Dissertations / Theses on the topic 'CPM (Continuous Passive Motion)'

A Policy Guide to Decrease the Use of Continuous Passive Motion Machines by Rosa M. Cooper MSN, Walden University, 2009 BSN, Immaculata University, 2007 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2015 This project was conducted at a post-acute rehabilitation hospital that served post-acute orthopedic, stroke, brain injury, cardiac, and skilled nursing patients. On the orthopedic unit, there were 5 practicing physicians, 3 of whom consistently used continuous passive motion (CPM) therapy on total knee arthroplasty (TKA) and 2 of whom did not. As a result of discussions with physicians who did and did not utilize CPM therapy, a practice problem was identified that CPM use may not be consistent with current literature and practice evidence. Scholarly literary reviews were done on current CPM evidence- based research. Observational data were collected on patients' ambulatory function, knee range of motion, and pain durance. This information was then presented by the interdisciplinary team (IDT), which consisted of the physical therapist, occupational therapist, and nurses. The physicians input along with the observational data obtained by the IDT all supported the hypothesis that CPM usage did not promote faster healing nor added a benefit to patient outcomes. A project to revise the existing CPM policy and develop a guide decreasing CPM usage was implemented and guided by the theories of organization change and a total quality management model. The purpose of this quality assurance project is to promote a cost-effective practice change that would be beneficial to the TKA population as it relates to care and treatment. As the increase in TKA continues to rise in the United States due to such co-morbidities as obesity causing an increase in disabilities, implementing the best practice as it relates to patient outcomes brings about a positive social change.

