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Veterinary rehabilitation and its application in pain management (Proceedings)

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Aug 01, 2009

What is veterinary rehabilitation?

In order to discuss the application of veterinary rehabilitation in pain management, it is important to understand what veterinary rehabilitation is. Many people believe that veterinary rehabilitation consists of a series of therapeutic exercises, especially involving the Under Water Treadmill, which can be applied to our animal patients. The notion that this field would be easy to grasp, with intuitive reasoning, and little training, has lead many to attempt to add rehabilitation to their veterinary practices. In reality, veterinary rehabilitation is the application of an all-new diagnostic algorithm to our patients. The physical therapy evaluation focuses upon soft tissues rather than bone and joint. It involves special tests that allow for determination of specific tendinopathies and soft tissue abnormalities. The use of Objective Outcome Measures, evaluated with Goniometers and Gulick Girthometers provides clear evidence of the progress of the patient during and after rehabilitation therapies have been applied. The emphasis in rehabilitation therapy is on meeting goals that are functional for the patient.

The goals of rehabilitation include the restoration, maintenance and promotion of optimal function and quality of life as they relate to movement disorders. The majority of rehabilitation therapeutics involves manual therapies and problem solving rather than the use of 'toys'. Examples of manual therapies include joint mobilizations, focusing on arthrokinematics rather than osteokinematics, stretches, focusing upon flexibility and hypo mobility, and therapeutic exercises, progressing from concentric to eccentric contractions. Equipment utilized on a regular basis in veterinary rehabilitation includes LASER, ultrasound, electrical stimulation, physioballs, therapy bands, rocker/wobble boards, Cavaletti poles and land treadmills. Hydrotherapy equipment can include pools, resistance pools and underwater treadmills.

Future trends in the industry

What is driving this new field? Public awareness is bringing dog owners to veterinary hospitals, expecting state-of-the-art care for their pets. This is not unlike Acupuncture's rise in the 1980's...client-driven demand for new veterinary services. The current drivers include the huge interest in Agility and Flyball in the US. In addition, the government is now seeking rehabilitation care for service dogs injured in the line of duty.

The 6th International Symposium on Veterinary Rehabilitation will take place in August of 2010 at Auburn University's College of Veterinary Medicine. This biannual symposium alternates between the US and Europe. The 2010 meeting expects to draw nearly 500 people from over 20 countries for 4 days of lectures and laboratories. National veterinary meetings in the US have also seen growing interest in rehabilitation medicine. The ACVS, NAVC and of course CVS have all progressed from brief mentions of rehabilitation to hosting full day lecture-lab sessions on rehabilitation.

Pain management in rehabilitation medicine: diagnostic techniques

The aforementioned diagnostic techniques that physical therapists bring to veterinary rehabilitation allow for improved care for patients who were previously lumped into the 'soft tissue injury' category. By determining specific soft tissue pathologies, we are able to apply focused therapeutics, providing considerably better outcomes than our former "Rest and NSAID's" approach. The soft tissue injuries that are now commonly diagnosed include Supraspinatus Tendinopathy, Medial Shoulder Instability, and Iliopsoas Muscle Strain. In order to diagnose a problem, we must be very familiar with what is normal in joint, ligament, muscle and tendon behavior. A physical therapist approaches a patient in a way that focuses upon the soft tissues surrounding the bones and joints and upon the interaction of joint surfaces during movement.

A common finding with soft tissue injuries is abnormal joint range of motion. Causes of abnormal range of motion include, but are not limited to intra-articular lesions, joint capsule pathology, ligament shortening, pain, and swelling in or near the joint. How can we tell these apart? Physical therapists use End Feels here. An End Feel is defined as the sensation or feeling which the therapist detects when the joint is at the end of its available PROM. There are several End Feels that are commonly used.