work of field and the consequent movement, which can results smaller or bigger (pictute 5).

 

 

Here below (picture 5) an example of different setting of Fisiotek HP2 for various movements: when changes the grade of Fisiotek HP2's body, it changes also the work of field (angle), in spite of the scapular plan which is different for each positions.

 

 

 

 

 

Picture 5

 

In the graphic representation over mentioned, we see that the body of Fisiotek HP2 is bent in three different ways, depending on the position of the patient and the movement to do.

 

 



 



 

 

We invite you to visit our account on Youtube, where you can find different videos tutorial about Fisiotek HP2 (setting and programming) .

Enjoy!






 

Passive mobilization: an important ring of the rehabilitation chain

 

Why is important Passive mobilization for physical rehabilitation?

 

Evidence in use of Fisiotek CPM devices

 

 

There are two important parts of the rehabilitation on a global scale of traumatised person:

 

1) the rehabilitation of the lost capabilities, that is, for instance, walking, handling, clasping, etc..

 

2) that rehabilitation necessary to secure the indipendence of the disabled person, so allowing for his/her reintegration into society.

 

The recovery of lost abilities (rehabilitation) is striven for through a methodology of valuation, which for a long time has been quality-based, but which is now becoming more and more quantitative. There is a change over from a descriptive type of terminology, like for example: better, good, bad, so so, etc... to a precise evaluation which can be repeated and monitored, and it is therefore possible today, to create scientific throughways, which are repeatable both on the diagnostic and on the therapeutic levels.

 

 

Numerous studies have indicated that unsuitable rehabilitation causes a very high level of new injuries. From this point of view, functional rehabilitation covers a fundamental role, not only pertaining to the recovery of lost abilities, but above all to prevent new traumas caused by specific factors (to do with work or sports activities in athletes).

 

An injury is rarely so slight so as not to require some sort of rehabilitation. Generally speaking, the more severe the injury, the longer and more important is the rehabilitation. The aim of the physiotherapist is to recuperate the functions to the best possible point, and in the shortest time. Another important factor is the progressive work load the physiotherapist must apply. To do this, it is necessary to have a wide range of technical capabilities so as to be able to apply the load increases in the most linear manner possible.

 

 

In modern functional re-education, progression is the application of heavier loads with less jumps in intensity, so nearing the theoretical optimum.. It is important to know the methodology used in neurological re-education and muscle strenghthening methodology in order to have a vast range of loads.

 

The most important methods of functional re-education are the following: isokinetics, isotonics, isometrics, biofeedback, hydrokinesitherapy, stretching techniques, proprioceptive and functional bandages (kinesio bandages).

 

 

In simple words, one can say that rehabilitation means that there is an initial passive stage (the injured articulation is mobilised, controlling the pressure, the speed and the degree of movement), followed by an active one (participation of the patient, and  the involvement of all the rings making the "kinetic chain").

 

Fisiotek's line of equipment covers the passive isokinetic part of the rehabilitation chain.

 

The rehabilitation program illustrated below, deals with the rehabilitation and consequent reconstruction of a front crossed ligament (FCL), which along with meniscus injuries are the most frequent causes of a trauma to the knee:

 

 1st - 2st day: Passive mobilization (CPM) from 10° to 70° - rigid valve locked in extension to rest - ice

 

3rd - 5th day: CPM from 0° to 90°, beginning of the deambulation with the help of crutches and knee support locked in complete extension, isometrics exercises for the ischiocrurals.

 

6th - 14th day: Passive mobilization at home (CPM), deambulation with the help of crutches and articulated knee support free between 0° and 45°, increase in the isometric exercises for the ischiocrurals.

 

 

3rd - 4th week: Passive mobilization by the therapist progressively forcing the deficient parts, the attempt to obtain full extension. The movement range (ROM) at the end of this period is between 0° and 110°, mobilization of the kneecap and the kneecap setting, treatment of the scars, exercise of the ischiocrurals with biofeedback, limb extensions, swimmingpool, deambulation of the knee without the use of knee supports and the gradual discarding of the crutches, exercises for the lateral articulations and limb, cycling, up-down foot extension exercises.

 

At this point, the educational programme has more or less completed the passive phase, and it continues using methodologies which include the whole of the kinetic chain.

 

 

Have you ever had an intervention for the reconstruction of FCL?

 

Leave your comment!

 

 

 

 

 

 

 

 



Rehabilitative protocol after an intervention of reconstruction of the Anterior Cruciate Ligament (ACL): application of CPM devices

Reconstruction of the Anterior Cruciate Ligament (ACL)

 

Use of Continuous passive motion (CPM) devices in the first weeks after the intervention.

 

 

Injuries of the Anterior Cruciate Ligament (ACL - picture 1) are very frequent in sport field, and often they happen together with meniscu's fractures and others ligamental structures (Posterior Cruciate Ligament or Exterior Cruciate Ligament), with reference to different faces of the trauma.

 

 

Picture 1

 

 

ACL injury can not be easily referred to precise cinetics outlines, due to the wide variety of traumatic events. Generally, it's possible to affirm that injury mechanisms result as a combination of different stresses at knee level: some examples are in valgus-flexion external rotation, in varus-flexion internal rotation, in varus or valgus with extended knee and so on. 

