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Physical Rehabilitation 1151.e7

Physical Rehabilitation Client Education
Sheet
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is a risk of complications in patients with
Difficulty level: ♦♦
○ The clinician gently rocks the surface
urinary or intravenous (IV) catheters and • Balance board
Synonym feeding tubes. Patients with urinary tract of the board from side to side while the
Rehab infections, diarrhea, or open wounds patient stands on the platform.
(including recent surgical incisions) are poor • Exercise balls and rolls
Overview and Goal candidates for hydrotherapy. ○ The patient’s forelimbs are placed on the
To restore and optimize function, minimize • Avoid overworking the patient, particularly ball with hindlimbs on the ground to build
the progression of disabilities, reduce pain, and at the outset of the physical rehabilitation balance and coordination.
enhance quality of life program, to prevent exacerbation of clinical • Exercises are generally performed 3-5 times
signs. per day for 2-5 minutes at a time.
Indications Active ROM exercises: Procedures and Techniques
• Neurological conditions Procedure • The motion of a joint by active muscle
• Degenerative joint disease (pp. 721 and 888) Procedural techniques depend on many contraction, increasing the strength and
• Before and after orthopedic and neurologic factors such as the condition(s) being treated, coordination of muscle groups
surgeries the severity and duration of clinical signs, • Commenced after the patient is indepen-
• Pain management concomitant diseases, expected prognosis, and dently ambulatory
• Weight management goals. Modalities may be used independently • May be performed during a patient’s regular
• Sporting injuries or concurrently, according to individual patient gait cycle on common surfaces (e.g., sidewalk)
• Athletic conditioning factors. or with additional challenges to enhance and
Passive range-of-motion (ROM) exercises: expand ROM:
Contraindications • The movement of a joint without muscle ○ Walking in water, tall grass, sand, or snow.
Contraindications depend on the specific contraction through its natural range using ○ Swimming in a pool or natural body of
modality being employed. For example, a an external force water eliminates weight bearing.
urinary tract infection is a contraindication to • Useful in the postoperative period before ○ Walking up a hill or ramp increases ROM
underwater treadmill therapy, and neoplastic weight bearing; aids in the prevention of joint of the forelimb joints.
lesions are a contraindication for laser therapy. contracture, minimizes pain, enhances blood ○ Stair-climbing increases ROM and exten-
and lymphatic circulation, and decreases sion of the hindlimb joints.
Equipment, Anesthesia atrophy ○ Wheelbarrowing increases thoracic limb
Although not an exhaustive list, commonly • Performed in a quiet, comfortable strength. The patient’s pelvic limbs are
employed equipment modalities include: environment held off the ground while the clinician
• Cavaletti rails, balance boards, exercise balls • The patient is placed in lateral recumbency walks the patient forward.
• Hot/cold packs, cold compression unit with the affected limb up. ○ Dancing exercises increase pelvic limb
• Underwater treadmill, pool • The clinician holds the limb proximal and strength. Here, the patient’s thoracic
• Neuromuscular electrical stimulation unit distal to the affected joint. limbs are held while the clinician walks
• Transcutaneous electrical neuromuscular • Motion occurs by flexion and extension of the patient two steps forward and then
stimulation unit the joint though the available ROM. two steps backward.
• Therapeutic ultrasound • Other joints on the limb should remain ○ Cavaletti rail exercises increase ROM, pro-
• Low-level laser unit stable; alternatively, they may be simultane- prioception, and coordination. Horizontal
ously placed through ROM exercises such rails are spaced evenly at a low height
Anticipated Time as bicycling movements to mimic normal off the ground for the patient to walk
The time required varies widely according to gait. over.
the status of the patient, the condition being • The number and frequency of repetitions Superficial thermal modalities:
treated, and the modality employed. In general, depends on the condition; however, 15-20 • Cryotherapy (cold therapy) is most effective
sessions can be 20-60 minutes, performed daily reps 2-4 times per day are typical. immediately postoperatively or after trauma
or up to several times per week. Active assisted ROM exercises: to reduce pain and inflammation. Commonly
• Used to combat the consequences of used tools to facilitate treatment:
Preparation: Important immobilization. ○ Crushed ice in a sealable double bag
Checkpoints • Involves guided motion of the patient’s ○ Water and rubbing alcohol (3 : 1 ratio) in
• Patient history (including medical and dietary), joint(s) by the clinician through the available a sealable double bag stored in the freezer
current medications, and supplements ROM, with assistance of the patient’s own ○ Frozen peas or corn
• Physical examination, including body weight, muscular contractions. ○ Commercially available gel packs
body condition, and muscle condition • Various exercises may be performed. ○ Whirlpool or ice bath
• Diagnostics: CBC, serum biochemistry panel, ○ Sling-walking while facilitating limb ○ Cold compression unit
urinalysis, imaging (as appropriate) movements through the gait cycle • Treatment times generally are 10-20 minutes
• Orthopedic and neurologic evaluations ○ Assisted walking on ground or in the water every 2-4 hours during the first 48 hours
• Measurement of muscle mass (thigh girth) while the clinician supports the limbs after injury.
and range of motion (goniometry) Balance and assisted standing exercises: when • Thermotherapy (heat therapy) can be used
• Pain score evaluation when pain is present an animal is able to safely stand, exercises that thereafter to enhance circulation, minimize
aim to enhance balance can be initiated: pain, reduce muscle spasm, and increase soft
Possible Complications and • Weight shifting tissue extensibility. Commonly used tools to
Common Errors to Avoid ○ While in a standing position, the clinician facilitate treatment:
• The physical rehabilitation program should gently nudges the patient to one side while ○ Warm towels
not interfere with medical therapies. There providing support on the opposite side. ○ Commercially available hot packs

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