Introduction to Physical Rehabilitation PDF

Introduction to Physical Rehabilitation VCS 806 z Kim Mayers, DVM, MS, CCRT, CVA Physical Rehabilitation Clinician October 2023 Slides and photos courtesy of Dr. Stephanie Thomovsky 1. Understand what is meant by the term physical rehabilitation and the legal issues surrounding its practice. 2...

Introduction to Physical Rehabilitation VCS 806 z Kim Mayers, DVM, MS, CCRT, CVA Physical Rehabilitation Clinician October 2023 Slides and photos courtesy of Dr. Stephanie Thomovsky 1. Understand what is meant by the term physical rehabilitation and the legal issues surrounding its practice. 2. Understand how PR improves function in patients with orthopedic disease. 3. Familiarize yourself with the physical rehabilitation exam. 4. What is the goal of PR in the typical orthopedic patient. 5. Understand the PR techniques and modalities commonly used to treat orthopedic disease. z Objectives z Outline  What is physical rehabilitation?  How do you decide what patient would benefit from PR?  The PR examination  Goals of PR in the orthopedic patient  Common orthopedic diseases treated with PR  Techniques and modalities used to treat orthopedic conditions  Case examples z What Is Physical Rehabilitation? Purdue PT Room A little space goes a long way!  Physical rehabilitation = physical therapy  PT is a trademarked term used in human medicine  Veterinary physical rehabilitation is ‘the use of noninvasive techniques, excluding veterinary chiropractic, for the rehabilitation of injuries in nonhuman animals.’ z Outline  What is physical rehabilitation?  How do you decide what patient would benefit from PR?  The PR examination  Goals of PR in the orthopedic patient  Common orthopedic diseases treated with PR  Techniques and modalities used to treat orthopedic conditions  Case examples z Who Can Practice Veterinary Physical Rehabilitation?  Licensed veterinarian  Licensed, certified, or registered veterinary or animal health technician educated in veterinary physical rehabilitation (depending on state laws)  Licensed human physical therapist educated in nonhuman animal anatomy and physiology (depending on state laws) z How Do You Decide What Patients Would Benefit From PR?  Any patient who needs to improve:  Gait  Balance  Proprioception  Pain relief  Posture  Range of motion  Aerobic/fit status/endurance  Weight loss  Arousal or cognition z Most Common Orthopedic Patients Who Would Benefit From PR  Following orthopedic surgery  Prior to elective orthopedic surgery  An attempt to make the patient a better surgical candidate   Soft tissue injury   Ex. The obese patients prior to elective orthopedic surgery Muscle strains Canine (and equine) athletes z Outline  What is physical rehabilitation?  How do you decide what patient would benefit from PR?  The PR examination  Goals of PR in the orthopedic patient  Common orthopedic diseases treated with PR  Techniques and modalities used to treat orthopedic conditions  Case examples z The PR Examination  Assess patient’s physical fitness  Weight, TPR, muscle quality  Orthopedic health  Neurologic health Pay attention to muscle mass, muscle tone, joint motion, joint stability and pain z The PR Examination  Start with a gait assessment  Combination of the orthopedic and neurologic examinations  Palpate long bones  Palpate muscles  Palpate joints  Range of motion  Check proprioception  Check reflexes Post op FHO PR Examination: a melding of the orthopedic and neurologic examinations! Goniometry - Hip z Extension Flexion z Limb Girth z Outline  What is physical rehabilitation?  How do you decide what patient would benefit from PR?  The PR examination  Goals of PR in the orthopedic patient  Common orthopedic diseases treated with PR  Techniques and modalities used to treat orthopedic conditions  Case examples z Goals Of PR In The Orthopedic Patient  Pain relief  Improve muscle strength and flexibility  Improve range of motion  Improve muscle and joint balance, coordination and proprioception  Prevent muscle contracture z Outline  What is physical rehabilitation?  How do you decide what patient would benefit from PR?  