A prestação de serviços na área da saúde apresenta uma demanda por novas tecnologias. Os fisioterapeutas utilizam desde equipamentos mais simples aos mais complexos para auxiliar na elaboração do diagnóstico cinético funcional, na prescrição, planejamento, ordenação, análise, supervisão e avaliação das atividades fisioterapêuticas dos clientes. Considerando a importância da articulação do cotovelo para as atividades de vida diárias dos indivíduos, bem como a complexa reabilitação das articulações do cotovelo e radioulnares, que requerem intervenção precoce para evitar a rigidez articular, a perda de amplitude de movimento e de força; foi identificada a necessidade de desenvolver um equipamento inovador para a reabilitação do cotovelo e antebraço. Assim, essa tese tem como objetivo geral desenvolver um equipamento inovador para a reabilitação do cotovelo e antebraço. Os objetivos específicos são: (i) analisar os estudos científicos e patentes que abordam o desenvolvimento de equipamentos de Movimentação Passiva Contínua para a reabilitação do cotovelo e antebraço; (ii) realizar a análise funcional e operacional de equipamentos para a reabilitação do cotovelo a antebraço disponíveis no mercado; (iii) identificar os requisitos dos stakeholders da cadeia de valor do produto para o desenvolvimento de um equipamento inovador para a reabilitação do cotovelo e antebraço; (iv) desenvolver o módulo de vibração muscular localizada do equipamento inovador para a reabilitação do cotovelo e antebraço; (v) desenvolver o módulo de Movimentação Passiva Contínua do equipamento inovador para a reabilitação do cotovelo e antebraço; (vi) avaliar a utilização do equipamento inovador para a reabilitação do cotovelo e antebraço em seres humanos. Para atingir os objetivos desta tese foram utilizadas metodologias e ferramentas para a gestão do processo de desenvolvimento de produtos, bem como testes experimentais dos protótipos funcionais com seres humanos. Os resultados envolvem a obtenção de conhecimento científico acerca do tema do desenvolvimento de equipamentos inovadores para a área da saúde, bem como o protótipo funcional de um equipamento inovador para a reabilitação do cotovelo e antebraço, apresentados na forma de seis estudos científicos.<br>The healthcare service rendering requests new technologies. Physical therapists use equipments from the simplest to the most complex to assist in the developing of functional kinetic diagnosis, prescription, planning, managing, analyzing, monitoring and evaluation of customers’ therapy activities. A need of developing a novel equipment for the elbow and forearm rehabilitation came from the importance of the elbow joint for the daily living activities of people and the complex rehabilitation of elbow and radioulnar joints. These joints require early intervention to prevent joint stiffness, loss of range of motion and strength. Based on this context, the general goal of this PhD thesis is to develop a novel device for elbow and forearm rehabilitation. The specific goals are: (i) analyze the scientific studies and patents about the development of Continuous Passive Motion devices for the elbow and forearm rehabilitation; (ii) analyze functional and operationally the devices for the elbow and forearm rehabilitation which are available in the market; (iii) identify the stakeholder requirements of the device value chain to develop a novel device for the elbow and forearm rehabilitation; (iv) develop the local muscle vibration module of the novel device for the elbow and forearm rehabilitation; (v) develop the Continuous Passive Motion module of the novel device for the elbow and forearm rehabilitation; (vi) evaluate the use of the novel device for the elbow and forearm rehabilitation on human subjects. Management product development process methodogies and tools, as well as experimental tests of the functional prototypes on human subjects were used to achieve the thesis goals. The results include the generation of scientific knowledge about the development of new devices for the health area, as well as a functional prototype of the novel equipment for the elbow and forearm rehabilitation presented as six scientific studies.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior<br>This research demonstrates the development of a new principle of operation for elbow and forearm continuous passive motion (CPM) equipment. For that were integrated knowledges of Physical Therapy and Production Engineering to make a prototype of a CPM device for the purpose of enabling the programming of various sequences of passive movements of elbow and forearm by means of computerized numerical control (CNC). The conceptual design of prototype mechanical equipment was carried out, as well as the construction and development of a program to specify the principles of operation of the equipment. Computerized CPM allows the independent or synchronized passive movements on two axes: elbow flexion/extension and forearm pronation/supination. The prototype has stepper motors connected to a microcomputer by means of drivers. The motors are controlled by commercial CNC machine software control. The language read and interpreted by this program is generated by other software, this was developed for this equipment to facilitate its use by the Physical Therapists. It has language accessible to this professionals and it allows the insertion of such variables as time and angle. The software calculates the speed of movement with these variables automatically. Data entered into the program are saved and generate a text file with standard CNC language, which is recognized by the program control. The sequences of movements are created by Physical Therapist and adapted to patients according to treatment goals and the individual characteristics. The control software also provides the flexion/extension and pronation/supination range of motion (ROM) passive evaluation, the data of each patient can be stored for monitoring progress and possible reuse. Based on what was done, we can assert that this operating principle can be used in CPM device, the software developed can be used on any machine of this type wich CNC principle of operation and if them have the availability of two axes of movement. This technique can be used to other equipments specific to the health area.<br>Neste trabalho é demonstrado o desenvolvimento de um novo princípio de operação para equipamentos de movimentação passiva contínua (CPM) para cotovelo e antebraço. Foram integrados conhecimentos de Fisioterapia e Engenharia de Produção para construir um protótipo de um equipamento de CPM que possibilite a programação de variadas sequências de movimentos passivos do cotovelo e antebraço por meio de técnicas empregadas em equipamentos com Comando Numérico Computadorizado (CNC). Foi realizado o projeto conceitual da mecânica do protótipo, sua posterior construção e desenvolvido um programa para especificar os princípios de operação do equipamento. O CPM Computadorizado possibilita os movimentos passivos independentes ou sincronizados em dois eixos: flexão/extensão do cotovelo e pronação/supinação do antebraço. Possui motores de passo, conectados a um microcomputador por meio de driveres. Os motores são comandados por um software controle comercial de máquina CNC. A linguagem lida e interpretada por este programa é gerada por outro software, o qual foi desenvolvido para este equipamento, visando facilitar a utilização pelo fisioterapeuta. Ele disponibiliza, em linguagem acessível ao profissional da área, a inserção de variáveis como tempo e ângulo, com as quais calcula automaticamente a velocidade de movimento. Os dados inseridos no programa são salvos e geram um arquivo texto com linguagem CNC padronizada reconhecida pelo programa controle. As sequências de movimentos são criadas pelo fisioterapeuta e adaptadas aos pacientes, de acordo com os objetivos do tratamento e as características individuais. O software controle proporciona também uma avaliação passiva da amplitude de movimento (ADM) da flexão/extensão e pronação/supinação e os dados de cada paciente podem ser armazenados para acompanhamento da evolução e possível reutilização. Com base no que foi realizado, é possível afirmar que este princípio de operação pode ser empregado em equipamentos de CPM e o software desenvolvido pode ser utilizado em qualquer máquina deste tipo com princípio de operação CNC, onde exista a disponibilidade de dois eixos de movimentos. Esta técnica ainda pode ser utilizada em outros equipamentos específicos da área da saúde.

With improvements in actuation technology and sensory systems, it is becoming increasingly feasible to create powered exoskeletal garments that can assist with the movement of human limbs. This class of robotics referred to as human-machine interfaces will one day be used for the rehabilitation of paralysed, damaged or weak upper and lower extremities. The focus of this project was the development of an exoskeletal interface for the rehabilitation of the hands. A novel sensor was designed for use in such a device. The sensor uses simple optical mechanisms centred on a spring to measure force and position simultaneously. In addition, the sensor introduces an elastic element between the actuator and its corresponding hand joint. This will allow series elastic actuation (SEA) to improve control and safely of the system. The Hand Rehabilitation Device requires multiple actuators. To stay within volume and weight constraints, it is therefore imperative to reduce the size, mass and efficiency of each actuator without losing power. A method was devised that allows small efficient actuating subunits to work together and produce a combined collective output. This work summation method was successfully implemented with Shape Memory Alloy (SMA) based actuators. The actuation, sensory, control system and human-machine interface concepts proposed were evaluated together using a single-joint electromechanical harness. This experimental setup was used with volunteer subjects to assess the potentials of a full-hand device to be used for therapy, assessment and function of the hand. The Rehabilitation Glove aims to bring significant new benefits for improving hand function, an important aspect of human independence. Furthermore, the developments in this project may one day be used for other parts of the body helping bring human-machine interface technology into the fields of rehabilitation and therapy.

