Preliminary clinical experience of a contracture correction device

Joint contractures which do not respond to conventional physiotherapy can b e difficult to treat. Serial plastering has been used effectively but is ex pensive, inconvenient to the patient and does not permit daily hygiene or c linical inspection. A mechanical device has been developed consisting a hin ged orthosis which spans the affected joint to which is attached a gas stru t to provide a corrective moment about the anatomical joint. Such an arrang ement enables prescribed corrective moments to be applied accurately follow ing clinical assessment using routine physiotherapy techniques. The inheren tly low spring rate of a gas strut ensures that the specified corrective to rque is maintained as correction occurs. Initial treatment experience under the control of the developers had genera ted wider interest in the system. A geographically distant independent orth otic supply centre was trained in the techniques of application, They treat ed nine elbow and three knee joints in patients who had not responded to ph ysiotherapy treatment. All of the patients experienced improvement. The ave rage for elbow joints was a reduction in the contracture of 25.6 degrees wi th a corrective moment of 6.8Nm over a period of 3.9 weeks. For the knee jo ints the averages were a reduction in contracture of 10.7 degrees with a co rrective moment of 12.7Nm over a period of 4 weeks. The results confirmed the practicality of transferring the system to indepe ndent clinical centres and provide evidence to support funding for a formal prospective clinical trial of the treatment approach.