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ANESTHESIA - 2 > 39 – Rehabilitation I > Flashcards

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
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2
Q

Why do we use rehabilitation vs. physiotherapy?

A
  • *physio is a protected term and only performed by a licensed physiotherapist
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3
Q

Rehabilitation includes

A
  • Application of heat and cold
  • Ultrasound
  • Electrical stimulation
  • Low level lasers
  • Stretching, massage, therapeutic exercises
  • Aquatic therapy
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4
Q

Disuse and immobilization

A
  • Even with rehab, sometimes a limb will need to be immobilized or avoid them from using a limb
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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
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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
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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
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8
Q

Type I (slow twitch) fibers

A
  • More susceptible to atrophy due to immobilization
  • Found in large numbers in postural muscles (ex. quads)
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9
Q

Type II (fast twitch) fibers

A
  • Less susceptible to effects of immobilization
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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
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11
Q

Where is the weakest point of a tendon/ligament?

A
  • Insertion point on bone
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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
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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)
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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
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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
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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
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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
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18
Q

How can myofascial trigger points be treated?

A
  • Acupuncture
  • Massage
  • Laser
  • Therapeutic ultrasound
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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
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20
Q

How does cryotherapy provide analgesia?

A
  • Reducing nerve conduction velocity
  • Decreasing activation of A-delta fibers and C fibers
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21
Q

Cold and compression combination

A
  • More effective cooling than cold alone
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22
Q

What are the contraindications of cold?

A
  • Vascular disease
  • Altered sensation
  • Areas of previous frostbite
  • Open wounds
  • Exposed superficial nerves
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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
  1. Transcutaneous electrical neuromuscular stimulation (TENS)=analgesia
  2. 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
  1. Focused
  2. 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

ANESTHESIA - 2 (17 decks)

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