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A Career Path with Bite
Therapists and doctors appreciate the rewarding
aspects of canine rehab
By Erin Erb Roblero, MSPT
November 20, 2006
Max is 11 years old.
He suffers from arthritis in his hip, and was referred to
physical therapy by his doctor. Max, however, is no
ordinary patient, nor is he being seen by an ordinary therapist.
Max is an 11-year-old Labrador retriever being treated in canine
rehabilitation. He has a form of canine osteoarthritis
called hip dysplasia, and he was referred to physical therapy by
a doctor of veterinary medicine (DVM), not an MD.
Canine rehabilitation is
not a new concept. In the mid 1990's, rehabilitation
principles were beginning to be applied to the canine species as
a way of helping them to recover after surgical procedures.
Principles used in human physical therapy were adapted and
modified for the canine patient.
Today, veterinary clinics
around the country employ veterinarians, physical therapists,
veterinary technicians, physical therapist assistants, or a
combination of clinicians, to help dogs return to their fullest
potential after an illness or injury. There are also many
independent clinicians who have established their own businesses
and accept referrals from veterinarians outside their clinics.
Human vs. Canine Patients
There are many obvious differences when treating
dogs, including anatomy, communication style and the types of
diseases and injuries to which dogs are more prone.
Clinicians report that one of the most difficult aspects of
their job is getting the animal to participate in therapeutic
exercises. It takes some creativity to find the best way
to get the dog involved, which is why equipment such as
physioballs, cones and hurdles, ladders, balance boards and tug
toys can be helpful.
Another challenge is determining the true cause of
the dog's condition.
"Determining the root cause of the patient's
presentation can be challenging, because obviously verbal cues
aren't available," said Nancy Doyle, MPT, director of
rehabilitation and fitness at Gulf Coast Veterinary Specialists
in Houston, TX. Unlike human patients, dogs are unable to
tell the clinician what is wrong, what happened or where it
hurts the most.
Amie Lamoreaux Hesbach, MSPT, certified canine
rehabilitation practitioner (CCRP) and owner of For Paws
Rehabilitation in Huntingtown, MD, agreed. The most
challenging aspect is "finding the root or actual cause of
a problem. Animals compensate so well and many times I am
treating the results of chronic compensation," she said.
Training
Advocated of canine rehabilitation emphasize the
importance of gaining advanced training in the form of
post-graduate courses. This allows the physical therapy
clinician to obtain a greater understanding of the specific
anatomy and conditions that are encountered in the canine
patient.
Certification in canine rehabilitation is also an
option through a few specialized programs. Susan Mize, PT,
certified canine rehabilitation practitioner (CCRP) and owner of
Hampton Roads Pet Rehabilitation in Chesapeake and Virginia
Beach, VA, said the certification process "provides
significantly advanced skills and knowledge base," while
lending a "significant amount of credibility and assurances
to referral sources and [animal] owners."
Laurie McCauley, DVM, of TOPS Veterinary
Rehabilitation in Grayslake, IL, and a certified canine
rehabilitation therapist (CCRP), agreed.
"Certification gives you the basics and the advanced
courses add to the knowledge of rehabilitation."
Most therapists agree that gaining certification
provides credibility to the referral sources and acceptance from
other professionals. In most, if not all states, a
veterinary referral is required prior to treating the animal.
Other practitioners emphasize hands-on training,
observation at other canine rehabilitation practices,
internships and experience in the field as important components
of learning about canine rehabilitation.
Common Conditions
Most dogs referred to rehabilitation have undergone
some type of surgery by a licensed veterinarian. Surgery
on the knee joint, or the stifle in the dog, is by far the most
common surgery seen by the rehabilitation clinician. The
cranial cruciate ligament in the stifle is similar to the human
anterior cruciate ligament. This ligament is responsible
for limiting anterior glide of the tibia on the femur in both
species.
The ligament is often torn in dogs and may require
surgical repair. Many of these dogs benefit from
rehabilitation which can include modalities for pain relief and
edema control, electrical stimulation for muscle reeducation,
stretching to regain full range of motion in the stifle, as well
as progressive strengthening and ambulation exercises.
Other common cases include neurological diagnoses
such as degenerative myelopathy and disc herniation, which is
common in breeds such as German shepherds and dachshunds.
Degenerative myelopathy is an autoimmune disease
that leads to degeneration of the nerve fibers in the spinal
cord and the myelin insulation around these axons. It is
similar to the diagnosis of multiple sclerosis in humans.
Although there is no cure for this condition,
exercise can help slow progression of the disease by helping
maintain the dog's muscle strength and retain ability to perform
functional tasks.
Disc herniation is also similar to the condition in
humans and can lead to severe pain, weakness and paralysis.
