Veterinary Medicine - April 2009 - (Page 186)

Special Section PEER-REVIEWED UNDERWATER TREADMILL THERAPY Patients with cardiac or respiratory disease may experience more dif culty exercising in water than on land. However, most of these patients can exercise on an underwater treadmill if properly monitored and exercised conservatively.1 Increased resistance in the water causes increased cardiovascular and respiratory demand. Short sessions of exercise followed by sessions of rest (initially walking one minute, resting two minutes, repeating twice) may be more appropriate for these patients. The patient is never exercised to the point of fatigue, and its respiratory rate is closely monitored with exercise ceasing before panting occurs. As with any active therapy, each patient’s general health must be evaluated before initiating therapy to ensure it is capable of safely and comfortably performing the activity. In addition to general health concerns, the practitioner must determine if a patient’s pain level is too great to initiate active exercise. In most situations, patients in pain derive relief from aquatic activity.1 Initially, a therapist may choose to perform passive range of motion or standing exercises with the patient in the water and progress to active walking when the patient is more comfortable. Certain instabilities (such as spinal instabilities) may need to be resolved before initiating underwater treadmill therapy. Some patients with instabilities may be safely exercised underwater.3 Many experienced practitioners will initiate underwater treadmill therapy before anterior cruciate ligament surgery and in some instances when surgical correction is not possible. It is also best to avoid immersing a newly sutured area, a large wound, incontinent patients, or patients with diarrhea. Hot spots will heal faster because of the sanitation system in the water as long as the patient is dried thoroughly in the affected area. As a general rule, any condition that would warrant caution for land exercise would also warrant caution for water therapy. If a dog is tetraparetic, there should be at least two or three people in the pool with it: one to work with the rear limbs, one to work with the forelimbs, and if the patient is unable to control neck motion, a third person to prevent head submersion. Several tanks are too small to accommodate this many people, so this need should be a purchasing consideration if a practice works with neurologic patients frequently. 1. A patient walking on an underwater treadmill with jets for added resistance under the guidance of Sierra Nash, treatment assistant. exion of these joints.6 When the water is at elbow level, there is signi cant resistance with minimal buoyancy (85% weightbearing)6 since the chest is not displacing water. This level is excellent for dogs you want to increase strength and endurance in, such as athletes. Water levels at or just above the shoulder have maximum buoyancy for strengthening the limbs with minimal joint load (38% weight-bearing) and are most bene cial in patients with osteoarthritis or recovering from surgery in which full weight-bearing is contraindicated or painful.6 Water levels above this level cause dogs to shorten their strides, which can reduce the exercise’s bene t. Treadmill speed Increasing the treadmill speed increases a patient’s exertion through turbulence and resistance. Slow speeds (0.1 to 0.6 mph) are used in dogs that have neurologic problems since the viscosity of the water gives patients more reaction time and patients are more likely to step correctly instead of dragging their feet. Moderate speeds (1 to 2 mph) are used for most postsurgical and arthritic patients initially and to warm up and cool down athletes. Fast speeds (2.2 to 5 mph) are used for athletes and stronger patients that are more advanced in their rehabilitation. Limb length and, thus, stride length are used to determine a starting speed. In our experience, a medium-sized dog just starting out on an underwater treadmill does best with initial speeds of 1 to 1.5 mph, which results in a comfortable, brisk walk. TREADMILL VARIABLES Many treadmill parameters, such as water depth and turbulence and walking speed and direction, need to be determined each session to best achieve the desired outcome for a patient. Water temperature may also vary, but this variation occurs less frequently in practice than the other parameters. Walking direction Although used less frequently than forward walking, backward walking strengthens the biceps femoris, semitendinosus, semimembranosus, and super cial, middle, and deep gluteal muscles, which are often the muscles that weaken markedly in older patients, patients with metabolic or musculoskeletal disease, and patients with degenerative myelopathy. These muscles are also important for jumping, so backward walking is also an excellent exercise for athletes. The duration of backward walking is markedly shorter than that of walking Water depth Changing the water depth can markedly alter a patient’s motion and exercise exertion level. A low water level, just above the carpus (91% weight-bearing), increases carpal and hock exion more than any other level does and is useful in patients with reduced 186 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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