passive movements in itu - worthy?

[Martin345]

i've just started at a new hospital
the previous itu senior physio said they don't do passive movements on itu patients as there is no evidence that doing these once per day has sufficient carryover to the next day to make them worthwhile. if ROM is decreasing then splints should be used.

what do you think? i'm all in favour of splints if things are deteriorating, but i've always been a fan of passive movements for a variety of reasons.

is there any evidence or research into this that has been related to itu? i have asked this same question in the cardiorespiratory forum.

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[Physiobase]

Range might be one measure and perhaps your senior is correct. However joint lubrication is another. I am only guessing here but I imagine that joint movement itself has an effect on the synovial tissue and makeup of the constituent fluid. Perhaps you can research this for us. If so passive movements would help preserve joint integrity which will later be important as the muscles begin to be used.

If this is true then it would support to use of passive movements for a broader benefit 8o

[sdkashif]

In patients who cannot exercise actively, passive exercise, to prevent joint stiffness and muscle contracture, is used. Passive exercises have the benefit of maitaining the existing joint range and preventing the further deterioration in the range loss due to immobility. Although the splints have the benefits of preserving the existing range, yet exercise have their own benefits and these are

Adhesion formation is prevented and the present free range is maintained. One passive movement, well given and at frequent intervals, is sufficient for this purpose, but the usual practice is to put the joint through two movements twice daily.

When active movement is impossible due to inactivity, these movements may help to preserve the memory of movement patterns by stimulating the receptors of kineasthetic sensation.

When full range active joint movement is impossible, the extensibility of muscle is maintained, and adaptive shortening is prevented.

The venous and lymphatic return may be assisted slightly by mechanical pressure and by the stretching of the thin walled vessels which pass across the joint moved. Relatively quick rhythmical and continued passive movements are required for this. They are used in conjunction of the elevation of the part to relieve oedema when the patient is unable unwilling to perform sufficient exercise.

The rhythm of the passive continued movements can have a soothing effect and indue furtehr relaxation.

[friendlypain]

Hey all,

from what I remember, passive movements are essential for joint health and muscle length. if there was surgery done to a muscle, loose bodies in the joint, or a broken bone, then it is contraindicated.... infact, I cant think of anything else that would be a contraindication.

Adamo

[alophysio]

Hi.

I am a cynic simply because we spend a few minutes doing their passive movements and then they spend hours lying there in rought the same position.

I am not saying that it is not beneficial, just a little silly if we only see them once or twice a day.

If we are going to do them, then perhaps an hourly routine may be better but who has got the time to do that. Either that or sweet talking the nurse to do it - unlikely.

Of course, I have aboslutely no evidence either way to either back up my assertions or deny yours!

[friendlypain]

Hey Alophysio

I dont think ANY study has been done on it. I think it's more of strategic value to do passive movements. It offers a quick diagnostic, for instance, to see if a structure is suffering from a contracture or is not healing properly or <insert reasons here>.

I do agree that moving it for 60 seconds for joint nutrition will be similar to giving a starving man a sliver of candy. Since there is a limited time available for each patient, passive movements may not be a desired protocol <trying hard not to sound like a parrot> .

So Martin345, in my own opinion, I think your senior is right. There are more effective techniques to aid your patients to get to the stage where they can do assissted ROM.

Adamo