Some dogs will undergo surgery such as a laminectomy or
discectomy and be seen afterward for rehabilitation.
This is by no means an exhaustive list of
conditions that are routinely seen in canine rehabilitation.
Dogs with osteoarthritis and total hip replacements are treated
frequently. Athletic or working dogs can also benefit from
canine rehabilitation to emphasize their condition and fitness
level. Use of the underwater treadmill, swimming and other
exercises can help increase the dog's strength, endurance,
balance and flexibility.
Canine rehabilitation can also provide help with
weight reduction. It is estimated that 25 percent to 34
percent of dogs in the United States are overweight. A
rehabilitation program can help "Fido" shed a few
pounds, while decreasing the likelihood of heart disease,
arthritis, circulatory problems, diabetes and future injuries.
Equipment
The two most frequently used modalities in canine
rehabilitation according to many clinicians are the underwater
treadmill and their hands.
"I trust my hands," said Hesbach.
"I get feedback directly from my patient through my
hands."
"The biggest think I've come to appreciate in
doing this work is just how much we can accomplish with our
hands," said Carol Helfer, DVM. Dr. Helfer has been
performing canine rehab for four years and Canine Peak
Performance Sports Medicine and Physical Rehabilitation in
Portland, OR. She advises practitioners to "learn to
use your hands as your most valuable tools."
Doyle said that since dogs' communication is
non-verbal, "my observation and palpatory skills are
challenged in every case."
Mize added that not only are her hands important as
diagnostic tools, but she uses "a lot of massage, range of
motion, prolonged stretching, weight bearing, gait training,
rebalance activities, edema and pain control, scar-tissue
management and functional activities. Each treatment plan is
specifically designed with the dog in mind to achieve optimal
results.
Many people also cite the underwater treadmill as
the piece of equipment used most frequently due to its
versatility and the results that can be obtained through its
use. The underwater treadmill has the capacity to decrease
weight bearing on the limbs due to the buoyancy of the water.
Dogs with painful joints secondary to arthritis, or
limbs that are too painful after surgery to bear weight fully,
can get the benefit of partial weight bearing and gait training
the underwater treadmill. Other modalities are similar to
the ones used in human physical therapy, including ultrasound,
electrical stimulation, hot packs and ice.
Rewards and the Future
Dr. McCauley, who has worked in teh field for eight
years, says the best part of her job is "taking dogs that
have been given no hope and returning them to a pain free and
restriction free life."
At Healing Touch Small Animal Rehabilitation Center
in San Jose, CA, W.E. Hiatt, DVM, a certified canine
rehabilitation practitioner, said that his greatest satisfaction
comes from seeing animals return to normal function that would
not have recovered without the help of rehabilitation.
"Dogs that may have been euthanized in the past can now
benefit from rehabilitation to improve their quality of
life."
Marianne Zaninovich, veterinary technician and
certified canine rehabilitation practitioner (CCRP) at the K-9
Rehab Center in West Bountiful, UT, describes her job as a
passion. "Every day is a new challenge; a stretch of
compassion and mind."
Most clinicians believe that canine rehabilitation
is a field that will continue to expand in the future.
"[Canine] rehab is going to become more and more
important," said Pam Nichols, DVM, certified canine
rehabilitation practitioner (CCRP) and owner of the Animal Care
Center and K-9 Rehab Center in Utah. Dr. Nichols believes
that ultimately people will come to expect canine rehabilitation
for their pets, just as we expect physical therapy for
ourselves.
Zaninovich agreed. "This field can only
get better! People love their animals, and they all want
to seek ways of improving the quality of their animals'
lives."
Successful outcomes come in different forms in the
field of canine rehabilitation. For example, Ginger, a
3-year-old terrier mix, is now able to walk again after being
hit by a car and suffering paralysis of her back limbs.
Betsy, a Gordon setter, has returned to performing field trials
after a "maternity leave," and Baxter, a Beagle mix,
can now walk up stairs after a cranial cruciate surgery.
Ava Frick, DVM, owner of The animal Fitness Center
in Union, MO, has been working in canine rehabilitation for the
past nine years, and has been a DVM for 26 years. Dr.
Frick stated the best part of her job is the unique challenges
that she is faced with every day, as well as the rewards of
saving a life or improving a dog's quality of life.
Clinicians agree that working with dogs in this capacity is very
rewarding, and for Dr. Frick, working in canine rehabilitation
is just plain "good for the soul."
Reference
1 Lund, E., Armstrong, P., Kirk, C., et al.
(1999). Health status and population characteristics of
dogs and cats examined at private veterinary practices ni the
Unites States, JAVMA, 214, 1336-1341.
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