veterinary rehabilitation, dr. laura perez, 11/8/14
TRANSCRIPT
Veterinary Rehabilitation
Can your patients benefit?
Laura M. Perez, DVM, CVA, CCRT
Objectives
Basic understanding of veterinary rehabilitation and its associated techniques and modalities
Review the types of cases that would benefit from rehab
Review basic techniques that can be implemented in your practice
Favorite quote
“I believe that in the near future, failing to refer a patient for physical therapy will amount to malpractice”
H.A. Apfelbach, MD 1959
Director of Orthopedics
Rush Presbyterian Medical Center
Chicago, IL
What is Veterinary Rehab?
Human Physical Therapy Treating the soldiers of World War I (1914-1918)
Equine Rehab 1960’s
Equine and Canine Rehab Mainstream in Europe and UK by 1980’s Canine Rehabilitation Institute University of Tennessee
What is Veterinary Rehab?It is NOT just the underwater treadmill or LASER therapy!
What is Veterinary Rehab? Manual therapies Therapeutic exercises Modalities Hydrotherapy
Problem solvingManaging expectationsMeeting owner’s goals
Manual Therapies
Massage
Joint mobilizations
Joint compressions
Stretching
Video
Therapeutic Exercises
Peanut ball, donut, balance disc, etc.
Rocker boards
Cavaletti poles
Hills, variety of surfaces, etc
Video
Therapeutic Exercises
CONTROLLED LEASH WALKS!!!!
Modalities
LASERTherapeutic UltrasoundNMES (E-Stim), TENSMagnetic Field Therapy (PEMF)Thermal Therapies (Heat, Cold)Shockwave
Acupuncture
LASER - Effects
Cartilage stimulation
Fibroblast production
Endorphin release
Increased angiogenesis
Lymphocyte production
Accelerated inflammatory phase
Acceleration of collagen synthesis
Reduce oxidative stress
Help take the body through the stages of healing more quickly
LASER - Indications
Arthritic conditions
Tendonitis, bursitis, fasciitis, capsulitis
Neuralgia
Ligament/tendon injuries
Wound healing
Scar tissue
Improve circulation
Pain relief
Muscle spasm
Superficial skin lesions
Stimulate acupuncture points
LASER - CONTRAindications
Over the eye
Over cancer
Over photosensitive scrubs
Over areas recently treated with cortisone injections
Over the thyroid gland
Over areas of hemorrhage
Over a pregnancy
Over unclosed fontanels
Over the vagus nerve
Over the sympathetic ganglia
Over the heart in cardiac patients
Ultrasound
ContinuousThermal effects
Increased blood flow
Increased soft tissue extensibility
Pain relief
Pulsed
Tissue repair
Bone repair
Reduce swelling
Ultrasound - Indications
Muscle spasm
Trigger points
Tendonitis, capsulitis, bursitis
Soft tissue healing
Chronic synovitis
Contusions
Fracture healing
Joint swelling
Wound healing
Adhesions
Calcifications
Ultrasound - CONTRAindications
Over eyes
Over cancer
Over areas of infection
Over areas of reduced circulation
Over a pregnancy
Over the heart
On the testes
Immediately after exercise
Immediately post-op
Ultrasound - Precautions
Boney prominences
Flared arthritic joints
Implants
Over major nerve or blood vessels
Over intracapsular swelling
Bursitis
Over the growth plate in young animals
Neuromuscular Electrical Stimulation (NMES, Estim) - Indications Disuse atrophy
Neurological atrophy
Improper muscle firing sequences
Joint effusion
Pain
Muscle spasm
Post injury muscle inhibition
Tendon/fracture healing
Neuromuscular Electrical Stimulation (NMES, Estim) - CONTRAindications
Infection
Anytime active movement is contraindicated
24 hours after active inflammation
Over analgesic areas
Animals with seizure disorders
Irritated or broken skin
Magnetic Field Therapy
Theoretic Mechanism of Action Damaged cells have altered rest potentials
(permeability to Na+ and K+). The rest potential of the cell is proportional to the ion exchange occurring at the cell membrane.
Ion exchange is affected by the rhythm of the pulsation introduced by a PEMF
Ion exchange is responsible for oxygen utilization of the cell
Lack of oxygen utilization is a problem with delayed healing and arthritic joints.
