This document provides an overview of a presentation on canine rehabilitation given by Jenn Wolfe. The presentation covers Ms. Wolfe's credentials in veterinary technology and canine rehabilitation. It then outlines the topics to be discussed including the benefits, indications, types (outpatient, inpatient, home programs), modalities, cases, and questions. The remainder of the document consists of slides from the presentation discussing the history of canine rehabilitation, common indications, different modalities used like laser therapy and electrical stimulation, manual therapies, hydrotherapy, and therapeutic exercises.

1. JENN WOLFE, LVT, CCRP
THE IN’S AND OUT’S OF REHABILITATION

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 B.S in Biology from UNC-Wilmington
 Licensed Veterinary Technician since 2006
 Certified Canine Rehabilitation Practitioner since 2008 through
University of Tennessee
MY CREDENTIALS
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 Benefits of rehabilitation
 Indications
 Rehabilitation at UVS
 Out patient rehab
 In patient rehab
 Home programs
 Modalities
 Cases
 Questions
WHAT TO EXPECT…
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 The American Veterinary Medical Association (AVMA)
established guidelines in 1996.
 “Veterinary Physical Therapy is the use of non-invasive
techniques, excluding veterinary chiropractic, for the
rehabilitation of injuries for the non-human animals”.
HISTORY
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 State Practice Acts
 Some states have different rules though the AVMA requires all
therapy be under the supervision or referral of a veterinarian
 NYS does not allow canine rehabilitation to be referred to as “physical
therapy”
 NYS requires a person earning their canine rehabilitation certificate to
be an LVT or veterinarian
HISTORY
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 Trauma causes tissues to undergo changes
 which can lead to disuse
 --injury, surgery, disease
 Disuse can result in weakness, atrophy and contracture
 --tissues that have remained too tight for too long and become shorter which can
decrease
 mobility
 Disuse can lead to the inability to carry out daily activities which can
decrease quality of life
WHY REHAB???
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 Non-invasive techniques
 Can decrease and improve recovery time
 Can decrease complications
 Can help prevent further injury
 Can decrease post-trauma pain
 Can decrease the need for medications
WHY REHAB???
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 Increase strength, endurance and cardiovascular health
 Improve proprioception and balance
 Increase flexibility and functional mobility
 Improve work or athletic performance
 Enhances quality of life
WHY REHAB???
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 Osteoarthritis
 Dysplasia
 FHO, THR
 Cruciate injury
 Luxating patella
 Amputation
 Congenital disorders- OCD, UAP
COMMON INDICATIONS
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 Soft tissue injuries
 Strains, contractures, tendinopathy
 Intervertebral Disc Disease
 Degenerative Myelopathy
 Fibrocartilagenous Embolism
 Wobblers Syndrome
 Conditioning for canine athletes
 Weight loss
COMMON INDICATIONS
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 SURGERY NOT AN OPTION??
-age, disease, owner afraid, +/- cost
 Rehab and assistive devices can still be beneficial though it cannot replace
surgical repair.
- Carts- Eddies Wheels, K9 Carts, Walkin’ Wheels
-Wraps- Dog Leggs, TheraPaw
-Braces- OrthoPets
-Specialized programs to keep the pet as comfortable and mobile as possible.
COMMON INDICATIONS
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ASSISTIVE DEVICES
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 In house referral
 Surgical vs. non-surgical
 RDVM referral
 Ortho or neuro consult first??
 Initial consult with rehab department
 Treatment plan
 Out patient treatment, HEP
OUT-PATIENT REHABILITATION
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 Patient history
 Signalment, past surgeries, injuries, ailments and/or diseases, diagnostics, meds
and supplements, diet
 Owners impression and knowledge of patient
 How is pet affected, occurrence and duration, specific time (am/pm, weather),
quality of life, likes/dislikes
 Goals
 Owners expectations
INITIAL ASSESSMENT
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 Observation at rest
 Observation during transitions
 Observation at varied gaits
 Orthopedic and neurologic exams
 Measurements
 Goniometry and muscle mass
 Body condition score
 Pain assessment
INITIAL ASSESSMENT
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 Discuss observations and findings
 Abnormal gait, pain, asymmetry, decreased ROM
 Diet, meds, supplements
 Weight loss, pain relief, chondroprotectants, omega fatty acids
 Homecare
 Assistive devices (slings, harnesses, carts, supportive wraps, braces)
 Things to avoid (stairs, slippery floors, jumping…)
INITIAL ASSESSMENT
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 PLAN-
 Expectations and goals
 Be realistic
 Short term vs. long term
 Recovering from surgery or injury
 Geriatric care
 Non-surgical maintenance
 Committing to a program
 Owner and pet compliance
 Cost
 In house modalities
 Are owners willing and able to work with the pet at home?
 Can decrease frequency of visits necessary and cost
INITIAL ASSESSMENT
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 For owners that are willing and able to work with their pet at
home.
 Specific exercises that target areas in need
 Start simple and easy
 Use household items as props
 Incorporate hills, stairs, curbs, varied surfaces- on walks
 Rechecks are case specific, more frequent to start
 Increase difficulty if pet is doing well
HOME EXERCISE PROGRAM
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 Combined effort with multiple departments
-neurology, surgery, ER
 Post surgical pain management- shorter stay-neurosurgery,
orthopedic surgery
 In-house rehabilitation- longer stay
-non-ambulatory, unable to handle at home, daily rehab and nursing care
important in recovery, surgical or injury
IN PATIENT REHABILITATION
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 Most common--post spinal surgery or spinal injury
 Hemilaminectomy, FCEM
 Assistive devices to aid paretic patients
 Quad cart, overhead lift, rubber floor, man power
 24 hour nursing care important for non-ambulatory patients
 Incontinence, bed sores, pneumonia
 Frequent use of modalities and manual therapies
 Avoid depression, keep engaged and stimulated
IN HOUSE REHABILITATION
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IN PATIENT REHABILITATION
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QUAD CART
OVERHEAD LIFT
RUBBER FLOOR

