Exam 4: Lecture 29 - Physical Rehabilitation Flashcards
what is the definition of rehabilitation therapy
use of non-invasive excluding veterinary chiropractic for the rehabilitation of injuries in non-human animals
what are a 3 examples of rehab therapy (even though there are a LOT more)
- thermotherapy
- ROM and stretching
- massage
what are the 3 main goals of physical rehab
- restore, maintain, and promote optimal function
- improve the outcome of patient following major sx
- enhance quality of life
restore, maintain, and promote optimal function have what 2 benefits
improves muscle strength and reduce atrophy
improve the outcome of patient following major sx have what 2 benefits
increases rate of tissue healing and remodeling of scar tissue
enhancing the quality of life have what improvements
decrease pain, swelling, muscle spasms and improve fitness
what are 2 other goals of therapy
- for ideal return to function after ligament injury
- for musculotendinous injury avoidance of scar formation is the key to successful treatment
who can perform physical rehab
- licensed vet
- registered/certified vet tech trained in rehab
- licensed PT educated in veterinary anatomy and physiology
T/F: it is the responsibility of the individual practicing vet PT to know legal issues
true!!
what is the basic knowledge needed for vet PT
- behavior
- anatomy
- orthopedic and neurological eval
- tissue healing
- response of musculoskeletal tissue to disuse and remobilization
- exercise physiology
- principals behind therapeutic modalities
what is important about the medical record
you should create a written plan with expectations for the client and this becomes part of the record!
why do we do an ortho exam
to differentiate between musculoskeletal and neurological conditions
what can an ortho exam help with
ID which limb lameness originates from and localize the site, narrow down diagnostic tests, formulate treatment plan, and give owner a prognosis
what are the parts of the ortho exam
- observe patient standing and while moving esp at a trot
- observe posture
- palpation while standing and recumbent
what are the things we look for during an ortho exam while the patient is standing/moving
- listen for scuffing and watch toenails for contact with ground
- head bobbing
- video the gait in real time and slow motion
- utilize different surfaces, ramps, stairs, curbs
what is CREPIM
crepitus, ROM, effusion/swelling, pain, instability, myofascia
what do we feel for during palpation when patient is standing
- CREPIM
- end-feel of joint
- ROM of vertebrae
- palpation of caudal (tail) vertebrae and muscles
- check proprioceptive placing
- palpate any painful areas last
what do we do during a recumbent exam
- place patient in comfortable position
- can perform distal to proximal or proximal to distal
- check paw pads, nails, etc (FEET)
- access joint ROM
- evaluate all other tissues
how do we localize a lesion
based on ortho exam, consider imaging
what is important to remember about the neuro exam
do the basic PE first!!
what are the goals of the neuro exam
- assess the patients current deficits/abilities
- detect areas of pain
- assist in the development of rehab plan
how do we do a neuro exam
- observe from a distance
- observe closer
- test CNs
- postural reactions
- spinal reflexes
- palpation
- nociception and pain
what is included in the active functional assessment
- posture
- gait/mobility
- transfers from laying to standing, etc
- muscle strength test
what is included in the passive functional assessment
- passive ROM
- end-feel
- goniometry
- joint play
- flexibility
- muscle girth
- myofascial exam
what does PROM (passive ROM) show us
assess for pain, restriction, laxity of joint
what is included in PROM of each joint
flexion, extension, abduction, adduction, internal and external rotation
what is goniometry
joint angles that are measured using specific anatomic landmarks
what is flexibility testing
evals ability of the muscle to stretch and can help develop a stretching plan
T/F: flexibility testing can be normal, increased, or decreased
true
how do we do flexibility testing
slowly stretch the muscle by perform the opposite joint motion of the action of the muscle being tested
what do we use to measure muscle girth
gulick tape measure
what is this
gulick tape measure used to measure muscle girth
what is a strength test
determines if weakness is contributing to lameness and is scored on a scale from 0-5
what is a myofascial trigger point
it is a taut band of skeletal muscle
what are the steps to putting everything together to make a rehab plan
- from these exam finding put together a problem list
- come up with goals for patient
- develop a treatment plan
a _______ approach to treating pain is ideal
multi-modal
T/F: patients are not super painful when they need rehab so pain management does not need to be addressed
false!! many patients ARE painful so we must address it or therapy will not be optimal
T/F: as patients comfort levels improve, pain management strategy doesn’t really need to be adjusted
false!! the plan/strategy CAN be adjusted
what are some home modifications for dogs diagnosed with OA
- flooring
- bedding
- stairs
- nail/foot care
- feeding station
when is cryotherapy used
during the ACUTE inflammatory phase… usually 1-3 days after sx or injury
what is the benefit of cryotherapy
reduced inflammation, edema, and pain to improve mobility, minimizes hematoma formation and reduced muscle spasms
T/F: cryotherapy can be applied using a bag of crushed ice, frozen peas, or frozen gel pack
true
how long and how often should we use cryotherapy
15-25 mins for 2-6 times a day
when do we need to use caution for cryotherapy
when applying over an open wound, areas of poor sensation or vascular compromise, or in very young/old patients
when do we use thermotherapy
indicated for patients with CHRONIC pain
how does thermotherapy help
increased tissue temp leads to vasodilation and increased blood flow to remove accumulated metabolites
T/F: thermotherapy can help with connective tissue extensibility and muscle relaxation to reduce overall stiffness
true!