The PR examination  Goals of PR in the orthopedic patient  Common orthopedic diseases treated with PR  Techniques and modalities used to treat orthopedic conditions  Case examples z Common Orthopedic Diseases Treated With PR General Conditions  Fractures/luxations  Osteoarthritis  Osteochondritis dissecans (OCD)  Angular limb deformities  Tendon trauma  Superficial and deep digital flexor tendons  Patella tendon  Long digital extensor tendon  Common calcaneal (Achilles) tendon z Common Orthopedic Diseases Treated With PR Shoulder Conditions Elbow Conditions  Bicipital tenosynovitis   Supraspinatus tendinopathy  Medial shoulder instability  Infraspinatus contracture  Elbow dysplasia  Fragmented medial coronoid process of the elbow  Ununited anconeal process (UAP)  OCD Elbow incongruity z Common Orthopedic Diseases Treated With PR Pelvis and Hip Conditions Thigh Conditions  Hip dysplasia  Quadriceps contracture  Legg-Calve-Perthes disease  Iliopsoas strain  Hip luxation  Fibrotic myopathy z Common Orthopedic Diseases Treated With PR Stifle Conditions  Cranial and caudal cruciate ligament rupture  Patella luxation z Outline  What is physical rehabilitation?  How do you decide what patient would benefit from PR?  The PR examination  Goals of PR in the orthopedic patient  Common orthopedic diseases treated with PR  Techniques and modalities used to treat orthopedic conditions  Case examples z Techniques Used To Treat Orthopedic Disease  Massage  Range of motion  Active and passive  Joint mobilizations and glides  Weight shifting   Dancing, Supermans Hot and cold therapy z For What Purposes Are These Techniques Used?  Massage  improve circulation, extensibility and pliability and flexibility of tissues, pain relief, reduction in contracture  Hot therapy  improve circulation, extensibility and pliability and flexibility of tissues, pain relief, reduction in contracture  Cold Therapy  reduce inflammation, pain relief  Range of motion  reduce contraction, improve joint health via improved synovial flow  Joint mobilizations and glides  reduce joint capsule contraction  Weight shifting  improve limb and joint proprioception, sensory stimulation, mind/body connection Modalities Used To Treat Orthopedic Disease z Non-electrical equipment  Wobble boards  Bosu ball  Physioballs or peanuts  Rocker board  Ramps and stairs  Cavaletti rails  Holistic/alternative therapy  Acupuncture Post op TPLO z Modalities Used To Treat Orthopedic Disease Electricity please! Post op TPLO  Therapeutic laser  Therapeutic ultrasound  Electrical stimulation  Transcutaneous Electrical Nerve Stimulation (TENS)  Neuromuscular Electrical Stimulation (NMES)  Land treadmill (LTM)  Extracorporeal shock wave (ECSW)  Pulsed electromagnetic field (PEMF)  Water treadmill (UWTM)  Therapy pool  Compression cooling z For What Purposes Are These Modalities Used?  Pain Relief  TENS, therapy laser, acupuncture, PEMF  Range of motion  ramp/stair work, cavaletti rails, UWTM, LTM, therapy pool  Balance  wobble board, bosu ball, physioball/peanut, cavaletti rails, rocker board  Muscle building  ramp/stair work, UWTM, LTM, therapy pool, NMES  Improved healing  therapy ultrasound (pulsed), therapy laser, ECSW, PEMF  Heating  therapy ultrasound (continuous)  Cooling  compression cooling  Maintain/improve aerobic fitness  UWTM, LTM, therapy pool, hill/stair work Cavaletti Rails Physiopeanut Bosu Ball Wobble Board Electrical stimulation - TENS Therapeutic LASER z Underwater treadmill Land treadmill Medial shoulder instability Extracapsular stifle repair Hip OA Psoas strain Calcanean tendon rupture z Outline  What is physical rehabilitation?  How do you decide what patient would benefit from PR?  The PR examination  Goals of PR in the orthopedic patient  Common orthopedic diseases treated with PR  Techniques and modalities used to treat orthopedic conditions  Case examples z A Few Case Examples  Post op TPLO - Vinny  Muscle strain - Mac z Vinny  Signalment   3 year old CM Pit Bull History  Acute onset left pelvic limb lameness 4 weeks ago  No improvement on pain medications and rest z  Vinny TPLO performed left pelvic limb 1.5 weeks before presenting to Purdue z What’s Your Plan?  