Evaluation of admittance control as an alternative to passive arm supports to increase upper extremity function for individuals with Duchenne muscular dystrophy.

The degree of upper extremity active range of motion provided by an admittance control robot compared with a commercially available passive arm support for individuals with DMD who have limited arm function was investigated in this study. The reachable workspace evaluation was used to assess active range of motion provided by both devices. A visual analog scale was also used to secure participant-reported outcome measures. The admittance control robot significantly increased reachable surface area scores compared with the passive arm support for the dominant arm (Wilcoxon T = 5, P = .022, r2 = 0.263) and for the nondominant arm (paired-samples t test, t(9) = 4.66, P = .001, r2 = 0.71). The admittance control robot also significantly decreased participant-reported exertion compared with the passive arm support. Results of this study substantiated the benefits of admittance control for individuals with DMD compared with a commercially available passive arm support.

Evaluation and Verification of A Novel Wrist Rehabilitation Robot employing Safety-related Mechanism.

In this paper, we propose a wrist rehabilitation robot employing a novel actuation mechanism composed of electromagnetic clutch, brake, and motor and a safe-related mechanism. The actuation mechanism of the robot can perform both passive and active rehabilitation by the same mechanism. A torque sensor is also coupled to the actuation mechanism so as to measure the wrist joint moment in real-time. User can align his/her wrist joint to the center of rotation with the indication device. Moreover EMG is measured in real-time to evaluate effectiveness of active rehabilitation and to detect an emergency situation such as muscle spasm while doing active rehabilitation. In experiments, the effectiveness of active rehabilitation is evaluated and verified by 3D motion capture data and EMG data measured in real-time. The feasibility of the indication device is evaluated in the wrist joint alignment by verifying X-ray image of wrist and robot. Finally, we performed a usability test with five experts working in medical field, and the test result showed that the proposed robot can be applied to wrist rehabilitation.

Effect of repetitive transcranial magnetic stimulation combined with robot-assisted training on wrist muscle activation post-stroke.

OBJECTIVE: To compare the effects of active assisted wrist extension training, using a robotic exoskeleton (RW), with simultaneous 5 Hz (rTMS + RW) or Sham rTMS (Sham rTMS + RW) over the ipsilesional extensor carpi radialis motor cortical representation, on voluntary wrist muscle activation following stroke. METHODS: The two training conditions were completed at least one week apart in 13 participants >1-year post-stroke. Voluntary wrist extensor muscle activation (motor unit (MU) recruitment thresholds and firing rate modulation in a ramp-hold handgrip task), ipsilesional corticospinal excitability (motor evoked potential [MEP] amplitude) and transcallosal inhibition were measured Pre- and Post-training. RESULTS: For MUs active both Pre and Post training, greater reductions in recruitment thresholds were found Post rTMS + RW training (p = 0.0001) compared to Sham rTMS + RW (p = 0.16). MU firing rate modulation increased following both training conditions (p = 0.001). Ipsilesional MEPs were elicited Pre and Post in only 5/13 participants. No significant changes were seen in ipsilesional corticospinal excitability and transcallosal inhibition measures (p > 0.05). CONCLUSIONS: Following a single rTMS + RW session in people >1-year post-stroke, changes were found in voluntary muscle activation of wrist extensor muscles. Alterations in ipsilesional corticospinal or interhemispheric excitability were not detected. SIGNIFICANCE: The effects of rTMS + RW on muscle activation warrant further investigation as post-stroke rehabilitation strategy.

