understanding your dog workshop canine rehabilitation

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Understanding Your Dog Workshop Canine Rehabilitation

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Page 1: Understanding Your Dog Workshop Canine Rehabilitation

Understanding Your Dog Workshop

Canine Rehabilitation

Page 2: Understanding Your Dog Workshop Canine Rehabilitation

Understanding Your Dog WorkshopIntroductions

Mike Jones - Course Director

Page 3: Understanding Your Dog Workshop Canine Rehabilitation

Understanding Your Dog Workshop

Page 4: Understanding Your Dog Workshop Canine Rehabilitation

Understanding Your Dog Workshop

Overview

• The Study of Dogs

• The Village Dog

• Wolves into Dogs

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Understanding Your DogOverview

• Taming the Wolf

•Training the Wolf

•Domesticating the Wolf

•So, What happened?

Page 6: Understanding Your Dog Workshop Canine Rehabilitation

Studying Dogs

Biologists characterise domestic dogs – Canis Familiarus – as successful.

There are 400 million dogs in the world.

Page 7: Understanding Your Dog Workshop Canine Rehabilitation

Studying Dogs

For the last 150 years the discussions about which wild canids dogs descended from as attracted some note-able investigators.

A “Correct” answer doesn’t matter here.

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Studying Dogs

When one species evolves into another, often the evolving species is better adapted to the changing niche than the old. The new species thrives and the old passes into fossil land.

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Studying DogsPopulation of Wolves, Coyotes, Jackals and Dogs

Wolves (Canis Lupus C. Rufus) 400,000

Coyotes (Canis Latrans) 4,000,000

Jackals (C. mesomelas, C. aureusC. simensis C. adustus) 40,000,000

Dogs (C. familiarus) 400,000,000

Page 10: Understanding Your Dog Workshop Canine Rehabilitation

The Evolution of the Basic Dog

Commensalism:

• Where ever you go in the world there are village dogs.

• We should always be looking at contemporary descendants of the original dog

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Wolves Evolve into Dogs

At some point in history there were no dogs. There where Wolves, Jackals and Coyotes but no dogs.

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Wolves Evolve into Dogs

The widely popular view is that people created dogs by artificial selection. People took pups from the den and made pets of them. They tamed them, trained them and then went out hunting. After many generations of this regime, the wolves evolved into dogs.

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Wolves Evolve into Dogs

What the wolf-pup-into-dog hypothesis is really depending on is that wolves are related to dogs (true), that dogs easily form associations with people (true), and therefore wolves must have formed relationships with people in the past (not true).

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Wolves Evolve into Dogs

Other vague assumptions are needed to support the hypothesis. For example, tame wolves supposedly behave more like dogs than wolves (also not true)

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Wolves Evolve into Dogs

• First the wolves learned to be tame, then they learn to be trainable, and the eventual result is that they become (genetically) domestic dogs.

• Wolves are not an animal to be portrayed as (very) tameable or (very) trainable.

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Taming the Wolf

The first question is, do “tame” wolves act like dogs (or, can wolves truly be tamed)?

• German wolf biologist Erik Zimmerman attempted to socialise captive wolf pups at about 19 days, he never succeeded.

• Now compare that to a dog which can still be socialised with humans at 10 weeks.

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Taming the Wolf Captive wolf pups have to be removed

from their parents at 8 to 10 days and be raised by human surrogates to get them accustomed to being around people simply so they can have their cages cleaned and they are also introduced to a leash so the handlers can move them easily while day to day cleaning operations can be made in safety. All of this is very time consuming.

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Taming the Wolf Can a wolf be tamed so it forgets its wild

ancestry? And if so does domestication follow easily?

To equate the Crislers’ experiences with that of early man, and to hypothesis that domestic dogs could result from a few people friendly wolves, is again, to overlook the basic principal of evolution.

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Training the Wolf

Now let’s look at the other hazy assumption about wolves, that once tamed, they can be trained to do something useful.

Tame wolves are never responsive to even the modest of requests such as “sit” or “stay,” you never see wolves exhibited at obedience shows or agility.

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Training the Wolf

How about training wolves to pull a sled?

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Domesticating the Wolf

Even if Mesolithic people were able to tame generations of wolves, and then train some of them to obey simple commands such as come to recall or sit, still the burning question remains:

What changes wolf genes into dog genes?

