Getting Your Patients Back on All Fours: By Robert Sullivan, VMD
Understanding Rehabilitation Medicine
As veterinarians, we took an oath that included, “The prevention and relief of animal suffering… .” Since becoming a veterinarian, the meaning of those words has evolved many times for me. They now include physical rehabilitation and integrated pain management. Very quickly after learning how to repair ACLs and plate broken bones, I learned that knowing how to repair these maladies was only part of the healing process for our patients. We have to get our patients moving using physical rehabilitation along with appropriate pain medication. I enrolled in the Certified Canine Rehabilitation Program at the University of Tennessee (Knoxville) to learn more. According to the American Association of Rehabilitation Veterinarians, “Physical rehabilitation is the diagnosis and management of patients with painful or functionally limiting conditions, particularly those with injury or illness related to the neurologic and musculoskeletal systems. The goal of rehabilitation is to achieve the highest level of function, independence, and quality of life possible for the patient.” During the rehabilitation program at UT, we were introduced to methods to evaluate and measure our patient’s condition at the beginning of therapy and to track their progress during therapy. Knowing these measurements and comparing them to norms not only help us to create a treatment plan, it gives us data to show owners to demonstrate their pet’s improvement.
Some of the measurements and tools we use include: • Goniometry measures the angles of flexion and extension of the joints. • Tape measures measure the circumference of the limbs to show loss or gain of muscle mass. • Video, especially slow motion, aids in determining which limb or joint is in need of attention. • Force plates, either static or a runway, will digitally show which limb the patient is using less and on which limb the pet is placing more weight. • Thermography can pinpoint an area of inflammation in a joint, muscle, or tendon. As important as the objective measurements are, subjective, hands-on exams are essential to determine the source of lameness or pain. Observing the pet’s response, or lack of response, to flexion, extension, rotation, palpation, and pressure will help determine where you need to focus your attention. Palpating each joint to feel for crepitus, effusion, or warmth will also aid in locating injury or illness.
Simple range-of-motion exercises can be done by the owner and are part of each rehab session in the office. Cross-legged extension, which involves lifting the leg opposite the injured limb to stimulate the pet to extend the affected limb, can be taught to the owner as well. Other exercises, such as wheel-barrowing, walking on hind legs, and sit-to-standto-sit-to-lie-to-sit will also be part of the treatment plan. If capable, the patient can be asked to walk an obstacle course, the easiest being cavaletti rails for the pet to step over. Core strengthening exercises work on the whole patient, building up abdominal; epaxial; and the small, but vitally important, adductor muscles of the groin and thorax. Leaning, gently pushing the pet forward, backward, or side to side so the pet pushes back at you, are easy to learn and teach. Using exercise balls and balance boards can be added to increase the difficulty and will also allow you to pinpoint specific muscle groups.
Once the patient’s needs have been determined, a plan must be created to return the pet to normal function. Owners must understand that this is not a short process. Explaining to the owner that a single session is not enough has proven to be our biggest hurdle. The first, and sometimes hardest, step in rehab is to get the patient moving. For each day of immobility, there can be up to one week of rehab. Owners can play an important role in this stage of treatment.
Typically, when rehabilitation is mentioned, the image is of the underwater treadmill (UWT). The UWT is a wonderful tool for getting a patient to continued on next page >
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