The Flexionater can generate loads from zero to several hundred foot-pounds of torque to accommodate the specific mechanical characteristics of...
For approximately the first 6-8 weeks following a first time injury or surgery it is important to closely monitor post operative progress --- your patient’s rate of progress in recovering joint motion. Situationally, the physical therapist may or may not draw your attention to abnormal deficits, in range of motion, but it is an important healing period.
As an example, we heard (from numerous treating physical therapists, treating knee flexion deficits) that a normal knee patient who begins conventional therapy, experiences a normal gain of about 5 degrees of flexion per week. Any pace slower than that is cause for concern. The short timeframe for development of intractable contractures means that staying alert is essential.
When communication about patients is good, a physical therapist may suggest that you order an ERMI device when they notice that a patient is failing to make satisfactory progress. It is important to follow this suggestion promptly. Again, the window of opportunity to avoid a permanent loss of motion may be closing.
However, many therapists are unaware of the ERMI option. Others resist using an ERMI device and prefer treating a patient longer manually themselves, despite some early signs of lack of motion gains. Other therapists believe that all home mechanical therapy is the same and compliance is low.
When you experience the difference, you can help any of these types of therapists understand that ERMI devices are different and will improve their clinical outcomes.
It is important to note that problems can occur in detecting failure to recover range of motion in time to correct it because:
- Some PTs do not habitually measure range of motion precisely, which is a best practice.
- Communication gaps occur between Physical Therapists and Physicians when patients are in rehab and do not go back to the physician’s office for a check up for several weeks. Others neglect to draw your attention to the big picture, and expect you to pour over the detailed patient notes, buried in their report and see their implications.
- Communication gaps and separate visits to physician and physical therapy offices can often cause lags in the detailed patient notes about how little range of motion progress is being made, so the implications associated with deficits in motion and the necessity to medically treat the condition can be unintentionally buried.
A good way to prevent these problems is to communicate more and work with PTs closer, who you know are alert to these issues, or to include in your order a request for the PT to measure and report the actual number of degrees of progress or loss each week.
If you are dealing with a therapist whose clinical track record is unknown to you, be sure to stay alert for lack of progress. Take the initiative to determine if there is lack of progress, and consider introducing or ordering an ERMI device.
Alternatively, a trained ERMI representative will work and partner with you, your team, and the therapist to identify patients who are failing to make gains under usual therapy, and before the scar tissue matures further beyond 8-12 weeks post surgery in the natural history of this small segment of patients. In cases where the patient has a history of failing to make motion gains, some physicians order ERMI devices to support rehab and physical therapy more aggressively after second surgeries or manipulation under anesthesia (MUAs). These physicians treat known outliers earlier by ordering ERMI devices for use immediately after a second procedure on the joint to avoid further medical complications.