Select Manual Assessment Techniques and Clinical Reasoning Skills Used in Canine Physical Rehabilitation Before Engaging in Manual Therapy Treatment.

Manual therapy is a cornerstone of physical therapy and canine physical rehabilitation. Although veterinary literature has tackled the topic of manual therapy treatments in animal patients, less attention has been paid to the assessment techniques and clinical reasoning skills that guide a practitioner toward determining if, when, and where manual therapies will be most effective. This article tackles the topics of clinical reasoning, the functional diagnosis, observational skills, and physical evaluation techniques that serve as prerequisites to the use of manual therapeutics.

Utilização da fisioterapia na reabilitação de bezerro com poliartrite e paresia neuromuscular: relato de caso / Use of physiotherapy in the rehabilitation of calves with polyarthritis and neuromuscular paresis: case report / Uso de la fisioterapia en la rehabilitación de un ternero con poliartritis y parisia neuromuscular: reporte de caso

A reabilitação animal na medicina veterinária é um campo recente, porém crescente a cada dia. Neste sentido, a fisioterapia veterinária atua trazendo inúmeros benefícios, como melhoria dos movimentos, redução da dor, edema e outras. Interfere ainda no tempo de recuperação, redução de custos para o proprietário, podendo ser hoje utilizada como um tratamento na recuperação pós-cirúrgica. Desta forma, objetivou-se relatar o uso da fisioterapia em uma bezerra com poliartrite e paresia neuromuscular. O animal apresentou um aumento de volume nas articulações cárpicas e társicas após histórico de onfalite, permanecendo em decúbito esternal por vários dias. O proprietário resolveu aplicar ferro dextrano na região glútea do animal, o que causou uma lesão de nervo isquiático. Foram instituídos protocolos medicamentosos e fisioterápicos, que culminaram no estímulo da marcha, propriocepção, além de hipertrofia muscular. Porém, em virtude de complicações resultantes de onfalite, o animal veio a óbito.(AU)

Animal rehabilitation in veterinary medicine is a recent field, but growing every day. In this sense, veterinary physiotherapy works bringing numerous benefits, such as improved movements, reduced pain, edema and others. Reducing the recovery time, reducing costs for the owner, and today it can be used as a treatment in post-surgical recovery. In this sense, the objective was to report the use of physiotherapy in a heifer with polyarthritis and neuromuscular paresis. The animal showed an increase in volume in the carpal and tarsal joints after a history of omphalitis, remaining in sternal decubitus for several days. The owner decided to apply iron dextran to the animal's gluteal region, which caused an injury to the sciatic nerve. Medicinal and physical therapy protocols were instituted, which culminated in the stimulation of gait, proprioception, in addition to muscle hypertrophy. However, due to complications resulting from omphalitis, the animal died.(AU)

La rehabilitación animal en medicina veterinaria es un campo reciente, pero en crecimiento cada día. En este sentido, la fisioterapia veterinaria actúa aportando numerosos beneficios, como mejora de los movimientos, reducción del dolor, edemas y otros. Disminución del tiempo de recuperación, reducción de costos para el propietario, pudiendo ser utilizado hoy en día como tratamiento en la recuperación posquirúrgica. En ese sentido, el objetivo fue reportar el uso de fisioterapia en una vaquilla con poliartritis y paresia neuromuscular. El animal presentó un aumento de volumen en las articulaciones del carpo y del tarso tras un antecedente de onfalitis, permaneciendo en decúbito esternal durante varios días. El propietario decidió aplicar hierro dextrano en la región glútea del animal, lo que provocó una lesión en el nervio ciático. Se instauraron protocolos farmacológicos y de fisioterapia, que culminaron con estimulación de la marcha, propiocepción, además de hipertrofia muscular. Sin embargo, debido a complicaciones derivadas de la onfalitis, el animal falleció.(AU)

Conservative Management of Hip Dysplasia.