Doctor of Philosophy (PhD)<br>With improvements in actuation technology and sensory systems, it is becoming increasingly feasible to create powered exoskeletal garments that can assist with the movement of human limbs. This class of robotics referred to as human-machine interfaces will one day be used for the rehabilitation of paralysed, damaged or weak upper and lower extremities. The focus of this project was the development of an exoskeletal interface for the rehabilitation of the hands. A novel sensor was designed for use in such a device. The sensor uses simple optical mechanisms centred on a spring to measure force and position simultaneously. In addition, the sensor introduces an elastic element between the actuator and its corresponding hand joint. This will allow series elastic actuation (SEA) to improve control and safely of the system. The Hand Rehabilitation Device requires multiple actuators. To stay within volume and weight constraints, it is therefore imperative to reduce the size, mass and efficiency of each actuator without losing power. A method was devised that allows small efficient actuating subunits to work together and produce a combined collective output. This work summation method was successfully implemented with Shape Memory Alloy (SMA) based actuators. The actuation, sensory, control system and human-machine interface concepts proposed were evaluated together using a single-joint electromechanical harness. This experimental setup was used with volunteer subjects to assess the potentials of a full-hand device to be used for therapy, assessment and function of the hand. The Rehabilitation Glove aims to bring significant new benefits for improving hand function, an important aspect of human independence. Furthermore, the developments in this project may one day be used for other parts of the body helping bring human-machine interface technology into the fields of rehabilitation and therapy.

Human leg is one of the most important part in the human body. It helps a person in travelling from one place to desired destination and thus, act as primary vehicle for mobility. This process of locomotion is either achieved through walking or running. Also, it has been proven that this process of locomotion induces stress in the person’s body. By maintaining healthy legs and adopting correct walking methods, the generated stress can be reduced. The most important part in the human leg is the knee joint. It is a hinge joint which governs flexion – extension of the human leg and thus helps a person in locomotion. These actions can only be performed correctly by a healthy human leg (knee joint). Though the human leg plays such an important role in the locomotion of the human body, it is subjected to many injuries in this process like sprains, strains, burning sensation, calf pain, leg cramps, swelling and numbness of the limb. These injuries can be treated easily at home and does not require special treatment from a doctor. These injuries can be avoided by implementing the correct walking method of humans called bipedal human gait pattern. Adopting the bipedal human gait pattern in walking not only reduces the efforts in locomotion but also corrects the walking posture of the concerned person. Using this bipedal human gait pattern ensures the person of having the correct posture of thigh, lower leg and the heel. To relieve a person from the problems of incorrect walking and post-treatment process, an inhome device was required. This indicated the need of a device which could ease out the posttreatment process for the patients. Therefore, this work presents the design and development of an orthotic device which integrates the bipedal human gait pattern in a continuous passive motion device. The most significant feature of the developed device will be its ability to involve bipedal human gait pattern while being light-weight, portable and cost-effective at the same time. The proposed device will be used in the first phase of rehabilitation during the post-treatment process or during no weight-bearing period. Controlling post-operative pain, reducing inflammation, providing passive motion in a specific plane of movement and protecting the healing tissue are the main aims of the first phase of rehabilitation. A CPM device helps in moving a joint through a controlled range of motion; the exact range is dependent upon the joint, but in most cases this range of motion is increased over time. Procuring the bipedal human gait pattern involves a lot of complications and requires high level skills to guarantee perfection. Qualisys Track Manager (QTM) made this task easier with its four high speed cameras, clocking at 100Hz. QTM was used to capture the bipedal human gait pattern. In addition to retrieving the bipedal human gait pattern, incorporating it in a CPM device further raised the complexity of the project. Besides retrieving the bipedal human gait pattern, validating its imitation in the proposed CPM device was also done by QTM. The research was carried out in two phases. The first phase of research involves the collection of data and the concept designing was done in Computer Aided Design (CAD) environment in Computer Aided Three Dimensional Interactive Application (CATIA) V6 software. The initial concept designs showed the need to provide proper rest to patient’s leg and that the usage of the designed CPM device must not induce any kind of stress or fatigue. For this very purpose, proper cushioning in the designed CPM device has been provided at all the contact points / surfaces of the patient’s body with the CPM device. The second phase involves the manufacturing the prototype of the CPM device. This phase also involves to program the CPM device to make it follow bipedal human gait pattern.

