Many people believe that veterinary rehabilitation consists of a series of therapeutic exercises, especially involving the underwater treadmill, which can be applied to our animal patients. The notion that this field would be easy to grasp, with intuitive reasoning, and little training, has led many to attempt to add rehabilitation to their veterinary practices.

In reality, veterinary rehabilitation is the application of an all-new diagnostic algorithm to our patients. It focuses upon soft tissues rather than bones and joints. It involves special tests that allow for determination of specific tendinopathies and soft tissue abnormalities. The use of objective outcome measures, evaluated with goniometers and Gulick Girthometers provides clear evidence of the progress of the patient during and after rehabilitation therapies have been applied. The emphasis in rehabilitation therapy is on meeting goals that are functional for the patient.

The goals of rehabilitation include the restoration, maintenance and promotion of optimal function and quality of life as they relate to movement disorders. The majority of rehabilitation therapeutics involves manual therapies and problem solving rather than the use of 'toys'. Examples of manual therapies include: joint mobilisations, focusing on arthrokinematics rather than osteokinematics; stretches, focusing upon flexibility and hypomobility; and therapeutic exercises, progressing from concentric to eccentric contractions.

Equipment used on a regular basis in veterinary rehabilitation includes physioballs, therapy bands, rocker/ wobble boards, cavaletti poles and land treadmills. Hydrotherapy equipment can include pools, resistance pools and underwater treadmills.

History of Veterinary Rehabilitation

The field of human physical therapy began during World War I, when tens of thousands of injured soldiers returned home in need of extensive care in order to return to productive lives. Equine rehabilitation began in the 1960s with the advent of increased interest in equine sporting events. In Europe and the UK, canine rehabilitation became mainstream in the 1980s.

In the US, canine rehabilitation began to grow in the early 1990s with the start of the certification programmes in 1997. The American Veterinary Medical Association (AVMA) first added 'veterinary physical therapy' to the AVMA guidelines in 1996.

There are currently 17 veterinary colleges in the US that are offering canine rehabilitation in a clinical setting. Several of these are discussing the addition of student electives and clinical rotations in their rehabilitation centres.

The terms physical therapy and physiotherapy are protected terms. This means that only licensed physical therapy professionals can use these terms to describe their practice. Anyone wishing to add rehabilitation to their veterinary practice should review both the veterinary and the physical therapy practice acts for their area.

Current Events in Veterinary Rehabilitation

There is active discussion in several states and all of the Canadian provinces regarding the practice of veterinary rehabilitation and the involvement of physical therapists in this field. Many are watching the results of the 2004 Nevada practice act revision, which added a certification process for physical therapists that allows them to practise 'animal rehabilitation'. This is not 'direct access', meaning that the physical therapist must work in conjunction with the referring veterinarian. In 2007, Colorado passed a bill that allows physical therapists to work with animals. This bill spells out the additional training which the physical therapist must obtain, the hours of practical experience, and the collaborative relationship which must take place between the referring veterinarian and the physical therapist. Officials in both Nevada and Colorado report very good results thus far.

Future Trends in the Industry

Veterinary rehabilitation is widely regarded as the 'fastest growing area in veterinary medicine'. Evidence of this is seen in the numbers of graduates from the two certification programmes as well as sales figures from rehabilitation-specific equipment manufacturers. In 2010, there were approximately 1000 people certified by the four programmes available in the US.

What is driving this new field? Public awareness is bringing dog owners to veterinary hospitals, expecting state-of-the-art care for their pets. This is not unlike acupuncture's rise in the 1980s: client-driven demand for new veterinary services. The current drivers include the huge interest in agility and flyball. In addition, the government is now seeking rehabilitation care for service dogs injured in the line of duty.

There is international interest in veterinary rehabilitation. The 6th International Symposium on Veterinary Rehabilitation took place in August 2010, at Auburn University's College of Veterinary Medicine. This biannual symposium alternates between the US and Europe. The 2010 meeting saw nearly 500 people from 29 countries gather for 4 days of lectures and laboratories. Veterinary meetings in the US have also seen growing interest in rehabilitation medicine. The 7th International Symposium will take place in August 2012 in Vienna, Austria.

Training the Rehabilitation Team

Training in rehabilitation medicine is available in four programmes in the US. Two offer canine rehabilitation and two offer equine rehabilitation training. There is no oversight board for these programmes. How can you choose which programme to attend? We suggest that you look at the experience of the faculty, the success of their graduates and the amount of hands-on experience offered.

All programmes offer the training in multiple modules. The basic certification requires approximately 15 classroom days to complete. Exams, case reports and internships round out the programmes. You can get more information at the Veterinary Rehabilitation List Serve: VetRehab@yahoo.com.

Managing the Rehabilitation Team

Before opening your rehabilitation practice, we advise that you read your local regulations. Be sure to use the terms 'physical rehabilitation' or 'animal rehabilitation' rather than physical therapy or veterinary physical therapy to describe your practice's new offering. Create a cohesive team that will create a profitable centre for your practice. This team, all trained in veterinary rehabilitation, should have a veterinary surgeon, as team leader, who maintains responsibility for the case; a physical therapist who develops the therapeutic programme and performs treatment techniques and modalities; a veterinary technician who assists in the hands-on care, freeing up the veterinary surgeon and the physical therapist to see the next case.

Is veterinary rehabilitation a viable business? Done correctly, YES! The business models that have worked the best include referral centres that have surgery and oncology, free-standing rehabilitation-only/referral-only facilities, and speciality centres with an emphasis on complementary medicine and pain management.

There is great interest in this field, and great opportunity. Excellent training and careful business management are both required to make this new art and science a viable business.

References

1.  American Association of Rehabilitation Veterinarians, Model Standards for Veterinary Physical Rehabilitation Practice 2010 (www.rehabvets.org).

2.  American Physical Therapy Association, Annual Report,1993 (www.apta.org).

3.  Canapp S, Acciani D, et al. Rehabilitation therapy for elbow disorders in dogs. Veterinary Surgery 2009;38:301–307.

4.  Colorado HB 07 1126: www.leg.state.co.us/CLICS/CLICS2007A/csl.nsf/fsbillcont3/DF72AB6359568F2987257251007B8BC7?Open&file=1126_enr.pdf