Rehabilitation of the ortho patient Flashcards
What is the most important thing to consider when admitting an ortho patient?
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
What is important to challenge in rehabilitation of the ortho patient?
Muscles and tissues to continue to progress rehab
List the stages of healing
Post-oeprative 48 hours
regeneration 5days to 3 weeks
remodelling 6 weeks to one year
What occurs in the first 24-48 hours post-op in an orthopaedic patient and how do you treat?
pain swelling odema healing tissues Treatment analgesia pain scores massage cryotherapy rest non-weight bearing movement
Regeneration phase in tissue healing
fragile new collagen fibres forming
Treatment
controlled lead exercise
passive and active ROM
what occurs in Tissue Re-modelling?
Consolidation
Cellular fibrous tissue, strength and alignment
Maturation
vascualrity and metabolic rate returns to normal
what occurs in bone re-modelling?
Regeneration
bridging callus forms
remodelling
clinical union of the bone
What is the primary goal of rehabilitating the ortho patient?
Weight bearing
active ROM
muscle building
What is included in a good rehabilitation plan?
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
Pre-emptive considerations and treatments for the orthopaedic patient?
Cryotherapy supportive dressing weight bearing pain management assessment of other lifestyles and conditions
Why is it important to consider each patient individually when creating an pre-emptive orthopaedic plan?
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
What may pre-emptive treatments achieve before othro surgery?
Reduced swelling
reduced pain
reduced muscle fibrosis and spasms
What are subjective and objective measurements during orthopaedic assessment?
Subjective
lameness score
objective
Force plat gait analysis
How is temperature therapy applied and what methods are used in the orthopaedic patient?
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
Why is massage a useful therapy?
increases lymph flow increases venous return increases patient relationship reduces odema minimises pain mobilises adhesion prepares muscle for exercise aids recovery after exercise
What are the five massage techniques?
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
How should PROM be completed?
Comfort first soft padded bedding
gentle flex and extend of joints
don’t forget digits
bicycle
Assisted therapeutic exercises used for the orthopaedic patient?
Assisted standing Weight shifting Side bending and cervical flexion/extension Balance boards/ swiss balls muscle stimulation
Active therapeutic exercise used for the orthopaedic patient
slow walks stair climbing sit to stand, down sit treadmil walking dancing wheel barrowing
How does ortho rehabilitation differ with fractures?
Degree of fractures and site
Pre-existing disease
Degree of soft tissue damage
Presence of open wounds
Name the different types of fractures
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
List the rehab process for a fracture patient
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
What considerations during rehab should be considered for an external fixator?
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
What rehab considerations must be made for joint surgery patients?
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)
what must be considered during rehab for the following specific condtions?
Excisional arthroplasty
Arthrodesis
Luxations
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
What considerations must we make when rehabing a tendon patient?
PROM started after 3 weeks
exercise limited 3-6 weeks
tendon still not full strength at 6 weeks