This thesis presents a novel table top hand rehabilitation device. The purpose for creating this device is to assist therapists in treatment of hand after injury. Injuries to the hand are common and can be very debilitating since our hands are our primary means for interacting with our world. The device is capable of independently mobilizing the metacarpophalangeal joint (MCP) and proximal interphalangeal joint (PIP) in the fingers of the hand, and recording their motion. The device is capable of moving either joint through a range of 0° to 90°, and can be used for either the left or right hand. In the Continuous Passive Motion (CPM) mode, the device moves the MCP and PIP joints through a trajectory that approximates healthy hand motion, known as the minimum jerk model. This is done using a Proportional Integral Differential (PID) controller, which compares the actual position of the device to the desired minimum jerk trajectory. The trajectory following of the minimum jerk model was found to be successful with a maximum error of only 1.46° in the MCP joint and 2.10° in the PIP joint across all trials with injured participants with an average error of 0.11° and 0.14° for the MCP and PIP joints respectively. The device also incorporated various user-friendly features such as user-defined maximum permitted torque, range of motion limits, speed control, and visual feedback. A survey of the participant’s perceived comfort, safety, smoothness and passivity produced positive results. The average responses of the injured hand participants to questions of perceived Comfort, safety and Smoothness were above 9 out of 10 for each question. The average increases in ROM for the active extension of the MCP joint and the PIP joint were 3.3° and 3.2° respectively. The average increases in ROM for the flexion of the MCP joint and the PIP joint were 8.9° and 7.2° respectively. This is a sign that the device has an effect on the participant even if this effect can not be shown to last beyond the one hour session. It will require further testing with a long term group of participants and a control group to determine if this is a lasting effect and if the device is ready for clinical use. The active resistance and haptic modes are both operational but require additional work to increase smoothness and stability before testing can begin.

碩士<br>長庚大學<br>復健科學研究所<br>94<br>Background and Purpose: All joints should be moved after the operation to prevent the stiff or deterioration of peripheral joint. Continuous passive motion instrument (CPM) is an external motorized device and it enables a joint to move passively. At presents, it becomes one of selection of rehabilitation therapy tool. In the past study, although the joint influenced by the speed and relevant joints when was stretched repeatedly. But it did not aim at the parameters of CPM instrument such as the regulation of postures and velocities during the CPM machine motion in clinical. The purpose of this study was to investigate the consistency of joint angle with CPM instrument. Methods: Two electrogoniometers were used to record the varied range of motion of knee joint and the CPM machine. The first thing was to confirm angles shown on the operation panel with the real angle monitored on the CPM machine. The measurement of consistency of joint angle was to expect asking for thirty healthy subjects and five patients following the knee problem. In the study, it had two topic groups and separated the different velocities (slow, moderate, and fast) and postures (supine-lying, semi-lying, and upright). They were randomized assign to an item of the different topic groups. Results: There were statistically significant different between CPM and CPM (EG) of flexion (p<0.001) and extension (p<0.001). There were statistically significant different between CPM (EG) and knee at all velocities (p<0.001) and all postures (p<0.001) in the control group, there were not statistically significant different between the velocities in all times (p>0.05). There were statistically significant different between the postures in all times (p<0.05). In the patient group, there were not statistically significant different between the velocities and postures in all times (p>0.05). The angle differences of the patient group were smaller than the control group in all condition. Conclusion: Although the CPM machine and CPM(EG) had highly correlation within full range, it had lower correlation at start to flex or extend about 40°. The differences between CPM machine and CPM(EG) were not over 10°. There were no consistency between the angle of CPM (EG) and knee at all velocities and postures. The angle differences did not significant change by velocities, but it significant changed by postures. And the different mainly occurred in the upright posture. But the changes did not significant occur on the patient group. Clinical Relevance: It suggested that the angles were not consistent entirely during the CPM machine motion. To obtain treatment effects, we should calibrate on a regularly and consider the angle differences at all condition.