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Domesticating the Wolf

A concise Statement about this biological dichotomy was written by Laurie Corbett and Australian Biologist in his book:

The Dingo in Australia and Asia, in 1995:

Page 24: Understanding Your Dog Workshop Canine Rehabilitation

Domesticating the Wolf

The problem here is that tamed and trained wolves cannot pass those learned tricks to their offspring. To postulate artificial selection among wild wolves by Mesolithic people, starting with puppies from the wolf den, with the goal of producing domestic dogs, is wishful thinking.

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Domesticating the Wolf

Since wolves can’t pass on their tame and trained qualities to the next generation, then we have to postulate some other mechanism for the transformation of wolves into dogs.

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Speciation requires populations to Evolve – Not Individuals

Selective breeding is the way most scientists visualise the creation of dogs from wolves.

A new species then evolves over time through gradual shifting of gene frequency.

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Speciation requires populations to Evolve – Not Individuals

The biggest problem with this Hypothesis is:

There is no archaeological evidence that Mesolithic people had a big enough population of tamed or trained wolves living among them.

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So, what happened?

One significant thing happened around 15,000 years ago around the end of the last Ice Age…

Permanent settlements began springing up.

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So, what happened?

Why is the rubbish dump important?

Food remnants and bones get thrown on the dump and an ideal place for scavengers. It was around this time too, coincidentally, that archaeological evidence has shown the first form of the dog shows up.

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What happened?

The dog as we know it began to evolve from wolves naturally, these where the ones that had less of a flight response to man or, a shorter flight distance.

These wolves started to evolve with smaller heads and brains, shorter teeth and snouts more adapted to foraging than hunting.

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So, what happened?

Page 32: Understanding Your Dog Workshop Canine Rehabilitation

What happened?

Israel: Puppy in a grave circa 10,000BC

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What happened?

Page 34: Understanding Your Dog Workshop Canine Rehabilitation

What happened?

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What happened?

Simply put, selective breeding for the tameness trait set off and stimulated an entire slew of genetic changes within the animals in a surprisingly short period. It is now widely believed that the wolf underwent a similar transition to eventually evolve into the domestic dog.

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So, what happened?

Milo the village dog, checks out the dump

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So, what happened?You can still see artificial selection in action in many parts of the world, where dogs exist on the margins of society and feed on scraps.

If the final process of artificial selection is the same, distinguishing between these two theories of the evolution of dogs may seem like splitting hairs.

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Understanding dogs workshop

Summary

• We looked at the study of dogs

• The evolution of the basic dog

• Wolves into dogs

• Taming the wolf

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Understanding dogs workshop

Summary

• Training the wolf

• Domesticating the wolf

• Speciation

• What happened?

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Understanding dogs workshop

Any Questions?

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Understanding Your Dog Workshop

Canine Rehabilitation

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Understanding Your Dog Workshop

The Way Dogs Learn and Canine Communication

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Understanding Your Dog Workshop

Overview:• How Do Dogs Learn?

We will take a brief look at how dogs learn.

• The way dogs communicate.

We will look at the way dogs use body language to communicate

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Understanding Your Dog Workshop

Overview:•Calming and Stress Signals

We will look at the calming and stress signals.

• Understanding what your dog is telling you.

We will look at the dog’s body language to see what they are telling us.

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Understanding Your Dog Workshop

How Do Dogs Learn?

This part of the presentation is to give you an insight into how dogs learn

We all have our own ideas of how dogs learn and most people are surprised when they find out how they do actually learn.

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Understanding Your Dog Workshop

How Do Dogs Learn?

• Operant Conditioning

•Classical Conditioning

•Observation

•Association

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Understanding Your DogHow Do Dogs Learn?

It is important to understand that dogs learn by association so, if you only ever work with them in the garden then that is the only place that they will follow your requests. We have to work with them in as many locations as possible, at home, in the park, at the shops and out on a walk.

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Understanding Your DogThe Way Dogs Communicate

How Do You Think Dogs Communicate?

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Understanding Your DogThe Way Dogs Communicate

Dogs communicate through body language and expressions, you will hear this referred to as calming and stress signals through out the presentation

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Understanding Your DogThe Way Dogs Communicate

What we are going to do next is demonstrate the differences with human and canine introductions with the communication game. That way, you get to see it from the dog’s point of view as well.