Hip dysplasia (HD) is a common orthopedic condition seen in small animal patients that leads to osteoarthritis of the coxofemoral joint. The disease can be managed conservatively or surgically. The goals of surgical treatment in the immature patient are to either prevent the clinical signs of HD or to prevent or slow the progression of osteoarthritis. In mature patients surgery is used as a salvage procedure to treat debilitating osteoarthritis. Conservative management can be used in dogs with mild or intermittent clinical signs and includes nutritional management and weight control, exercise modification, physical rehabilitation, pain management and disease-modifying agents.

Physical Rehabilitation for the Management of Canine Hip Dysplasia.

Hip dysplasia is among the most common orthopedic conditions affecting dogs. Joint laxity is responsible for abnormal development of the femoral head and acetabulum, leading to excessive wear of the articular cartilage. Wear leads to secondary osteoarthritis. Rehabilitation is either conservative or after surgical management. Conservative rehabilitation therapies are directed at decreasing pain, improving hip range of motion (ROM), and building or maintaining muscle mass. Postoperatively, rehabilitation focuses on decreasing postoperative pain and inflammation, improving comfort and limb use, and protecting the surgical site. Once the patient has healed, rehabilitation is directed at improving ROM and promoting muscle mass.

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.

Use of physical therapy in a dog with bilateral severe plantigrade stance.

A 3.5 yr old spayed female Staffordshire terrier weighing 25.5 kg was presented with a 7 wk history of bilateral plantigrade stance in the pelvic limbs directly following an ovariohysterectomy procedure. Upon presentation, the dog had bilateral atrophy of the distal pelvic limb muscles, enlarged popliteal lymph nodes, and ulcerative wounds on the dorsa of her rear paws. Orthopedic examination revealed intact calcaneal tendons bilaterally and neurologic examination localized the lesion to the distal sciatic nerve. A diagnosis of compressive and stretch neuropathy was made affecting the distal sciatic nerve branches. Physical therapy modalities included neuromuscular electrical stimulation, ultrasound, and low-level laser therapy. Other therapeutic modalities included the use of orthotics and progressive wound care. The dog had increased muscle mass, return of segmental reflexes, return of nociception, and the ability to walk on pelvic limbs with higher carriage of the hock 15 mo following presentation. The use of custom orthotics greatly increased the quality of life and other physical therapy modalities may have improved the prognosis in this dog with severe bilateral plantigrade stance due to neuropathy.

Swimmer syndrome in a clouded leopard (Neofelis nebulosa) cub.

A 32-day-old, hand-reared, captive-born female clouded leopard (Neofelis nebulosa) cub presented as being unable to stand, ambulate, or adduct both hind limbs. The cub exhibited hyperextension of both tarsal joints and a flattened thorax, which limited mobility to "swimmer-like" movements. Neither congenital defects nor neurologic deficits were observed during the medical examination. Radiographic examination showed the thorax was compressed dorsoventrally, but no other skeletal abnormalities were detected. Based on clinical signs, the condition was more consistent with swimmer syndrome, which has been described in young offspring of several domestic species. Over the course of 3 wk, affected limbs were treated by intensive physiotherapy, corrective bandages were applied, and thermotherapy was used to improve circulation, which resulted in a complete recovery and development of subsequent normal ambulation. It is concluded that early diagnosis and treatment of this condition led to the resolution of clinical signs, resulting in normal development of the clouded leopard cub reported here.

The use of allied health therapies on competition horses in the North Island of New Zealand.

AIM: To obtain data on the use of allied health therapy within competitive equestrian sport in the North Island of New Zealand. METHODS: Data were collected during January 2010 by survey at show jumping and dressage championships in the North Island, and from racing yards in the Central Districts of New Zealand. The survey consisted of 30 open, closed and multiple-choice questions, and was conducted face-to-face, by the same interviewer. Information on the demographics of riders or trainers and horses in each discipline (show jumping, dressage, and Thoroughbred racing), the use of allied health therapy (physiotherapy, chiropractic and equine sports massage) on horses, and knowledge of training and qualifications of the allied health therapists was obtained. Univariable and multivariable logistic regression were used to examine relationships between demographic variables and the use of allied health therapists. RESULTS: In total, 110 riders or trainers participated in the survey. The relative contribution of responses across disciplines was 39/110 (36%), 41/110 (37%) and 30/110 (27%) for show jumping, dressage, and Thoroughbred racing respectively. Allied health therapists were used by 68/110 (62%) respondents to treat their horses. The most common types of allied health therapy used were chiropractic (25/68; 37%) and physiotherapy (16/68; 24%). The main reasons for using allied health therapies were for back pain (22/68; 32%) and lameness (17/68; 25%). Only 5/68 (7%) respondents chose a type of allied health therapy based on veterinary advice, and 49/68 (72%) stated that their veterinarian and allied health therapist did not work together when treating their horses. The final multivariable model for use of allied health therapists included the explanatory variables discipline of the rider or trainer and the number of horses in training per season. CONCLUSIONS AND CLINICAL RELEVANCE: The use of allied health therapies for the treatment of competition and racehorses was widespread. Many riders or trainers perceived allied health therapy to be beneficial, however many therapists and veterinarians do not work together and therefore the integrative treatment approach to rehabilitation is lost.