碩士<br>國立陽明大學<br>復健科技輔具研究所<br>92<br>Background and objective：There are many reasons that cause hand disease through clinical examinations, such as fracture, tendon rupture, burns, arthritis etc. Rehabilitation is often used to prevent from evolved hand disease. Therefore, the purpose of this study is to build a hand CPM (continuous passive motion) machine for rehabilitation. The machine is designed according to the suggestions of the orthopedists and physical therapists and the function refers to the rehabilitative motions which are radial deviation, ulnar deviation, extension, hyperextension of wrists and adduction, abduction, flexion, extension of fingers. Methods：The research process is divided into three phases. The first phase is to conduct a literature review and to sum up the criteria such as motions, angles, and forces of the machine. The second phase goes on to design the mechanism and manufacture of the machine according to the criteria, and followed with the safety and functional tests of the machine. Finally, the third phase is to examine the Colles’ fracture patients who use the machine and investigate the patients through the process of rehabilitation in order to verify the validities by the clinical examinations. Results：It shows that this study of rehabilitation machine is not only to reach the functional requests of wrist and fingers, but also to increase the patient’s ROM(Range of motion). After the six weeks of rehabilitation, the average value of progress of the three subjects’ wrist flexion was 、wrist hyperextension was 、wrist radial deviation was 、wrist radial deviation was ．Besides, there was no one hurt in the clinical examinations. Conclusion：The rehabilitation machine of this study includes both wrist and hand rehabilitation, and user can adjust the parameters which are time, pressure, pulling force and angle. The rehabilitation machine of this study has verified its efficacy under the clinical examinations.

碩士<br>長庚大學<br>機械工程研究所<br>88<br>Impairment of volitional motor activity is common after stroke, head injury, spinal cord injury and other conditions of upper motor neuron dysfunction. This finding is particularly relevant in stroke patients who have achieved substantial recovery of speech and gait, but volitional motor activity of the hand remained incomplete or absent. Therefore, the evaluation and training of the hand motor control functions become an important part of the rehabilitation therapy for these patients. In view of the above, this study is made aimed at the clinical needs of the upper motor neuropathy patients by combining the efforts of doctors, rehabilitation therapists and engineers and by integrating the sensors, computerized images, feedback controls and computer technologies for developing and pioneering a human hand motor control assessment and training system as well as a hand continuous passive motion rehabilitation training system for the patients. This study will be proceeded by dividing it into three parts, the first part was using the 5DT gloves available in the market and combining which with the hardware units of hand/palm pressure measurement module, digit hand-writing pad module and biofeedback hand dexterity assessment, training module, etc. to design and develop a hand motor control assessment and training system, whose functions include: articulation activity real time measurement and display, hand/palm pressure measurement, virtual 3D palm interaction display, hand-writing performance evaluation, etc.; the second part was to design a hand continuous passive motion (CPM) mechanical glove, which has 5 tendon driven fingers, each has a 2 degree of freedom. With the aid of interacting windows and post-treatment database, the goal of continuous passive motion and functional movement training can then be achieved. While the third part was using the hand motor control assessment and training system developed in to use to carry out clinical evaluations and experiments on hand motor control functions for 13 normal individuals and 26 patients with focal dystonia (such as patients with writer''s cramp). Tests were conducted in 2 modes of: writing without wearing the glove, writing by wearing the glove with hand/palm pressure sensors. The main evaluation items included as follows : the hesitation time during writing, the number of letters written, the delay time for starting writing, the contact pressure of hand against paper during writing, the contact pressure of hand against pen during writing. The experimental were analyzed. The results showed apparent differences between normal subject and patients with writing contraction disease, for example, the average hesitation time per letter of the patient group was 3.5 times longer than that of the normal subject group, the delay time for starting writing of the former group was 2.25 times as longer as that of the latter, moreover, the pen/paper contact pressures of the former were 1.43 times higher than those of the latter. With the accomplishment of this study, the developed hand motor control assessment and continuous passive motion rehabilitation training system not only can be immediately provided for evaluation and rehabilitation training by the clinical physicians for patients with hand motor control function disorders, but also can be synchronously used to collect physical signals (such as articulation activity degrees, finger/palm pressures, etc.) of the patients during the course of rehabilitation training. Quantitative index introduces in this study may be used for evaluating the therapeutic effects of the palm motor control functions of the patients. Besides, the prototype of the pioneered system should have the potential of applying for patent, and the design conception, software/hardware of the developed system can be transferred to the relevant medical industries in order to inspire the interest of people in researching, developing and manufacturing high-tech rehabilitation treatment apparatus, thus promote the upgrading of domestic medical care industry.