Robotic-Assisted Shoulder Rehabilitation Therapy Effectively Improved Poststroke Hemiplegic Shoulder Pain: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to investigate the therapeutic effects of a newly developed shoulder robot on poststroke hemiplegic shoulder pain. DESIGN: Prospective, single-blind randomized controlled trial. SETTING: Inpatient department of a tertiary university hospital. PARTICIPANTS: Hemiplegic shoulder pain patients (N=38) were consecutively recruited and randomly assigned to an intervention or control group. INTERVENTIONS: A newly developed robot was designed to perform joint mobilization and stretching exercises with patients lying in the supine position. Conventional physical therapy directed at both improving upper extremity mechanics and reducing neurologic injury was performed twice per day in both groups. In the intervention group, additional robotic-assisted shoulder rehabilitation therapy was administered for 30 minutes per day, 5 times per week for 4 weeks. MAIN OUTCOME MEASURES: The visual analog scale was the primary outcome, and the pain-free passive range of motion of the shoulder joint, the Korean version of the Shoulder Disability Questionnaire, and ultrasonographic grades were the secondary outcomes. The outcomes were evaluated at baseline (T0), postintervention (T1), and a 4-week follow-up (T2). RESULTS: Significant time and group interaction effects were found on the visual analog scale, in the abduction passive range of motion, and on the Shoulder Disability Questionnaire (F2,33=16.384, P=.002; F2,33=10.609, P=.012; F2,33=32.650, P=.008, respectively). Significantly higher improvements in these outcome measures were observed in the intervention group than in the control group at T1 after post hoc analysis (P<0.05, all). These improvements were sustained at T2 when the intervention group was compared with the control group (P<.05, all). CONCLUSIONS: A prototype shoulder rehabilitation robot as an adjuvant therapy improves hemiplegic shoulder pain and self-reported shoulder-related disability.

Voluntary ambulation using voluntary upper limb muscle activity and Hybrid Assistive Limb® (HAL®) in a patient with complete paraplegia due to chronic spinal cord injury: A case report.

Context: We sought to describe our experience with the Hybrid Assistive Limb® (HAL®) for active knee extension and voluntary ambulation with remaining muscle activity in a patient with complete paraplegia after spinal cord injury. Findings: A 30-year-old man with complete paraplegia used the HAL® for 1 month (10 sessions) using his remaining muscle activity, including hip flexor and upper limb activity. Electromyography was used to evaluate muscle activity of the gluteus maximus, tensor fascia lata, quadriceps femoris, and hamstring muscles in synchronization with the Vicon motion capture system. A HAL® session included a knee extension session with the hip flexor and voluntary gait with upper limb activity. After using the HAL® for one month, the patient's manual muscle hip flexor scores improved from 1/5 to 2/5 for the right and from 2/5 to 3/5 for the left knee, and from 0/5 to 1/5 for the extension of both knees. Conclusion/clinical relevance: Knee extension sessions with HAL®, and hip flexor and upper-limb-triggered HAL® ambulation seem a safe and feasible option in a patient with complete paraplegia due to spinal cord injury.

Effects of Walkbot gait training on kinematics, kinetics, and clinical gait function in paraplegia and quadriplegia.

BACKGROUND: The robotic-assisted gait training (RAGT) system has gained recognition as an innovative, effective paradigm to improve functional ambulation and activities of daily living in spinal cord injury and stroke. However, the effects of the Walkbot robotic-assisted gait training system with a specialized hip-knee-ankle actuator have never been examined in the paraplegia and quadriplegia population. OBJECTIVE: The aim of this study was to determine the long-term effects of Walkbot training on clinical for hips and knee stiffness in individuals with paraplegia or quadriplegia. METHODS: Nine adults with subacute or chronic paraplegia resulting from spinal cord injury or quadriplegia resulting from cerebral vascular accident (CVA) and/or hypoxia underwent progressive conventional gait retraining combined with the Walkbot RAGT for 5 days/week over an average of 43 sessions for 8 weeks. Clinical outcomes were measured with the Functional Ambulation Category (FAC), Modified Rankin Scale (MRS), Korean version of the Modified Barthel Index (K-MBI), Modified Ashworth Scale (MAS). Kinetic and kinematic data were collected via a built-in Walkbot program. RESULTS: Wilcoxon signed-rank tests showed significant positive intervention effects on K-MBI, maximal hip flexion and extension, maximal knee flexion, active torque in the knee joint, resistive torque, and stiffness in the hip joint (P <  0.05). These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. These improvements were associated with functional recovery in gait, balance, mobility and daily activities. CONCLUSIONS: These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. This is the first clinical evidence for intensive, long-term effects of the Walkbot RAGT on active or resistive moments and stiffness associated with spasticity and functional mobility in individuals with subacute or chronic paraplegia or quadriplegia who had reached a plateau in motor recovery after conventional therapy.

