Embed Size (px)
Citation preview
JENN WOLFE, LVT, CCRP
THE IN’S AND OUT’S OF REHABILITATION
WWW.UVSONLINE.COM
B.S in Biology from UNC-Wilmington
Licensed Veterinary Technician since 2006
Certified Canine Rehabilitation Practitioner since 2008 through University of Tennessee
MY CREDENTIALS
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Benefits of rehabilitation
Indications
Rehabilitation at UVS
Out patient rehab
In patient rehab
Home programs
Modalities
Cases
Questions
WHAT TO EXPECT…
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
The American Veterinary Medical Association (AVMA) established guidelines in 1996.
“Veterinary Physical Therapy is the use of non-invasive techniques, excluding veterinary chiropractic, for the rehabilitation of injuries for the non-human animals”.
HISTORY
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
State Practice Acts
Some states have different rules though the AVMA requires all therapy be under the supervision or referral of a veterinarian
NYS does not allow canine rehabilitation to be referred to as “physical therapy”
NYS requires a person earning their canine rehabilitation certificate to be an LVT or veterinarian
HISTORY
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Trauma causes tissues to undergo changes
which can lead to disuse
--injury, surgery, disease
Disuse can result in weakness, atrophy and contracture
--tissues that have remained too tight for too long and become shorter which can decrease
mobility
Disuse can lead to the inability to carry out daily activities which can decrease quality of life
WHY REHAB???
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Non-invasive techniques
Can decrease and improve recovery time
Can decrease complications
Can help prevent further injury
Can decrease post-trauma pain
Can decrease the need for medications
WHY REHAB???
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Increase strength, endurance and cardiovascular health
Improve proprioception and balance
Increase flexibility and functional mobility
Improve work or athletic performance
Enhances quality of life
WHY REHAB???
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Osteoarthritis
Dysplasia
FHO, THR
Cruciate injury
Luxating patella
Amputation
Congenital disorders- OCD, UAP
COMMON INDICATIONS
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Soft tissue injuries
Strains, contractures, tendinopathy
Intervertebral Disc Disease
Degenerative Myelopathy
Fibrocartilagenous Embolism
Wobblers Syndrome
Conditioning for canine athletes
Weight loss
COMMON INDICATIONS
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
SURGERY NOT AN OPTION??
-age, disease, owner afraid, +/- cost
Rehab and assistive devices can still be beneficial though it cannot replace surgical repair.
- Carts- Eddies Wheels, K9 Carts, Walkin’ Wheels
-Wraps- Dog Leggs, TheraPaw
-Braces- OrthoPets
-Specialized programs to keep the pet as comfortable and mobile as possible.
COMMON INDICATIONS
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
ASSISTIVE DEVICES
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
In house referral Surgical vs. non-surgical
RDVM referral Ortho or neuro consult first??
Initial consult with rehab department
Treatment plan Out patient treatment, HEP
OUT-PATIENT REHABILITATION
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Patient history
Signalment, past surgeries, injuries, ailments and/or diseases, diagnostics, meds and supplements, diet
Owners impression and knowledge of patient
How is pet affected, occurrence and duration, specific time (am/pm, weather), quality of life, likes/dislikes
Goals
Owners expectations
INITIAL ASSESSMENT
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Observation at rest
Observation during transitions
Observation at varied gaits
Orthopedic and neurologic exams
Measurements
Goniometry and muscle mass
Body condition score
Pain assessment
INITIAL ASSESSMENT
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Discuss observations and findings
Abnormal gait, pain, asymmetry, decreased ROM
Diet, meds, supplements
Weight loss, pain relief, chondroprotectants, omega fatty acids
Homecare
Assistive devices (slings, harnesses, carts, supportive wraps, braces)
Things to avoid (stairs, slippery floors, jumping…)
INITIAL ASSESSMENT
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
PLAN- Expectations and goals
Be realistic
Short term vs. long term
Recovering from surgery or injury
Geriatric care
Non-surgical maintenance
Committing to a program
Owner and pet compliance
Cost
In house modalities
Are owners willing and able to work with the pet at home?
Can decrease frequency of visits necessary and cost
INITIAL ASSESSMENT
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
For owners that are willing and able to work with their pet at home.