碩士<br>長庚大學<br>物理治療學系<br>100<br>Introduction: Cerebral palsy (CP) is a group of disorders of the development of movement and posture but often changing motor impairment syndromes. The spastic subtypes are the most common manifestations of cerebral palsy who perform movement difficultly due to hypertonia. Decease of spinal cord pathway, hyperactivity of alpha and gamma motoneuron and reduction of presynaptic inhibition may cause tendon reflex increase and hypertonia in individuals with CP. There are many ways to improve the hypertonia. In the past studies, the fast repeated range of motion could reduce muscle's activation effectively. The polyarticular movement training might increase joint range of motion and reduce the muscle activation. But the polyarticular movement training is difficulty for some individuals with CP. The single joint movement training may achieve the same effect as the polyarticular movement training. The purpose of this study was to investigate the effects of continuation passive range of motion (CPM) training whether could get the improvement of soleus hypertonia in individuals with CP. Methods: This study included 8 individuals with spastic CP (mean age= 22 years old), who performed the 4-week CPM training for 1 hour per day, 5 sessions weekly. 2 out of 8 individuals with CP continued the training for 4 months. The effects of CPM training on soleus hypertonia in individuals with CP were measured by the Hoffman reflex (H-reflex), modified Ashworth scale ( MAS), leg girth, ankle range of motion and visual analogue scale ( VAS). The repeated one-way ANOVA was used for statistic analysis, the statistical significance was set as p<0.05. Results: After 1-month CPM training, the H-reflex had the statistical significance, which showed the improvement of the soleus hypertonia phenomenon of individuals with CP. The continuity of 4-month training can maintain the improvement. Conclusion and clinical relevance: The CPM training can improve the soleus hypertonia of individuals with CP effectively. It provides the comfort of soleus and may possibly affect the ambulation ability of individuals with CP, which will be worthy to investigate in the future studies.

Success of post-operative and post-traumatic therapy and rehabilitation of conditions related to major joints typically requires continuous passive movement of the affected joint. Physiotherapeutic devices are commonly used to promote rehabilitation of damaged or injured synovial joints. The research work aims to develop an assisted motion device for the physiotherapeutic treatment of the human knee joint. A cam-follower mechanism is proposed to reproduce actual gait cycle with varying flexion and extension of knee joint. The proposed model defines the passive motion device in terms of an improvised range of motion similar to the variation of the knee angle during normal walking gait cycle. Experiments are conducted on the proposed device to verify its angle variation and ease of use for the patients. The intuitive device finds its application in knee joint rehabilitation after knee replacement surgeries, fractures, injuries and other knee joint diseases to facilitate joint flexibility and promote well-being. The demonstrated works lays the groundwork for the prospective passive knee models and prosthesis design

Background: Spasticity of the ankle can occur in multiple sclerosis and stroke, and can significantly reduce quality of life by impeding walking and other activities of daily living. Robot driven continuous passive motion (CPM) of the ankle may be a beneficial rehabilitation strategy for lower limb spasticity management, but, objective measures of decreased spasticity and improved locomotion remains uncertain. Additionally, the acute and chronic effects of CPM on spinal cord excitability are unknown. Objectives: To evaluate: 1) the acute changes in spinal cord excitability induced by 30 min of CPM at the ankle joint, in neurologically intact individuals and in those with lower limb spasticity; and, 2) chronic training-induced effects of 6 weeks of bilateral CPM training on reflex excitability and locomotion in those with lower limb spasticity. Methods: Spinal cord excitability was assessed using Hoffmann (H-) reflex recruitment curves, collected immediately before and following 30 min of CPM of the right (neurologically intact) or more affected (clinical) ankle. A multiple baseline repeated measures study design was used to assess changes following 18 bilateral CPM training sessions. Spasticity and locomotion were assessed using the Modified Ashworth Scale, the 10 m Walk test, and the Timed Up and Go test. Results: Twenty-one neurologically intact (6 female, 15 male, mean age 24.5 ± 1.7y) and 9 participants with spasticity (3 female, 6 male, mean age 58.9 ± 9.7y) due to various neurological conditions including stroke (n=4), MS (n=3), spinal cord injury (n=1), and cerebral palsy (n=1). In the neurologically intact group, CPM produced a bi-directional modulation of H-reflex creating ‘facilitation’ (n=12) (31.4 ± 20.9% increase in H-reflex amplitude) and ‘suppression’ (n=9) (32.9 ± 21.0% decrease in H-reflex amplitude) groups. In the clinical participants, acute CPM before training significantly increased H-reflex recruitment curve variables H@Thres and H@50; but there was no significant effect of acute CPM post-training. Baseline reflex excitability following training was reduced on the MA side for H@Thres, H@50 and H@100 by 96.5 ± 7.7%, 90.9 ± 9.2%, and 62.9 ± 21.1%, respectively. On the less affected side there was a significant decrease in H@Thres and H@50 by 83.4 ± 29.0% and 76.0 ± 28.3%. Time to complete the 10 m Walk Test was not different (5.2 ± 7.9% change, p = 0.06), and time to complete the Timed Up and Go was decreased (9.5 ± 12.3% change, p = 0.05). Spasticity of the ankle plantar flexor muscles, assessed by the Modified Ashworth Scale, was reduced in 4 participants with spasticity. Conclusion: Acute and chronic CPM of the ankle can significantly alter spinal cord excitability. CPM training may be a useful strategy to decrease spasticity of the ankle plantar flexors.<br>Graduate<br>2018-09-15