Use of Hybrid Assistive Limb (HAL®) for a postoperative patient with cerebral palsy: a case report.

BACKGROUND: The Hybrid Assistive Limb (HAL®) is an exoskeleton wearable robot suit that assists in voluntary control of knee and hip joint motion. There have been several studies on HAL intervention effects in stroke, spinal cord injury, and cerebral palsy. However, no study has investigated HAL intervention for patients with cerebral palsy after surgery. CASE PRESENTATION: We report a case of using HAL in a postoperative patient with cerebral palsy. A 15-year-old boy was diagnosed with spastic diplegia cerebral palsy Gross Motor Function Classification System level IV, with knee flection contracture, equinus foot, and paralysis of the right upper extremity with adduction contracture. He underwent tendon lengthening of the bilateral hamstrings and Achilles tendons. Although the flexion contractures of the bilateral knees and equinus foot improved, muscle strength decreased after the soft tissue surgery. HAL intervention was performed twice during postoperative months 10 and 11. Walking speed, stride, and cadence were increased after HAL intervention. Post HAL intervention, extension angles of the knee in stance phase and hip in the pre-swing phase were improved. In the gait cycle, the proportion of terminal stance in the stance and swing phase was increased. CONCLUSIONS: Hybrid Assistive Limb intervention for postoperative patients with cerebral palsy whose muscle strength decreases can enhance improvement in walking ability. Further studies are needed to examine the safety and potential application of HAL in this setting.

Upper limb robot-assisted therapy in subacute and chronic stroke patients using an innovative end-effector haptic device: A pilot study.

BACKGROUND: Significant results have been shown when an upper limb robot-assisted rehabilitation is delivered to stroke patients. OBJECTIVE: To evaluate the effects of upper limb robot-assisted rehabilitation on motor recovery in stroke patients who underwent a treatment based on a haptic device. METHODS: Thirty-nine stroke patients (twenty-three subacute and sixteen chronic) underwent rehabilitation training by using MOTORE/Armotion haptic system. Thirteen healthy subjects were recruited for comparison purpose.The following clinical outcome measures were used: Chedoke-McMaster Stroke Assessment, Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FM), Medical Research Council, Motricity Index (MI), Box and Block Test (B&B) and Modified Barthel Index (mBI).The following parameters were computed: mean speed, maximum speed, mean time, path length, normalized jerk, mean force, mean error, mean energy expenditure and active patient-robot interaction percentage.The assessments were carried-out before and after treatment. RESULTS: Significant changes were observed in both groups in the FM, MI, B&B and mean speed. Significant changes were observed in mBI, mean time, mean force, mean energy expenditure and active patient-robot interaction percentage in subacute stroke patients. In chronic stroke patients significant changes were found on the MAS-elbow. CONCLUSIONS: The haptic device used is at least as effective as an existing device used in similar studies.

Post-stroke Constraint-induced Movement Therapy Increases Functional Recovery, Angiogenesis, and Neurogenesis with Enhanced Expression of HIF-1α and VEGF.

