Page 133 - Veterinary Laser Therapy in Small Animal Practice

Pointing light at musculoskeletal and neurological conditions: clinical applications 119

QOL Check Table 4.2 for an overview of these pain scales,
QOL questionnaires some of which are included in Appendix A.
• Of course, force plate stance and gait analysis is
the gold standard for evaluating lameness, due to
its accuracy and objectivity. The two most common
variables analyzed are vertical impulse and peak
force, which is the maximal force applied in stance.
Nevertheless, it is not available for every practice,
and interestingly, does not always correlate with
Pain Loss of functionality functional mobility and with how much the pain
Pain scales Activity monitors interferes with the patient’s willingness to exercise
and move. [342]
Functional mobility • Assessment of functional mobility: this includes

Neuro-evaluation the usual movements and postures and the transi-
ROM
EMG tions between them, balance and propioception,
Goniometry as well as daily activities such as eating, drink-
ing, or eliminating. Sometimes the first noticeable
sign of pain is a reduction in grooming, a change
Lameness
Muscle atrophy/ in the eliminating posture, etc., and regaining such
asimmetry Force plate activities or normalizing the posture is part of the
Morphometry Gait analysis patient’s improvement. We can make up our own
questionnaire for this, or even better, use one of the
Figure 9.7 Representation of clinical changes and their scales that includes questions about daily activi-
assessment. Illustrator: Elaine Leggett; photo: Marc Gelbke ties, like the Canine Brief Pain Inventory (CBPI)
or the Hudson Visual Analogue Scale (VAS), [343] or
parameters. Together with imaging changes, such as add a functional score such as Canine Functional
radiographic progression of fractures and osteotomies, Independence Measure. [344]
we should be able to answer three main questions • Goniometry of the range of motion (ROM) of
about our patients and have a system to quantify and joints, which can be a source and/or a consequence
record these answers (and not just when it comes to of pain (see section 9.6.2 for more on goniometry).
laser therapy). • Check for morphological changes in muscles or
muscle groups. Morphometric or circumferential
• Is my patient more comfortable, with less pain? measuring of different muscle groups gives us an
• Is she able to move more and be more functional idea of the muscle mass. It is most commonly per-
and independent? formed at the femur, but can also be applied to tibial
• Has her quality of life improved? muscles and the forelimb. Measures should always
be taken in the same position and at the same point:
These questions can be answered based on scien- for instance, at 70% of the length of the femur, in
tifically validated scoring and assessment systems, and lateral recumbency, and with the coxofemoral joint
relate to physical and functional changes that can also in a neutral position. Don’t forget to measure bilat-
be measured (Fig. 9.7). Some of the following tools are erally. We frequently find atrophy with compensat-
available for every clinician: ing contralateral hypertrophy, and the % difference
should decrease as the condition improves, the
• Pain scales: once you start working with them, animal is more comfortable, and regains weight-
you become quite fast at scoring pain, provided bearing and motion.
you are consistent in your methods. Section 9.6.1 • Recently, a new instrument to stage and monitor
is dedicated to musculoskeletal and chronic pain osteoarthritis was developed, the Canine
scoring. OsteoArthritis Staging Tool (COAST). [345] This

REDONDO PRINT (4-COL BLEED).indd 119 08/08/2019 09:48