To develop a plan there are things you need to consider:  Is the patient unstable?  When was the surgical repair?  Are the muscles, bones, joint capsule healed?  Is the patient painful?  What is the ROM?  Typically following, in this case a TPLO, how is the mobility affected? z PR Physical Exam And Assessment  Left pelvic limb lameness (grade 3/5)  Decreased range of motion – specifically extension hip and stifle on left side  Goniometry measurements  Pain on left stifle manipulation  Mild muscle atrophy left stifle   Girth measurements No obvious ataxia, CP or reflex deficits in pelvic limbs Goniometry Hip z Post L TPLO Extension Left Right Flexion Goniometry Stifle z Post L TPLO Extension Left Right Flexion Limb Girth z Post L TPLO Left Right 34.7 cm 37 cm z What Are Your PR Goals?  Improve strength  Improve mobility  Improve flexibility and range of motion  Get the patient back to his ‘normal’ or pre-injury activity level z How Do We Achieve These Goals? z Typical Post-op TPLO Painful on stifle manipulation Weeks 1-2  Analgesics  Acupuncture  Electrical stimulation  Decreased stifle and hip extension Reduced weight bearing TENS  Heat therapy  PROM exercises  Therapeutic laser  Weight shifting exercises  On land, flat surface z Whoohoo Vinny! Therapy Laser z Typical Post-op TPLO Weeks 2-4  Analgesics  Acupuncture  Electrical stimulation Painful on stifle manipulation  Decreased stifle and hip extension  Heat therapy  PROM  AROM exercises  Reduced weight bearing TENS  UWTM therapy or Cavaletti Rails Weight shifting exercises  Wobble board  Modified Supermans/dancing  Front limbs elevated z Go Vinny! Supermans Wobble board with front limbs elevated z Typical Post-op TPLO Decreased stifle and hip extension Reduced weight bearing Improve strength Weeks 4-8  Heat therapy  AROM    Land treadmill (elevated)  Cavaletti rails  Stairs Weight shifting exercises  Wobble board  Modified Supermans/dancing  Front limbs elevated Exercises  UWTM and Land TM z Physiobone Go Vinny! z Mac  Signalment   2 year old CM Sheltie History  Acute onset of right pelvic limb lameness after not clearing a rail at an agility competition z What’s Your Plan?  To develop a plan there are things you need to consider:  Is the patient unstable?  Is the patient painful?  What is the ROM?  Typically following, in this case a TPLO, how is the mobility affected? z PR Physical Exam And Assessment  R pelvic limb lameness (grade 3/5)  Pain on psoas palpation at origin and insertion  No obvious muscle atrophy in affected limb  No obvious ataxia, CP or reflex deficits in pelvic limbs z What Are Your PR Goals?  Decrease pain  Improve strength  Improve mobility  Get the patient back to his ‘normal’ or pre-injury activity level z How Do We Achieve These Goals? z Typical Muscle Strain Painful on palpation of psoas at origin and insertion Weeks 1-2  Analgesics  Acupuncture  Electrical stimulation   Decreased extension hip (often secondary to pain) Reduced weight bearing TENS Heat therapy  Therapeutic ultrasound or therapy laser  PROM exercises  Weight shifting exercises  On land, flat surface z Typical Muscle Strain Painful on palpation of psoas at origin and insertion Weeks 2-4  Analgesics  Electrical stimulation  Decreased extension hip (often secondary to pain)  Acupuncture  Heat therapy  Improve ROM TENS Therapeutic ultrasound or laser  PROM exercises  Active exercises  UWTM, Cavaletti Rails (low level) z Mac & His PR Therapy Laser z Typical Muscle Strain Painful on palpation of psoas at origin and insertion Weeks 4-8  Analgesics  Electrical stimulation  Decreased extension hip (often secondary to pain) Improve ROM TENS  Acupuncture  Heat therapy  Therapeutic ultrasound or laser  Acupuncture  PROM exercises  Active exercises  UWTM or Land TM, Cavaletti Rails  Small hill climbs, short stairs Objectives z 1. Understand what is meant by the term physical rehabilitation and the legal issues surrounding its practice. 2. Understand how PR improves function in patients with orthopedic disease. 3. Familiarize yourself with the physical rehabilitation exam. 4. What is the goal of PR in the typical orthopedic patient. 5. Understand the PR techniques and modalities commonly used to treat orthopedic disease.