Page 51: Understanding Your Dog Workshop Canine Rehabilitation

Understanding Your DogThe Way Dogs Communicate

The Communication Game

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Understanding Your DogCalming and Stress Signals

Let’s Watch the DVD

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Understanding Your Dog

Understanding What Your Dog is Saying

We will now look at a conversation with dogs.

What do we mean by a conversation?

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Understanding Your Dog

Understanding What Your Dog is Saying

Scenario One:

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Understanding Your Dog

Understanding What Your Dog is Saying

Scenario Two:

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Understanding Your Dog

Understanding What Your Dog is Saying

Scenario Three:

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Understanding Your Dog

Understanding What Your Dog is Saying

Scenario Four:

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Understanding Your Dog

Understanding What Your Dog is Saying

The exception: Ruby

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Understanding Your Dog

Understanding What Your Dog is Saying

What we have to remember is to watch our dog’s body language; it will tell us exactly how they are feeling at any given moment in time. We should also be aware of what our own body language is saying too,

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Understanding Your Dog

Why dogs do things we rather they didn’t.

• Chewing-

What we as humans need to understand is, dogs don’t have hands with opposable thumbs so they pick things up in their mouth to experience taste, texture, feel and chew-ability.

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Understanding Your Dog

Why dogs do things we rather they didn’t.

• Sniffing –

How many times have I seen owners dragging their dog up the road away from a lamp post, wall or telegraph pole because their dog wanted to stop and sniff dog pee or something more disgusting?

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Understanding Your Dog

Why dogs do things we rather they didn’t.

• Jumping up –

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Understanding Your Dog

Why dogs do things we rather they didn’t.

• Pulling on the lead –

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Understanding Your Dog Workshop

Summary:• How Do Dogs Learn?

We took a brief look at how dogs learn.

• The way dogs communicate.

We looked at the way dogs use body language to communicate

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Understanding Your Dog Workshop

Summary:•Calming and Stress Signals

We looked at the calming and stress signals.

• Understanding what your dog is telling you.

We looked at the dog’s body language to see what they are telling us.

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Understanding dogs workshop

Any Questions?

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Understanding Your Dog Better Workshop

With Canine Rehabilitation

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Understanding Your Dog Better Workshop

Other Things That Can Affect Behaviour

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Understanding Your Dog Better Workshop

How Diet Can Affect Behaviour

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Introduction

• Digestion System of the Dog

• How commercial pet foods came to be

• What the pet food manufactures don’t tell you

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Introduction

• Commercial Foods’ effects on behaviour and health

• Biologically appropriate raw food for dogs “BARF”

 

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Digestion System of the Dog

To look at nutrition for dogs we first need to look at their digestive physiology

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Digestion System of the Dog

Carnivores are classified as meat-eaters, (Latin, carne meaning flesh and vorare meaning to devour).

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Digestion System of the Dog

Omnivores, (from Latin omne—all, everything; vorare to devour) eat both plants and animals as their primary food source.

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Digestion System of the Dog

Herbivore is an animal that is adapted to eat plants and not meat.

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Digestion System of the Dog

That clarified in a nutshell; let’s explore the Components of a

Dog’s Digestive System:

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Digestion System of the Dog

The Mouth, Teeth Jaws and Saliva

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Digestion System of the Dog

The Dog's Dentition

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Digestion System of the Dog

The Dog Tooth Structure

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Digestion System of the Dog

Teeth Growth in dogs

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Digestion System of the Dog

Humans who lack all of their teeth get sick or malnourished because they do not digest

their food well. Chewing is an important part of digestion

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Digestion System of the Dog

Dog’s saliva does not have these enzymes. Dogs have no need for chewing their food! They can’t. Their stomach takes care of the digestion without any support from the saliva. The saliva you see when dogs are excitedly waiting for their food—lacks the enzymes. The dog’s saliva does

have a purpose—it is a lubricant for swallowing.

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Digestion System of the Dog

You can test this if you have mind too, but you need to gather enough of your own saliva and then your dog’s, put in it a dish, and do some chemical experimenting.

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Digestion System of the Dog

The Canine Stomach—and How it Digests Food

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Digestion System of the Dog

Humans have approximately 30 feet of intestine. Dogs have about 3-feet. That can help paint the

canvas for how differently we digest foods. When you hear the expression “wolfing the food down”, that is exactly what wolves and dogs do

they don’t spend a LOT of time chewing, although I have noticed my dogs thoroughly

enjoy their food, especially when they get older (Schultze 1999, 2007).

