4. Discussion

The present equipment is a final product from the technological area, that is, it is not based on documented knowledge but technology itself. Its development requires the direct production of goods, inventiveness, innovation, and it is, therefore, aimed at economic development (Battaglia, 1999).

The technological product of this present work is innovative compared to the ones mentioned in current Literature (Beny, Oster, 2004; Culhane et. al. 2001, 2006; Knoll, 2002; Mavroids et. al. 2005; Mason, Howard, 2004, 2006; Ou et. al. 2004, 2006), because it provides the creation of sequential  movements within a  timeframe, ROM and speed, specifically for each   timeframe. The knee CPM equipment developed by Sperb (2007) presents examples of graded oscillations that can also be developed in the present prototype. Both pieces of equipment have the same operation and control principle; however, they were developed for distinctive joints.

The invention of Beny, Oster (2004) also developed an orthosis for joint rehabilitation of the upper limbs, particularly with the passive movement method, adjustable for each patient according to his anatomic features for both upper limbs. This orthosis performs adduction/abduction, horizontal flexion and extension movements, internal and external rotation of the shoulder, and pronation/supination of the forearm, independently or simultaneously at different speeds and at specific angles. It is differs from the present equipment because it is exclusively designed for the elbow and forearm.

The equipment’s adjustable supports for the arm and forearm were designed and produced according to previous anthropometric measurements available in the literature (Mazzer, 2001). The arm and forearm supports are aligned to the corresponding parts and to the anatomical axis of this joint, as emphasized by Sieber (2009).

Saringer, Culhane (1999, 2005) patented in United States and Canada, a CPM equipment specifically designed for upper limbs with adjustable support for forearm length. It performs a complete ROM  pronation/supination of 90º of elbow flexion. It is electronically activated and connected to a control that is kept by the patient, with an on/off switch and load reverser for the electronic circuit. If the patient is in pain and resists the motor, the device locks the motor and the circuit modifies the direction of rotation. The drive contains two switches to control the rotation amplitude for  the forearm. In case this invention is intended for commercialization, it is suggested to use equipment control. 

A CPM device, which performs isolated or combined forearm flexion/extension and pronation/supination movements, was developed in Brazil by Mazzer (2001). National technology was utilized as the ideal systems support base, ; a swivel chair with an adjustable seat  and back; an  independent and combined movement system, which consists of motors, spindle, arm and forearm supports and pulley systems; drive and control mechanism, which consists of an on/off control, and a speed and movement control. It is worth noting that this equipment is not computerized.

Culhane et. al. (2001, 2006) patented a therapeutic movement device that includes an elbow flexion/extension mechanism, forearm pronation/supination and compensation for the valgus angle of the elbow. It enables a complete ROM variation of forearm flexion, pronation and supination either synchronized, independent or in series.  The equipment  for this study is controlled by an interface that allows  the operator to adjust the travel speed in CPM, ROM, pause time at the end of the cycle and load reversion; however, it does not allow  programming the sequence of movements.  

Mavroids et. al. (2005) built and optimized a portable device for elbow rehabilitation with three configurations: passive, active and orthosis. It functions as a CPM device in which a sensor provides a constant feedback, enabling the patient to perform maximum ROM during each cycle.   Passive movement speed and torque are controlled through a motor that controls   the current and tension, respectively. In the active mode a variable resistance is applied by using a breaker. Both modes are controlled, monitored and recorded using a specific computer program.

Ou et. al. (2004, 2006) developed a piece of equipment in which the CPM mode is activated when the monitor does not detect muscle contraction; otherwise it only assists the movement. D'Alessandro et. al. (2005) underscores the existence of isokinetic dynamometers, which are largely utilized in muscle performance assessment; however, its application in clinical practice is uncommom due to its high cost.  Aquino et. al. (2006) explains that those isokinetic dynamometers, for example, the Biodex Medical System, has a passive mode of operation in which the patient’s desired articulation is made at a constant speed, at predetermined amplitudes, and  with torque resistance  against the movement register.

Study limitations

The Computerized CPM prototype is only the initial phase of the product development. The project for this equipment needs to be completed and to be tested with patients; the equipment must be improved and optimized. This study is a Masters Program project, thus the completion of this project was not accomplished and its development is linked to the time taken for the execution of the research project.  Furthermore, greater financial investment is required for its optimization.

By implementing  the software to automatically create text files in standard CNC language, which is necessary for the equipment to function with the proposed technique, it is demonstarted that the technique is easy to understand and it does not require knowledge about CNC machine programming by the physical Therapist. This software demonstrates that the methodology can be used on other CPM equipments currently available on the market. It is  necessary only to make adjustments on which stepper motors or servo motors are to be used as drive elements for the axis of the movements. However, there is an incompatibility between the technical knowledge of the CNC machine operators, for which the control programs were developed, and the health professionals. This demonstrates a   necessity for implementing resources to drive the motors in the generation system for CNC programming. It is recommended to invest in the improvement of a program dedicated to this type of machine.  This improvement can be performed through the application of control techniques as presented in the studies carried out by Goellner (2006) and Cristo (2009).

5. Conclusions

The prototype of the Computerized CPM Elbow and Forearm   Equipment, in addition to being compact and easily   adapted    for use in hospitals, clinics, consultation rooms, universities and research laboratories; demonstrates a new possibility to utilize computerized numerical drive and control systems.  This innovation, through automation technology, will facilitate the work of professionals and will contribute to efficient treatment in respect to patient recovery. .

It is worth noting that the methodology of this study does not replace professionals within the industry. The computerized CPM must be considered only as a tool for the physical therapist, to assure the automatic and precise performance of what has been programmed.  The efficiency of the treatment depends on the correct specification regarding operational data and the supervision of the process by professionals who are qualified for rehabilitation and work with movement malfunctions.

Therefore, the proposed objectives for this study were met. The Computerized Elbow and Forearm Continuous Passive Motion Equipment was built. CNC technology was used to operate the equipment. This enables the automatic creation and execution of movement sequences. However, additional studies can improve the technology better for patient testing, or for use it in other equipments for the health care area.

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