BACKGROUND: Constraint-Induced Movement Therapy (CIMT) is one efficient approach to improve functional recovery after ischemic stroke. The underlying molecular mechanism remains unclear. In the current study, we investigated the effects of CIMT on angiogenesis and neurogenesis. To start linking our findings to molecular mediators, we further examined the expression of Hypoxia-Inducible Factor-1α (HIF-1α), Factor Inhibiting HIF-1 (FIH-1) and Vascular Endothelial Growth Factor (VEGF). METHODS: Rats were randomly assigned into three groups: a Middle Cerebral Artery Occlusion group (MCAO), a therapeutic group (CIMT+MCAO), and a sham middle cerebral artery occlusion group (Sham). Seven days after surgery, a plaster cast was placed around the unimpaired upper limb of the rats in the CIMT+MCAO group for 14 days. CIMT was performed on a horizontal ladder. Neurobehavioral consequences were evaluated using the Open-Field Test (OFT) and the Foot-Fault Test (FFT). The number of new neurons, the length of vessels as well as the expression of HIF-1α, FIH-1, and VEGF were examined before and after 14 days of CIMT. RESULTS: The CIMT+MCAO group showed a significant increase in the total length of microvessels and increased number of Bromodeoxyuridine+ (BrdU+)/NeuN+ double-labeled cells. These changes were correlated with an increase in HIF-1α and VEGF expressions and a decrease in FIH-1expression. FFT showed that the CIMT+MCAO group exhibited marked improvement in neurobehavioral outcome when compared to the MCAO group. Adverse effects on total activities or anxiety were not observed using open field analysis. CONCLUSION: CIMT-induced neuroprotection and functional recovery following cerebral ischemia were possibly mediated by an increase in endogenous HIF-1α and VEGF expression with subsequent neurogenesis and angiogenesis.

The Effects of Exoskeleton Assisted Knee Extension on Lower-Extremity Gait Kinematics, Kinetics, and Muscle Activity in Children with Cerebral Palsy.

Individuals with cerebral palsy often exhibit crouch gait, a debilitating and inefficient walking pattern marked by excessive knee flexion that worsens with age. To address the need for improved treatment, we sought to evaluate if providing external knee extension assistance could reduce the excessive burden placed on the knee extensor muscles as measured by knee moments. We evaluated a novel pediatric exoskeleton designed to provide appropriately-timed extensor torque to the knee joint during walking in a multi-week exploratory clinical study. Seven individuals (5-19 years) with mild-moderate crouch gait from cerebral palsy (GMFCS I-II) completed the study. For six participants, powered knee extension assistance favorably reduced the excessive stance-phase knee extensor moment present during crouch gait by a mean of 35% in early stance and 76% in late stance. Peak stance-phase knee and hip extension increased by 12° and 8°, respectively. Knee extensor muscle activity decreased slightly during exoskeleton-assisted walking compared to baseline, while knee flexor activity was elevated in some participants. These findings support the use of wearable exoskeletons for the management of crouch gait and provide insights into their future implementation.

Experience in the use of non-pneumatic anti-shock garment (NASG) in the management of postpartum haemorrhage with hypovolemic shock in the Fundación Valle Del Lili, Cali, Colombia.

BACKGROUND: The aim of this case series is to describe the experience of using the non-pneumatic anti-shock garment (NASG) in the management of severe Postpartum hemorrhage (PPH) and shock, and the value of implementing this concept in high-complexity obstetric hospitals. METHODS: Descriptive case series of 77 women that received NASG in the management of PPH with severe hypovolemic shock from June 2014 to December 2015. Vital signs, shock index (SI), the lactic acid value and the base deficit were compared before and after NASG application. RESULTS: Fifty-six (77%) women had an SI > 1.1 at the time shock management was initiated; 96% had uterine atony. All women received standard does of uterotonics. The average time between the birth and NASG applications was 20 min. Forty-eight percent of women recovered haemodynamic variables in the first hour and 100% within the first 6 h; 100% had a SI < 1.0 in the first hour. The NASG was not removed until definitive control of bleeding was achieved, with an average time of use of 24 h. There were no mortalities. CONCLUSIONS: In this case series of women in severe shock, the NASG was an effective management device for the control of severe hypovolemic shock. It should be considered a first-line option for shock management.

