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Rehab medicine gets pets back on track

Canine athletes, senior animals, and service animals can all benefit from the many modalities used in rehab practices

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Rehab practice can decrease the likelihood of euthanizing a pet, while maximizing the results of neurological and orthopedic surgeries, and improving quality of life.

Elmo, an obese sealpoint Siamese cat, had severe hip arthritis. His pain was so relentless he was unable or unwilling to use his litter box. Elmo’s dedicated owners brought him for rehab to Marti Drum, DVM, DACVSMR, at the University of Tennessee.

Cats have a reputation for being hard to handle, but Elmo was laidback and loving. Those characteristics helped him successfully complete a weight loss program to help relieve the pain in his hips.

“He was incredibly tolerant of the underwater treadmill,” Dr. Drum says. “With a little weight loss, he began resuming normal litter box habits and eventually began jumping small heights again.”

Rehab techniques—the term physical therapy is protected and used only when referring to human patients—help canine and feline patients improve or return to normal function, whether they are suffering from health effects related to obesity or orthopedic, neurological, and chronic diseases, or recovering from injuries or surgery. Canine athletes, senior animals, service animals, and pets with chronic debilitating conditions can all benefit from the many modalities used in rehab practices. Adding rehab to a practice has multiple advantages.

“When conventional medicine and surgery fall short, a rehab practice can offer additional tools to promote pain control, mobility, and rapid healing for the patients,” said Marta Sanchez-Emden, DVM, founder of Animal Health and Rehabilitation Center in Miami. “This translates to less euthanasia and maximizes the results of neurological and orthopedic surgeries, and improves the quality of life of our geriatric patients.”

Another is that it strengthens ties between client and practice, said Pam Nichols, DVM, owner of Animal Care Center in West Bountiful, Utah.

“It’s not that lucrative, but it is super rewarding, and it bonds the client to your hospital,” she said, adding the ability to provide pain control through rehab leads to better patient care and greater staff satisfaction.

Animals who can benefit include those with joint injuries, traumatic orthopedic injuries (e.g. pelvic fractures, deranged stifles, degenerative joint disease), neurologic conditions (e.g. vascular or compressive injuries to the spinal cord), limb amputations, or deformities causing problems with limb usage. It’s not unusual for pet owners who have experienced the benefits of physical therapy in their own lives to seek it out for their pets.

Rehab challenges

In any case, evaluating pain in a dog or cat is one of the most challenging aspects of veterinary medicine, but pain assessment is the first step in preparing a plan for rehabilitation. That said, anxiety, fear, pain, hunger, side effects of medication, and more, can affect a pet’s behaviours and responses.

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In her 2018 VMX lecture, Purrfect Rehab: Mobility and Pain Management Techniques for Cats, Carolina Medina, DVM, DACVSMR, said a thorough history of behaviour changes is the most accurate way to evaluate pain in animals. Look at maintenance of normal behaviours, loss of normal behaviours, and development of new behaviours that may indicate adaptation to pain or response to pain relief.

Pain scales to use include the UNESP-Botucatu Multidimensional Composite Pain Scale and the University of Glasgow’s facial expression tool for assessing acute pain in cats. Colorado State University has canine and feline acute pain scales, as do the American Animal Hospital Association (AAHA) and the American Association of Feline Practitioners (AAFP).

The next step is to evaluate range of motion in the affected area and the animal’s overall fitness level and muscle mass. Gait analysis should also be part of the exam.

The goal is to rebuild muscle and improve range of motion, said Joseph J. Wakshlag, DVM, DACVSMR, at the Sports Medicine and Rehabilitation Service at Cornell University Hospital for Animals in Ithaca, N.Y.

Animal rehab frequently calls for a multimodal approach, incorporating medical treatment, weight loss, exercise, environmental changes, and rehab therapies. Some patients may respond better to one modality than to another. Each modality can have specific benefits, as described in the sidebar on the opposite page.

For instance, laser therapy helps reduce inflammation in easily accessible areas, such as the elbow, stifle, or lower back. Since it warms tissues and improves circulation and neuronal function, it can benefit small dogs with spinal cord injuries.

“Laser therapy decreases pain, releases beta endorphins and serotonin, decreases bradykinins, blocks depolarization of C fibres, decreases inflammation, decreases prostaglandin synthesis, reduces interleukin-l, and promotes angiogenesis,” Dr. Medina said in her lecture.

Neuromuscular electrical stimulation, which causes muscles to contract so they don’t atrophy, also provides relief for chronic pain in geriatric animals or animals with chronic arthritis pain.

For a serval with a spinal fracture from jumping off a second-storey balcony, underwater treadmill therapy was central to her recovery.

“Due to the spinal fracture, she was initially unable to walk, and then only in a very ataxic manner,” Drum says. “Once she began therapy, her ataxia quickly improved and her mobility returned to normal after two sessions. Keeping her quiet quickly became the primary focus as her fracture continued to heal.”

