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Articular Cartilage Pathology and Therapies
Published in Kyriacos A. Athanasiou, Eric M. Darling, Grayson D. DuRaine, Jerry C. Hu, A. Hari Reddi, Articular Cartilage, 2017
Kyriacos A. Athanasiou, Eric M. Darling, Grayson D. DuRaine, Jerry C. Hu, A. Hari Reddi
Concomitant treatments, such as different rehabilitation regimens (Hambly et al. 2006; Reinold et al. 2006), and patient age (Giannoni et al. 2005) and surgical history (Mithofer et al. 2005) are all factors that influence treatment outcomes. For instance, clinical studies involving joint repair have long established that immobilization inhibits long-term healing in articular cartilage (Kim et al. 1995; Athanasiou et al. 1998; Alfredson and Lorentzon 1999; Lee et al. 2003). Motion is needed to induce movement of fluid and nutrients throughout the joint spaces, as well as to provide mechanical cues that can stimulate the chondrocytic phenotype. However, for emerging therapies, such as engineered articular cartilage, the strenuous mechanical environment of the joint can prove to be too challenging for newly formed tissues, resulting in rapid failure of such implants. Thus, continuous passive motion (CPM) is an adjunctive therapy that is commonly used for the first 2 weeks after surgery to improve the therapeutic outcomes of surgical treatments (Figure 3.24). CPM facilitates the transport of fluid, nutrients, and solutes within the joint, thereby stimulating chondrocyte metabolism (Lee et al. 2003). CPM alone may be insufficient since it does not allow any significant loading of the tissue (Athanasiou et al. 1998). Active motion, including incremental strength and weight-bearing exercises, may be necessary to stimulate repair processes during rehabilitation. As in many in vitro experiments, chondrocytes respond favorably when suitable mechanical forces are present.
Treatment Devices
Published in Laurence J. Street, Introduction to Biomedical Engineering Technology, 2023
These continuous passive motion (CPM) devices simply flex and extend joints, especially knees, by gripping an extremity such as a foot and moving it back and forth. The rate and degree of motion can be set for each patient, and a timer may be used to set treatment duration.
Treatment Devices
Published in Laurence J. Street, Introduction to Biomedical Engineering Technology, 2016
These continuous passive motion (CPM) devices simply flex and extend joints, especially knees, by gripping an extremity such as a foot and moving it back and forth. The rate and degree of motion can be set for each patient, and a timer may be used to set treatment duration.
Soft medical robotics: clinical and biomedical applications, challenges, and future directions
Published in Advanced Robotics, 2019
Jen-Hsuan Hsiao, Jen-Yuan (James) Chang, Chao-Min Cheng
Mobility impairment of the hand or limb caused by neurological disorders, post-traumatic arthritis, cerebral palsy, etc., may affect quality of life. Those afflicted must do rehabilitation exercises such as continuous passive motion (CPM) exercise, to help them augment their range of motion and strength. Many robotic devices have been built in order to assist these patients with motion. However, most of the current robotic devices are built with metallic materials. Not only are these rigid exoskeletons costly, they are hard to align with real hand or limb movement. These hard robotic devices must often be operated in clinical or complex settings, making it difficult to provide easy-access, daily living assistance. Recent soft actuator developments have introduced soft robotic gloves as an alternative solution to rehabilitation therapy and daily-living assistance [38–40]. The lightweight, low inherent stiffness and compliant materials characteristic of soft actuators have facilitated soft robotic approaches to improve motion paths that are kinematically similar to human’s (Figure 4). One review paper that focused on recently developed hand rehabilitation and assistance devices developed a general framework to compare key design elements including portability, user intent detection method, safety input, actuation system, human-robot interface, evaluation metrics, and modes of rehabilitation in their analysis [41].