Zoological companion animals need rehab, too

Though ZCA species are excellent candidates for rehabilitation, such alternative options for treatment are not often considered

Diagnostics

Figure 1: A rabbit utilizing an underwater treadmill.

Diagnostic imaging is an important final step in a comprehensive mobility assessment prior to instituting therapy. It is critical to obtain a definitive diagnosis to best provide a prognosis for recovery and further guide the physical rehabilitation plan.

Commonly employed diagnostics include radiographs and/or computed tomography (CT) for evaluation of osseous and articular pathology. Iodinated contrast administration with CT can help to identify soft tissue lesions, such as neoplasia. Soft tissue pathology in the absence of dystrophic mineralization identified on radiographs can be more of a challenge, with musculoskeletal ultrasound and magnetic resonance imaging (MRI) proving more useful for muscle, tendon, and ligament pathology. The latter may also be warranted for diagnosis of neurologic disease.

Understandably, cost and access to musculoskeletal ultrasound and MRI, as well as challenges related to time needed to perform the diagnostic and lack of appropriately sized equipment compatible in the MRI, may limit a practitioner’s ability to utilize these techniques. Baseline radiographs at a minimum are strongly recommended to evaluate for bone and articular pathology.

After a thorough assessment inclusive warranted diagnostics and identification of pain generators and functional limitations has been done, a physical rehabilitation plan can be created. Most often, a therapeutic exercise program is the foundation to the zoological companion animal’s treatment plan; however, other physical modalities similar to those used in small animal medicine (including photobiomodulation and acupuncture) can often be supplemented based on the underlying pathophysiology.

Therapeutic exercise

Therapeutic exercises can be used both in the hospital and at home to help a patient regain range of motion by encouraging active range of motion, targeting areas of muscle atrophy and decreased strength, decreasing chronic pain, and improving overall mobility.

While this can be challenging in ZCA species, there are many targeted exercises owners can try (particularly when food or toys are incorporated as motivation). Using lick mats with suction cups, for example, and encouraging the pet to maintain a position or to reach up and hold for a spreadable treat is an example of an exercise owners can practice at home once it has been properly demonstrated in clinic. Other options may include placing food at a distance to encourage mobility or creating basic obstacle courses where pets can find treats.

It is essential to start with easy modifications that will not create issues with patients being able to eat normally, then gradually increase difficulty as the pet gets used to the changes and, ideally, becomes stronger and more mobile. When designing a therapeutic exercise plan, it is also crucial to consider not only the biomechanics and desired intent of the prescribed activity, but also the degree and phase of the injury and tissue healing principles.

Indeed, a therapeutic exercise plan in ZCA species is often limited only by the creativity of the practitioner! What follows are some species-specific examples for inspiration based on the authors’ experience.

Avian

In avian species (particularly psittacines [parrots] with impairments affecting foot strength and mobility when grasping toys), the use of food or substrates can increase range of motion and strength. It can be beneficial to utilize a wire grid (similar to a kennel or rigid chicken wire pattern) and have avian patients walk or climb on the structure, gradually increasing the angle to increase the difficulty while luring the pet with treats or toys to encourage participation. Some avian patients, especially aquatic birds, may even tolerate the underwater treadmill (Video 5).

Rodents

Rodents (particularly rats) tend to be very amenable to obstacle courses, and the authors have had success using cardboard boxes with strategically placed small holes to make a cavaletti course. Additional therapeutic challenges for these patients include having them walk up ramps or walk on unstable surfaces by modifying the substrate of the box as they progress. Examples of useful substrates here include hot water bottles, balance discs, bean bags, foam, and even bubble wrap.

Rabbits

Rabbits are also often willing to do exercises, especially when they are rewarded with their favourite treats. The authors have utilized obstacle courses, including stepping over low poles, weaves, unstable surfaces, inclines, and declines. Some rabbits are also amenable to walking on underwater treadmills (Figure 1).

Photobiomodulation

Figure 2: A Class IIIb laser unit being used to perform photobiomodulation in a ball python.

Photobiomodulation, also called low-level laser therapy, is the application of light energy to induce a biochemical response in a target tissue. Laser light differs from ordinary light with respect to its monochromaticity, coherence, and collimation, promoting its penetration into tissue. The three main effects photobiomodulation has been proposed to exert include modulation of inflammation, analgesia, and acceleration of tissue healing. (A comprehensive review of the principles of photobiomodulation and mechanism of action are far beyond the scope of this article.)

The literature with respect to ZCA species is sparse; however, given the limited pharmacologic options available to control pain, as well as the increasing prevalence of the modality in specialty and general practice, photobiomodulation has become increasingly popular. Similar to its application in small animals, the practitioner can consider the use of this modality in ZCA species for a variety of neuromusculoskeletal disorders and wound healing. In avian patients, for example, the authors have used photobiomodulation in cases of feather destructive behaviour, as well as pododermatitis, with good—albeit anecdotal—success.

One primary consideration with all ZCA patients is the determination of cost and potential benefit when deciding if laser is a reasonable addition to a rehabilitation plan. General contraindications are similar to small animal species, and include avoiding laser over suspected or confirmed neoplasia, pregnancy, eyes, thyroid, areas of active hemorrhage, tattoos, or after administration of photoactive drugs or application of medicated creams.

Particular caution is advised when using higher powered and Class IV lasers as thin skin and feathers can quickly experience thermal damage. Likewise, ensuring the patient’s eyes are protected against the scatter of electromagnetic radiation may be a challenge; however, some Class IIIb laser units do not necessitate protective eyewear and, thus, can be safely used (Figure 2).