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Digestion System of the Dog

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Digestion System of the Dog

Raw food is not simple to digest. It takes some very strong chemistry to break down the raw proteins. The dog’s stomach will produce some large amounts of strong

acid, lowering the pH level down to somewhere between 1 and 2.

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Digestion System of the Dog

Most enzymes are extremely sensitive to pH. If pH is off what they need, they simply won’t function. From this perspective, the enzymes the dog has available for its own

digestion is totally different in nature to those you have in your own stomach. This implies that food that is great for a human to digest might not be digestible for a dog

and vice versa.

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Digestion System of the Dog

This is amazing and important, at the same time

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Digestion System of the Dog

Recently a client came to me with a two year old Dog de Bordeaux for training. While I was

getting some information from them on training issues they would like to deal with I noticed a

really nasty and possibly infected scar tissue on her head where the ear joined the scalp.

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Digestion System of the Dog

Scarlett After her Change In Diet

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How Commercial Pet Foods Came to Be

Up until the 1940’s commercial pet foods didn’t exist, dogs were fed what we call today, biologically appropriate raw food

and table scraps.

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What the Manufacturers Don’t Tell You

Commercial pet foods are also packed out with cheaper cereals, and are clearly stated

on the labels.

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What the Manufacturers Don’t Tell You

THE INGREDIENTS:This is in relation to the lamb variety ingredientsMeat and Animal Derivatives (Min 4% Fresh Meat, Min 4% Lamb), Derivatives of Vegetable Origin, Oils and Fats, Minerals, Coloured with CaramelAnalysis: Protein 7.5%

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What the Manufacturers Don’t Tell You

Oil 6.3%Ash 2.5%Fibre 0.8%Moisture 80.0%Copper 5mg/kg as Copper SulphateVitamin A 1500IU/kgVitamin D 150IU/kgVitamin E 50mg/kg*Vitamin levels are guaranteed until the best before date*

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What the Manufacturers Don’t Tell You

The calculation should look like this:

 

100%- 80% water content = 20%

7.5%protien – 20% dry matter = 0.35

0.35 x 100 = 35% actual protein content.

So as you can see not all is as it seems with food labelling.

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What the Manufacturers Don’t Tell You

“No artificial additives or preservatives”

How many food packages state this claim to fame?

Additives and preservatives are added to raw ingredients before the manufacturers

receive them from suppliers.

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What the Manufacturers Don’t Tell You

How often do you see wild Canids cooking their food

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What the Manufacturers Don’t Tell You

Why Do Vets & Breeders Recommend Processed Food?

When the breeder and the vet recommend feeding your dog, cat or ferret on

commercial pet food, why should you ignore such advice?

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What the Manufacturers Don’t Tell You

• As far as the breeders are concerned, it may simply be because they don’t have any knowledge of the alternative.

• Nutritional teaching in all veterinary schools is given by lecturers sponsored or provided by pet food companies

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What the Manufacturers Don’t Tell You

• It would be wrong to blame the vet students and, ultimately, the qualified vets for their lack of education concerning feeding a raw food diet. It is down to the influence and money of the pet food companies.

• Human health care professionals ALL advocate that we eat fresh and natural foods whenever possible - why should it be SO different for our pets?

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What the Manufacturers Don’t Tell You

• Pet food companies sponsor dog shows and television programmes. They advertise in your vet’s waiting room.

• We are not trying to sell you a product - we don’t make anything to sell. The many raw feeding web sites available are not trying to sell you anything either.

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What the Manufacturers Don’t Tell You

• Processed food has been around for only about 100 years.

• Be prepared to have to argue your corner with vets - and sometimes other pet owners.

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Commercial Foods’ effects on behaviour and health

Not unlike just a few years ago with E numbers and artificial colourings in human

food stuffs and drinks and the effects it had on behaviour and health of the human

population in the UK we are currently doing the same to our beloved pets when

we continue to feed biologically inappropriate foods to them.

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Commercial Foods’ effects on behaviour and health

A good example would be hypothyroidism in dogs

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Commercial Foods’ effects on behaviour and health

It’s important to look at all aspects when working and

living with dogs dog’s

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Biologically Appropriate Raw Food for Dogs

BARF versus RMB

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Biologically Appropriate Raw Food for Dogs

RMB advocates the giving of only raw meat and bones as they reason that dogs are carnivores and don’t need vegetable matter keeping it to as natural a prey diet

as their wild counterparts would eat, leaving the stomach contents of their prey.

