Physiotherapy and physical rehabilitation

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Physiotherapy is concerned with physical function, and regards movement and optimal function as central to the health and well being of individuals. This chapter looks at Physiotherapy in small animal practice; Indications for physiotherapy; The physiotherapy process; Physiotherapy treatments; Rehabilitation; and Special considerations.

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9.1 The overlapping roles of the veterinary team involved in physiotherapy and rehabilitation.
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9.3 Stages for possible referral to the veterinary physiotherapist.
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9.5 Kinetic analysis. Force plates measure ground reaction forces acting on the limb during the stance phase of gait. The forces are measured in three orthogonal planes: medial–lateral (), craniocaudal () and vertical (). Measurements obtained include peak forces and impulses, and analysis allows comparisons to be made at different times (same limb), or at the same time (different limbs). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. The dog is led across the force plate by a handler, in a consistent manner and with no interference from the handler. Three satisfactory foot strikes are required to provide adequate data for analysis. (b, courtesy of the Royal Veterinary College)
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9.6 Kinematic analysis. Reflective markers are applied to specific anatomical landmarks on the animal. The subject is then moved down a runway and the movement filmed by a series of video cameras. The motion of the markers is converted into digital images, allowing analysis of limb and joint movements. Comparisons can be made at different times (same joint) or by comparing equivalent joints on each side. (Courtesy of the Royal Veterinary College)
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9.7 Pressure mat scanning systems allow clinicians to collect information about foot biomechanics, gait and balance. The use of pressure plates is a useful way of examining weightbearing through the limb and helps identify specific high/low pressure areas. (Courtesy of the Royal Veterinary College)
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9.9 Measuring carpal joint flexion using a goniometer.
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9.12 Stroking involves a gliding movement performed in any direction on the surface of the body, although it usually starts proximally and ends distally.
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9.13 Effleurage is a stroking movement starting distally and moving proximally in the direction of the flow of the veins and lymphatics. In the limbs the movement starts at the paw. The hand(s) must be relaxed and moulded accurately to the shape of the limb or part being treated.
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9.14 Kneading. The muscles and subcutaneous tissues are pressed alternately inward and upward by one or both hands. The skin is moved on the underlying tissue, and the hands (or fingers) moved in a circular motion. The hand(s) glides very gently over the area under treatment during the relaxation phase, with small areas being treated with the tips of the fingers or thumb.
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9.15 Picking-up. The muscles are grasped, lifted, squeezed and released. During the lift, the fingers and thumb(s) should be controlled by the intrinsic muscles and the palm(s) must not lose contact with the skin. A good technique for the larger muscles of the fore and hindlimb.
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9.16 Wringing. The tissues are grasped with both hands, lifted, and then the hands moved in opposite directions, backwards and forwards across the long axis of the muscles, stretching the tissues. This is a good technique to use on the animal’s back and hindquarters.
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9.17 Skin rolling. The skin and subcutaneous tissues are grasped between the fingers and thumbs of both hands. The tissues are then rolled forwards or backwards against the fingers or thumbs. This is a useful technique for finding adhesions between the skin and deeper structures, and then for treating those adhesions.
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9.18 Frictions are performed by the thumb or fingertips, with the superficial tissues moved on the deeper ones, the depth varying with the structure to be treated. There should be no movement of the finger or thumb on the skin. Transverse frictions move across the muscle fibres and maintain even pressure throughout. Circular frictions work on one area and progressively increase in depth.
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9.19 Percussion. Hacking is performed with the ulnar border of the little finger, either alone or supplemented by other fingers. The operator’s elbows are flexed to about 90 degrees, the wrists are held in extension, and the fingers are relaxed. The striking movement is one of alternate pronation and supination of the hands/forearms. Hacking is a good technique for the back muscles, and the thicker muscles of the hindquarters. Pounding uses a similar movement to hacking, with a loosely clenched fist striking the part with the ulnar border of the hand. During clapping (coupage) the operator’s hands are cupped and the forearms pronated. The elbows are bent, and alternate flexion and extension of the wrists brings the hands sharply into contact with the patient’s body, resulting in a deep toned clapping sound. This can be used over most muscular areas, and it is often used over the ribs to loosen secretions. Beating is similar to clapping but is performed with a loosely clenched hand so that the dorsal aspect of the fingers and the base of the hand come into contact with the part being treated. Beating should be used only over large muscle groups.
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9.20 A rhythmic shaking – performed by holding the body part with one or both hands, moving it from side to side, up and down, or in and out to stimulate circulation. Vibrations are a finer form of shaking, conveyed through the hands or fingertips for just a few seconds. This technique relaxes the nervous system, is useful over joints and around bony prominences, and near well-healed scar tissue to reduce adhesions. It is generally thought to be more effective in loosening chest secretions than the more vigorous form of shaking.
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9.21 Passive movements. Flexion and extension passive movements performed on the stifle. The joint is moved into flexion to the first point of resistance (or animal reaction), and then similarly into extension. This is repeated in a rhythmic manner 15–20 times, and should be performed several times daily. Hindlimb moved in a bicycling motion to simulate normal gait patterning; a useful technique for patients with neurological disease that are unable to walk.
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9.22 Stretch applied to hamstrings with hip in flexion and stifle in extension. The muscles are stretched to the point of resistance and held for 30 seconds (range can be increased if resistance eases during this time). The stretch is repeated 2–3 times, and this regime should be performed several times daily.
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9.23 Mobilizations performed on the cervical spine.
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9.24 Accessory movements occurring during flexion to extension movement at the stifle joint. Through the combined movements of rolling, sliding and rotation, the stifle is able to move from flexion to full extension. These movements are reversed when the stifle returns to flexion. Any interference with these accessory movements can result in pain and reduction in range. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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9.25 Joint manipulation to correct a pelvic dysfunction.
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9.26 Cold compression unit. The sleeve around the animal’s limb is connected by a hose to a container filled with iced water. Water enters the sleeve by gravitational effect when the container is held above it. The hose can then be disconnected to allow the animal to move around or exercise. At the conclusion of treatment, the hose is reconnected and the container lowered to empty the sleeve.
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9.27 Ice massage of the cranial tibial muscle. Ice is rubbed over the area using short strokes for 5–10 minutes, parallel to the muscle fibres.
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9.28 ‘Dancing’ is a muscle-strengthening exercise.
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9.29 Endurance exercises include swimming.
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9.30 Flexibility exercises include: stepping over obstacles; weaving; and baiting (here, a treat is used to encourage the animal to move in a certain way, thereby mobilizing its spine and adjusting its balance and weightbearing).
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9.31 Balance exercises include activities requiring rapid responses to changes of the supporting surface. Balance pads can be used to achieve these.
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9.34 Manual treatments such as massage and passive movements, as well as exercises to improve strength and mobility can be used in cats.
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