Specific exercises that target areas in need Start simple and easy
Use household items as props
Incorporate hills, stairs, curbs, varied surfaces- on walks
Rechecks are case specific, more frequent to start
Increase difficulty if pet is doing well
HOME EXERCISE PROGRAM
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Combined effort with multiple departments
-neurology, surgery, ER
Post surgical pain management- shorter stay-neurosurgery, orthopedic surgery
In-house rehabilitation- longer stay
-non-ambulatory, unable to handle at home, daily rehab and nursing care important in recovery, surgical or injury
IN PATIENT REHABILITATION
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Most common--post spinal surgery or spinal injury Hemilaminectomy, FCEM
Assistive devices to aid paretic patients Quad cart, overhead lift, rubber floor, man power
24 hour nursing care important for non-ambulatory patients Incontinence, bed sores, pneumonia
Frequent use of modalities and manual therapies
Avoid depression, keep engaged and stimulated
IN HOUSE REHABILITATION
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
IN PATIENT REHABILITATION
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
QUAD CART
OVERHEAD LIFT RUBBER FLOOR
WWW.UVSONLINE.COM
1.5 year old Great Dane diagnosed with wobblers disease.
Under went an 8 hour spinal surgery.
Tetra-paretic post-op (expected)
Stayed hospitalized to receive daily rehab treatments, acupuncture and 24 hour nursing care until mobile.
Owners were able to take him home after 3 weeks.
Set up with a HEP and rechecks as he improved.
IN PATIENT REHAB- MICK
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
IN PATIENT REHAB- MICK
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Laser
Electrical stimulation
Ultrasound
Therapeutic exercise
Manual interventions
Hydrotherapy/Underwater Treadmill
Acupuncture
MODALITIES
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Light Amplification by Stimulated Emission of Radiation
Transmits energy in the form of photons by infrared light directed over tissues.
Photons are absorbed by cytochromes in the mitochondria.
Tissues normalize by photons producing energy and activating enzymes.
LASER THERAPY
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Accelerate tissue repair and cell growth
Wound healing
de-gloving, lick granuloma, “happy tail”, surgical wounds
Reduce scar tissue formation
fibrotic myopathy, contractures
Reduce pain, inflammation and edema
Increase nerve regeneration and activity
Increase circulation
LASER USES
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
LASER THERAPY
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
E-stim is used to treat acute or chronic muscle pain and atrophy by using low-frequency electrical currents.
NMES- Neuro-Muscular Electrical Stimulation
TENS- Transcutaneous Electrical Nerve Stimulation
ELECTRICAL STIMULATION
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Pain management (TENS) TENS temporarily blocks the transmission of pain sensations to the brain. It also stimulates the
release of endorphins- the body’s natural painkilling substance
Muscle strengthening and atrophy prevention (NMES)
Increase circulation (TENS/NMES)
Nerve stimulation (NMES)
ELECTRICAL STIMULATION
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
ELECTRICAL STIMULATION
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
NMES
TENS
WWW.UVSONLINE.COM
Sound waves generated by oscillating crystals in the US head.
Sound waves are converted to heat by colliding molecules.
A coupling agent is used between US head and skin because air reflects the sound waves.
Heat generated penetrates deeper than
Hot packs with an approximate depth of 2-5 cm.
THERAPEUTIC ULTRASOUND
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Decrease pain
Decrease muscle spasm and contracture
Increase circulation
Increase tissue and wound healing
Increase ROM and decrease stiffness
Break down scar tissue
ULTRASOUND BENEFITS
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
ULTRASOUND
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
A variety of exercises and equipment used to promote proprioception, flexibility, balance, range of motion and muscle strengthening.
THERAPEUTIC EXERCISE
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
balance board/wobble board
cavaletti’s
physio-rolls/exercise balls
transitions
figure 8’s, spirals, circles, weaves
side stepping, backing up
3 leg and 2 leg stands
land treadmill
CREATIVITY!!
THERAPEUTIC EXERCISE
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
THERAPEUTIC EXERCISE
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
THERAPEUTIC EXERCISE
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
THERAPEUTIC EXERCISE
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Passive range of motion (PROM)
-Helps improve tissue extensibility and flexibility.
-Helps reduce tissue adhesion and contracture.
-Helps increase circulation, O2 and flow of body fluids.
Stretching
-Helps elongate shortened tissues.
-Increases flexibility and joint motion.
-Can be performed in conjunction with PROM.
MANUAL INTERVENTIONS
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Massage
-Provides relaxation or stimulation depending on technique.
-Increases circulation and delivery of nutrients.
-Provides relief from tension and discomfort.
Joint mobilization
-Specific techniques targeted to a joint with
-Decreased mobility.
