A Two-Pronged Approach

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Just because something works, doesn’t mean you can’t improve it. Therapists use a variety of rehabilitation equipment every day and are always searching for new ways to optimize patients’ progress.

I’ve used traditional continuous passive motion (CPM) devices for a long time with relatively good results. They help increase range of motion (ROM) faster than treatment protocols that don’t include CPM. However, the equipment’s use is limited to the initial stages of recovery and the type of therapy for which it was originally designed.

For example, most knee and foot CPMs are targeted for early rehab and used from a supine position. This limits their use to non-weight bearing ROM for the knees and feet. In addition, they’re complicated to set up, especially for patients in pain or those who are recovering from surgery or trauma. Therefore, patient compliance with these devices is unsatisfactory in home settings.

My colleagues and I get better, more sustainable results by using a two-pronged approach. We incorporate manual therapy with CPM therapy. Manual therapy helps patients cognitively reconnect with traumatized nerve and muscle groups. It reinforces the gains made by CPM, as it oxygenates the area, reduces edema and rebuilds muscle strength. In addition, it helps patients take an active role in rehab, which facilitates compliance and faster recovery rates.

We’re also using a new type of CPM device. Orbital Enterprises’ UltraMotion CPM is used from a seated position and permits partial weight-bearing exercises. More importantly, I can use the device concurrently with continuous active motion (CAM) devices that closely follow the actions of CPM. Orbital Enterprises offers several patient-friendly CAM devices for manual exercise that work different parts of the body. The company manufactures a single wobble board (Orbital Workout), a dual balance board (Orbital Dual Workout), and a dual balance and resistance training board (Orbital Balance Gym) that’s equipped with resistance tubes, adjustable handles and a Pilates bar for upper and lower body exercises that work core muscle groups.

Our patients find the UltraMotion CPM system easy to use. Its hand-held variable speed controller allows incremental increases in the movement of the foot platform so that patients can gain confidence in their ability to move. In addition, patients that aren’t weight bearing can lean into the CPM and obtain a greater stretch sooner than usual. The unit also provides treatment to one or both feet simultaneously or separately, depending on a patient’s needs.

Orbital’s CAM products offer patients a sense of security, since they don’t slip or slide on the floor. Instead of using a ball, the balance boards rotate off a pivot point and have numerous rubber feet at the bottom of a flat base. The dual balance board allows the right and left foot platforms to operate independently. Staff members like the boards’ scalability features, since the boards can be used from a seated position, to a stretch, to a balance board to an upper and lower body resistance exercise device.

The UltraMotion CPM2 is designed for nursing home residents and patients dealing with a stroke, contractures, cerebral palsy, multiple sclerosis or peripheral arterial disease. The device has surgical shoes attached to the bottom footplate. I can flip up the footpad from a wheelchair and place the patient’s feet into the surgical shoes.

The device gives us a new way to treat these patient populations with therapy that helps maintain bone and muscle mass, decrease edema and increase circulation to the lower extremities. So far, results have been positive and the unit has created more time for my staff.

By combining UltraMotion CPM and CAM manual therapy, my patients increase ROM faster, reduce edema and produce lower VAS scores and rehab times, compared with traditional treatment protocols. Patients take a more active role in rehab and exhibit a higher level of compliance. We usually send patients home with the CAM Orbital Workout so they can continue home treatment and avoid the “drop off” syndrome that can occur between therapy visits.

Patients sent home with the UltraMotion CPM System can obtain reimbursement by private insurance, Medicare or Medicaid. Orbital Enterprises helped obtain the new HCPCS code E0936 for CPMs. It’s still a new code, but Medi-Cal, California’s Medicaid program, is paying for monthly rentals and purchases for CPMs under this HCPCS code.

Maria Kirgin, PT, is a senior physical therapist at Wade Park Veterans Hospital in Cleveland, Ohio. (For more information on the HCPCS code, go to www.orbitalindustries.com)

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