thermotherapy treatment should last ______ mins
30-45 mins
when is thermotherapy contraindicated
during acute inflammation, over an area of hemorrhage, or over malignant tissue
what does massage provide for the patient
pain relief, relaxation, and promotes circulation
when is massage most useful
post-exercise to reduce muscle soreness, in patients with OA, and patients with edema
when is massage contraindicated
open wounds, unstable fxs, severe pain, coagulation disorders, infection, or neoplasia
what are the techniques of massage therapy
stroking, effleurage (from distal to proximal), petrissage (rolling/kneading tissue), trigger point therapy
what are some therapeutic exercises
- stretching
- ROM (passive and active)
- aerobic conditioning, muscle strength and endurance training
- correction of gait abnormalities
- use of a variety of surfaces to walk on
T/F: it is important to understand the stages of tissue healing in order to safely implement a plan and not worsen a patients condition
true!
what are the 3 stages of healing
- inflammatory stage
- reparative stage
- remodeling stage
as the patient ___1_____, the ____2___ is adjusted
- improves
- exercise plan
what are 6 tips given for therapeutic exercises
- form is the backbone of rehab
- use good footing, keep toenails trimmed
- use a harness to support/control patient that does not restrict ROM
- keep sessions positive with treats and praise
- start low and go slow
- always warm up and cool down
what is the FITT principle
Frequency = regularity of exercise sessions
Intensity = difficult level of exercises
Time = duration of exercise sessions
Type = rehabilitation exercises selected
it is safe to increase activity by _____ per week as long as no pain or lameness
10-15%
what are the benefits of the underwater treadmill
- muscle strengthening with reduced impact on joints
- improves proprioception
- endurance improvement
- increase ROM
- hydrostatic pressure reduces edema
- warm water relaxes muscles
what is a home exercise program
a plan for patients to get regular exercise at home between rehab sessions
what is low-level laser therapy
single wavelength light that leads to a photochemical reaction in the cells
what does LASER stand for
Light Amplification by Stimulation Emission of Radiation
what is the new term for laser
photobiomodulation
what are the 5 therapeutic effects of low level laser therapy
- blocks pain transmission to the brain
- increases release of endogenous opioids
- reduction in inflammation
- used to stimulate muscle trigger points and AP points
- cellular stimulation helps wounds heal faster and tissue to regenerate
what cases are low level laser therapy very useful for
managing chronic and minor pain, especially OA and muscle spasms
what are the 2 most important parameters that impact low-level laser therapy
- wavelength
- power
what does wavelength determine
tissue penetration
what is wavelength
red and near-infrared range have biomodulatory properties and penetrate tissue
what wavelength is good for AP stimulation and wound healing with laser
636 to 660 nm
what wavelength is good for treating ligaments, joint capsule, and intra-articular structures
780 to 905 nm
what is power of laser measured in
watts or miliwatts
what is the rate of photon derlivery in superficial tissue
3-4 J/cm^2
what is the rate of photon delivery deep tissue
8-10 J/cm^2
T/F: class 4 lasers have higher power and makes for faster treatment and are more effective but do not easily cause injury
false!! they do have higher power and shorter treatment time BUUUTT they are NOT more effective and MORE easily cause thermal injury
how do we do low-level laser therapy
- ideally clip the treatment area to avoid hair absorbing light
- wash off any iodine or povidone-iodine to allow greater transmission of light
- must have protective eye gear
- do not apply laser over open fontanels, tattoos, photosensitive skin, etc
- hold the probe perpendicular to skin
- each laser brand has specific wavelengths
what are the 7 things we should avoid doing with laser
- avoid laser over injected medications
- avoid using over gravid uterus
- avoid use over tumor
- avoid using over active epiphysis
- avoid during hemorrhage
- avoid using on testicles
- avoid using laser on metal table or around other reflective surfaces including implants
how do we determine the number of laser treatments needed
by the degree of tissue damage and how fast healing is occuring
T/F: You can use the laser SID or EOD
true!
T/F: patients do not often have immediate improvement with lasers
false! they will often experience immediate improvement in comfort level and effectiveness peaks at 24 hours
T/F: you can use laser before other treatment modalities such as massage
true!