-Helps relieve pain and stiffness related to surgery and osteoarthritis.
MANUAL INTERVENTIONS
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
MANUAL INTERVENTIONS
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
Stretching /PROMMassage
WWW.UVSONLINE.COM
Uses the properties of water and a thermo-therapeutic temperature to create an environment of low impact and resistance.
This enables the body to increase muscle mass and tone, flexibility and range of motion without stress on the joints.
It can also help reduce edema and swelling, and promote cardiovascular activity.
HYDROTHERAPY/UNDERWATER TREADMILL
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Buoyancy- the upward thrust of water on an immersed or floating object. It aids in reducing the amount of weight a patient carries which creates a low impact environment.
Water height at hip 38% of weight
Water height at stifle 85% of weight
Water height at hock 91% of weight
PROPERTIES OF WATER
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Resistance - The amount of force needed to move through water.
Water resistance can be used to strengthen and tone muscle.
Viscosity - A measure of resistance of fluid depending on the adhesion of water molecules.
Water viscosity can allow the ability to perform certain exercises in the water that may not be performed on land.
PROPERTIES OF WATER
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Surface Tension- Cohesion, or attractiveness, of water molecules is greatest at the surface increasing the difficulty of an exercise depending on the water level.
EXAMPLE: Water at hip level has more buoyancy than it would at lower levels. Therefore, parts of the body that are submerged endure less surface tension and resistance, but more viscosity.
PROPERTIES OF WATER
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
HYDROTHERAPY
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
Initially, unable to stand in water unassisted. Needed high water level, life vest and a lot of support.
Weeks later, lower water and less support needed, resulting from simple exercises in water and other modalities.
WWW.UVSONLINE.COM
HYDROTHERAPY/UNDERWATER TREADMILL
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
Both pets here have some degree of spinal trauma. They are able establish a “spinal walking” gait in the UWT. Both get weekly treatments.
WWW.UVSONLINE.COM
CASE STUDIES
MAX- 5YR OLD ROTTWEILER
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Weak in the hind end for ~1 year
Lame ~2 wks prior to initial rDVM visit
Was found by the owner acutely unable to stand or rise
rDVM diagnosed pet with tetanus and treated accordingly.
No improvement so rDVM referred to UVS neurology.
MAX
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
MRI confirmed C6/7 disc herniation.
Dorsal laminectomy of C6/7 performed.
Developed pneumonia 3 days post-sx so pet remained hospitalized for intensive supportive care for 2 weeks.
Transferred for rehabilitation once stable.
MAX
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Upon admittance for rehabilitation pet presented:
Tetra-paretic, non-ambulatory
Only able to lay in lateral position and required help to change recombancy
Severe muscle atrophy
Severe neck pain
Increased rigidity of forelimbs
MAX
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Admitted for intensive in-house rehab and nursing care.
Rehab included:
TENS, NMES, Laser, Ultrasound, position and transition exercises, hydrotherapy, therapeutic exercise, motivational exercise, quad cart exercise, massage, stretching, PROM.
MAX’S PLAN
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
MAX
UNABLE TO DO ANYTHING BUT LAY LATERAL
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Sitting and sternal exercises.
Notice rigid forelimbs.
MAX
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Hydrotherapy and standing exercises
MAX
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
MAX
WALKING EXERCISES IN QUAD CART
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
MAX
LAYING MORE COMFORTABLY AND LESS RIGID MUSCLE MASS AND TONE INCREASING (NOTICE
HEAD)
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
PRE-INJURY
MAX
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
1 YEAR POST
WWW.UVSONLINE.COM
ACCESS
1 YEAR OLD LABRADOR RETRIEVER
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Service dog in training
TPLO repair after an acute rupture of the CCL
Measurements showed a 5.5cm difference in the hind limb muscle mass and decreased ROM
Partial weight bearing on LRL
Started rehab 2 weeks post-surgery
ACCESS
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Rehab included:
Massage/Stretching/PROM
Laser therapy
Therapeutic exercise
Balance board
Ball work
Cavaletti’s
Land treadmill
Hydrotherapy
Home exercises
ACCESS
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
ACCESS
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
Post-rehab achievements 8wks post-op
Symmetrical muscle mass and stifle ROM
Normal weight distribution
Able to return to work and training with normal gait and function to enable the best possible performance
ACCESS
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
WWW.UVSONLINE.COM
QUESTIONS???
11/14/20172017 FALL CE | THE INS AND OUTS OF REHABILITATION