As most of their prey animals are herbivores the stomach contents would

consist of vegetable matter.

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Biologically Appropriate Raw Food for Dogs

BARF advocates maintain that dogs need the vegetable matter as well as the raw

meaty bones to maintain a healthy, balanced diet and in fact, would eat the

stomach contents of prey animals.

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Biologically Appropriate Raw Food for Dogs

To deny dogs are different biologically and physiologically from their wild canid

counterparts will only serve to promote ill health and disease in our pets dogs.

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Summary

• Digestion System of the Dog

• How commercial pet foods came to be

• What the pet food manufactures don’t tell you

Page 113: Understanding Your Dog Workshop Canine Rehabilitation

Summary

• Commercial Foods’ effects on behaviour and health

• Biologically appropriate raw food for dogs “BARF”

 

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Understanding dogs workshop

Any Questions?

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Understanding Your Dog Better Workshop

With Canine Rehabilitation

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Canine Health and Wellbeing

Annual Boosters – necessity or not?

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Canine Health and Wellbeing

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Introduction

• The Immune System

• How Vaccines Work

• Why there is no benefits to boosters

• Alternative Protection

• Other chemical treatments and alternatives

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The Immune System

The immune system is the surveillance and defence system of the body. It recognizes foreign substances (those not belonging to the body, e.g., viruses, bacteria, pollen) by their molecular features and eliminates them from the body.

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The Immune System

Innate immune system: All organisms, even trees, have what could be considered an innate defence system. For trees it would be their bark, for dogs and cats it would be their skin, and for a bacterium it would be the cellular wall around it.

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The Immune System

A medieval castle would be a good analogy of the innate immune system.

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The Immune System

Adaptive immune system: In addition to the innate system, dogs, cats, and other animals including humans have an adaptive immune system

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The Immune System

In our castle analogy, the adaptive immune system would include archers, spear-throwers, cannoneers, and swordsmen

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The Immune System

Working together: The innate system is the first line of defence, If the invader is stopped by the innate system, no disease will occur.

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Cells of the Immune System

As we learn more about how the immune system works, it will help to have a better understanding of the players. The cells of the immune system all start out in the bone marrow, but mature along different pathways.

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Cells of the Immune System

Monocytes and macrophages

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Cells of the Immune System

Granulocytes: There are several different types of granulocytes, which differ in function and in appearance when stained with certain stains in the laboratory.

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Cells of the Immune System

Lymphocytes: Lymphocytes have a life cycle similar to animals. They are 'born' in the bone marrow. As they mature, they are 'educated.'

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Cells of the Immune System

Once educated, both the B and T lymphocytes are then employed and move throughout the body to where the jobs are.

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The Immune Response

What are antigens?

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The Immune Response

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The Immune Response

The cells of the animal’s body also contain antigens. The B and T cells are taught to ignore these and regard them as 'self'. The various blood types in people: A, B, AB, and O result from different antigens on the red blood cells.

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The Immune Response

The B cell response, antibodies, and humoral immunity:

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The Immune Response

The antigen binding sites are not 100% specific. This means that although the antibody was produced in response to one antigen, in this case Antigen1, it may also be able to bind with other antigens, e.g., Antigen2.

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The Immune Response

Cross reactions can be a problem when performing laboratory tests.

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The Immune Response

In the body, the binding of the antigen by the antibody can result in:

• Neutralizing a toxin if the antigen was on a toxin

• Deactivating a virus if the antigen was on a virus

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The Immune Response

• Activating a cell-killing series of proteins called 'complement'; antibody and complement together can lyse (break apart) bacteria and kill them

• Making the antigen (and what it is attached to) more appealing to phagocytes. This is called opsonisation. Antibody bound to the antigen is like mustard on a hot dog - the phagocytes will eat it with more relish.

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The Immune Response

The T cell response and cell-mediated immunity:

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The Immune Response

Memory: Whether the body's response is primarily humoral (through antibodies) or cell-mediated, certain T and B cells become 'memory cells.'

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The Immune Response

The memory cells created against some diseases live a long time, while those for other diseases may have a relatively shorter life span.

