Unit 7 - Mechanical Traction & Motion Devices (CPM)

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18 Terms

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Biomechanical and Physiological Effects of Traction
cervical spine

  • Increase in intervertebral foramina (CT scan)

  • Increase in intervertebral disc spaces (neutral and flexion)

  • Separation of facet joint (extension)

  • Reduction in disc herniation area

  • Improve fluid exchange and nutrient transport through annulus fibrosus

  • Variable results in terms of muscle activity (increase, decrease, no
    changes)

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positioning for cervical traction

  • neck is positioned between two padded wedges at the level of the
    mastoid processes.

  • wedges should not compress the patient's neck, and the
    patient should feel a slight pressure, but be comfortable

  • Different angulations are achieved by raising or lowering the
    table

  • patient's positioning of the upper and lower extremities. Notice a roll of sheet or towel supports the arms, and the legs rest on a bolster with about 45 degrees of hip and 60 degrees of knee flexion

  • This position helps keep the spinal muscles relaxed and the patient comfortable

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Biomechanical and Physiological Effects of Traction

lumbar spine

  • Muscle activity increased initially and then subsides.

  • Increase blood flow in the musculature

  • 'Decrease pain

  • Create a negative pressure draws in a protrude disc

  • Reduction in disc herniation area (CT scan)

  • Decrease in sciatic radiating pain (Straight leg raise measurement)

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Lateral Flexion Angle

  • Greater distractive effect on ONE side of the cervical spine when the symptoms.

  • This is not a common application, and there is no scientific evidence for the benefits of these application

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General Parameters

cervical traction

  • Patient Position: Supine

  • Static or Intermittent- 3:1 (Stretch) or 1:1 (Pain)

    • Ex: 30 seconds at the greater tension to 10 seconds at the lower tension (lower is half than greater tension)

  • Force of pull: 10 to 25 lbs

  • Treatment time: 10 to 20 minutes

  • Cervical Unit Angle:

    • C1 C2: 0 to 5-degrees

    • C3-C4:10 to 20-degrees

    • C5 C7:-25 to 30-degrees

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General Considerations

cervical traction

  • Intermittent (3:1) is most common.

  • If Static is chosen: less tension and total duration (5-8 mins)

  • After cervical traction, allow the patient to rest for approximately 5 minutes before rising. Ask for dizziness of feeling faint.

  • Rebound - reduction of symptoms during traction followed by an increase and persistence of symptoms for minutes or hours after the session ends. Communication

  • Expected effects: Symptoms relief such as peripheral pain or paresthesia, improved ROM, functional activities, and upper- extremity strength

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Lumbar Traction Preparation

Harness is placed superior to the patient’s iliac crests and to the widest lateral dimension of the rib cage

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General Parameters

lumbar traction

  • Patient Position: Supine or Prone

  • Static or Intermittent- 3:1 (Stretch) or 1:1 (Pain)

  • Ex: 30 seconds at the greater tension to 10 seconds at the lower tension

  • Force of pull: 1/3 to 50% of Patient’s weight

  • Treatment time: 10 to 20 minutes

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General Considerations

lumbar traction

  • Intermittent (3:1) is most common

  • If Static is chosen, less tension and total duration

  • Communication regarding expectations and responses to treatment.

  • Expected effects:

    • Improvement of the hip flexion during straight leg raising

    • Improvement in reflexes or sensation

  • Adverse effects are rare, but some patients have been reported
    headaches, nausea, and fainting

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Traction Indications
Cervical or Lumbar mechanical pain syndromes

  • Lumbosacral muscle strain,

  • Disk herniation,

  • Muscle spasms

  • Chronic traumatic pain

  • Chronic mechanical low back pain from overuse

  • Radiculopathies

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Precautions for Mechanical Traction

  • Claustrophobia

  • Chronic obstructive pulmonary disease (COPD)

  • Cervical traction during pregnancy

  • Worsening of symptoms

  • Disoriented patients

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Contraindications for Mechanical Traction

  • Acute cervical trauma, including whiplash injury

  • Osteoporosis or osteopenia

  • Compromise bone integrity (steroids use)

  • Connective tissue diseases due to rheumatologic disorders such as ankylosing spondylitis’Joint hypermobility/instability

  • Lumbar traction during pregnancy

  • Prior surgical stabilization or decompression

  • Spinal implants/prosthetic discs

  • Nonmechanical pain (tumors, infections, spondyloarthritis)

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Continuous Passive Motion

  • Motion devices are mechanical devices that are used to generate continuous passive motion (CPM).

  • CPM consists of moving a joint slowly and continuously within a controlled range of movement.

  • CPM has healing benefits for joint diseases, injury, and damaged soft tissues

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when is cpm used

after surgeries; the patient can still be under anesthesia, and the continuous passive movement produced by motion devices will move the joint as soon as possible if the bulky dressing, that is a dressing used to control the bleeding, prevent the early motion

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Guidelines and Parameters

motion devices

  • Motion devices are applied to the involved extremity immediately after surgery while the patient is still under anesthesia or as soon as possible if bulky dressings prevent early motion.

  • The physician and PT must determine the degree of joint motion. Usually, a low arc of 20° to 30° is often used initially and progresses 10° to 15° per day as tolerated.

  • The available range of motion and patient tolerance determines the portion of the range to
    initiate the treatment.

  • The rate of motion is usually 1cycle/45 sec or 2 min

  • Time is variable, but the most effective was from
    4 to 8 hours.

  • Treatment duration: less than a week or when the ROM was obtained.

  • Physical Therapy is performed when the patient is not in the machine - motor control gain.

  • The longer periods of time per day have shown a shorter hospital stay, fewer postoperative complications, and greater ROM at discharge

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Effects of CPM

  • Preventing the development of adhesions and contractures and, thus, joint stiffness

  • Providing a stimulating effect on the healing of tendons and ligaments

  • Enhancing the healing of incisions over the moving joint

  • Increasing synovial fluid lubrication of the joint and thus increasing the rate of intra-articular cartilage healing and regeneration

  • Preventing the degrading effects of immobilization

  • Providing a quicker return of ROM

  • Decreasing postoperative pain

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cpm contraindications

  • Insufficient soft tissue constraints (ligaments)

  • Unstable joints

  • Fractures are not rigid fixed

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cpm precautions

  • Increase joint bleeding

  • Wound healing complications

  • Swelling of the joints (avoid end range)

  • Nerve compression on the device

  • Risk of thromboembolism