Basic Rehabilitation for the Neurologic Patient
•Download as PPTX, PDF•
2 likes•508 views
Laura Perez, DVM, CVA, CCRT & Jenn Wolfe, LVT, CCRP Description: This lecture will review basic rehabilitation techniques and concepts that can be applied to patients with neurologic dysfunction/deficits. We will review what techniques and exercises are appropriate for the most common dysfunctions seen, as well as the science behind these techniques. We will also review the variety of assistive devices that are available for neurologic patients including booties, slings, harnesses, carts, etc. Learning Objectives: - Understand the concepts behind rehabilitation techniques used in neurologic patients - Identify a few basic rehabilitation techniques for neurologic patients, with a focus on “down dogs” such as Dachshunds. - Be familiar with assistive device options for neurologic patients such as harness, slings, booties, carts, and more.
Recommended
More Related Content
What's hot
Similar to Basic Rehabilitation for the Neurologic Patient
Similar to Basic Rehabilitation for the Neurologic Patient (20)
More from upstatevet
More from upstatevet (20)
Recently uploaded
Recently uploaded (20)
Basic Rehabilitation for the Neurologic Patient
- 1. LAURA PEREZ, DVM, CVA, CCRT JENNIFER WOLFE, LVT, CCRP REHABILITATION FOR THE NEUROLOGIC PATIENT
- 2. WWW.UVSONLINE.COM Discuss the Human models behind the techniques used in canine rehabilitation Review care of the “down dog” Review a few rehab techniques that you can start using in your clinic Go through the variety of assistive devices that are available for neurologic patients OVERVIEW 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 3. WWW.UVSONLINE.COM Proprioceptive Neuromuscular Facilitation Neurodevelopmental techniques Sensorimotor Postural Reactions Manual therapies HUMAN MODELS OF NEURO REHAB 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 4. WWW.UVSONLINE.COM Proprioception: perception or awareness of the position and movement of the body Proprioceptive (adj): relating to stimuli that are produced and perceived within an organism, especially those connected with the position and movement of the body. Neuromuscular: of, relating to, or affecting nerves and muscles Facilitation: the enhancement of the response of a neuron to a stimulus following stimulation. PROPRIOCEPTIVE NEURMOMUSCULAR FACILITATION - PNF 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 5. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 6. WWW.UVSONLINE.COM Developed in the 1940’s The relaxation, re-education, stabilization, strengthening and coordination training of the body following a neurologic insult Treatments are progressively goal directed towards functional activities/movements and repeated several hundred times to promote motor skill learning or relearning Using purposeful and functional movements in normal patterns PROPRIOCEPTIVE NEURMOMUSCULAR FACILITATION - PNF 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 7. WWW.UVSONLINE.COM Patterns….patterns….patterns….patterns.…patterns.…patterns… patterns….patterns….patterns….patterns….patterns…. PROM AAROM AROM RROM Walk/run pattern Lateral to sternal and reverse Sit to stand/stand to sit PROPRIOCEPTIVE NEURMOMUSCULAR FACILITATION - PNF 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 8. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 9. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 10. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 11. WWW.UVSONLINE.COM Patterning Techniques Relaxation technique for Spasticity What are your points of control? Re-education technique to activate unresponsive muscles Stabilizing techniques to strengthen weak postural muscles Rhythmic stabilization Manual contact Strengthening techniques Resistance Coordination techniques PROPRIOCEPTIVE NEURMOMUSCULAR FACILITATION - PNF 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 12. WWW.UVSONLINE.COM POINTS OF CONTROL 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 13. WWW.UVSONLINE.COM POINTS OF CONTROL 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 14. WWW.UVSONLINE.COM RHYTHMIC STABILIZATION 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 15. WWW.UVSONLINE.COM Bobath technique; evolved from PNF Lesion results in uncoordinated movement patterns and interferes with development of normal postural control Goal: Normalize muscle tone and decrease effects of these abnormal responses to then promote development of NORMAL postures and movements NEURODEVELOPMENTAL TECHNIQUES - NDT 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 16. WWW.UVSONLINE.COM Concepts Relearn basic movement patterns to assume normal postural alignment AVOID learned non-use Facilitate normal tone, posture, balance and movement via handling or activity Need core strength and stability to get distal strength and stability Constant evaluation and modifications NEURODEVELOPMENTAL TECHNIQUES - NDT 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 17. WWW.UVSONLINE.COM Ex. Spasticity to hind end Reduce spasticity – key points of control! Incorporate “normal” sensations once in normal positions Facilitate movement in a functional sequence Lateral to sternal Sit to stand and reverse – how? Walk BODY FOLLOWS HEAD NEURODEVELOPMENTAL TECHNIQUES - NDT 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 18. WWW.UVSONLINE.COM Ex. Spasticity to hind end Voluntary Movements Place them in positions they can hold on their own and then have them take treats, etc. NEURODEVELOPMENTAL TECHNIQUES - NDT 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 19. