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Care of the Down Dog: Part Two

Matt Brunke, DVM, CCRP, CVPP, CVA Diplomate, American College of Veterinary Sports Medicine and Rehabilitation

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WHAT'S YOUR NEXT STEP?

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Stretching/PROM (Passive Range of Motion)
- Head - Tail
- Standing or Laying Down
- Gentle
- Not slamming a door
- Don’t forget the toes
- One at a time, or all together
- 10-15 reps/3-5x a day
- Flip and do other side

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Thermotherapy
DON’T USE ELECTRIC HEATING PADS.
Be creative.

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Running hot and cold
Heat
- Vasodilation
- Increase blood flow
- Warm up before stretching
- Pain relieving
- Reduce muscle spasm
- NOT: on cancer, open wounds, impaired circulation
- Test on yourself first

Cold
- Vasoconstriction
- Decrease blood flow
- Anti-inflammatory
- Pain relieving
- NOT: advanced CV dz, open wounds, cancer, never directly to skin (use a thin towel). Careful around implants

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Light Amplification by Stimulated Emission of Radiation
- Photobiomodulation
- Amplification or Oscillation? (better acronym)
- Activate cytokines and other tissue factors
- Decrease pain and inflammation
- Increase wound healing
- Always use goggles
- Can use in acupuncture
- Not on cancer or pregnancy

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Other modalities
Therapeutic Ultrasound
Electrical Stimulation

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In further detail....
Therapeutic Ultrasound
- Deep heating of tissues.
- Quadriceps, biceps tendonitis, fibrotic myopathy
- Heat and stretch contractures
- Not on cancer or pregnancy (E-stim too)

Electrical Stim
- Two types
- NMES (Neuro Muscular Electrical Stim)
– Mimic muscle movement
- TENS (Transcutaneous Electrical Nerve Stimulator)
– Pain relieving

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What’s next?
- Know what we are dealing with
- Pain addressed?
- Fundamental nursing care
- Joint/muscle care (ROM, massage)

Get Up! Stand Up for Your Rights

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Assisted Standing Exercises
- Strengthen the patient
- Aid in proprioception
- Improve circulation and respiration
- Chance to eliminate
- Mental well-being
- Down dogs, train wrecks

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Maximal Assistance
- Support 75-100%
- Cannot independently stand
- Team effort
- Place feet appropriately
- Sling, towel, Help Em Up Harness
- In “normal” position
- Adjust for tolerance
- Start with 10-15 reps, 2- 3x a day, increase to 5 minutes per session

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Active Assisted Standing
- As they get stronger let them do more
- <75% effort from us
- Just enough support to maintain standing
- Physiorolls great for this
- Carts/Hoists- Great for some independence
- Always supervised
- Eddie’s Wheels Clinic Quad Cart
- Overhead Hoist

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Clinic Quad Cart

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Overhead Hoist

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Standby Assisted Standing
- Now has strength and motor to support against gravity
- Still ataxic or weak
- Right by their side, only there to prevent a fall
- Every 2-4 hours (or more)
- Take a break at night
- Sleep is important too!

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Peanuts

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Proprioceptive Training
- Standing independently – time to do it right
- Dynamic balance – maintain while in motion
- 1) weight shifting
- 2) unloading of a limb
- 3) balance board
- 4) exercise balls and rolls

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Standing Exercises
- Frequency – foot placement. Team approach
- Non-slip flooring
- Work on the ground
- Be patient

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Weight shifting
- Follow the ball/treat
- Push them at shoulder/hip
- Use a sling
- Right after IVDD surgery – don’t let them lose it!
- Bump them when walking (caution)

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Standing Exercises - Staged
Assisted Standing Maximal Assistance Active Assisted Standby Assisted
Strengthen the patient Support 75- 100% <75% support from us Now has strength and motor to support on own

Aid in proprioception Cannot independently stand Maintain standing longer Can work against gravity

Improve circulation and respiration Team effort Some independence Still ataxic or weak

A chance to eliminate Place feet appropriately Carts/hoists Right by their side

Mental well- being Start with 10-15 reps, Up over a peanut, Always adjust for
(upright, engaged 2-3x a day, increase to other inflatable tolerance throughout
in environment) 5 minutes per session

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Thank You
- Matt Brunke, DVM, CCRP, CVPP, CVA Diplomate, ACVSMR
DrMattBrunke@gmail.com
DrBrunke.wordpress.com