p.1

"Feline Physical Rehabilitation and the Veterinary Nurse
Mary Ellen Goldberg BS, LVT, CVT, SRA, CCRVN, CVPP, VTS – physical rehabilitation, VTS- lab animal Medicine (research anesthesia)
VetScope "

p.2

Organizations for Pain and Physical Rehabilitation

p.3

A Cat is Not A Dog

p.4

"Ask Me Nicely
-Understanding Feline Behavior
-Excellent Handling Skills "

p.5

"What's Involved in Feline Rehabilitation?
-Manual therapy (e.g. Massage, Passive Range of Motion, Stretching) "

p.6

"What's Involved in Feline Rehabilitation?
Thermotherapy (e.g. Hot and cold)"

p.7

"What's Involved in Feline Rehabilitation?
Electrotherapy (e.g. Laser therapy, Ultrasound therapy, Neuromuscular electrical nerve stimulation (NMES) "

p.8

"What's Involved in Feline Rehabilitation?
Flexibility exercises such as baiting (a) and step-overs (b) help restore or improve ROM to joints. Baiting primarily exercises the spinal joints, and assists balance retraining; step-overs also assist with balance and gait re-education "

p.9

"What's Involved in Feline Rehabilitation?
Hydrotherapy – Underwater Treadmill and Swimming "

p.10

"Reasons for Cat Physical Rehabilitation
-Injuries from Trauma
-Joint Conditions "

p.11

"Feline Referrals for Rehabilitation
-Osteoarthritis
-Fractures
-Neurological conditions
-Femoral head and neck excision (FHNE)
-Weight reduction "

p.12

"How do cats react to stress?
1.They run away
2.They may attempt to groom or ""waste time""
3.As a last resort, they use aggression"

p.13

"Helpful Hints for Handling Stress, Anxiety and Pain
-Is the kitty stressed or painful?
-Is the cat upset about the trip to the vet's office?
-What about the waiting room? Are there dogs there too?
-Are they waiting a long time to be seen?"

p.14

"Ways to Alleviate the Stress and Anxiety
-Use pheromone diffusers like Feliway® or Comfort Zone® Feliway® is clinically proven to help reduce stress related to traveling and visiting the veterinarian.
-Diffuser
-Diffuser – multicat
-Spray
-Wipes"

p.15

"How to help cats
1.Keep waiting time to a minimum
2.Have separate areas fo dogs and cats
3.Put cat in examine room away from dogs
4.Exam area no traffic, be quiet and secure
5.Let the cat explore the area before beginning
6.Avoid sudden and repid movements
7.Have a variety of treats for the kitty"

p.16

Bring the Cat's Bedding and Toys

p.17

"Must know signs of feline pain
- Apprehensive facial expression
- Growl or hiss
- Inappetance
- Hiding
- Stiff or hunched posture
- Lack of grooming
- Increased pulse rate and pupillary dilatation
- Excessive licking or limping"

p.18

"Manual Therapy that the Rehabilitation Nurse can perform
- Massage
- Range of Motion Exercises
- Stretching"

p.19

"Benefits of Massage
- Reduced muscle soreness
- Increase in connective tissue strength
- Scar tissue mobilized and softened (restores function after injury and surgery)
- Increases venous and lymphatic flow
- Decreases inflammation, pain, and muscle fatigue
- The types of techniques used are Stroking, Effleurage, Compression (kneading, wringing), Friction, Percussion. "

p.20

"Massage
Stroking Massage Kneading Massage
a) Stroking massage is used to calm and relax cats.
Kneading Massage
b) Kneading massage to the paravertebral muscles increases circulation and relaxes the muscles "

p.21

"Range of Motion – Passive or Active
- Passive
Manually exercise joints
No voluntary muscle contraction
Performed on post surgical patients or weak patients that can’t walk on their own
- Active
Put joints through active muscle contraction
Cavaletti rails, climbing stairs, swimming, and walking in water, sand, or tall grass
"

p.22

"Passive Range of Motion
- Passive movements
- To the left shoulder joint into extension. These are gentle, safe movements that just touch onto initial resistance or point of discomfort
"

p.23

Active Range of Motion

p.24

"Stretching
- Is a passive movement
- Improve or restore full range to a joint
- Improve or restore full length to a muscle
- Stretches create permanent changes in length/range of muscle
- Long term effects add sarcomeres to muscle mass
- More effective if preceded by light exercise, massage, heat or therapeutic ultrasound
Stretching is generally more effective if preceded by light exercise, massage, heat or therapeutic ultrasound, all of which increase the extensibility of collagen. Think of runners that stretch before their workout but after their warm-up "

p.25

"Stretching
Stretching neck for kitty
Stretch being applied to the flexor muscles
"

p.26

Stretching

p.27

"Electrotherapy
- Laser
- Ultrasound
- Neuromuscular Electrical Nerve Stimulation (NMES)
- All possess inherent dangers and should only be used by operators who have received specialist training. "

p.28

"Laser Therapy-Photobiomodulation
- Decreases pain
- Release of endogenous opioids
- Increase of cellular metabolism
- Increase in circulation
- Promotion of neovascularization
- Decrease in fibrosis formation
- Decreases inflammation
Neovascularization definition, the development of new blood vessels, especially in tissues where circulation has been impaired by trauma or disease.
"

