Rehabilitation of the ortho patient

Question 1

What is the most important thing to consider when admitting an ortho patient?

Answer 1

Client communication and expectation
They must understand what condition their dog will be in when they collect and the time it will take to return to full function

Question 2

What is important to challenge in rehabilitation of the ortho patient?

Answer 2

Muscles and tissues to continue to progress rehab

Question 3

List the stages of healing

Answer 3

Post-oeprative 48 hours
regeneration 5days to 3 weeks
remodelling 6 weeks to one year

Question 4

What occurs in the first 24-48 hours post-op in an orthopaedic patient and how do you treat?

Answer 4

pain swelling odema healing tissues
Treatment 
analgesia 
pain scores 
massage 
cryotherapy 
rest 
non-weight bearing movement

Question 5

Regeneration phase in tissue healing

Answer 5

fragile new collagen fibres forming
Treatment
controlled lead exercise
passive and active ROM

Question 6

what occurs in Tissue Re-modelling?

Answer 6

Consolidation
Cellular fibrous tissue, strength and alignment
Maturation
vascualrity and metabolic rate returns to normal

Question 7

what occurs in bone re-modelling?

Answer 7

Regeneration
bridging callus forms
remodelling
clinical union of the bone

Question 8

What is the primary goal of rehabilitating the ortho patient?

Answer 8

Weight bearing
active ROM
muscle building

Question 9

What is included in a good rehabilitation plan?

Answer 9

Assists with return to function 
minimal stress at the surgical site 
subjective and objective 
continually assessed at the stages of healing 
good understanding of the condition

Question 10

Pre-emptive considerations and treatments for the orthopaedic patient?

Answer 10

Cryotherapy 
supportive dressing 
weight bearing 
pain management 
assessment of other lifestyles and conditions

Question 11

Why is it important to consider each patient individually when creating an pre-emptive orthopaedic plan?

Answer 11

Minimal stress on patient with maximal therapeutic benefits
consider age old dogs prone to OA, bedding and positioning for physio
Younger dogs lower pain thresholds high energy

Question 12

What may pre-emptive treatments achieve before othro surgery?

Answer 12

Reduced swelling
reduced pain
reduced muscle fibrosis and spasms

Question 13

What are subjective and objective measurements during orthopaedic assessment?

Answer 13

Subjective
lameness score
objective
Force plat gait analysis

Question 14

How is temperature therapy applied and what methods are used in the orthopaedic patient?

Answer 14

Cold
early application initial 72 hour period
vasocontriction 
analgesic 
reduced odema
15 mins 3 x daily 
Heat 
46 degrees 
care-reduced sensation 
before exercise increases blood flow and elasticity of the muscles

Question 15

Why is massage a useful therapy?

Answer 15

increases lymph flow 
increases venous return  
increases patient relationship 
reduces odema 
minimises pain 
mobilises adhesion
prepares muscle for exercise aids recovery after exercise

Question 16

What are the five massage techniques?

Answer 16

Effleurage
direction of hair growth, open hands, start at the neck and proceed down the back and hind limbs
Petrissage
(kneading, wringing, skin folding)
Cricular
(manipulate depper tissues for tight, knotted muscles
Shaking
Relaxing technique between deep tissue manipulations and at the end of the session
Percussion
Relaxes muscles and improves circulation, used over lungs

Question 17

How should PROM be completed?

Answer 17

Comfort first soft padded bedding
gentle flex and extend of joints
don’t forget digits
bicycle

Question 18

Assisted therapeutic exercises used for the orthopaedic patient?

Answer 18

Assisted standing 
Weight shifting 
Side bending and cervical flexion/extension 
Balance boards/ swiss balls 
muscle stimulation

Question 19

Active therapeutic exercise used for the orthopaedic patient

Answer 19

slow walks 
stair climbing 
sit to stand, down sit 
treadmil walking 
dancing
wheel barrowing

Question 20

How does ortho rehabilitation differ with fractures?

Answer 20

Degree of fractures and site
Pre-existing disease
Degree of soft tissue damage
Presence of open wounds

Question 21

Name the different types of fractures

Answer 21

Articular
subchondral bone and articular cartilage (soft tissue damage, rigid fixation)
Salter-Harris (growth plate)
rapid healing in young patients and implants usually enage only small epiphyseal fragment
Distal femoral physeal fractures
difficult to reduce, proximal, distal aspect of the femur is fractured for more than 48 hours severe complication of quadriceps
Multi-fractures
risk of implant failure
most aggressive rehab

Question 22

List the rehab process for a fracture patient

Answer 22

Pain relief 
Restricted exercise
start with sling walking slow and short 
Epidural- urinary retention limb position
cold compress around surgical site 
Slow walking and weight shifting 
PROM within comfort movement may need massage 
Supportive dressing 
if swelling is profuse

Question 23

What considerations during rehab should be considered for an external fixator?

Answer 23

Know limitations, how far patient can flex and bend
cryotherapy and massage as many areas as you can get to
Active exercises useful
protect yourself and the patient from damage of the ex fix
always check for swelling and rubs

Question 24

What rehab considerations must be made for joint surgery patients?

Answer 24

Immediate post-op cryotherapy
will often use pressure dressings for the elbow 12-24 hours after surgery
gentle PROM build up once dressing removed
massage once dressing off
Pain management
Therapeutic exercises begin within a few days
weight-bearing (prevents muscle atrophy)
Initial exercises-controlled and low impact
Hydrotherapy
after acute inflammatory period hot therapy (5days)

Question 25

what must be considered during rehab for the following specific condtions?
Excisional arthroplasty
Arthrodesis
Luxations

Answer 25

Excisional arthroplasty (removal of the head and neck of the bone)
Normal gait function not expected, early active use to prevent excessive fibrosis and loss of motion, sit to stand to build gluteals and muscle strength
Arthrodesis
Often in cast, PROM on adjacent joints, gait will not be normal
Luxations
After sling is removed, PROM is limited to sagittal plane, weight bearing exercises are limited

Question 26

What considerations must we make when rehabing a tendon patient?

Answer 26

PROM started after 3 weeks
exercise limited 3-6 weeks
tendon still not full strength at 6 weeks