The geriatric/arthritic patient
The geriatric patient is a unique rehabilitation candidate mainly because the wear and tear of their body are not the only things to be managed. Improving cognitive function is also important. Most geriatric dogs are stiff, arthritic and in pain and usually have poor nerve function. They also mostly rely on pain relief for movement which is concerning because of the deterioration of their kidney and liver function as they age. Rehabilitation of this patient would aim to reduce pain via the use of cold packs, laser therapy and/or acupuncture or TENS. Laser therapy is particularly useful in these patients as it provides them a drug-free alternative to pain management which reduces the burden on their kidneys. Not only does laser therapy help with pain, but it also promotes the healing of damaged tissue. Once pain is under control, it is possible to work on balance, proprioception, and strengthening by performing various therapeutic exercises on and off a canine land treadmill. Aquatic therapy, particularly the underwater treadmill is a wonderful therapeutic modality in the geriatric animal as the buoyancy of the water provides support whilst the animal moves. The aim is also to reduce muscular and joint stiffness with heat therapy, massage, and stretching exercises. It must be noted that any form of therapy in geriatric and arthritic patients will constitute a maintenance regime mainly due to the progressive nature of their condition. Think back to the use of medication to help your companion move. If you weren’t administering those drugs, no way were they moving. Therefore a maintenance therapy of once a week, once a fortnight, or once a month depending on the patient, will be required to provide the best possible outcome for your companion.
The postoperative joint patient
These patients include those who have elbow and hip dysplasia, joint replacement (total hip and total elbow), cruciate surgery and patella surgery. Depending on the type of surgery performed, these patients tend to have a rest period of typically 6-12 weeks to ensure the implants placed and surgical site heals optimally. This doesn’t mean that rehabilitation is postponed until after recovery as most times a period of inactivity for this long means that muscle atrophy (decrease in size and strength of muscle), muscle contracture (shortening of the muscle) and joint contracture sets in. Therefore, in these patients, the initial phase of their rehabilitation program constitutes the use of laser therapy for pain relief and reduction of inflammation, preservation of muscle mass with neuromuscular electrical stimulation, passive range of motion exercises, massage and assisted standing exercises. Once the orthopedic surgeon has confirmed the healing of the surgical site, then strengthening type exercises can commence.
The postoperative fracture patient
These patients include long bone fractures, pelvic fractures, articular fractures, and spinal fractures. The stabilization technique used will depend on the type of fracture repair and hence the healing time is anywhere between 8 to 12 weeks. Because the limb is held rigidly after the repair, it becomes extremely important to preserve soft tissue (muscle, tendon, ligament, joint capsule) structure via a passive range of motion exercises and neuromuscular electrical stimulation. This is necessary to prevent joint and muscle contracture and muscle atrophy which results in stiffness causing decrease mobility in the animal. The underwater treadmill aids in the early introduction of exercise with minimal weight-bearing while the fracture site heals. Once the fracture site is completely healed then strengthening type exercises can gradually be introduced to not only increase muscle strength but increase bone density as well.
The postoperative neurological patient
These patients have almost always sustained a spinal disc injury and have undergone decompressive surgery. Rehabilitation is absolutely crucial in these patients to maximize chance of recovery after a very invasive procedure. The primary aim is to control pain and inflammation at the surgical site to ensure that the patient is comfortable and that the nerve pathways within the spinal column are preserved. Laser therapy is absolutely beneficial in these cases as it optimizes the body’s healing ability thereby controlling inflammation and hastening repair, including nerve repair. Nerves allow muscles to contract, therefore neuromuscular electrical stimulation is necessary to preserve muscle tone and strength while the spinal cord heals.
Nursing care is very important in some patients as they may be unable to urinate and defecate without assistance. The next important aim of these patients is to increase joint position awareness (proprioception). Simple tactile and balancing exercises are used to help them feel their limbs and teach them how to position their limbs when they are standing and similarly when they are walking. Once these patients are comfortable walking the rehabilitation program can be ramped up to include more core strengthening exercises because a strong core protects the spine.
The non-surgical neurological patient
These are patients that usually have back and neck pain or conditions where surgery is not the solution to the problem such as degenerative myelopathy or brachial plexus injury. The use of laser therapy, therapeutic exercises, and neuromuscular electrical stimulation preserve strength and function in the limb as animals recover from a nerve injury or cope with a progressive condition like degenerative myelopathy. Although clinical trials have proved laser light to aid with nerve regeneration, clinically it is not a guarantee as factors such as extensiveness of nerve damage, age of the animal and duration of injury affects the regenerative potential of the nerve. In dogs with neck or back pain, acupuncture or laser therapy are good alternatives to corticosteroid injections to manage pain and/or inflammation.
It is recommended to treat severe wounds from, accidents, self-trauma due to allergies or behavioral issues (mainly in cats) as well as a surgical wound with the use of therapeutic laser. It is highly effective in reducing inflammation and healing time which means that your animal will be more comfortable and cured in a shorter period of time. The only wounds that cannot be treated with laser therapy are post-surgical removal of cancerous lumps.
Posted by Dr. Priya Streram from ARK Veterinary Rehabilitation – Melbourne