The features of Gait Exercise Assist Robot: Precise assist control and enriched feedback.

BACKGROUND: In a patient with severe hemiplegia, the risk of the knee giving way is high during the early stage of gait exercise with an ankle-foot orthosis. However, use of a knee-ankle-foot orthosis has many problems such as large amount of assistance and compensatory motions. To resolve these problems, we have engaged in the development of the Gait Exercise Assist Robot (GEAR). OBJECTIVE: To evaluate the improvement efficiency of walk with GEAR in a stroke patient. METHODS: The subject was a 70-year-old man presented with left thalamus hemorrhage and right hemiplegia. The patient underwent exercise with the GEAR 5 days a week, for 40 minutes per day. We evaluated the Functional Independence Measure score for walk (FIM-walk score) every week. The control group consisted of 15 patients aged 20-75 years with hemiplegia after primary stroke, who had equivalent walking ability with the subject at start. As the primary outcome, we defined improvement efficiency of FIM-walk, which was gain of FIM-walk divided the number of required weeks. RESULTS: Improvement efficiency of FIM-walk of the subject was 1.5, while that of control group was 0.48±3.2 (mean±SD). CONCLUSIONS: GEAR is potentially useful for gait exercise in hemiplegic patients.

Active elbow flexion is possible in C4 quadriplegia using hybrid assistive limb (HAL®) technology: A case study.

CONTEXT: Patients with complete quadriplegia after high cervical spinal cord injury are fully dependent with activities of daily living. Assistive technology can improve their quality of life. We examined the use of a hybrid assistive limb for single joints (HAL-SJ) in a 19-year-old man with complete C4 quadriplegia due to chronic spinal cord injury to restore function of active elbow flexion. This is the first report on the use of the HAL-SJ in a patient with spinal cord injury. FINDINGS: The HAL-SJ intervention for each elbow was administered in 10 sessions. Clinical assessment using surface EMG was conducted to evaluate muscle activity of the trapezius, biceps brachii, infraspinatus, and triceps brachii muscle before, and during the 2nd, 3rd, 6th, and 9th interventions. Surface electromyography (EMG) before intervention showed no contraction in the upper arms, but in the bilateral trapezius. The HAL-SJ used motion intention from the right trapezius for activation. After the 6th and 7th session, respectively, biceps EMG showed that voluntary contraction and right elbow flexion could be performed by motion intention from the right biceps. After the 10th session, voluntary bicep contraction was possible. HAL-SJ treatment on the left elbow was performed using the same protocol with a similar outcome. After completing treatment on both upper extremities, both biceps contracted voluntarily, and he could operate a standard wheelchair for a short distance independently. CONCLUSION: HAL-SJ intervention is feasible and effective in restoring elbow flexor function in a patient with C4 chronic spinal cord injury and complete quadriplegia.

The voluntary driven exoskeleton Hybrid Assistive Limb (HAL) for postoperative training of thoracic ossification of the posterior longitudinal ligament: a case report.

CONTEXT: The hybrid assistive limb (HAL) is a wearable robot suit that assists in voluntary control of knee and hip joint motion by detecting bioelectric signals on the surface of the skin with high sensitivity. HAL has been reported to be effective for functional recovery in motor impairments. However, few reports have revealed the utility of HAL for patients who have undergone surgery for thoracic ossification of the posterior longitudinal ligament (thoracic OPLL). Herein, we present a postoperative thoracic OPLL patient who showed remarkable functional recovery after training with HAL. FINDINGS: A 63-year-old woman, who could not walk due to muscle weakness before surgery, underwent posterior decompression and fusion. Paralysis was re-aggravated after the initial postoperative rising. We diagnosed that paralysis was due to residual compression from the anterior lesion and microinstability after posterior fixation, and prescribed bed rest for a further 3 weeks. The incomplete paralysis gradually recovered, and walking training with HAL was started on postoperative day 44 in addition to standard physical therapy. The patient underwent 10 sessions of HAL training until discharge on postoperative day 73. Results of a 10-m walk test were assessed after every session, and the patient's speed and cadence markedly improved. At discharge, the patient could walk with 2 crutches and no assistance. Furthermore, no adverse events associated with HAL training occurred. CONCLUSION: HAL training for postoperative thoracic OPLL patients may enhance improvement in walking ability, even if severe impairment of ambulation and muscle weakness exist preoperatively.