碩士<br>長庚大學<br>醫療機電工程研究所<br>94<br>“Adhesive capsulitis” is the most common chronic shoulder degenerated disease and it is generally called “Frozen shoulder”. According to literatures investigation, “Frozen shoulder” is one of the chronic shoulder diseases and often occurs people between the ages of 40 and 60. Shoulder pain may last for five years when the disease aggravating, When capsular fibrosis occurs within the patients’ shoulder joint, the shoulder joint will become stiffness, contraction and restriction and then greatly affects ones daily activities. Therefore, the shoulder condition is getting worse because of less motions due to shoulder pain and restriction within the motion range. Kaltenborn stated that the effective remedy for frozen shoulder is not only to enhance the shoulder joint exercise but also shoulder traction. Unfortunately there is no intergrated shoulder joint traction and passive motion rehabilitation device in the market. Presently in clinic physical therapists usually use manual therapy to increase the frozen shoulder patient range of motion, reduce joint stiffness, and release shoulder pain. But manual therapy is sometime a time-consuming strategy and requiring strenuous effort. Physical therapists also cannot accurately control the force of joint traction and the angle of shoulder motion. Thus, how to design and set up a rehabilitation device combined with shoulder joint traction and passive motion to improve cure of frozen shoulder becomes more important . For this reason, we will develop a robotic arm integrated joint traction and passive motion function, drawing on Innovative Design of Mechanism, Mechatronics Engineering, and Automatic Control Engineering technique. It is to help clinical physical therapists and physicians make clinical treatments of the frozen shoulder better. The research will be divided into three parts. The first part is the design and development of the robotic arm mechanism. The second part is the development and integration of the control system and operating interface software. The third part is test of the robotic arm and evaluation of the conduct application. In the first part, we will study anthropometry and do the research for how to use commercialized upper limb rehabilitation device on clinical treatment. Then, we will make requirement utilizing Quality Function Deployment (QFD) analysis technique , to set the function of the machine and engineering designed standard. We will proceed with mechanical design, analysis, and simulation. In addition to, we design and develop mechanical device of the robotic arm and its components including base lifting mechanism, wristlet structure, motion traction control mechanism and joint motion mechanism. This design utilize SolidWorks® 3D software to draft the above-mechanism and modify its detailed function. It also use motion analysis software (MSC.VisualNastran®) to simulate mechanical dynamic motion. Using finite element analysis software(SolidWorks Cosmos Works®) to analysis mechanical structure. Finally we use homogeneous transformed matrix theory to deduces mechanical forward and inverse kinematics equation. Then we can compute the mechanical motion space and manufacture, fabricate the robotic arm prototype. In the second part, we mainly integrate the control system, and develop operating software. The control system components includes Galil motion control card, servo motor, relay,and relating to electrical circuit, etc . We alse select rotational encoder, force gauge, and limit switch to detect feedback control signal. Then, Our research uses Visual Basic software to develop the operation software program. The operation program module includes: Patient Database Module, Single-/ Multi-axials Motor Control Module, and Motion Rehabilitation traction Control Module. And we must check and make sure this software program works properly. Besides, in order to insure the effect on rehabilitation of upper limb joint motion is substantial, we also use Zebris 3D ultrasonic motion analyzer to measure the human motion traction and create experimental tests. Final, we combine the control hardware with software, and proceed to an integrated functional test. In the third part, we will test the machine all function, and evaluate the human application test. The machine functional test includes: traction force measure test, continuous motion function control test, and motion rehabilitation traction control test. Then we will select 5-10 volunteers for clinical testing in one month. The clinical human application test includes: simulation of the upper limb joint traction test and the rehabilitation motion test. Finally, we use Zebris 3D ultrasonic motion analyzer measure upper limb motion trajection, rehabilitation times, motion frequency and motion angle on patients , and record all data. Results:In the traction force test, the traction force(y)/voltage(x) is a linear regression association ( y = 25.622 x2 +8.6083x- 1.4648). In the single/multi-axial motion control test，the mechanical range of motion for shoulder rotation is 0~100°, shoulder elevation is 0~90°, and elbow rotation is - 90°~90°. In the motion traction control test, we can control the reachable point and linear trajectory . In the human application evaluate: there are four people to complete the clinical test. People can accept 4~5 centimeters traction distance at 15 kilograms traction force. The motion angle rate between the machine and human is following the linear association, and the motion angle mean error is 1±2. Conclusion:Our research has finished the “Development and Evaluation of an Integrated Upper Extremity Joint Traction and Continuous Passive Motion Rehabilitation Robotic Arm.” It can be used in clinical treatment, and we will apply for a patent. We offer quantification database of the joint traction force and motion control function to improve the traditional manipulation treatment. In the future, we hope our research can help clinical physical therapists make the rehabilitation programs and processes simply.

