39 – Rehabilitation I Flashcards
1
Q
Rehabilitation
A
- Use of non-invasive techniques to return non-human animals to functional activity after injury
- Chiro and acupuncture are considered SEPARATE
2
Q
Why do we use rehabilitation vs. physiotherapy?
A
- *physio is a protected term and only performed by a licensed physiotherapist
3
Q
Rehabilitation includes
A
- Application of heat and cold
- Ultrasound
- Electrical stimulation
- Low level lasers
- Stretching, massage, therapeutic exercises
- Aquatic therapy
4
Q
Disuse and immobilization
A
- Even with rehab, sometimes a limb will need to be immobilized or avoid them from using a limb
5
Q
What are the cartilage changes with immobilization?
A
- Decreased synovial fluid production and diffusion of nutrients
- Decrease in chondrocytes and ECM
- If splinted in flexion: reversible thinning of cartilage
- If splinted in extension: irreversible changes (similar to OA)
- Erosion of cartilage and osteophyte production
- *changes in young and growing dogs are more PRONOUCED=take longer to improve
6
Q
Changes with immobilization are worse with more rigid fixation: examples
A
- External fixator > cast > splint
- *small amounts of motion will reduce the amount of cartilage damage
7
Q
Response of muscle to disuse
A
- Rapid atrophy and loss of strength
- Weight-bearing is critical to maintain muscle mass
- *takes at least 2x as long to regain muscle as the immobilization time
8
Q
Type I (slow twitch) fibers
A
- More susceptible to atrophy due to immobilization
- Found in large numbers in postural muscles (ex. quads)
9
Q
Type II (fast twitch) fibers
A
- Less susceptible to effects of immobilization
10
Q
Tendon and ligaments when splinted
A
- Rapidly lose strength
- Passive range of motion w/o weight bearing increases tensile strength and realign fibers
- *after a year of remobilization they still are NOT at full strength
11
Q
Where is the weakest point of a tendon/ligament?
A
- Insertion point on bone
12
Q
Bone and disuse
A
- Bone production decreases, but resorption continues at normal or increased rate
- *bone loss more pronounced in DISTAL limb
- *bone loss worse in trabecular (spongy) bone than cortical bone
- Immature dogs: lose bone faster, but also regain it faster once using limb
13
Q
What is the summary of effects of splinting? (cartilage, muscle, tendon, bone)
A
- Cartilage: thinning, possible erosion
- Muscle: atrophy and reduced strength
- Tendon: rapid decrease of strength (floppy foot)
- Bone: fracture healed, bone atrophy (especially distal bones)
14
Q
What are the general goals of rehabilitation?
A
- Reduce pain and inflammation in early stages of healing
- Minimize changes caused by disuse and immobilization
- Return patient to normal activity by making their range of motion, proprioception and strength as normal as possible
- *early controlled used of injured area
15
Q
What does early controlled use of injured area do?
A
- Facilitates and speeds healing of bone, muscle and tendon
- Improves ultimate function
- Allows patient to return to activity as quickly as possible
16
Q
Myofascial pain
A
- Regional pain syndrome characterized by myofascial trigger points (MTP) in palpable taut bands of skeletal muscle that refer pain to a distance
17
Q
What are myofascial trigger points?
A
- Dense, hyperirritable areas within a taut band of muscle
- Painful on palpation and pain may radiate
- Electrical activity similar to areas of muscle cramping
- Can be significant source of pain
- Can contribute to central sensitization
- Associated with motor dysfunction
- Reduced athletic performance
18
Q
How can myofascial trigger points be treated?
A
- Acupuncture
- Massage
- Laser
- Therapeutic ultrasound
19
Q
When is cryotherapy used?
A
- during acute inflammatory phase (first 5 days) to decrease:
o swelling
o activity of inflammatory factors
o tissue metabolism
20
Q
How does cryotherapy provide analgesia?
A
- Reducing nerve conduction velocity
- Decreasing activation of A-delta fibers and C fibers
21
Q
Cold and compression combination
A
- More effective cooling than cold alone
22
Q
What are the contraindications of cold?
A
- Vascular disease
- Altered sensation
- Areas of previous frostbite
- Open wounds
- Exposed superficial nerves
23
Q
When is heat used?
A
- Sub-acute and chronic inflammatory phase (starting after 5 days)
o Relax muscles
o Increase blood flow to muscles
o Increase venous and lymphatic damage
o Increase flexibility of superficial tissues before stretching
24
Q
How is heat thought to decrease pain?
A
- Increase blood flow to ischemic areas and reducing muscle spasm
- Stimulation of cutaneous thermal receptors=decreases pain transmission to the brain at level of dorsal horn in spinal cord
25
Q
What are the contraindications of heat?
A
- Vascular disease
- Decreased sensation
- Obtunded patient
- Over a tumour
- Over pregnant uterus
- Acute inflammation (first 5 days)
- Infection
26
Q
Therapeutic ultrasound
A
- Application of sound waves at higher frequencies than can be heard
- CANNOT be done with a diagnostic ultrasound machine
- Can reach up to 5cm depth
- Can chose either heating or non-heating settings
o BOTH speed tissue healing
27
Q
Heating settings of an ultrasound
A
- Cause deep heating of tissues to reduce muscle spasms and adhesions
- In chronic conditions: promotion of an inflammatory response is thought to speed/restart healing process
- Heating settings should NOT be used in ACUTE inflammation
28
Q
What are the indications for ultrasound?
