Design and Fabrication of Continuous

Passive Motion (CPM) Machine for Physio-Therapy of

two crucial joints namely Elbow and Knee
Submitted by:
Name Roll No.

Submitted to:

Department of Mechanical Engineering Bahauddin

Zakariya University, Multan, Pakistan
Abstract:
Continuous Passive Motion (CPM) device is widely used for knee and elbow
rehabilitation to recover the range of motion or to lessen edema and swelling of the knee and
elbow following injuries or surgeries. The objective of this work is to design and develop a
smart continuous passive motion (SCPM) for knee and elbow rehabilitation after the total knee,
and elbow arthroplasties.

Introduction:
Continuous passive motion (CPM) treatment is widely used in treating patients after various
joint surgeries to avoid joint stiffness and improve
patient’s recovery. It enhances the knee flexion range
and functionality in the initial stage of postoperative
for total knee arthroplasty (TKA). This type of
treatment can also be combined with alternative
medicines or therapy. Continuous Passive Motion
(CPM) machine automates the CPM procedure, and it
is important for helping the patients to regain their
upper or lower limb functionality after a surgery or
post joint trauma. It works by moving the patient’s
joints which can be knee, elbow, shoulder, wrist, or
fingers repetitively within a specified range of motion
(ROM) without the patients having to move the limbs
by themselves. Its continuous and passive movement avoids joint stiffness that is indicated by
joint pain and limited movement. CPM machines can also reduce pain, decrease the number of
adhesions and amount of atrophy experienced by the supporting muscles, reduce scar tissue
formation, and increase range of motion (ROM) and flexibility of the joints.

Knee osteoarthritis (OA) is a joint disease characterized by the failed repair of joint damage
caused by external stress. Symptoms and signs of knee OA include pain, stiffness, and reduced
range of motion (ROM), resulting in discomfort and reduced physical activity in older adults.
Several guidelines suggest non-pharmacological and pharmacological treatments and
emphasize the importance of maintaining physical fitness and avoiding sedentary lifestyles for
patients with OA. In cases of refractory knee OA, surgical treatment can be a useful clinical
management tool. Among surgical procedures, total knee Arthroplasty (TKA) is one of the most
successful and has resulted in a substantial increase in quality of-life gain in patients with
refractory arthritis. Continuous passive motion (CPM) machines provide passive ROM exercises
of the knee joint in a pre-defined arc of motion. CPM can be used in the early rehabilitation of
patients after TKAs and has been suggested to have advantages in regaining ROM of the knee
joint in several reports in the 1980s. Recent systematic reviews show controversy in routine use
of CPM and its advantages. A Cochrane review on CPM after TKAs was published in 2014. In this
review, CPM increased active knee flexion ROM by only 2° compared to the control groups and
did not have clinically important short-term effects on pain. CPM reduced the risk of
manipulation and adverse events, although the quality of evidence was very low. It was
reported a systematic review on use of CPM after TKAs in 2021, which demonstrated a slight
difference in active knee extension at 1 week (mean difference = 3.00°, P = 0.019), passive knee
extension at 1 week (mean difference = 3.00°, P = 0.031), and at 3 months (mean difference =
3.00° P = 0.019) compared with the control groups. Many researchers and clinicians do not
believe that these slight statistical differences in ROM lead to meaningful clinical outcomes.
Moreover, the long-term efficacy of CPM after TKAs has been questioned by many researchers.
Some studies showing the superiority of CPM over physical therapy alone applied the regimens
with a larger arc of motion.

Literature Review:
Richard L et al. 1998 [5] published the article in which he discussed the comparison between
continuous passive motion machine and professional physical therapy. To compare the
effectiveness 103 consecutive primary total knee arthroplasties in 80 patients was performed. It
was concluded that CPM machine after the hospital discharge of patients having total knee
replacement is an adequate rehabilitation with lower cost and with no difference in results
compared with professional therapy.

Bible et al. in 2009 [2] found some differences between the Actual range of motion of Knee and
that of a CPM Machine. Therefore, proper calibration and fittings are required for proper
functioning of machine. He further discovered that accuracy of CPM can be enhanced by
increasing bed angle from 30 degrees to 60 degrees.

Jidapa Rattarojpan, Sumet Umchid, (2011) [8] published the article in which it was discussed
how important a CPM machine is knee rehabilitation. The objective was to design and develop
a CPM machine with display input. The device is capable of flexing/extending the knee joint in
the range of motion from 0 to 120 degrees. Towards the goal of improved knee rehabilitation
equipment, a new design of CPM is developed and it gives better results compared to its
predecessors.

Le et al. in 2013 [4] designed and fabricated a Knee CPM machine in order to solve two design
issues. One of these issues was sliding of foot and thigh relative to linkages of machine during
training and second was unavailability of user-friendly interface. He solved 1 st problem by
proposing a sliding joint mechanism and a parallelogram linkage joints.
Dominik et al. 2015 [7] published the article presenting the design of CPM machine based on
kinematic model of lower limb. CPM machine is used to prevent the stiffening of joints and
allow recovering their full functionality after surgical interventions. The research conducted in
rehabilitation centers states that there is necessity of using CPM machines. There is need to
modernize the already existing models by improving and re-constructing functions already
implemented.

Fausti et al. in 2015 [9] discovered that the use of devices (CPM) for regaining mobility is an
important part of rehabilitation treatments for knee, elbow and shoulder. For development of
continuous passive motion machine, it is important to understand involved pathologies and a
study of treatment method and study should be carried out with persons belonging to the
clinical reality.

