Richard A. Read, BVSc (Hons), PhD, FANZCVS (Small Animal Surgery)
Professor, Small Animal Surgery, School of Veterinary and Biomedical Sciences, Faculty of Health Sciences, Murdoch University, Murdoch, Western Australia
Are Dogs and Cats Different From Humans?
Companion animal veterinary practice has changed dramatically in the past 30 years and these changes have been driven by a combination of the following factors:
Rapid increase in scientific research into the causes, diagnosis and management of diseases of dogs and cats
Development of a much bigger range of therapeutic products specifically for dogs and cats
Recognition in many societies of the value of pets to the community, particularly to the physical and emotional wellbeing of the pet owners
Expanded use of dogs to assist people with disabilities
Expanded use of dogs in law enforcement
Improved standard of living, particularly for people living in cities, with associated increases in disposable income
Decreased family sizes in many countries with pets often acting as substitutes for children in many families
All these changes have contributed to a changed attitude to the level of care that many pet owners are demanding for their pets. Just as the recognition that dogs and cats benefit from receiving analgesic drugs after surgery to relieve pain and speed their recovery, so we now recognize that dogs and cats are no different from humans in their recovery from orthopedic and neurological disorders.
We recognize that many dogs and cats that are affected by orthopedic and spinal injuries or disease have difficulty returning to their normal activity levels after surgery and other in-hospital treatments. Humans who are confined to bed predictably lose muscle and bone tissue, and become weak and less agile - the same effects are seen in dogs and cats after prolonged "cage rest" and other enforced activity restrictions such as having a limb in a splint or cast.
What Does Rehab Involve?
Scientific studies have clearly shown that human patients that participate in structured physiotherapy and rehabilitation programs after surgery experience a more rapid and complete recovery than those who just go home with instructions about how to exercise properly. There is growing evidence that dogs and cats are no different. What all these patients need is a combination of exercise and activities that work together to improve strength, increase mobility, reduce pain and discomfort and restore agility and confidence. If we can achieve gains in all these areas, the net result is a more rapid return to health, vitality and "the good life".
It is the task of veterinarians to offer the full range of diagnostic and treatment options to pet owners, and then to assist the owner to make the decision that is the best for themselves and their pet. Clients' levels of enthusiasm and commitment for spending time with their pet on rehab vary significantly - what is possible for one client may not be possible for the next.
Veterinarians must be dedicated to providing a range of options to pet owners to assist the recovery of pets from illness and surgery. This should include:
Full assessment and evaluation of the needs of each patient
Discussion of a range of options with each pet owner to devise the best treatment plan, including less intensive options if time or resources demand this
Less intensive options will include tasks that the owner can complete either alone, or if the patient is less cooperative, with two family members. Local climate and access to either pet swimming pools or rivers/beaches with calm water and easy entry can influence the emphasis of both complex and simple rehab programs.
In its most simple form, a rehab program may involve:
Passive range of motion (PROM) exercises
Assisted standing and ambulation using a range of physical support devices (tail bandage, towel sling, commercially available dog harness or sling
Application of heat and/or cold
Swimming in a local pool or river
More complex rehab programs may involve:
Development of an individually-tailored rehabilitation program for each patient
Access to therapy modalities including underwater treadmill/swim tank, land treadmill, muscle/joint retraining through the use of Cavaletti rails, massage and other therapeutic modalities such as ultrasound and electromagnetic field
Evaluation of response by trained veterinarians and through the objective measurement of gait and limb function using force-platform analysis of gait
Support for owners continuing with ongoing rehabilitation activities in the home setting
Advice re appropriate diet and other nutritional advice to support full and rapid recovery
Advice/assistance with managing pain and inflammation during surgical recovery
In the immediate post injury or post surgery situation, orthopedic and neurological patients should commence rehab as soon as possible while in hospital. Achieving effective levels of analgesia is more simple while the patient remains hospitalized, which is important to gaining the confidence and cooperation of the patient. In-hospital rehab can be readily performed multiple times per day. In the more chronic phases, most rehab patients are managed as outpatients - their owners will drop them in to a rehab centre in the morning, they will be evaluated by the staff and any improvements or problems recorded. They will then stay for the day and have one or a number of therapy sessions, before being picked up and taken home again that evening. Most patients will be treated 2–3 times per week for an intensive period of 4–6 weeks, following which occasional recheck visits/therapy sessions may be indicated.
The duration of a particular rehab program will depend on two factors:
The rate of improvement in the patient
The time availability of the people performing the rehab (in a specialist facility this factor may translate to cost ($$) instead of time)
It can be readily argued that rehab programs should be never-ending; it is often soon after a program lapses that re-injury occurs.
Many pet owners will do anything to keep their pet active and healthy - some will commit large amounts of time and enjoy an enhanced period of close relationship with their pet, while others will gladly pay for specialized treatment at a dedicated rehab centre. Recognizing which of your clients fall into this category is a skill that veterinarians need to develop, because if well supported and cared for, these clients will become your most enthusiastic ambassadors.
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2. Bromily MW. Physiotherapy in Veterinary Medicine. Blackwell Scientific, 1991, London.
3. Levine D, Millis DL, Marcellin-Little D, Taylor R. Rehabilitation and Physical Therapy. Veterinary Clinics of North America (Small Animal Practice). 35(6), 2005.
4. McGowan C, Goff L, Stubbs N. Animal physiotherapy. Assessment, Treatment and Rehabilitation of Animals. 2007. Blackwell Publishing, Oxford.
5. Millis D, Levine D, Taylor RA. Canine Rehabilitation and Physical Therapy. WB Saunders, 2004, Philadelphia.