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 1.5 year old Great Dane diagnosed
with wobblers disease.
 Under went an 8 hour spinal
surgery.
 Tetra-paretic post-op (expected)
 Stayed hospitalized to receive daily
rehab treatments, acupuncture
and 24 hour nursing care until
mobile.
 Owners were able to take him
home after 3 weeks.
 Set up with a HEP and rechecks as
he improved.
IN PATIENT REHAB- MICK
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IN PATIENT REHAB- MICK
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 Laser
 Electrical stimulation
 Ultrasound
 Therapeutic exercise
 Manual interventions
 Hydrotherapy/Underwater Treadmill
 Acupuncture
MODALITIES
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 Light Amplification by Stimulated Emission of Radiation
 Transmits energy in the form of photons by infrared light directed
over tissues.
 Photons are absorbed by cytochromes in the mitochondria.
 Tissues normalize by photons producing energy and activating
enzymes.
LASER THERAPY
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 Accelerate tissue repair and cell growth
 Wound healing
 de-gloving, lick granuloma, “happy tail”, surgical wounds
 Reduce scar tissue formation
 fibrotic myopathy, contractures
 Reduce pain, inflammation and edema
 Increase nerve regeneration and activity
 Increase circulation
LASER USES
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LASER THERAPY
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 E-stim is used to treat acute or chronic muscle pain and
atrophy by using low-frequency electrical currents.
 NMES- Neuro-Muscular Electrical Stimulation
 TENS- Transcutaneous Electrical Nerve Stimulation
ELECTRICAL STIMULATION
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 Pain management (TENS)
 TENS temporarily blocks the transmission of pain sensations to the brain. It also stimulates the
release of endorphins- the body’s natural painkilling substance
 Muscle strengthening and atrophy prevention (NMES)
 Increase circulation (TENS/NMES)
 Nerve stimulation (NMES)
ELECTRICAL STIMULATION
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ELECTRICAL STIMULATION
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NMES
TENS

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 Sound waves generated by oscillating crystals in the US head.
 Sound waves are converted to heat by colliding molecules.
 A coupling agent is used between US head and skin because air
reflects the sound waves.
 Heat generated penetrates deeper than
 Hot packs with an approximate depth of 2-5 cm.
THERAPEUTIC ULTRASOUND
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 Decrease pain
 Decrease muscle spasm and contracture
 Increase circulation
 Increase tissue and wound healing
 Increase ROM and decrease stiffness
 Break down scar tissue
ULTRASOUND BENEFITS
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ULTRASOUND
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 A variety of exercises and
equipment used to promote
proprioception, flexibility,
balance, range of motion and
muscle strengthening.
THERAPEUTIC EXERCISE
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 balance board/wobble board
 cavaletti’s
 physio-rolls/exercise balls
 transitions
 figure 8’s, spirals, circles, weaves
 side stepping, backing up
 3 leg and 2 leg stands
 land treadmill
 CREATIVITY!!
THERAPEUTIC EXERCISE
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THERAPEUTIC EXERCISE
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THERAPEUTIC EXERCISE
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THERAPEUTIC EXERCISE
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 Passive range of motion (PROM)
-Helps improve tissue extensibility and flexibility.
-Helps reduce tissue adhesion and contracture.
-Helps increase circulation, O2 and flow of body fluids.
 Stretching
-Helps elongate shortened tissues.
-Increases flexibility and joint motion.
-Can be performed in conjunction with PROM.
MANUAL INTERVENTIONS
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 Massage
-Provides relaxation or stimulation depending on technique.
-Increases circulation and delivery of nutrients.
-Provides relief from tension and discomfort.
 Joint mobilization
-Specific techniques targeted to a joint with
-Decreased mobility.
-Helps relieve pain and stiffness related to surgery and osteoarthritis.
MANUAL INTERVENTIONS
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MANUAL INTERVENTIONS
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Stretching /PROMMassage

