Veterinary Neurologic Rehabilitation: The Rationale for a Comprehensive Approach.

The increase in client willingness to pursue surgical procedures, the heightened perceived value of veterinary patients, and the desire to provide comprehensive medical care have driven the recent demand of using an integrative treatment approach in veterinary rehabilitation. Physical therapy following neurologic injury has been the standard of care in human medicine for decades, whereas similar rehabilitation techniques have only recently been adapted and utilized in veterinary medicine. Spinal cord injury is the most common neurologic disease currently addressed by veterinary rehabilitation specialists and will be the primary focus of this review; however, research in other neurologic conditions will also be discussed. Of particular interest, to clients and veterinarians are techniques and modalities used to promote functional recovery after neurologic injury, which can mean the difference between life and death for many veterinary patients. The trend in human neurologic rehabilitation, often regardless of etiology, is a multimodal approach to therapy. Evidence supports faster and improved recoveries in people after neurologic injury using a combination of rehabilitation techniques. Although the primary neurological disorders researched tend to be spinal cord injury, peripheral neuropathies, allodynia, multiple sclerosis, and strokes-many correlations can be made to common veterinary neurological disorders. Such comprehensive protocols entail gait training activities in combination with neuromuscular electrical stimulation and directed exercises. Additionally, pain-relieving and functional benefits are bolstered when acupuncture is used in addition to rehabilitation. Studies, both laboratory and clinical, support the use of acupuncture in the management of neurologic conditions in small animals, specifically in cases of intervertebral disc disease, other myelopathies, and neuropathic pain conditions. Acupuncture's ability to promote analgesia, stimulate trophic factors, and decrease inflammation, including neuroinflammation, make it an alluring adjunct therapy after neurologic injury. Although there is limited research in veterinary medicine on physical techniques that expedite recovery after neurologic injury, there are sparse publications on clinical veterinary research suggesting the benefits of acupuncture, rehabilitation, and LASER in dogs with intervertebral disk disease. Accordingly, due to the relative lack of evidence-based studies in veterinary neurologic rehabilitation, much of the data available is human or laboratory-animal based, however, evidence supports the utilization of an early, comprehensive treatment protocol for optimal neurologic recovery. The rationale for why an integrative approach is critical will be detailed in this review; in addition, literature on specific physical rehabilitation techniques that have evidence of improved recoveries after neurologic injury, will be addressed.

Physical agent modalities in physical therapy and rehabilitation of small animals.

Physical agent modalities can be effective components of the overall rehabilitation of small animals. This article reviews the effects, indications, contraindications, and precautions of cold, superficial heat, therapeutic ultrasound, and electrical stimulation.

Nonpharmaceutical approaches to pain management.

A nonpharmaceutical approach to managing pain is one that does not employ a medication. The use of such approaches, in conjunction with pharmaceuticals as part of multimodal methods to managing pain, is becoming more popular as evidence is emerging to support their use. Cold therapy, for one, is used to reduce the inflammation and tissue damage seen in acute injuries and can be very effective at reducing acute pain. Incorporating the use of superficial heat therapy when treating pain associated with chronic musculoskeletal conditions is often employed as heat increases blood flow, oxygen delivery, and tissue extensibility. Acupuncture is gaining acceptance in veterinary medicine. Research is confirming that release of endogenous endorphins and enkephalins from the application of needles at specific points around the body can effectively control acute and chronic pain. The use of 2 newer therapies-extracorporeal shockwave therapy and platelet-rich plasma-represent an attempt to eliminate the causes of pain at the tissue level by promoting tissue healing and regeneration. Reviewed in this article, these therapies are intended to be used in conjunction with pharmaceuticals as part of a multimodal approach to pain management.

Bovine ocular squamous cell carcinoma.

Ocular squamous cell carcinoma (OSCC) in animals is a primary neoplasm of epithelial origin. OSCC or "cancer eye" is the most common malignant tumor affecting cattle in North America and is responsible for significant economic losses. In the United States, the prevalence of OSCC varies geographically and is higher in the southwestern region and in lower latitudes with higher levels of sunlight. Control of this disease would be of considerable significance to the economics and profitability of the beef and dairy cattle industries. This article reviews the characteristics of the most commonly affected animals, the factors that are believed to contribute to the development of OSCC, and the treatment options that have been proposed.

Acute laminitis: medical and supportive therapy.

Acute laminitis is a serious complication of many primary conditions in the horse. This article summarizes the most appropriate approach to management of the horse with acute laminitis, based on current information.

Effects of cold compression, bandaging, and microcurrent electrical therapy after cranial cruciate ligament repair in dogs.

OBJECTIVE: To compare 4 therapeutic techniques to reduce soft tissue swelling after cranial cruciate ligament repair in the dog. STUDY DESIGN: Prospective study. ANIMALS: Twenty-four dogs with cranial cruciate ligament rupture (CCLR). METHODS: Dogs with naturally occurring CCLR, were surgically repaired by an extracapsular technique and randomly divided into 4 treatment groups (cold compression [CC], modified Robert Jones bandage [B], cold compression and bandage [CCB], and microcurrent electrical therapy and bandage [METB]) each with 6 dogs. Data were collected at 2 time points, the morning after surgery before the 1st treatment and 72 hours later after the last treatment. Limb girth was measured at 3 anatomic locations to assess soft tissue swelling and all affected limbs were evaluated for presence (or absence) of pitting edema and bruising. Analysis of covariance was used to determine effect of treatment on the percent change in circumference. Duncan's multiple-range test was used to determine differences in treatment groups circumferential percent change over 72 hours. Statistical significance was set at P<.05. RESULTS: Use of a Robert Jones bandage had the least effect on reducing postoperative soft tissue swelling with CC, METB, and CCB being equally effective in reducing swelling by 72 hours after surgery. CONCLUSION: Use of cold compresses alone or with a bandage, or using microcurrent electrical therapy in combination with a bandage decreases soft tissue swelling over 72 hours more than a bandaging alone after extracapsular repair of CCLR. CLINICAL RELEVANCE: CC, METB, and CCB should be considered as viable options to limit soft tissue swelling after extracapsular repair of CCLR in dogs.

Rehabilitation in the first 48 hours after surgery.

Physical therapy is commonly used postoperatively in humans to decrease pain, inflammation and recovery time. The same goals can be achieved in our veterinary patients using similar modalities such as; cryotherapy, passive range of motion, massage, transcutaneous electrical stimulation and low-level light laser therapy. When used in the first 48 hours following surgery, the reduction in pain, increased mobility, and decreased inflammation will aid in early return to normal function. Applied appropriately these treatments have both immediate and long term benefits.

Physical agent modalities.

The purpose of this article is to review the use of cold, heat, therapeutic ultrasound, and electrical stimulation in small animal rehabilitation. The material in this article is a compilation from the veterinary and hu-man literature. Additional information is needed on how to adapt the techniques used in human beings to small animals and then to establish the efficacy of these techniques in animals.

The role of exercise and physical modalities in the treatment of osteoarthritis.

Physical rehabilitation is a valuable and often underutilized part of the overall management of small animals with OA. A team consisting of the veterinarian, physical therapist, veterinary technician, and owner is vital to determine and carry out an appropriate therapeutic regimen. To maintain enthusiasm for the program, measurements should be regularly obtained to document progress. In addition, controlled studies should be performed to determine the degree of improvement that may be expected with physical rehabilitation programs.