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Developing Protocols for Physical Therapy

Robert Taylor United States

This is a frequent request that I receive in person, mail, phone, and e-mail. I would like to address how one assesses the patient and develops a protocol that matches the need of the patient and client with the capabilities of the rehabilitation provider.

Step 1: Statistics

Develop a sense for your “statistics of repair.” If you operate on 10 cruciate patients, what is the outcome of these patients in your hands, not what has been published? Where are they at one week, six weeks, twelve weeks, and one year?

Step 2: Outcome goals

Based on the injury, diagnosis, and technique of repair establish outcome goals. For example, I want my TPLO patients to be ready for all activity and competition by 12 weeks post-op.

Step 3: Capabilities and resources

Look at your capabilities/resources. Who will provide the rehabilitation therapy? What resources can I commit? (Purchase U.S., E-stim, therapy pool?) How do I achieve patient/client compliance? How can we be paid?

Step 4: Patient assessment

Patient assessment. The post-operative status of patients undergoing the same procedure is always different. One needs to have a good working knowledge of the repair used and the temporal aspects of wound healing.

A.   Extra capsular vs. BTB allograft

B.   Goniometry

C.   Limb circumference (muscle mass)

D.   Scar assessment

E.   Proprioception

F.   Gait

G.   Published recovery details for given procedure

H.   Demeanor of patient

I.   Willingness of owner to be part of the solution

Step 5: Patient/procedure specific protocol.

               Patient: 7 year “hunting” female Labrador

Acute CCL tear < 2 weeks old
Repair TPLO
Goal complete return of function
Trying to achieve Master Hunter Title
Anticipated surgical results—osteotomy healing 6-9 weeks
Return to competition 12-16 weeks.

               Your Capabilities

“Job dedicated” vet tech.
Heat/cold capabilities
Massage
TE
E-stim. unit

               Post-op patient assessment—first week

Left rear leg (repair)
Decrease ROM
Muscle atrophy—quads/hamstrings
“Tight” achilles
Mild synovial effusion
Scar adhesions

               Your Protocol

   i.   PROM Q.I.D.

Ice packs Q.I.D.
E-stim second week
Start leash walks—begin sit/stands/wall sits

   ii.   2-3 weeks

Leash walks
E-stim

   iii.   Reassessment—Phase II P.T. 3–6 weeks

Muscle development
Re-education of muscle—E-stim
Proprioception help—unbalance while walks
Decline walking 30-45 min. B.I.D.
Underwater treadmill?
mid frequency electrical stimulation?

   iv.   Reassessment Phase II 6-12 weeks

T.E. –muscle specific
Inclines
Stairs
Wheel barreling
Trotting
Figure of 8’s
(Swimming?)

With this stepwise format, one can design and implement a treatment protocol designed specifically for your patient, your clinic and PT capabilities.


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