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 Uses the properties of water and a thermo-therapeutic
temperature to create an environment of low impact and
resistance.
 This enables the body to increase muscle mass and tone,
flexibility and range of motion without stress on the joints.
 It can also help reduce edema and swelling, and promote
cardiovascular activity.
HYDROTHERAPY/UNDERWATER TREADMILL
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 Buoyancy- the upward thrust of water on an immersed or floating
object. It aids in reducing the amount of weight a patient carries
which creates a low impact environment.
 Water height at hip 38% of weight
 Water height at stifle 85% of weight
 Water height at hock 91% of weight
PROPERTIES OF WATER
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 Resistance - The amount of force needed to move through
water.
 Water resistance can be used to strengthen and tone muscle.
 Viscosity - A measure of resistance of fluid depending on the
adhesion of water molecules.
 Water viscosity can allow the ability to perform certain exercises in
the water that may not be performed on land.
PROPERTIES OF WATER
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 Surface Tension- Cohesion, or attractiveness, of water
molecules is greatest at the surface increasing the difficulty of
an exercise depending on the water level.
 EXAMPLE: Water at hip level has more buoyancy than it would at
lower levels. Therefore, parts of the body that are submerged endure
less surface tension and resistance, but more viscosity.
PROPERTIES OF WATER
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HYDROTHERAPY
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Initially, unable to stand in water
unassisted. Needed high water
level, life vest and a lot of support.
Weeks later, lower water and less
support needed, resulting from
simple exercises in water and other
modalities.

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HYDROTHERAPY/UNDERWATER TREADMILL
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Both pets here have some degree of spinal trauma. They are able establish a “spinal
walking” gait in the UWT. Both get weekly treatments.

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CASE STUDIES
MAX- 5YR OLD ROTTWEILER
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 Weak in the hind end for ~1 year
 Lame ~2 wks prior to initial rDVM visit
 Was found by the owner acutely unable to stand or rise
 rDVM diagnosed pet with tetanus and treated accordingly.
 No improvement so rDVM referred to UVS neurology.
MAX
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 MRI confirmed C6/7 disc herniation.
 Dorsal laminectomy of C6/7 performed.
 Developed pneumonia 3 days post-sx so pet remained
hospitalized for intensive supportive care for 2 weeks.
 Transferred for rehabilitation once stable.
MAX
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 Upon admittance for rehabilitation pet presented:
 Tetra-paretic, non-ambulatory
 Only able to lay in lateral position and required help to change
recombancy
 Severe muscle atrophy
 Severe neck pain
 Increased rigidity of forelimbs
MAX
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 Admitted for intensive in-house rehab and nursing care.
 Rehab included:
 TENS, NMES, Laser, Ultrasound, position and transition exercises,
hydrotherapy, therapeutic exercise, motivational exercise, quad cart
exercise, massage, stretching, PROM.
MAX’S PLAN
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MAX
UNABLE TO DO ANYTHING BUT LAY LATERAL
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 Sitting and sternal exercises.
 Notice rigid forelimbs.
MAX
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Hydrotherapy and standing exercises
MAX
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MAX
WALKING EXERCISES IN QUAD CART
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MAX
LAYING MORE COMFORTABLY AND LESS RIGID MUSCLE MASS AND TONE INCREASING (NOTICE
HEAD)
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PRE-INJURY
MAX
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1 YEAR POST

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ACCESS
1 YEAR OLD LABRADOR RETRIEVER
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 Service dog in training
 TPLO repair after an acute rupture of the CCL
 Measurements showed a 5.5cm difference in the hind limb muscle mass
and decreased ROM
 Partial weight bearing on LRL
 Started rehab 2 weeks post-surgery
ACCESS
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 Rehab included:
 Massage/Stretching/PROM
 Laser therapy
 Therapeutic exercise
 Balance board
 Ball work
 Cavaletti’s
 Land treadmill
 Hydrotherapy
 Home exercises
ACCESS
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ACCESS
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 Post-rehab achievements 8wks post-op
 Symmetrical muscle mass and stifle ROM
 Normal weight distribution
 Able to return to work and training with normal gait and
function to enable the best possible performance
ACCESS
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QUESTIONS???
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