The role of manual therapies in equine pain management.

Manual therapy includes a diverse array of techniques, such as touch therapies, massage, physical therapy, osteopathy, and chiropractic, that were originally developed for use in humans and have been gradually applied to horses. All forms of manual therapy have variable reported levels of effectiveness for treating musculoskeletal issues in humans, but mostly only anecdotal evidence exists in horses. This article explores the scientific literature for evidence of efficacy, safety, and common mechanisms of action of the different forms of manual therapies for potential use in managing acute or chronic pain syndromes in horses. Currently, there is limited evidence supporting the effectiveness of spinal mobilization and manipulation in reducing pain and muscle hypertonicity. Further research is needed to assess the efficacy of specific manual therapy techniques and their contribution to multimodal protocols for managing specific somatic pain conditions in horses.

Physical rehabilitation of the canine neurologic patient.

Rehabilitation therapy is a key component of recovery from neurologic disease. Each patient requires a rehabilitation protocol designed specifically for the patient's neurologic condition, owner expectations and level of participation, and expertise of the veterinary team. Initial therapy for nonambualtory patients may include standing exercises, range of motion, pain control, toe pinch exercise, aquatic exercise, and basic nursing care. Sling assisted walking with foot protection, cavaletti rails, and physioroll balancing are used commonly for ambulatory patients. As recovery progresses, stair climbing, carrying or pulling weights, resistance band walking, swimming against resistance, and exercises specific to the home environment are added. Modalities such as electrical stimulation, ultrasound, cryotherapy, and heat therapy are useful adjuncts but do not take the place of active exercise.

Nonsurgical management of osteoarthritis in dogs.

Osteoarthritis (OA), although superficially considered to be deterioration of the joint associated with pain and dysfunction, is actually quite a complex condition. When considering treatment of OA, a multitude of biochemical, physical, and pathologic alterations must be recognized. This article presents a review of the published material regarding various nonsurgical treatments for OA. When there are no data regarding a specific treatment or when a statement is the opinion of the authors, such a deficiency is identified.

Select modalities.

Physical rehabilitation modalities such as therapeutic ultrasound (TU), transcutaneous electrical neuromuscular stimulation (TENS), neuromuscular electrical stimulation (NMES), cold or low-level laser therapy (LLLT), and pulsed magnetic field therapy (PMF) can all, when used properly, assist in treating orthopedic injuries, neurological conditions, and chronic conditions brought about by normal aging in our small animal companions. TU uses sound waves to produce both thermal and nonthermal effects that aid in tissue healing, repair, and function. TENS uses different frequencies of electrical current to decrease pain and inflammation. NMES also uses an electrical current to stimulate muscle contraction to assist in normal neuromuscular function in postorthopedic and neurological injuries. LLLT uses light energy to reduce pain, decrease inflammation, and stimulate healing at a cellular level. PMF uses magnetic field to stimulate normal cellular ion exchange and oxygen utilization and promote generalized healing of tissues. These modalities are discussed in detail covering mechanism of action, parameters, settings, and indications/contraindications of use in our small animals. Although these modalities are important in the physical rehabilitation of small animals, they need to be incorporated with a proper diagnosis, manual therapy, and home exercise program into a specific and individualized patient treatment protocol.

