Technical note Continuous passive motion in hand rehabilitation

This paper reviews the literature comparing the results obtained in applying regimes involving motion with those involving rest following injury or surgery. The deleterious effects of immobilisation are compared to those obtained under conditions of passive motion and intermittent passive motion. It is concluded that continuous passive motion (CPM) represents an improvement on intermittent motion. Models of CPM machines are described and some results presented. It is proposed that "intelligent" CPM would represent a further improvement in technique and a prototype machine for this purpose and some preliminary results are described. Motion is better than no motion In 1982 Bob Salter from Toronto delivered his presidential address to the Canadian Orthopaedic Association entitled, "Motion versus rest—why immobilise joints?". He observed that from the very beginnings of Western medicine there have been two schools of thought about the best way of treating injured limbs, namely the "resters" and the "movers". In the fourth century BC Hippocrates taught that in illness "it is especially needful for the body to be at rest and to lie up" while Aristotle, in the same century wrote, "the principle is that movement is life". From this time, throughout the subsequent development of orthopaedic surgery in the western world, the "resters" have maintained their popularity. It was Hugh Owen Thomas, whose dictum that rest should be "complete, prolonged, uninterrupted and enforced", who influenced generations of orthopaedic surgeons all over the world. This opinion remained unchallenged until the beginning of the twentieth century when Champonniere wrote "every movement, which is not injurious by reason of its amplitude, favours repair". He believed that "massage and motion help to relieve pain rather