p.29

"Laser Therapy
- Osteoarthritis
- Degenerative lumbosacral stenosis
- Fractures
- Chronic wounds
- Stomatitis
Most cats tolerate the treatment well as it is not in itself painful and requires a relatively short time to deliver the treatment.
"

p.30

Laser Therapy

p.31

"Therapeutic Ultrasound
- Used for Deep Tissue Heating
- Improve the extensibility of connective tissues
- Decrease pain and muscle spasms
- Promote tissue healing
- Improve the quality of scar tissue
Tissue extensibility deals with the individual fibers that make up muscle and tendon. With motion, these fibers must “glide” over one another to allow smooth motion to occur. Anything that inhibits the gliding, or extensibility of the fibers will, in turn, affect the overall flexibility of a muscle or joint
"

p.32

"Therapeutic Ultrasound
- Therapeutic ultrasound can be applied using different size treatment heads. Coupling mediums can include ultrasound gel (pictured), water or a water- filled coupling cushion (plastic or rubber bag)
- low intensity pulsed ultrasound accelerates fracture healing
"

p.33

"Neuromuscular Electrical Nerve Stimulation (NMES)
- Introduce carefully to cats
- Muscle strengthening and pain control
- Muscle reeducation
- Electrical current stimulates muscles or a group of muscles
- This technique must be learned from professionals
- The use of NMES requires clipping of fur, cleaning of skin and the use of conductivity gel to maximize contact between the electrodes and the skin.
"

p.34

"NMES
"

p.35

"Therapeutic Exercises
- Final element in optimum function following injury, surgery or disease
- Assistance provided manually or with the aid of 'physio-rolls', slings, harnesses or carts."

p.36

Watch the quadriceps muscles

p.37

Cat after 2 weeks

p.38

"Therapeutic exercise may be used to improve:
- Aerobic capacity and endurance
- Agility, coordination and balance (static and dynamic)
- Gait and locomotion
- Neuromuscular capability and movement patterning
- Postural stabilization
- Range of motion
- Strength and power
- Pain "

p.39

"Types of exercise
- Balance and proprioception
- Strengthening
- Flexibility (suppleness)
- Endurance (stamina)"

p.40

"Balance and Proprioception
- Balance - even distribution of weight enabling something to remain upright and steady.
- Proprioception - ability to sense stimuli arising within the body regarding position, motion, and equilibrium.
- Proprioception - diminishes with age, and is also affected by injury or surgery, especially following neurological damage.
Balance is especially important for cats, and exercises to improve static balance include the use of unsteady surfaces such as bean bags, trampolines or wobble cushions
"

p.41

"Strengthening
- State of being strong
- Bodily or muscular power
- Vigor
Strengthening exercises such as dancing (a) and wheelbarrowing (b) allow limbs to be exercised against the cat’s bodyweight
"

p.42

"Flexibility (suppleness)
- Bending easily without breaking
- Helps to protect against injury
- Encourage reaching or stretching
- Crawling under items "

p.43

"Endurance (Stamina)
- Ability to exert itself and remain active for a long period of time
- Less important for cats
- Underwater treadmill walking is an example of endurance needed in weight loss.
Hydrotherapy can be successfully carried out with cats, whether in a pool or a water treadmill. Too weak to support itself on land, this cat is able to mobilize normally in the treadmill due to the buoyancy provided by the water.
"

p.44

Endurance????? Although????

p.45

"Land Based Exercises
- Bicycling
- Assisted Standing
- Weight Shifting
- Playing with Laser Lights
- Toys, and Treats
- Crawling Under Cavaletti Poles
- Wheelbarrowing
- Dancing
"

p.46

RockinRhonda# at the SPAW

p.47

"Bicycling and Assisted Standing
'Bicycling' exercises performed on the limbs can help with gait re-education through the repetitive activation of specific neural pathways. In addition to motor relearning, bicycling is also useful for balance retraining
A physio-roll provides a useful means to support a cat comfortably in the standing position
"

p.48

"Weight Shifting and Laser Lights
A cat with limited hip extension performing a functional stretch using their body weight and a tracking game. A toy is held in front of the cat and the harness is used to control their position.
Laser beam light being used in rehabilitation to increase hip extension ROM.
Weight Shifting and Laser Lights "

p.49

Toys,Treats and Cavaletti Poles

p.50

"Wheelbarrowing and Dancing
Wheelbarrowing promotes front limb usage Dancing exercises used to promote rear limb use.
This exercise can be performed forward or backward depending on the muscles or joints affected"

p.51

"Water-based exercise
- Hydrotherapy
Non-concussive active exercise
Improves limb mobility, strength and joint ROM
- Water treadmill
- Swimming"

p.52

"Underwater treadmill
- Rehabilitation technician/nurse should accompany the cat into the water
- The owner’s presence may reassure the cat
- Do not leave cat unattended i.e. water aspiration and drowning risks
- A lifesaving vest is encouraged
A cat in an underwater treadmill with life vest on for buoyancy and for control by the handler."

p.53

Swimming

p.54

Limb placement assistance

p.55

Attempting to strengthen hind limbs

p.56

Cat on a Wobble Board

p.57

Learn to speak"Cat"

p.58

Thank You