Effects of caloric restriction and a moderate or intense physiotherapy program for treatment of lameness in overweight dogs with osteoarthritis.

OBJECTIVE: To evaluate the effects of a weight reduction program combined with a basic or more complex physical therapy program including transcutaneous electric nerve stimulation on lameness in overweight dogs with osteoarthritis. DESIGN: Nonblinded prospective randomized clinical trial. Animals-29 adult overweight or obese dogs with a body condition score of 4/5 or 5/5 and clinical and radiographic signs of osteoarthritis. PROCEDURES: A weight-loss program was initiated for all dogs. One group received caloric restriction and a home-based physical therapy program. The other group received the identical dietetic protocol and an intensive physical therapy program including transcutaneous electrical nerve stimulation. Lameness was assessed clinically and by kinetic gait analysis on a treadmill with 4 force plates to measure symmetry of ground reaction forces (GRFs) of the affected and contralateral limbs in bimonthly intervals for 6 months. RESULTS: Significant weight loss was achieved in both groups; however, greater weight reduction was attained by dogs treated with caloric restriction and intensive physiotherapy. Mobility and symmetry indices of GRFs were improved after 6 months; the best outcome was detected in the group receiving energy restriction combined with intensive physical therapy. CONCLUSIONS AND CLINICAL RELEVANCE: Caloric restriction combined with intensive physical therapy improved mobility and facilitated weight loss in overweight dogs. The combination of dietetic and physical therapy may help to improve the health status more efficiently than dietetic treatment alone.

Daily controlled physiotherapy increases survival time in dogs with suspected degenerative myelopathy.

The purposes of the study reported here were to evaluate the signalment and clinical presentation in 50 dogs with degenerative myelopathy, to evaluate whether mean survival time was significantly affected by various means of physiotherapy performed in 22 dogs, and to determine whether neurologic status, anatomic localization, or age at onset had an influence on survival time in dogs that received physiotherapy. We found a significant (P < .05) breed predisposition for the German Shepherd Dog, Kuvasz, Hovawart, and Bernese Mountain Dog. Mean age at diagnosis was 9.1 years, and both sexes were affected equally. The anatomic localization of the lesion was spinal cord segment T3-L3 in 56% (n = 28) and L3-S3 in 44% (n = 22) of the dogs. Animals that received intensive (n = 9) physiotherapy had longer (P < .05) survival time (mean 255 days), compared with that for animals with moderate (n = 6; mean 130 days) or no (n = 7; mean 55 days) physiotherapy. In addition, our results indicate that affected dogs which received physiotherapy remained ambulatory longer than did animals that did not receive physical treatment.

Joint mobilization.

Therapeutic touch has been used in human beings to soothe aches and pains. Most dogs also seem to enjoy being touched. Manual therapy techniques are skilled hand movements intended to improve tissue extensibility; increase range of motion; induce relaxation; mobilize or manipulate soft tissue and joints; modulate pain; and reduce soft tissue swelling, inflammation, or restriction. The intent of this article is to provide an overview of the principles of manual therapy, followed by selected treatment techniques for the hip, stifle, elbow, shoulder, carpus.and thoracic and lumbar spine. The techniques of G.D. Maitland, an Australian physical therapist who developed a clinically based approach in the 1960s and 1970s, are emphasized.

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.

Emerging modalities in veterinary rehabilitation.

Many new modalities have been introduced in human and veterinary physical rehabilitation. In many instances, there is sound theory of how they may impact the physiology of various cells, tissues, or organs. This article reviews some of the modalities that have been introduced recently in human and veterinary rehabilitation. Topics include low-level laser, phototherapy, and extracorporeal shock wave treatment.

Equine rehabilitation therapy for joint disease.

The principles of physical rehabilitation therapy can be applied to the horse to provide a reduction in discomfort and dysfunction associated with the various forms of joint disease. Physical agents,such as ice, heat, electricity, sound, light, magnetic fields, compression, and movement, can be used by the rehabilitation therapist to attempt to control pain, reduce swelling, and restore optimal movement and function in the affected joint. The equine therapist's attention is focused not only on the affected joint but on the body as a whole to manage secondary or compensatory problems.