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 20. WWW.UVSONLINE.COM Sensorimotor stimulation Fast, brief stimulation = fast, brief muscle contraction Tapping, pinching, quick touch, quick brush Slow, rhythmic = calming, relaxing Postural reactions Manual therapies HUMAN MODELS 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 21. WWW.UVSONLINE.COM There is a lot of overlap and similar techniques Nice to know and how they apply, but how are you going to help the dog functionally?? What can/can’t the dog currently do? How can I use the things it can do to my advantage? How can I help it do the things it can’t do in a purposeful, functional manner? SO….WHAT? 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 22. WWW.UVSONLINE.COM Basic nursing care Paraparetic and Tetraparetic dogs following spinal cord insult have limited movement. Example; after surgery to address cervical spondylomyelopathy, most dogs can only lay in lateral recumbency and require extensive nursing care. The degree of severity and recovery time is different with each case THE DOWN DOG 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 23. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 24. WWW.UVSONLINE.COM Physiological complications Pulmonary Atelectasis; when a patient is laterally recumbent on one side for too long, it can result in the collapse of the down lung space. Aspiration Pneumonia; a patient should be fed in sternal position to avoid inhaling foreign material. Pressure sores/Decubital ulcers; result of a patient left in one recumbency for too long on an inappropriate surface. THE DOWN DOG 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 25. WWW.UVSONLINE.COM Physiological complications Urine scald; skin irritation resulting from bladder leakage. Urine retention; bladder expression, indwelling Foley catheters or passing red rubber catheters may be required in patients with loss of function. Urinary tract infection; can be a result of urine retention or lack of sterile technique in u-cath care. How do we prevent these things? THE DOWN DOG 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 26. WWW.UVSONLINE.COM Ensure your patients are clean Absorbent pads, baby wipes, waterless shampoo, powder, ointments Be aware of bladder function Leakage vs overflow, bladder expression- easy vs difficult, in-dwelling Foley catheter closed system vs red rubber- monitor output For patients who require bladder expression Gently palpate every 4-6 hours. If too difficult, consider medication to better allow expression. Ruptured bladders can happen!!! THE DOWN DOG 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 27. WWW.UVSONLINE.COM Monitor signs of a UTI; dark in color, strong odor, urgency and straining, increase in thirst Take patients outside!! Even if you are expressing them, get them outside for stimulation and comfort. Many dogs feel uncomfortable urinating inside and, may fight expression. Going outside can also be very motivating for them to get up and move. THE DOWN DOG 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 28. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 29. WWW.UVSONLINE.COM Depression It’s stressful, they don’t understand their inability to walk, they’re away from home and owners. Keep them engaged, be positive and happy in their nursing care, treat them as if they were your own. Show excitement and encouragement in their progress. They are depending on you in their recovery. THE DOWN DOG 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 30. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 31. WWW.UVSONLINE.COM Comfort… very important Bedding that is soft but not too plush that they can get tangled Use an absorbent top layer Be mindful of head and limb positioning. Use pillows and blankets to prop if necessary . Massage and PROM help avoid joint and muscle stiffness and soreness. THE DOWN DOG 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 32. WWW.UVSONLINE.COM Passive range of motion Walk/run pattern Toe tickles Positional practice Sternal Sitting Standing – bouncing, weight shifting THE DOWN DOG 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 33. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 34. WWW.UVSONLINE.COM “BICYCLING” 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 35. WWW.UVSONLINE.COM “BICYCLING” 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 36. WWW.UVSONLINE.COM SLOW MO GAIT 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 37. WWW.UVSONLINE.COM WALK/RUN PATTERN 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 38. WWW.UVSONLINE.COM Passive range of motion Walk/run pattern Toe tickles Positional practice Sternal Sitting Standing – bouncing, weight shifting THE DOWN DOG 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 39. WWW.UVSONLINE.COM Harnesses Help Em Up, slings, “hip lifters” Booties PAWZ, RuffWear, MyBusyDog, Toe ups Carts Eddie’s wheels, K9 carts, Walkin Wheels ASSISTIVE DEVICES 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 40. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 41. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 42. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT PAWZ MyBusyDog
