Importance of rehabilitation in your practice: how to get started (Proceedings)


Importance of rehabilitation in your practice: how to get started (Proceedings)

Aug 01, 2011

Surgical intervention for clinical problems arising from a traumatic episode (fracture, ligament sprain) or congenital abnormality (elbow dysplasia, hip dysplasia) is a common procedure in veterinary practice. As Veterinarians, each of us tends to rely on surgical intervention to resolve clinical dysfunction arising from one of the aforementioned conditions. There is no question that appropriate surgical procedure and surgeon expertise are important factors determining optimal outcome. However, perioperative pain control and rehabilitation are as important, if not more important, than the surgical procedure itself. Unfortunately, most Veterinarians place little emphasis on this part of the equation for optimal outcome. The benefits of post operative rehabilitation are described at length in the Human and Veterinary literature. As example, a study examining the kinematic analysis of the hind limb during swimming and walking in healthy dogs and dogs with surgically corrected cranial cruciate ligament rupture concluded that swimming resulted in greater ROM of the stifle and tarsal joints than did walking. In that ROM is a factor in the rate or extent of return to function, aquatic rehabilitation would likely result in a better overall outcome than walking alone (Marsolais, G. S.; McLean, S.; Derrick, T.; Conzemius, M. G: Journal of the American Veterinary Medical Association. American Veterinary Medical Association, Schaumburg, USA: 2003. 222: 6, 739-743. 40). A separate study examined the Rehabilitation of dogs with surgically treated cranial cruciate ligament-deficient stifles by use of electrical stimulation of muscles. This investigation concluded that improved lameness scores, larger thigh circumference, and decreased radiographically apparent bony changes were observed for the treated group of dogs. This finding supports the hypothesis that dogs treated by EMS after surgical stabilization of the CrCL-deficient stifle had improved limb function, with less DJD, than did dogs treated with the currently accepted clinical protocol of cage rest and slow return to normal activity. (Johnson JM, Johnson AL, Pijanowski GJ, Kneller SK, Schaeffer DJ, Eurell JA, Smith CW, Swan KS. Am J Vet Res. 1997 Dec; 58(12):1473-8. In addition to the investigational studies are journal articles and textbooks addressing Physical Therapy in dogs (and cats). In the NAVC Clinician's Brief (2005. 3: 6, supplement, 8 pp), Dunning et. al. reported that rehabilitation elevates the overall quality of medicine practiced, promotes patient recovery and function, and enhances client relationships. Clinical Techniques in Small Animal Practice (W.B. Saunders, Philadelphia, 2004. 19: 3, 180-191.), reported that rehabilitation is now becoming more common in small animals recovering from fractures. The detrimental effects of immobilization, including the potential for development of fracture disease, must be considered when formulating a Rehabilitation plan of care. Many Rehabilitation interventions are readily amenable to application by both Veterinary professionals and owners of patients. Superficial thermal modalities, passive range of motion and stretching, soft tissue massage, therapeutic ultrasound, electrical stimulation, and therapeutic exercise can ensure a more complete patient recovery. Providing owners with education regarding appropriate patient handling and home modifications allows a safer return to the home environment. Detailed written rehabilitation instructions for home care promote owner compliance and accurate completion of the surgical experience. The benefits of rehabilitation modalities are not limited to postoperative care. Conditioning of the canine athlete or senior dog (cat) with osteoarthritis is readily accomplished with appropriate exercises to promote strength, endurance, and greater range of joint motion. Printed in 2004 is a textbook by Millis et. al. entitled Canine Rehabilitation and Physical Therapy. This text is a comprehensive review of current scientific literature and a detailed description of Rehabilitation modalities. Everyone interested in canine rehabilitation should be an owner of this textbook.

As one becomes involved in prescribing rehabilitation for post operative care or treatment of osteoarthritis (conditioning), additional benefits associated with the rehabilitation process become apparent. As the owner returns for rehabilitation sessions, contact with the hospital and the staff provide a means for emotional contact between the owner and the hospital. At each session their pet is evaluated to determine progress of recovery. The owner is provided the opportunity to ask questions and express concerns. They see the care and compassion given their pet by the hospital staff and often have an opportunity to have conversation with the attending Veterinarian. The owner observes the in hospital rehabilitation modalities and is first hand witness to the progress being made by their pet.

At each session, the owner is given exercises to administer at home. More accurate and complete home care is provided and the owner becomes intimately involved with the treatment (post surgery, conditioning, or osteoarthritis) process. All these factors reinforce the emotional contact with the hospital and offer the owner a rewarding experience for owner and their pet.