(Umchid & Taraphongphan, 2016) [1] published the article in which it was discussed,
Continuous Passive Motion (CPM) device is widely used for knee rehabilitation to recover the
range of motion or to lessen edema and swelling of the knee following injuries or surgeries and
also this device can perform such routine physical movements without the assistance and
guidance from the physiotherapist by helping the knee joints move slowly and continuously in
order to accelerate the recovery and improve the range of motion (ROM) after injuries or knee
replacement arthroplasty.

Mistry et al. in 2016 [3] discovered that after TKA achievement of 110 degrees of knee flexion is
satisfactory and enables the patient to perform normal daily activities. To achieve this, patients
should be incorporated into post-operative rehabilitations.

Issa et al. in 2019 [6] developed a cpm machine using Arduino which could be controlled by a
mobile application. He was successful in developing it with a user-friendly interface where
patient could control the exercise without the need of any specialist. Various parameters
including number of round, speed, dimensions of machine, range of motion, and time could be
adjusted via app. He also suggested that there is a need of more robust design. The training
process could be made more intuitive if it could be incorporated with a VR game or something
like that.

Byung Chan Lee et al. 2022 [10] discussed in his article that Total Knee Arthroplasty is an
important management strategy for patients with knee osteoarthritis refractory to conservative
management. CPM is a machine that provides passive ROM exercises of the knee joint in a pre-
defined arc of motion. The research is in progress and the conclusion till now is that the
inconsistent results of CPM machines are due to poor fitting and measurement errors. This
study aims to present a protocol for investigating a new type of CPM machine that could be
applied in a sitting position in comparison with the conventional type.
Methodology/ Methods
Mechanical Structure:
Our machine would be Aluminum made simple L-shaped linkage with simple rotational motion of lower
link. It would be actuated by using servo motor (12v DC). Arduino would be used as a micro-controller.
LCD display will be provided for display and as a touch-based input device.

3D model will be made on Software named SOLIDWORKS and required simulations will be run on same
software. After this, model will be fabricated using local resources.

Before finalizing the structure design following parameters were determined

 Average length of thigh bone (Femur)

 Average length of leg bone (tibia Bone)
 Torque required to drive the linkage system
 Linear force required by the actuator

Working:
Our machine is unique in a way that same machine can be used to cater both (Knee and Elbow) joints
one at a time. The actuated linkage can be mounted on the designated areas in order to perform desired
operation. The mounting procedure is very simple and provided in USER MANUAL.

Our machine is a User-friendly easy to use CPM machine which anyone can operate. The specification of
the machine are as follows:

[Would be added after Discusson]

There is LCD display through which following Variables can be provided to Machine by the operator.

 Speed of Rotation
 Torque of machine
 Extension angle
 Flexion angle
 Time duration

There is an emergency button present to stop the machine during emergency in case of any mishap. This
button would be operated by the patient.
References:

1. Umchid, S. and P. Taraphongphan (2016). Design and development of a smart

continuous passive motion device for knee rehabilitation. 2016 9th Biomedical
Engineering International Conference (BMEiCON), IEEE.

2. Bible, J. E., Simpson, A. K., Biswas, D., Pelker, R. R., & Grauer, J. N. (2009). Actual knee
motion during continuous passive motion protocols is less than expected. Clinical
Orthopaedics and Related Research®, 467(10), 2656-2661.
3. Mistry, J. B., Elmallah, R. D., Bhave, A., Chughtai, M., Cherian, J. J., McGinn, T., ... &
Mont, M. A. (2016). Rehabilitative guidelines after total knee arthroplasty: a review. The
journal of knee surgery, 29(03), 201-217.
4. Le, N. B., Nguyen, H. N., Nguyen, D. A., & Vo, H. D. (2013). Study on Mechanical Adaptive
Design, Construction and Control of Knee Continuous Passive Motion Machine. Journal
of Automation and Control Engineering Vol, 1(3).
5. Richard L. Worland, MD, FACS, Jorge Arredondo, Francesc Angles, Francisco Lopez
Jimenez and Douglas E. Jessup: Home Continuous Passive Motion Machine versus
Professional Physical Therapy Following Total Knee Replacement 7:13, (1998)
6. Issa, A., Aqel, M. O., Ghaben, S., Asad, A. A., Eldahdooh, K., Alastal, S., & Bratanov, D.
(2019, October). Build and Control of a Continuous Passive Motion Device using Mobile
Application and Arduino. In 2019 International Conference on Promising Electronic
Technologies (ICPET) (pp. 22-27). IEEE.
7. Dwornicka Renata, Dominic Ireneusz: Design of Continuous Passive Motion Machine
Based on Kinematic Model of Lower Limb Vol. 712 (2015) 93-97
8. Jidapa Rattarojpan, Sumet Umchid: Design and Development of Touch Screen Based
Continuous Passive Motion Device for Knee Rehabilitation (2011)
9. Fausti, D., Petrogalli, G., Villafañe, J. H., & Faglia, R. (2015). Study, design and
preliminary tests of an automatic device for elbow rehabilitation. Applied Mechanics
and Materials
10. Byung Chan Lee, Chang Won Moon, Woo S Choi, Y Mo Kim, Yong Bum Joo and Da Gyo
Lee. (2022). Clinical evaluation of usefulness and effectiveness of sitting type continuous
passive motion machines in patients with total knee arthroplasty: a study protocol
for a single-blinded randomized controlled trial