Additionally, in patients intolerant of restraint, the potential benefits of laser treatment may not outweigh the stress of repeated capture and handling. Depending on the underlying pathology, more frequent treatments may be advised (particularly for acute conditions).

Finally, it is challenging to determine an appropriate laser dose—this, however, is not exclusively an issue for ZCA species. Indeed, it is documented the presence of a fur coat, increased coat pigment, and tissue thickness all impact laser penetration through skin. Aside from the treatment of cutaneous wounds, necessitating adequate laser penetration through skin is crucial to reach target tissues. Research regarding the relative laser parameters needed for animals with feathers, scales, or fur to achieve a therapeutic photobiomodulation dose has not yet been performed.

Photobiomodulation may present an opportunity in ZCA species to optimize an analgesic plan and promote tissue healing. The practitioner is encouraged to critically evaluate its utility on a case-by-case basis.

Acupuncture

Figure 3: A bearded dragon receiving acupuncture. Needle placement between scales is important so as not to disrupt their integrity.
Figure 3: A bearded dragon receiving acupuncture. Needle placement between scales is important so as not to disrupt their integrity.

Acupuncture is the insertion of small needles into specific points in the body. The International Veterinary Acupuncture Society (IVAS) was formed in 1974 and, along with other organizations (Table 2), provides acupuncture training for veterinarians.

Acupuncture was studied classically in humans and horses; thus, points in other species are transpositional points in which comparative anatomy has been used to identify their locations.2 Acupuncture points are typically found in palpable depressions between muscles, tendons, or bones. These have often been found to correlate with anatomic structures; histologically, they are associated with larger accumulations of mast cells, nerve bundles, and blood/lymphatic vessels.

Acupuncture may be beneficial in ZCA species for a variety of neuromusculoskeletal mobility impairments; however, stress and size are often the most significant limiting factors. In ZCA species, the benefit of the chosen technique must outweigh any negative consequences associated with restraint or the procedure itself.

Anatomic variations from traditional species when selecting transpositional points is also a key consideration. In some species, even the smallest hand needles are likely too large for the size and depth of the acupuncture point. For reptiles, placement of needles between scales is important so as not to disrupt their integrity (Figure 3). In avian species, knowledge of location of air sacs in birds is also crucial and these must be avoided. Laser acupuncture, which uses a laser to stimulate the acupoint, may be an alternative option in these patients, though this has not yet been researched. Educating owners on point locations and instructing them on the home-use of acupressure, which uses digital pressure on the acupuncture point, may also be an acceptable alternative to traditional acupuncture.

Conclusion

The assessment and treatment of mobility impairments in ZCA species can be handled similarly to traditional small animal species. Mobility impairments in ZCA species are likely underappreciated, and a veterinarian’s ability to diagnose and treat these conditions may open the doors to techniques to improve quality of life for these pets.

Lindsay Elam, DVM, MPH, DACVSMR, is an assistant professor at Colorado State University’s College of Veterinary Medicine and Biomedical Sciences. She earned her DVM and MPH degrees from University of Florida, where she remained for a specialty integrative medicine internship and sports medicine and rehabilitation residency. While her primary species of interest is dogs, Dr. Elam routinely consults on mobility-impaired zoological companion animals, wildlife, and zoological species, applying the examination, diagnostic, and physical rehabilitation principles of small animal orthopedic medicine. She can be reached at lindsay.elam@colostate.edu.

Kira Penney, DVM, CCRT, is a clinical associate at the Western College of Veterinary Medicine (WCVM) in the Veterinary Medical Centre’s rehabilitation service and part of WCVM’s Department of Small Animal Clinical Sciences. Dr. Penney grew up in Newfoundland and is a 2010 graduate of the Atlantic Veterinary College at the University of Prince Edward Island (UPEI). She joined the WCVM’s rehabilitation service in 2015, where she has had the opportunity to provide rehabilitation and acupuncture for dogs, cats, and rabbits as well as pot-bellied pigs, injured wild raptors, parrots, miniature horses, and many others. She can be reached at kira.penney@usask.ca.

Miranda Sadar, DVM, DACZM, is an assistant professor at Colorado State University’s College of Veterinary Medicine and Biomedical Sciences. She graduated from CSU with a BSc in zoology before earning a DVM degree from Colorado State University. Dr. Sadar completed an internship in zoological, zoological companion animal, and wildlife medicine at the University of Saskatchewan’s Western College of Veterinary Medicine. After finishing a two-year fellowship in wildlife medicine at the Wildlife Center of Virginia, she moved to Davis, Calif., and completed a residency in zoological medicine at the University of California. Sadar is a board-certified specialist in zoological medicine with a focus on zoological companion animals. She can be reached at miranda.sadar@colostate.edu.

References

1 Dorlis, Christos, et al. “Femoral condylar fractures in four continental giant breed rabbits.” Journal of Small Animal Practice (2021).

2 Gaynor JS, Muir WW. Handbook of Veterinary Pain Management, ed 3, St Louis, 2015, Elsevier Mosby.

 
ORGANIZATION WEBSITE
International Veterinary Acupuncture Society https://www.ivas.org
Chi University https://chiu.edu
Curacore https://curacore.org/vet
Canine Rehabilitation Institute https://www.caninerehabinstitute.com

Table 2: Organizations that provide acupuncture training for veterinarians. (Note this list is not all inclusive.)

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