Ortho Rehab Flashcards
why is it important to know the stages of tissue healing?
avoid excessive stress and strain
ensures tissues are challenged during recovery to encourage optimal return to function
why must tissues be challenged during recovery?
encourages optimal return to tissue function
what are the stages of healing?
post-operative
regeneration
remodelling
when does the post operative healing phase occur?
24-48 hours post op
when does the regeneration healing phase occur?
day 5 - week 3
when does the remodelling phase of healing occur?
6 weeks to 1 year
are the stages of healing the same for bone and soft tissue?
yes
what is experienced by the patient during the post op healing period?
pain
oedema
beginning of tissue healing
what is involved in the treatment of patients during the post operative healing phase?
reduction of pain through multimodal analgesia
cryotherapy
rest
easy movement only
what is the purpose of cryotherapy in wound healing?
vasoconstriction and reduction of oedema
what is treatment is critical during the post operative healing phase?
rest
analgesia
what movement should the patient be doing in the post op period?
easy movement only (non-weight bearing or supported weight bearing)
what is happening to the patient surgical site during the regeneration phase of healing?
still fragile
new collagen fibres beginning to form
callus forming around bone
why is relative rest still needed in the regeneration healing phase?
area is still fragile
what is involved in patient treatment during the regeneration phase of healing?
controlled lead exercise
passive/active ROM exercises
why can movement start to be gently introduced during the regeneration phase of healing?
new collagen fibres forming around site
what are the 2 stages in the remodeling phase of soft tissue healing?
consolidation
maturation
what is involved in the consolidation phase of remodelling in healing?
tissue moves from cellular to fibrous and becomes stronger
increase in strength and alignment
what is involved in the maturation phase of remodelling in healing?
vascularity increases
metabolic rate returns to normal
when does the maturation phase of remodelling in healing occur?
10 weeks to 1 year
what happens during the regeneration phase of bone healing?
bridging callus forms
what happens during the remodelling phase of bone healing?
clinical union of bone - crucial for bone healing
what sort of exercises may be involved in the remodelling phase of healing?
active e.g. hydro
what is a common factor in cruciate disease?
obesity
what may need to be started prior to cruciate surgery?
weight loss programme
what may be used to aid pre-op weight loss for cruciate patients?
hydrotherapy
why must hydrotherapy be stopped for a time post operatively for cruciate patients?
to aid wound healing
when could hydrotherapy restart following cruciate surgery?
once wound is sealed and sutures removed
what are the main cruciate repair options?
TPLO
TTA
lateral suture
what is involved in the rehabilitation of cruciate disease patients?
active exercise
may retrun to toe touching the day after surgery
what is the most common cruciate repair procedure?
TPLO
what dogs may TTA and lateral suture be less suitable for?
working dogs
what does the rehabilitation of fracture patients depend on?
degree of fractures and site
presence of pre-exisiting disease
degree of soft tissue damage
presence of open wounds
what preexisting disease may affect wound healing?
diabetes
what are the main components of a fracture rehabilitation plan?
adequate analgesia
restricted exercise
cold compress
encourage limb use
supportive dressing if applicable
what fracture patients is restricted exercise essential for?
THR
those who have had epidurals
how can usage of a limb following fracture repair be encouraged?
PROM exercises can be used carefully
what is the purpose of a supportive dressing for fracture patients?
pain relief
joint stability
what is the main difficulty if external fixators have been used for fracture repair?
can be difficult to apply treatments to the whole limb
what type of external fixators make massage and PROM more possible?
linear or ring
what physio therapy techniques are vital for external fixator patients?
active exercise
extension of the distal limb
why is extension of the distal limb in external fixator patients crucial?
natural flexion of the distal limb often seen with external fixation
what are the main issues seen post-op from joint surgery?
pain and swelling
what treatment should be used in the post op period following joint surgery?
cryotherapy
pressure dressings
PROM
massage
analgesia
when should cryotherapy be utilised post op in joint surgery patients?
immediately post op
how long should pressure dressings be applied to joints following joint surgery?
12-24hours post op
what is the purpose of cold therapy in joint surgery patients post op?
aids reduction of swelling
what is the purpose of PROM following joint surgery?
maintains normal ROM
encourages blood flow and lymphatic circulation
stimulates sensory awareness
what is the benefit of increasing blood and lymphatic circulation in joint surgery patients?
assists reduction of oedema
how should joint replacement surgeries be managed?
slow and controlled walking
must be settled and calm
clear signage on kennel
what can be done if joint replacement patients are stressed?
administration of sedation due to the risk of catastrophic damage to the implant
how is tendon injury managed?
rest
NSAIDs
when can PROM be started for tendon injury patients?
after 3 weeks rest
how long should exercise be limited for in tendon injury patients?
3-6 weeks
is the tendon at full strength after 6 weeks?
now
what can be used to assist a patient with a tendon injury?
support aids (e.g. boot)
what are the primary goals of rehabilitation?
weight bearing
active range of movement (ROM)
muscle building
what is the purpose of building muscles?
support of joints and limbs
what does rehabilitation assist with?
return to function
minimisation of stress on surgical site
what is required to perform rehabilitation well?
full understanding of the condition
what ways of measuring efficacy of rehab are there?
subjective - how you feel they’re doing
objective - actual measurement using scales
what is essential throught the rehab period?
adequate pain relief
what may be involved in rehab as well as post op care?
pre-emptive or surgical management
what is involved in pre-emptive / surgical management of ortho cases?
cryotherapy
support dressing
weight bearing encouraged where possible
pain management
assessment of other conditions / lifestyles
what is the role of a support dressing?
reduction of oedema and analgesia
what is the role of weightbearing in pre-surgical management?
reduced muscle atrophy
when is cryotherapy most effective?
initial 72 hour period post op/injury
what is the role of cryotherapy?
vasoconstriction
analgesia
reduction of oedema
how often should cryotherapy be performed?
3 x a day
how long should each session of cryotherapy be?
15 mins
what temperature is advised for heat therapy?
46 degrees C is sufficient
what is the benefit of heat therapy?
increased blood flow to region
increased elasticity of tissues
muscle relaxation
what must you be careful about when using hot and cold therapy?
test on self to ensure not too hot
wrap cold in a towel to prevent burns
what is the purpose of massage in rehabilitation?
increases blood flow and so oxygen supply to muscles
aids removal of waste products
helps muscle work more effectively
alleviates pain
settles patient
mobilisation of adhesions
when can massage be used?
before and after exercise or physiotherapy
what must always be performed before a physiotherapy session?
massage
what are the main types of physio exercises involved in rehabilitation?
assisted exercises
active exercises
what is the difference between assisted and active exercise?
assisted involves external support of the patient by RVN
active is the patient doing it for themselves
what are the main assisted rehabilitation exercises?
assisted standing
weight shifting
side bending and cervical flexion/extension
balance boards
swiss balls
muscle stim
what are the main active rehabilitation exercises?
slow walks
stair climbing
sit to stand or down to sit
treadmill walking
what is involved in advanced rehabilitation exercises?
dancing
wheelbarrowing
hydrotherapy
when would advanced rehabilitation exercises be started?
6-12 weeks post op
what is essential when managing a patient’s long term rehab?
communication between nurses, vet and client
having clear primary goal
how can we ensure effective communication regarding patient rehab?
clear notes on progress
any procedures recorded
videos of patient can help
discussion as a team of plans and any proposed changes
what must be communicated to an owner during rehabilitation?
progression
exercises
how they can help
management of expectations
get them to invest