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The Immune Response

Two ways to acquire immunity

(active and passive)

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How Vaccines Work

Active immunity:

When people or animals are exposed to a disease-causing organism by natural means or vaccination, the antigens on the organism interact with the cells of the animal's immune system. The B cells make antibodies to destroy the organism.

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How Vaccines Work

Passive immunity:

When an animal receives another animal's defence mechanisms (antibodies and/or lymphocytes), rather than developing its own defence system, we refer to it as 'passive immunity.'

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How Vaccines Work

A disadvantage of passive immunity is that the animal's body does not have the ability to replenish it (except in the case of a bone marrow transplant).

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How Vaccines Work

Abnormalities of the Immune System

The immune system does not always function properly. Sometimes, it reacts to the wrong thing (autoimmunity), other times, it reacts too much (hypersensitivity), and sometimes it simply does not react at all (immunosuppression and immunodeficiency).

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How Vaccines Work

Autoimmunity: In autoimmunity, the immune system mistakenly sees some part of the body as foreign and starts to attack it. Both the T cells and B cells may be involved in autoimmunity. What causes autoimmunity?

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How Vaccines Work

• Genetics may play a role in the development of some types of autoimmunity. An autoimmune disease called systemic lupus erythematosis (often just spoken of as 'lupus'), is more common in German Shepherds than many other breeds.

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How Vaccines Work

• Certain drugs may alter the molecular appearance of cells. Some drugs attach themselves to red blood cells, making the cells appear 'foreign.' The body then attacks the red blood cells causing autoimmune haemolytic anaemia.

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How Vaccines Work

• As with certain drugs mentioned above, in some cases, antigen-antibody complexes may adhere to cells and cause the same type of phenomenon - the body attacks the cells since they appear foreign. In some cases, a great deal of inflammation can accompany the killing of these cells. This type of autoimmune reaction is thought to contribute to rheumatoid arthritis.

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How Vaccines Work

• Errors in the 'education' of T and B cells may make them unable to distinguish 'foreign' from 'self.'

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How Vaccines Work

Organ Specific

Non Organ Specific

Juvenile diabetes

Pemphigus vulgaris (a skin condition)

Myasthenia gravis (a nerve condition)

Autoimmune haemolytic anaemia

Rheumatoid arthritis

Polymyositis (a muscle condition)

Systemic lupus erythematosis (SLE)

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How Vaccines Work

Hypersensitivity: A hypersensitive immune

system is one which overreacts to a stimulus.

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How Vaccines Work

Immunosuppression and immunodeficiency:

Certain drugs and disease-causing organisms can

suppress the immune system.

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How Vaccines Work

The immune system is an incredible defence mechanism which protects

the body from many kinds of disease-causing agents including bacteria,

viruses, toxins, and parasites.

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No Benefit to Annual Booster

Think for a moment about that last sentence:

• Sometimes, the immune system can malfunction and either attack its own body (autoimmunity), overreact (hypersensitivity), or react insufficiently (immunodeficiency or suppression).

• So what can cause or contribute to the immune system to malfunction?

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No Benefit to Annual Booster

Believe it or not, annual revaccination can cause or contribute to immune system malfunction and disease. Duration of Immunity studies have shown us since as early as 1972 that once vaccinated immunity last for at least 7-8 years even for life.

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No Benefit to Annual Booster

When we administer annual boosters we are actually causing the immune

system to attack itself

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Alternative Protection

So what are the alternatives?

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Alternative Protection

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Alternative Protection

There are many good resources on the internet covering this topic one we

recommend is Canine Health Concerns web site

www.canine-health-concern.org.uk

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Other Chemicals & Alternatives

Spot on and Other Flea Treatments

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Other Chemicals & Alternatives

Let Me ask you, would you apply flea products your dog? ....

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Other Chemicals & Alternatives

Would you like it to look like this?

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Other Chemicals & Alternatives

Please refer to the Table on page two of the

handout

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Other Chemicals & Alternatives

As you can see most of the ingredients in flea treatments are either neurotoxins or carcinogens!

So why do we use them on dogs???

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Other Chemicals & Alternatives

What are the Alternatives?

• Garlic

• Healthy Immune System

• Daily Grooming or Brushing

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Summary

• The Immune System

• How Vaccines Work

• Why there is no benefits to boosters

• Alternative Protection

• Other chemical treatments and alternatives

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Understanding dogs workshop

Any Questions?

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Thank You For Attending The Understanding Your Dog

Better Workshop

With Canine Rehabilitation