碩士<br>長庚大學<br>復健科學研究所<br>95<br>Background and Purpose: Following injury to the spinal cord, changes of the spinal circuit, namely low frequency depression of the H-reflex, reciprocal Ia inhibition, D1 and D2 inhibition, occur in parallel to the development of spasticity. These changes do not occur instantaneously, but instead undergo a series of adaptations with time post injury. Continuous passive motion in the form of passive cycling has been shown to be effective in the restoration of adapted low frequency depression in rodents and a human case report. Single-session effects on spasticity, as quantified by improvements in Modified Ashworth’s Scale (MAS) scores, stretch reflexes and the Hmax/Mmax ratio, in spinal cord injured individuals have also been documented. The purpose of this study was to investigate the possibility of restoring the adaptations of the spinal circuit by means of long term intervention of continuous passive motion of the ankle joint. Methods: Individuals with complete spinal cord injury (n=14) were allocated into either the control group or underwent continuous passive motion of the ankle joint for 1hour/day, 5 days/week for 4 weeks. Two individuals completed 12 weeks of training. The Modified Ashworth Scale (MAS) scores for evaluation of spasticity, H-reflex low frequency depression, reciprocal Ia inhibition, D1 and D2 inhibition were documented prior to and following intervention. Results and Discussion: The MAS scores improved after 4 weeks of continuous passive motion training, indicating a reduction in spasticity of the ankle joints. The low frequency depression is restored and the strength of reciprocal Ia inhibition is increased after 4 weeks of training. No significant changes in D1 and D2 inhibition were observed. We conclude that passive motion of the ankle joint alone is sufficient in reversing the adapted spinal circuit, and thus, acts as an indicator that management of spasticity using continuous passive motion may be possible in rehabilitation of spinal cord injured patients.

碩士<br>長庚大學<br>物理治療學系<br>99<br>Background and Purpose: In animal and human studies, histochemical and physiological evidences showed that the muscle transferred from slow, fatigue-resistant muscle to fast, fatigable muscle after spinal cord injury. The alternation of muscular property was accompanied by the alternation of spinal circuitry property, and was related to the immobilization adaptation. Previous study showed that remobilization by continuous passive motion (CPM) for one month would restore the function of spinal circuitry in individual with chronic SCI. It is possible that long term application of CPM can reverse the adaptation of contractile properties of the paralyzed muscle after SCI. The purpose of this study is to investigate the effect of a four month CPM training on muscular properties in individuals with chronic SCI. Methods: Seven chronic spinal cord injury patients were recruited. All subjects received four months of ankle continuous passive motion training with a range from plantar flexion 5° to dorsiflexion 5°. The CPM training was applied one hour per day, 5 days a week. The muscle twitch, tetanic contractile properties (including force and speed-related properties of contraction and relaxation), fatigue index, and clinical evaluations of soleus (SOL) and tibialis anterior (TA) muscles were recorded monthly. Result: The effects of CPM training were different on SOL and TA muscles. In SOL muscle, the contractile properties were fasted and fatigue index improved after 3 months of training. There were no significant training effects on the contractile properties of the TA muscle. The MAS score improved after 1 month of training, indicating the reduction in spasticity and stiffness of the ankle joint. Conclusion: Four months of CPM training of the ankle joint could reverse fatigue-related alternations of the slow ankle muscle after SCI. CPM training can be a safe and appropriate clinical treatment for in individual with chronic SCI.

碩士<br>國立台北護理學院<br>護理研究所<br>98<br>This study was designed to investigate bio-feedback intervention to reduce postoperative pain and anxiety, and knee pain during continuous passive motion (CPM) of rehabilitation exercise for patents received total knee replacement surgery. This study was a experimental study design. A convenient sample of 66 total knee replacement patients who met the elegibility criteria were recruited from a medical center in Taipei. Participants were randomly assigned to ether a control ( n =33 ) or a intervention group ( n =33 ). The intervention group received a muscle relaxation training with a biobeedback mechine prior to the surgey. The participants in the control group received a usual care. The results showed that knee replacement patients had great degree of anxiety (control group: 7.5±5.3; intervention group: 5.2±3.1), and wound pain (control group: 6.4±1.9: intervention group: 6.6±1.8), and their levels of pain were aggregated (control group: 7.3±1.9: intervention group: 5.9±1.8)during the continuous passive motion knee rehabilitation exercise . The results of Generalized Estimating Equations showed that biofeedback muscle relaxation intervention had potential to reduce postoperative anxiety (ß=-1.136~-4.268), pain (ß=-0.023，p<0.001) and pain affecting to their daily life ((ß=-0.383，p=0.12) for patients reveived a total knee replacement, and biofeedback muscle relaxation intervention eased pataints’ pain during the rehabilitation exercise(ß=-1.11，p<0.001).