Developing a Wearable Ankle Rehabilitation Robotic Device for in-Bed Acute Stroke Rehabilitation.

Ankle movement training is important in motor recovery post stroke and early intervention is critical to stroke rehabilitation. However, acute stroke survivors receive motor rehabilitation in only a small fraction of time, partly due to the lack of effective devices and protocols suitable for early in-bed rehabilitation. Considering the first few months post stroke is critical in stroke recovery, there is a strong need to start motor rehabilitation early, mobilize the ankle, and conduct movement therapy. This study seeks to address the need and deliver intensive passive and active movement training in acute stroke using a wearable ankle robotic device. Isometric torque generation mode under real-time feedback is used to guide patients in motor relearning. In the passive stretching mode, the wearable robotic device stretches the ankle throughout its range of motion to the extreme dorsiflexion forcefully and safely. In the active movement training mode, a patient is guided and motivated to actively participate in movement training through game playing. Clinical testing of the wearable robotic device on 10 acute stroke survivors over 12 sessions of feedback-facilitated isometric torque generation, and passive and active movement training indicated that the early in-bed rehabilitation could have facilitated neuroplasticity and helped improve motor control ability.

The Effect of Passive Movement for Paretic Ankle-Foot and Brain Activity in Post-Stroke Patients.

BACKGROUND: This study aims at investigating the short-term efficacy of the continuous passive motion (CPM) device developed for the therapy of ankle-foot paresis and to investigate by fMRI the blood oxygen level-dependent responses (BOLD) during ankle passive movement (PM). METHODS: Sixty-four stroke patients were investigated. Patients were assigned into 2 groups: 49 patients received both 15 min manual and 30 min device therapy (M + D), while the other group (n = 15) received only 15 min manual therapy (M). A third group of stroke patients (n = 12) was investigated by fMRI before and immediately after 30 min CPM device therapy. There was no direct relation between the fMRI group and the other 2 groups. All subjects were assessed using the Modified Ashworth Scale (MAS) and a goniometer. RESULTS: Mean MAS decreased, the ankle's mean plantar flexion and dorsiflexion passive range of motion (PROM) increased and the equinovalgus improved significantly in the M + D group. In the fMRI group, the PM of the paretic ankle increased BOLD responses; this was observed in the contralateral pre- and postcentral gyrus, superior temporal gyrus, central opercular cortex, and in the ipsilateral postcentral gyrus, frontal operculum cortex and cerebellum. CONCLUSION: Manual therapy with CPM device therapy improved the ankle PROM, equinovalgus and severity of spasticity. The ankle PM increased ipsi- and contralateral cortical activation.

Assistive Control System for Upper Limb Rehabilitation Robot.

This paper presents an assistive control system with a special kinematic structure of an upper limb rehabilitation robot embedded with force/torque sensors. A dynamic human model integrated with sensing torque is used to simulate human interaction under three rehabilitation modes: active mode, assistive mode, and passive mode. The hereby proposed rehabilitation robot, called NTUH-ARM, provides 7 degree-of- freedom (DOF) motion and runs subject to an inherent mapping between the 7 DOFs of the robot arm and the 4 DOFs of the human arm. The Lyapunov theory is used to analyze the stability of the proposed controller design. Clinical trials have been conducted with six patients, one of which acts as a control. The results of these experiments are positive and STREAM assessment by physical therapists also reveals promising results.

Robot-assisted humanized passive rehabilitation training based on online assessment and regulation.

