Physiotherapy Flashcards
What is the status of veterinary physiotherapy?
- RCVS Code of Practice for Vets
- Physios, osteopaths and chiropracters
- 19.12 The Veterinary Surgery (Exemptions) Order 1962 allows for the treatment of animals by physiotherapy, provided that the animal has first been seen by a veterinary surgeon who has diagnosed the condition and decided that it should be treated by physiotherapy under his/her direction.
What does ‘physiotherapy’ include?
‘Physiotherapy’ is interpreted as including all kinds of manipulative therapy. It therefore includes osteopathy and chiropractic but would not, for example, include acupuncture oraromatherapy.
Who does physio?
Nurses and vets with specific experience and training
Qualified physiotherapists with animal experience and/or holders of a conversion qualification
Therapeutic basis of physiotherapy?
- Physical techniques that have a direct impact on healing tissues
- Exercises that promote “proprioceptive learning”
- Overlap between the two
- Essential nature of integrating physiotherapy with the overall treatment plan
- Clients have a very high affinity for physiotherapy - but often limited evidence
- The cycle of examination, therapy and re-examination
- The therapist needs to be continually re-evaluating the patient, cataloguing changes and deciding on parallel evolution of the therapy with the changes
Massage - what are the direct impacts on tissue?
- Pain relief
- Decreased mobility
(Mechanical restriction, Post surgery, Disease) - Preventative against injury in athletes and preparatory for performance
(Warm up, performance enhancement, Recovery from fatigue and soreness)
How does massage work? 4
- relaxation (continuous touching and palpation creates a sense of security and lowered stress)
- pain relief via lowered stress and possibility of endorphin release
- direct activation of neuropeptide release in nervous system
- improved circulation and lymphatic flow (especially vascular and lymphatic return)
Outline practical masage
- can be for an isolated area
- usually an area (e.g. limb)
- often coupled with ROM exercises as warm-up
- time consuming and physically demanding n therapiist
Methods - practical massage - 4
- stroking (start with this)
- effleurage (hands move distal to proximal with medium pressure)
- compression and wrining (Petrissage)
- Percussion
Outline petrisage/ compression and wringing
- high pressure targetted at individual mm
- compress and hold for 15 seconds
Outline percussion
- cupped hand or hacking over areas of increased tone
- specific attention to spasmic nodules (trigger points)
What does cryotherapy do?
- Affects vasculature (constriction) and nerves (analgesia) directly
- Can be used even when patient is not ambulatory (Early in acute treatment)
- Most effective in the management of acute inflammation
- About 20 minute treatments
Methods - cryotherapy
- As simple as a plastic bag with a water/ice mix covered with a tea-towel (thin cloth)
- Cryogel packs (re-freezable)
- Jackets and filler flasks
- Ice bath immersion
- Vapour coolant
- Use 20 minute treatments and monitor for frostbite!
What does thermotherapy do?
- Affects vasculature (constriction) and nerves (analgesia) directly
- Can be used even when patient is not ambulatory (Not in the acute phase - heat will make swelling, heat and pain worse.
- Once initial swelling has decreased heat helps vasodilation
- Heat packs (microwave), hot water bottles
Indication - range of motion and stretching
- diminishing the effects of disuse and immobilty (increasing limb flexibility, improving ROM of joints, reducing adhesions and thickening around joints, improving muscle extension)
- expect small gains to occur slowly but effectively
What does muscle ROM equal?
= functional excursion
What is passive ROM?
- Limb supported by therapist, joint isolated
- Single joint flexed and extended until limits of ROM are reached
- Alternatively all joints of a limb can be put through ROM together (functional pattern)
- 15-20 repetitions 2-4 times per day
When is passive ROM useful?
Early - before patient wants to stand
What is active assisted ROM?
Therapist manually assists limb movement to encourage patient to use fuller ROM
When is active assisted ROM?
- once patient starts to walk
- could also be used in pool
What is ROM?