- 43. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 44. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 45. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 46. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 47. WWW.UVSONLINE.COM5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
- 48. WWW.UVSONLINE.COM QUESTIONS?? 5/29/2019CE SPRING 2019 REHABILITATION FOR THE NEUROLOGIC PATIENT
Editor's Notes
- I am not so naïve as to think we can cover the massive subject of neuro rehab in one hour, but more touch on some main points to hopefully give you an overview…
- This is not an exhaustive list, but the more common models used in human PT and what we base most of our techniques off of. I didn’t want to spend a lot of time on this, but as I went through the slides, I found myself going through the doggie version of these things, so, well, I guess I will spend some time on it. But, basically, it was to reassure you that there is some science behind this…that there is some method to my madness
- Body awareness in space – think people who do yoga or ballet. As a general rule, most animals don’t have great proprioception, specifically hind end awareness. One exception would be….? Working dogs and specifically, agility dogs. Video of Ember and/or Whip. How can we stimulate or enhance (facilitate) the body’s neuromuscular response to stimulus specifically related to body awareness
- Ember videos
- Basically outlining the order in which you work through
- Lots and lots and lots of patterns; what is the progression of these patterns PROM – no assistance from the patient; Assisted Active ROM – some activity which you assist; Active ROM; Resisted ROM = also progressing from stabilization through strengthening and coordination with these patterns Ex. Sit to stand, land treadmill or water treadmill we’re going to talk about the walk/run pattern later, so lets focus on the lateral to sternal movement In human PT, this is referred to as “bed mobility”
- Ripley videos – doesn’t pick up head until about 7 seconds in What moves first? Which hind leg is working? Bear weight and work in diagonals
- Movement starts 6 seconds in Head actually goes to the SIDE first. I used to see this more so when I was still doing horse work. People would be trying to get a horse to stand up and would be pulling their head forward…never going to work
- What moves in order for her to sit? More common for them to move their back feet Easier to control the dog’s hind end and assisting them to sit, but important to remember it might be awkward for the dog if they are used to front feet moving
- *Points of Control on a limb – photos, video; with spasticity, get control more distally (digits, carpus) to “break” the spasticity and allow you to flex the limb; with contracture (forced flexion), get control more proximally, use your palms to guide/push as opposed to pull. *Re-education: Flaccid muscles; trying to get ANY contractions; Shake/jerk the limb while doing PROM – try to be annoying! *Stabilizing: rhythmic stabilization (isometric holds); manual contact (surround the limb you want to stabilize or push down through the limb); BEFORE worrying about having the pet walk – in sternal, in sit, in stand *Strengthening: Resistance! UWTM is great for this, natural resistance of water and our ability to get our hands on them during movement. Able to stand? Lure them to take a treat, but resist them stepping forward. *Coordination: put the pieces together; more end stage; muscle timing – swishy hips
- How can you work through the spasticity? Usually, if you get control of the digits and carpus, so more distally on the limb, you can get the limb to flex Don’t be afraid to pinch their toes a bit to elicit the withdrawal reflex
- If the limb is in a forced flexion, gain control more proximally at the elbow and stifle. More emphasis on actually guiding the limb out into extension vs pulling the limb out. Push/guide through the elbow and stifle as opposed to pulling on their digits.
- Rhythmic stabilization video Don’t want the dog stepping, just rocking side to side and feeling them resist you Flat hands, more contact as opposed to finger tips Everybody stand up and find a friend -
- These are just a few examples of PNF techniques Using our hands to elicit a response/create an effect – can be both calming or stimulatory Traction (stretch) = reflexive flexion; Compression (flex) = reflexive extension, facilitates stability Optimal = max resistance or minimal assistance If you’re trying to stimulate, use a stimulating voice! If you are trying to inhibit, calming, slow voice. Basic principles that we already use. If a dog is easily excitable, you should not add to the excitement with high pitched excited voice.