Robot-assisted rehabilitation has been developed and proved effective for motion function recovery. Humanization is one of the crucial issues in the designing of robot-based rehabilitation system. However, most of the previous investigations focus on the simplex position control when comes to the control system design of robot-assisted passive training, and pay little attention to the dynamic adjustment according to the patient's performances. This paper presents a novel method to design the passive training system using a developed assessing-and-regulating section to online assess the subject's performances. The motion regulating mechanism is designed to dynamically adjust the training range and motion speed according to the actual performances, which is helpful to improve the humanization of the rehabilitation training. Moreover, position-based impedance control is adopted to achieve compliant trajectory tracking movement. Experimental results demonstrate that the proposed method presents good performances not only in motion control but also in humanization.

Experiments and kinematics analysis of a hand rehabilitation exoskeleton with circuitous joints.

Aiming at the hand rehabilitation of stroke patients, a wearable hand exoskeleton with circuitous joint is proposed. The circuitous joint adopts the symmetric pinion and rack mechanism (SPRM) with the parallel mechanism. The exoskeleton finger is a serial mechanism composed of three closed-chain SPRM joints in series. The kinematic equations of the open chain of the finger and the closed chains of the SPRM joints were built to analyze the kinematics of the hand rehabilitation exoskeleton. The experimental setup of the hand rehabilitation exoskeleton was built and the continuous passive motion (CPM) rehabilitation experiment and the test of human-robot interaction force measurement were conducted. Experiment results show that the mechanical design of the hand rehabilitation robot is reasonable and that the kinematic analysis is correct, thus the exoskeleton can be used for the hand rehabilitation of stroke patients.

Recuperación de la artroplastia de rodilla a través de la movilización pasiva continua / Recovery from total knee arthroplasty through continuous passive motion

El propósito de este estudio es conocer los efectos de la movilización pasiva continua en pacientes intervenidos de artroplastia total de rodilla. Se desarrolló una estrategia de búsqueda en las bases de datos CSIC, PubMed, Cochrane Library Plus, Dialnet y PEDro con el fin de captar todos aquellos ensayos clínicos, en inglés y español, indexados de enero del 2000 a noviembre del 2014. Se identificaron 537 publicaciones, pero se incluyeron 12 estudios en esta revisión. La valoración de 1.153 pacientes demuestra que no existe una diferencia significativa en la mejora de la amplitud articular, dolor, equilibrio, marcha, cicatrización y estancia hospitalaria utilizando la movilización pasiva continua frente al tratamiento de fisioterapia habitual para la artroplastia total de rodilla. La aplicación de la movilización pasiva continua, a largo plazo, no aporta ningún beneficio en cuanto a la amplitud del rango articular, dolor y mejora de bipedestación y marcha en comparación con el tratamiento convencional de fisioterapia postoperatorio en la artroplastia total de rodilla. A corto plazo se consigue una mejora del rango de movilidad articular a la flexión de la rodilla (AU)

The purpose of this study was to know the effects of continuous passive mobilization in patients who underwent total knee arthroplasty. A search strategy was developed to retrieve all clinical trials, written in English and/or Spanish, published in the electronic search databases PubMed, Cochrane Library Plus, Dialnet, CSIC and PEDro. The inclusion criteria were: clinical trials published from January 2000 until November 2014 in English or Spanish. Out of 537 clinical trials that were potentially relevant, a total of 12 were included in this review. The evaluation of 1,153 patients shows that there is no significant difference in improving the range of the joint, pain, balance, motion, healing and hospital stay using continuous passive mobilization against the regular physiotherapy treatment for total knee arthroplasty. The application of continuous passive mobilization in the long-term does not provide any benefit in terms of the breadth of the range of the joint, pain and improvement of standing and motion in comparison with conventional postoperative physiotherapy treatment in total knee arthroplasty. In the short term an improvement is obtained in the range of joint motion in knee flexion (AU)