Magnetic Field Therapy
Effects of PEMF Enhanced cartilage repair
Stimulation of chondrocytes
Increase in collagen synthesis
Increase in osteogenesis
+/- nerve repair??
Magnetic Field Therapy -
Indications Bone healing
Inflammation
Muscle spasm
Pain
Disorders of the neuro system
Tendon healing
Degenerative diseases of the musculoskeletal system
Infection
Poor circulation
MS, Parkinsons
Burns and wounds
Magnetic Field Therapy -
CONTRAindications Hemorrhage
Electrical implants
Cancer
Thermal Therapies - Heat
Indications Pain relief
Increase circulation
Muscle spasm
Facilitate tissue healing
Prepare a stiff joint or muscle for exercise
Chronic swelling
Tissue scarring
Thermal Therapies - Heat
CONTRAindications Circulatory problems
Cancer
Areas prone to hemorrhage
Areas with poor/no sensation
Thermal Therapies - Heat
Application Best AFTER the acute inflammatory stage (24-
48-72 hours)
Superficial heat penetrates 1cm
Deeper tissues need 15-30 minutes to warm up
Use water as hot as the hand can tolerate
101-105 F
Thermal Therapies - Cold
Indications Pain relief
Reduce inflammation
Hemorrhage
Fever
Muscle spasm
Thermal Therapies - Cold
Precautions Poor/no sensation
Impaired circulation
Hypertension
Cold sensitivity
Over wounds
Thermal Therapies - Cold
Application First 48-72 hours following acute
musculoskeletal injuries OR any time there is heat and swelling
Apply for 10-20 minutes every 2-4 hours
New units use circulating cold for longer time (combined with compression)
Effects occur when tissue temp gets between 59-66 F
Do NOT allow for an airspace between the skin and cold medium
Air gets colder and can damage the skin
Shockwave
How it Works High energy waves (pulses or shockwaves)
Energy is released at tissue interfaces
Energy released causes a cellular reaction that results in the release of cytokines that accelerate healing
Shockwave
Effects Neovascularization = increased blood supply to
the treated tissue = regeneration in tendons, joints and bone.
Reduce inflammation and swelling
Improve tendon/ligament/muscle fiber alignment
Fracture healing
Wound healing
Shockwave
Applications Osteoarthritis
Joint injuries
Chronic back pain/LS Disease
Non-union or delayed healing fractures
Tendon/ligament injuries
Chronic wounds (lick granuloma)
Acupuncture Stimulatory for neuro patients
Local points around a specific joint or limb
Hydrotherapy
Underwater treadmillWarm water
Buoyancy
Compression
Swimming
Who can benefit?
Orthopedic cases“Pre” hab
Post op
Surgery is not an option
Anesthetic risk, financial reasons, etc.
Neurologic casesChronic, degenerative diseases
Medically managed IVDD, Post-op surgery
FCEM
Who can benefit?
GeriatricsArthritic, overweight, subtle neuro deficits
Overweight
Athletic, working dogsConditioning
Sports related injuries
Evaluation
Symmetry Stance, movement, muscle girth, etc.
Current Abilities What are they still able to do?
Current Problems – owner’s opinion Painful?
Weak?
Poor balance?
Lack of endurance?
Stiff? ROM? Flexibility?
Orthopedic
Rory bilateral biceps and supraspinatus tendinosis
MistyOlder dog with extracapsular repair for
rCCL
Misty’s Daily PT
6/30 7/01 7/02 7/03 7/04 7/05 7/06
Square
sitting
Feet up+
S.Stepping
Balance
Challenge
Stepping
Over-2-3”
2 Leg
Standing
Walk, O’s
& 8’s
Neurologic
Banner – T3-L3 myelopathy
Jude - DM
Pepper – FCE
Geriatrics
Spinner
Overweight
Lacey
Conditioning
Beans – Schutzhund
Sable – agility
Basic Techniques
PROM, stretchingCookie stretchesSit to StandPush ups
Encourage leash walking!!!
Videos/pics
Fun stuff
Ball work
Wobble board
Front feet up
Beg
Diagonals – Dog yoga