- Patients that are walking or trotting more normally do not use full ROM
- Change exercise to encourage use of full ROM (Walking in water, Different surfaces e.g. Sand, vegitation, Exercise rails, tunnels, obstacles, stairs)
- Vary exercise appropriately for size of patient!
What does stretching do?
specific reference to taking joint past the normal ROM. Desgined to oppose shortening ot tissues and to break down fibrosis and adhesion. Largely in form of static stretching in animals!
Method - static strecthing
- Normally started with passive ROM
- Take the joint to the point of resistance and then firmly move to stretch
- Monitor pain – cause no more than mild discomfort
- Hold for 15 seconds and gently release
- Up to 20 times per session
What is prolonged static stretching?
- Similar level of stretch to static system
- Stretch is held for 20mins up to 4 hours using cast, splint or bandage
- Can also use variable devices like rubber bands and dynamic fixators
What is ballistic stretching?
- Series of short bouncing stretches
- More difficult to control
- Only appropriate in patients where pain is very well controlled
- Potential risk of injury
What are therapeutic exercises?
Vast variety of exercises that can be organised in relation to a specific problem targeted to a specific problem list
List types of therapeutic exercises
- Assisted standing, maximal assisted standing, active assisted standing
- Body Slings (Stabilise while taking initial steps, Relieves thoracic and abdominal compression, Carts and slings
Inflatable exercise rolls)
Aim - therapeutic exercises
to progress to standby assisted standing and finally to standing alone
Can electrotherapy, laser and ultrasound be used?
Yes - but specific equipment and training required
How does ultrasound work as a treatment?
Primarily works through a heating effect and has the capacity to heat deeper tissues but direct effect is difficult to monitor.
How long od you do ultrasound treatment?
short - 10 minutes
When is ultrasound useful as treatment?
Useful vs soft tissue shortening, subacute and chronic inflammation and pain e.g. Tendinitis, bursitis, joint contracture, mm pain and spasm
Define NMES
Neuromuscular electrical stiulation: an electrical current applied to the patient that depolarises a motor nerve and causes muscle fibre contraction
Aim - electrical stimulation (NMES) - 4
- Increases muscle mass, strength and oxidative capacity
- Provides a time efficient method of restoring muscle function in a protected environment
- May also have an analgesic effect
What is laser therapy?
- the least best evidenced sort of physical therapy
- claimed to work on vasodilation, pain and tissue regeneration by a combination of heating and direct photo stimulation effects
- very difficult to monitor how far the effect penetrates through the skin
What is proprioceptive training?
- Proprioceptive re-learning is a key to all physiotherapy
- Movement that the patient makes in recovery and rehabilitation needs to be “good” movement ie movement that relates to real life
- The patient needs to re-learn how to use its limbs correctly
- Most therapeutic exercises engender an element of proprioceptive re-learning
Examples - specific proprioceptive training exercises
- Weight shifting
- Manual unloading of one limb
- Balance boards
- Exercise balls and rolls
- Gait training
- Leash walking (Slow walking)
- Inclines and declines
- Changing the surface – foam, rubber, air mattress
- Stair climbing
- Treadmill walking
- Dancing, wheelbarrowing
- Sit to stand exercise
- Down to stand exercise
- Horizontal bars
- Pole weaving
- Encouragement of weightbearing
What are the resistant forces on ground and in a hydrotherapy pool?
- LAND: gravity
- POOL: viscosity, friction and turbulence but the loads are spread so less deterimental
Examples - different types of hydrotherapy
- Free swimming
- Assisted swimming
- Under water treadmill
- Walking in water
What must be considered during hydrotherapy?
- All hydrotherapy must be carefully observed and patients must not be over exercised in the pool especially at the beginning of therapy
- Steps always taken to ensure that the limb makes a proper gait cycle
- Numerous aids (Flotation jackets, individual limb floats, cranes, ramps)
- Consideration of other therapy and consideration of suture lines
