Veterinary Medicine - April 2009 - (Page 184)

Special Section PEER-REVIEWED UNDERWATER TREADMILL THERAPY while at the same time its resistance increases metabolic demand and improves muscle strength.1 SWIMMING Swimming can also be used as a mode of aquatic therapy. Its uses and bene ts are similar to those of an underwater treadmill, but it has a few key differences.1,4 Swimming dogs use a different pattern than a walking gait, so it may not be ideal for gait retraining in a dog with a neurologic injury.5 Water in most tanks can be adjusted to a suf cient depth to allow even a large dog to free-swim. Some equipment allows the use of jets to provide resistance. Some facilities use a separate pool for swim therapy, allowing more room for a natural swim environment. In some cases, swimming can be done in lakes or in the ocean, but these are less-controlled and, thus, more risky environments. CONTRAINDICATIONS AND PRECAUTIONS Some patients may be fearful of water, but most are willing to exercise on an underwater treadmill if they are slowly introduced to the equipment and the water. If a patient is fearful of the underwater treadmill, treats placed on the ramp and tread, or a frozen cup smeared with peanut butter, can often motivate such a patient to get into position to walk. A case example of physical rehabilitation in a dog after bilateral stiﬂe surgery Bella, a 1-year-old spayed female Labrador retriever, was presented for rehabilitation therapy after bilateral anterior cruciate ligament rupture and subsequent extracapsular repair of both stiﬂes. Initially, Bella’s left rear limb was lame but the lameness shifted to the right rear limb the next week. Radiographs showed inﬂammation but no overt degenerative joint disease. Surgery had been performed three weeks before presentation, which was four weeks after the initial lameness was detected. Recovery was slightly complicated by an incisional infection on the left side, but the incision had healed by the time of presentation. Bella was receiving a glucosamine supplement as well as ﬁsh oil. Initial ﬁndings included a body condition score of 3/5 (overweight), a bilaterally shortened stride length in both rear limbs with slight internal rotation through the contact phase, and a poor sitting posture with both rear limbs held to the side and thoracolumbar kyphosis. Range of motion measurements revealed marked restriction in hock ﬂexion (L 66 degrees, R 72 degrees) and hip extension (135 degrees bilaterally) and moderate restriction in stiﬂe ﬂexion ( L 50 degrees, R 46 degrees). Extension in the stiﬂes was slightly reduced (by less than 5 degrees). Bilateral medial buttress with joint capsule thickening and effusion was present, and the left stiﬂe had excessive scar tissue at the incision. No statistically signiﬁcant difference was noted in muscle circumference between the left and right sides. The initial rehabilitation program included daily passive range of motion exercises, daily therapeutic exercises, and underwater treadmill therapy two or three times weekly. Laser therapy to reduce scar tissue in the left stiﬂe was declined. The goal of therapy was to return Bella to her previously active lifestyle. Improvement in range of motion would be used as a measurable indication of improvement, and posture and gait analysis would be subjective indicators of return to function. Bella’s treadmill program was initiated immediately. She was placed in warm water (92 F [33.3 C]) to a depth reaching her shoulder (below her greater trochanter and above her stiﬂe). She walked for four minutes at a speed of 1 mph, which resulted in a brisk walking pace. She took even steps with both rear limbs, showing a correct stride length with no internal rotation. She showed typical exaggeration of hindlimb ﬂexion. The session ended at the point of fatigue, indicated by her riding back on the treadmill (not keeping up with the speed). A ﬁve-minute massage was performed after the session, and Bella was blow-dried to prevent skin infection. During subsequent sessions, the exercise time was increased by 30 seconds to one minute based on her level of fatigue. One month after therapy was initiated, Bella showed some improvement in range of motion (L hock ﬂexion relatively unchanged at 65 degrees, R markedly improved at 55 degrees, L stiﬂe slightly improved at 46 degrees, R improved at 40 degrees, and hips improved to 155 degrees bilaterally in extension). Bella’s gait had become somewhat uneven, with a shorter stride and continued internal rotation on the left side but a larger more ﬂuid stride on the right. Her left rear limb circumference was now 1.25 cm smaller than her right. Her posture was unchanged. Her therapy protocol was revised to improve symmetry and range of motion. The underwater treadmill sessions were changed to incorporate the use of a balloon encircled above her left hock to further exaggerate ﬂexion. The duration of exercise continued to increase based on her tolerance and averaged one or two additional minutes each session. Heat therapy before passive range of motion exercise on the left side was also recommended. Exercises were revised to address the new issues. One month later, Bella was again walking evenly, with a ﬂuid long stride bilaterally. She was ﬁnally able to sit squarely, and her hock and stiﬂe ﬂexion had improved dramatically (L hock 50 degrees, R 46 degrees, both stiﬂes 38 degrees— all normal or within 5 degrees of normal range). She was released from therapy eight weeks after her initial presentation. 184 April 2009 VETERINARY MEDICINE

Table of Contents Feed for the Digital Edition of Veterinary Medicine - April 2009

Veterinary Medicine - April 2009 Contents Idea Exchange Practical Matters An Update on Gallbladder Mucoceles in Dogs Digital Radiography Equipment Benefits and Considerations How to Perform a Two-portal Laparoscopic Ovariectomy Author Guidelines CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - April 2009

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