- Bobath is one of the clinicians who developed it Lots of overlap with PNF The lesion to the nervous system results in
- Where some concern comes in with putting a dog in a cart “too soon” so they stop progressing or “trying”. Learned non-use. But if done appropriately, can be used as a rehab tool Don’t let them learn that standing on the dorsum of their paw is “normal.” This can be exhausting for O’s, but I try to stress it as much as possible. Assess as you treat, treat as you assess Core strength – PT example of doing planks for knee rehab; START with core
- T3-L3 myelopathy. This insult results in spasticity to the hind end. Because of this spasticity, effects the dogs ability to walk normally If you have spasticity, you want to INHIBIT - Points of control - slow stroking, rhythmic and slow touch, rocking, increased pressure; SLOWLY performed PROM; warmth Place the patient in NORMAL position Follow a functional sequence – WATCH how they move -in lateral = use the HEAD!, prop up on down elbow, hips shifted under and feet under, tip head down, move front leg and pull forward as hind end pushes up -WALK = from a stand – HIND first, ipsilat front, other side -SIT = who moves? Front end or hind? Walk front legs forward and lower themselves into sphinx -DOWN = pop hips over, stretch “down” front leg and lower themselves into lateral
- HOW do they do these movements; GAIT VIDEOS -walk patterns – hind leg moves first -sit patterns – front legs move back vs. hind legs come forward and tuck
- What do we think is going on with this dog? What position do we want to get him into next? What does normal look like and feel like? This is not normal – don’t let it become the new normal How can you help this dog stand? What would you do first? Once in a sitting position, what could you do next that will require to “work” in the simplest manner? Reduce spasticity – key points of control! Incorporate “normal” sensations once in normal positions Facilitate movement in a functional sequence Lateral to sternal Sit to stand and reverse – how? Walk BODY FOLLOWS HEAD
- Slow, rhythmic – relaxing and calming; slow rocking (baby); slow stroke over midline Postural reactions – extensor postural thrust; hopping/side step; righting reactions; peanut ball Manual therapies – ace bandage wrap; new K9 Align; traction
- T-touch sort of wrap idea
- Deciding what technique is appropriate is obviously more important than its classification or designation
- C5-C6 dorsal laminectomy for Wobblers
- Flip every 4 hours; with large/giant breeds use harness, sling, towels, blankets to aid; spend time in sternal position, not just lateral- use blankets and pillows to help hold position (Always support neck!!); make sure patients are comfortable and not left in awkward positions (head supported, towel/pillow between limbs, not facing the wall!!); bedding- thick, soft, top layer absorbent
- Incontinence vs inability to void (different neurologic status; leakage=decreased bladder tone vs retention=increased bladder tone); veterinarian preference/case specific for Foley vs red rubber vs expression; monitor output for kidney function and hydration; refer to veterinarian for Prazosin, Bethanecol, Diazepam; Overdistension of the bladder can cause permanent damage!! Try to get patients outside for expression.
- Don’t face them towards the wall, make sure they are comfortable, use toys and treats for motivation, take outside to different areas for stimulation and motivation
- Dogs weren’t meant to look at the world on their side for prolonged periods of time, so getting them in to sternal is important
- VIDEOS – compare “bicycling” to actual walking; can we do it better Compare PROM to actual walking video Using blanket or mats or Help Em up to move them, not just shove them around Act as a spotter, let them do the work but be there to help them. GOOD FOOTING!! Yoga mats, rubber backed runners from home depot Use pillows, x-ray trough, etc, to help prop them up Once they are strong enough to hold a position, feed them in that position or help them to maintain that position while you feed them. If possible, follow the walk pattern to assist them Within each position, start to add little touches/perturbations – cookie stretches, nudging, give paw? Use food/rewards to maintain them in the position. If they can maintain a sit, feed them while sitting up.
- PROM – flexing and extending each available joint, usually reps of 10 or more
- What my dog thinks bicycling is
- What most client’s show me when I ask if they are doing PROM
- Slow mo gait pattern
- Actual walk/run pattern
- VIDEOS – compare “bicycling” to actual walking; can we do it better Compare PROM to actual walking video Using blanket or mats or Help Em up to move them, not just shove them around Act as a spotter, let them do the work but be there to help them. GOOD FOOTING!! Yoga mats, rubber backed runners from home depot Use pillows, x-ray trough, etc, to help prop them up How to get into sternal – BODY follows HEAD; prop them up on the down elbow Legs can’t be straight out, need to flex them under their pelvis in order to get into a normal sit – points of control, toe tickles Sphinx/square sit – take treats from different positions, feed them, rhythmic stabilization Lure forward with treat, maybe holding back feet in place or providing good traction – use the help em up, etc. LOTS of encouragement and touch = stand Standing – square, not on the dorsum of our feet; take treats, side to side, front to back; bouncing – rhythmically pushing down through their pelvic to mimic gravity
- We have a lot of these here with us today if you want to see what they look like
- Hip lifters made with 2 cheap slip leashes, tape, cast padding and vet wrap
- Pawz MyBusyDog
- OrthoPets – toe up boots to stop knuckling and scuffing
- TheraPaw
- Eddie’s Wheels – need to learn how to measure for this since it is a custom cart
- K9 cart – some measuring, but more forgiving in its adjustability
- K9 cart modified to be a quad cart Eddie’s wheels can also be modified, but much more cumbersome
- If you haven’t been in the rehab room, come on by for a visit to see our stuff We also have the benefit of multiple people since these patients are often very labor intensive. Equipment like peanut balls, discs, foam squares Reps, reps, reps, reps, reps and more reps
- More and more repetitions of the things we have discussed in this lecture
- Post-op
- New Bowser video?