A
- To improve joint mobility
- To improve tendon and bone healing
- To reduce scar tissue, adhesions and muscle spasms
- To treat calcified tendons
29
Q
What are the 2 main types of electrical stimulation (E-stim)?
A
- Transcutaneous electrical neuromuscular stimulation (TENS)=analgesia
- Neuromuscular electrical stimulation (NMES)=strengthening
30
Q
Transcutaneous electrical neuromuscular stimulation (TENS)
A
- Stimulates endorphin release
- Blocks transmission of pain impulses through the dorsal horn of spinal cord
- Improves blood flow and decreases muscle spasms
- Helps reduce edema
31
Q
Neuromuscular electrical stimulation (NMES)
A
- Stimulates a muscle to contract
- Used early in postoperative period to:
o strengthen muscles
o prevent muscle atrophy
o improve joint motion - also beneficial for enhancing circulation and reducing edema
32
Q
NMES vs. active exercise in strengthening muscles
A
- NMES is NOT as effective
o But it’s useful in patients that cannot bear weight and in neurological conditions where animals do NOT have motor function
33
Q
Low level laser (cold laser/therapy laser/photobiomodulation)
A
- Laser light photons absorbed by mitochondria and increase ATP production
- Also get increases in
o Nucleic acid synthesis
o Cell division
o Fibroblast proliferation
34
Q
Low level laser has likely several mechanisms of analgesia including
A
- Modulating tissues levels of NO and prostaglandins
- Anti-inflammatory effects
- Neural mechanisms that alter nerve conduction velocities
- Increased release of endogenous endorphin
35
Q
What are the indications of laser?
A
- Wound healing in plantar fasciitis and tennis elbow in humans
- Many have lab animals with few dogs and horses: CONFLICTING RESULTS
- Potentially useful for analgesia: human dental and dog OA study
36
Q
What does laser work well for?
A
- Granulomas
- Self-trauma
- Superficial skin irritation
- Supposed to work well for feather-picking in birds
- Some evidence for OA
37
Q
What are other possible uses of laser?
A
- IVDD
- Releasing tight muscles or trigger points
- Otitis externa
- Cystitis
- Superficial pyoderma
38
Q
Shockwave
A
- Application of high velocity and high pressure sound waves
- Promotes tissue healing and analgesia
- 2 types
39
Q
What are the 2 types of shockwave?
A
- Focused
- Radial
40
Q
Focused shockwave
A
- Increased depth of penetration
- Requires sedations or anesthesia
41
Q
Radial shockwave
A
- Waves ‘diffuse’ out
- Equal effectiveness to focused for superficial structures
- NO sedation required
42
Q
Shockwave for tissue healing
A
- Tension and compression within tissues result in cavitation bubbles within the tissue
- Can stimulate faster healing of soft tissues and non-union fractures
43
Q
What does collapse of bubbles from shock wave do?
A
- Release of energy
- Release of free radicals
- Increased membrane permeability
44
Q
Shockwave for analgesia
A
- Mechanisms poorly understood
o Overloading nociceptors
o Cell damage that prevents membrane potentials for transmission of pain
o Increase in anti-inflammatory cytokines
45
Q
Shockwave treatment schedule
A
- Once a week for 3 treatments
- Effects often last several months (6-9 months)
46
Q
What are the common uses of shockwave in dogs?
A
- Osteoarthritis
- Chronic tendinopathies (may only need the 3 treatments)
- Non-union fractures
47
Q
Relative density
A
- Ratio of weight of object to weight of equal volume
- *obese animals that are moving tend to float, lean animals tend to sink
48
Q
Buoyance
A
- Upward thrust of water on a body that creates an apparent decrease in weight
- *filling it up more (greater trochanter) =significantly reducing buoyancy (ex. 38% of weight)
- Lower (tarsus): 91% of weight
49
Q
Hydrostatic pressure
A
- Fluid pressure exerted on all surfaces of an immersed body
- Depends on depth and density of fluid
- Can help reduce edema
50
Q
Viscosity
A
- Frictional resistance caused by cohesive/attractive forces between molecules of a liquid
o Moving through water is more difficult than moving through air
51
Q
Surface tension
A
- Water molecules have a greater tendency to adhere to each other at surface of water
- More difficult to move in and out of water, then move fully immersed THROUGH water
52
Q
Treadmill vs. swimming
A
- Extension of hip: greater extension with walking
- Flexion of stifle up to 46 degree: swimming
- *depends what you are trying to achieve
53
Q
Underwater treadmill
A
- Allows controlled return to exercise post-surgery
o Starting day 3 after back surgery
o Starting day 7 after stifle surgery (if no skin sutures) - Improves range of motion and mobility
- Promotes weight loss
54
Q
Swimming
A
- No pool at WCVM: Use bungee on treadmill or lifejacket
55
Q
What are the aquatic therapy contraindications?
A
- Open wounds or infection
- Skin sutures
- External fixator/cast/splint
- Unstable repair
- CV or respiratory difficulties: use caution with brachycephalic
- Caution with epileptics
56
Q
Mitigate risk of water-treadmill with AF dog
A
- HR monitor
- Attached to ceiling (in case he feel down)
- *owner knows risk, but dog loved it