 

In the acute injury of ACL (picture 2), patient often complain an intense pain which go with a "crak" sensation, and clinically, it's possible to observe a behaviour in smooth flexion of the knee, functional impotence, tumefaction and articular instability, which can be underlined with some test (of the "anterior drawer", Jerk test, Lanchman test).

 

 

Picture 2

 

 

The election's treatment in ACL fractures, it's the surgical intervention of reconstruction which forecast a transplant of the new structure, with osteosynthesis screws, using part of the kneecap's tendon (more frequent) or those of the semi-tendon.

 

After this intervention, it's necessary to follow a specific rehabilitative program so as the patient recover the physical level present before the injury.

In order to facilitate the post-operative recover, it's suggested to have a good activity at the gym for almost one month before the intervention, as described here below:

 

PRE-OPERATIVE PERIOD

 

- At least one month before the intervention, exercises and activities at the gym for muscle strengthening, with growing loads;

- If it's possible, have an isocinetics muscle valutation test;

- Accurate education of the patient about the intervention's methodology and about the time of recovery in the post-operative period;

 

 

POST-OPERATIVE PERIOD (1st - 4th day)

 

 

The targets during this period are especially related to the reduction of hematoma and of the infiammation and a first recovery of the articular travel.

The most important steps are:

 

a) mobilization of the kneecap;

b) Passive mobilization  (with CPM) of the knee, at least up to 90°: in this case, is compulsory to be prudent and not exceed from the maximum load recommended.

 

Fisiotek CPM devices have an internal sensor which notices if the patient apply an opposite resistance (load) to the movement, reversing it to the lower limit set.

 

c) Isometric contractions for quadriceps and flexors;

d) beginning of the deambulation (partial and progressive), with canadians crutches from the first post-operative day;

 

 

PREMATURE PERIOD (5th - 30th day)

 

 

In this phase, the objectives are the recovery of the complete articular range, the prevention of the muscular atrophy and the recovery of deambulation without aids.

 

a) application of a growing load; within the 15th day, reaching of the full load;

b) Passive mobilization (with CPM) of the knee, over 90°: it's always recommended to be prudent, in order to not force the articulation.

 

All Fisiotek CPM devices have an handheld remote control with Start&Stop button, used to control the movement.

 

c) Isometric exercises at 30° - 60° - 90°, elevation with the knee locked and growing weights at the ankle;

d) stretching;

e) cyclette;

f) proprioceptive recover only with the kinetics chain closed;

g) exercises for muscle strengthening only with the kinetics chain closed;

h) possible exercises in water (avoid the frog-style);

 

 

After this period, it lefts a middle (31st - 60th day), an advanced (61st - 90th day) and a final step (91st - 150th day) where the patient have to recover the muscular tone, the agility and the sport's movement.

 

Even if passive rehabilitation represents a small part of all the rehabilitative program, it's very important for a correct recovery of the joint mobility: it's important to remember that passive mobilization is more accurate if done by a CPM device, and not manually, because the device has a software and features already programmed for that precise movement.

 

Our range of CPM devices are studied in order to cover all the needs in case of injury or fracture, from hip to ankle, and from shoulder to wrist.

 

 

 

What do you think about Fisiotek CPM mobilizers? Have you ever had experience with one of them?

 

 

Discuss your experience and leave a comment!

 

 

 

 

 

 



Fisiotek LT - your partner for passive rehabilitation of the shoulder

Fisiotek LT

your partner for passive rehabilitation of the shoulder

The increasing number of installations of Fisiotek LT

shows an excellent usefulness for shoulder's rehab

Since its creation, Fisiotek LT has been thought to be a simple device for passive rehabilitation of the shoulder, as it as the recent technological breakthrough of surgical techniques require to recover the mobility briefly and easily.

Always more structures for rehabilitation and physiotherapy services require to have a CPM device for the shoulder able to work in every condition, in case of a young sportman or in case of an old patient who have to recover after an intervention of joint replacement.; in this cases, the device "come near the patient" accepting to work in all the scapular plans of the shoulder.

Following what is required by most of the standard rehab protocols for the shoulder, Fisiotek LT permit to have available all the complete range of movements, like elevation, adduction/abduction, and internal/external rotation.

Which are the differences between LT and the others model on the market?

1) no limits of space for patient positioning: in addition to seated position, it's possible to treat in supine position which is preferable because it provides a more comfortable posture;

2) no pre-installed programs but simple setting of parameters and features: manual reset of the parameters for movement's changing;

3) greatest facility without give results up;

4) availability of all the most important movements required in a rehabilitation protocol of the shoulder, as the elevation, the adduction/abduction, the internal-external rotation;

Following recent statements, it's appeared that Fisiotek LT can provide excellents results both in the post-operative period after orthopeadic surgery, both for physiotherapy programs after joints injuries.

Fisiotek LT is also appreciated for domestic use; often patients dismissed from hospitals, are expected to follow a passive rehabilitation's program for maximum 3 weeks after the intervention.

In effect, boasting the possibility to work with batteries, Fisiotek LT is also appreciated for its versatility; it can be used also with a 12V battery, rechargeable in 1 hour, and able to work for 2 hours and 30 min. Alternatively, it can work with a current cable.

View our promotional video of Fisiotek LT on YouTube!