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Rehab modalities
Common rehab modalities used in practices are manual therapies, such as joint mobilizations, passive range of motion exercises and massage; therapeutic exercises to improve flexibility, strength, and proprioception; thermal therapy; cold laser; electrical stimulation; therapeutic ultrasound; treadmills and underwater treadmills; and extracorporeal shockwave therapy. Most require some level of training before use. The following are descriptions of various types of therapies and some potential benefits.

Acupuncture: The use of needles, heat, pressure, or laser light at certain points on the body to stimulate the nervous system. Some studies have demonstrated the effectiveness of acupuncture for analgesia in both surgical recovery and for chronic pain.

Cryotherapy: Application of cold to decrease pain and inflammation by reducing blood flow to the area. Used immediately after injury or surgery for up to one week, it can be effective in limiting swelling and decreasing pain. Surgeries for which it may be indicated include femoral head and neck ostectomy and tibial plateau leveling osteotomy.

Electrical stimulation (e-stim): Application of electrical currents to relieve chronic pain, post-operatively aid in nerve regeneration after back surgery, reduce edema, and prevent muscle atrophy from disuse.

Extracorporeal shockwave therapy (EST): Delivery of focused, high-energy pressure waves to a specific point in the body, causing cells to release anti-inflammatory cytokines, increasing blood flow to the area and releasing serotonin to help reduce pain. May benefit animals with arthritis, tendinopathies, and chronic non-healing wounds or fractures.

Hydrotherapy: Walking on an underwater treadmill or swimming provides non-weight-bearing exercise and allow patients to move more easily. The water resistance increases muscle strength and assists in improving range of motion, strength, and endurance.

Low-level laser therapy: Alteration or stimulation of cellular function through light energy decreases swelling and increases circulation. This therapy blocks a nerve’s ability to send a pain signal to the brain. Useful for nerve pain or damage, muscle strains, osteoarthritis, and faster wound healing.

Massage: Focused strokes for soft tissue manipulation to relieve pain, increase circulation, promote relaxation, and ease contracted muscles.

Platelet-rich plasma: Injection or intravenous delivery of a concentration of platelets and growth factors produced from an animal’s own blood. Promotes healing of damaged tissue, cartilage, or bone for conditions, such as muscle or ligament tears, osteoarthritis, or hip or elbow dysplasia.

Stem cell therapy: Injection or intravenous delivery of stem cells harvested from a pet’s fat tissue. Promotes healing and reduces pain and inflammation for orthopedic or soft-tissue injuries, degenerative joint disease, and post-surgical recovery.

Therapeutic exercises: Use of Cavaletti poles, steps, wobbler boards, or other equipment to improve proprioception, mobility, gait, co-ordination, and strength.

Therapeutic ultrasound: Application of high-frequency sound waves to improve healing of soft-tissue injuries through increased blood flow and reduced swelling, increase muscle flexibility, improve range of motion around a joint, and soften and break down scar tissue that is hindering mobility.

Thermotherapy: Application of heat to increase vasodilation and muscle flexibility.

Treadmill: Helps animals regain cardiopulmonary fitness or improve muscle strength.

Opportunities, considerations, and costs

Cats might seem like the ultimate unwilling rehab participant, but they can be good patients for veterinarians and staff who understand their unique personalities and needs.

Cats might seem like the ultimate unwilling rehab participant, but both Drum and Medina say they can be good patients for veterinarians and staff who understand their unique personalities and needs. More important, many older cats go untreated for a common painful condition and could benefit from rehab therapy.

“It is estimated that up to 90 per cent of geriatric cats suffer from arthritis in one or more joints,” Drum said. “Approximately half of my practice is treating arthritis, but rarely do we treat cats because signs of arthritis often go unrecognized in them. I would love to have the opportunity for more cats to receive the benefits of rehabilitation for arthritis.”

Unlike many areas of veterinary medicine, owner participation is an important part of the rehabilitation process. Be prepared to teach clients how to perform cryotherapy and thermotherapy, stretches, and therapeutic and range-of-motion exercises at home.

Costs are low for therapeutic exercise equipment—expect to spend several hundred dollars on it. In contrast, underwater treadmills, laser units, and shockwave therapy units are more expensive.

“You can be wildly successful without purchasing an underwater treadmill and other tools,” Dr. Nichols said. “If you do have the cash to do it, then great!”

But rehab therapy is more than using a laser machine or performing massage, Dr. Emden-Sanchez warns.

“Successful animal rehabilitation involves knowing what to do, what not to do, and when to do it. It is also important to know how to convince the patient to perform the behaviour you want and to have specific and realistic goals for each patient. For this reason, there is a huge learning curve that can only be acquired through experience.”

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