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

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A little about me... I like to keep busy

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Goals for this session
- TherEx background
- Tools of the trade
- Work from "down" to "up"
- Incorporate into a rehab program
- Do some work! (Demos, hands on)

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So what is TherEx?
- "Perhaps one of the most valuable modalities"
- The "meat and potatoes" of rehab - where the real work gets done.
- Fundamental exercises for core strength, basic life functions.

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Goals of TherEx
- Improve active pain free ROM
- Improve muscle mass and strength, balance, performance of daily function, aerobic capacity, prevent further injury.
- Reduce weight (when indicated) and lameness
- Important method to best return of function

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Before we begin we’ve
Read the history, CC, current meds, sx, etc.
Done our rehab evaluation, measurements, etc.
Established goals with owner, staff, surgeon (limitations)
Recognized state of tissue recovery
Assessed and addressed pain

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Tools of the trade
Be creative
Can be done on a budget
Syringe caps, tennis balls, walls, broom sticks
TotoFit, Canine Rehab Systems
Adapt to patient
Mix up routine

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Some basic equipment
A leash!
rails Cavaletti
Physio
rolls, peanuts, discs
Weave poles
Balance board

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Cavaletti rails

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Physio rolls

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Weave Poles

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Balance Board

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Wobble Boards

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Stairs/ramps

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Use your environment
Stairs (traction, not scary)
Couches (cushions)
Air Mattresses
Agility equipment
Work outside (hills, sand dunes, tall grass, snow)
Owner limitations? Have them sit at the table

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Before we begin
Be safe, patient
Introduce to patient
Written/video instructions for owner (CanineExercise.com)
Then introduce at home
Slowly increase frequency, duration, speed of activities

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What goes down must get up
Change recumbency, sides
Good soft clean bedding
Try keeping them sternal
Watch for IV lines, urinary catheters, incisions

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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

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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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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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Unloading a limb
Pick up one limb at a time
Challenge each limb
No weight on you

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Sit to stands
SQUAT!
Against a wall, or with a helper
Nice square approach, no leaning
7/10 the first week, 8/10 week two, etc.
Great for Hip DJD dogs.

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Not this

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Advanced Sit to Stand

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Down to stand

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Balance board and rolls
Mimic an earthquake
Make sure good traction
Use your weight to help shift
Can do just front limbs or hind limbs
Rhythmic stabilization

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Image

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Intermediate Work

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Dynamic Ambulation
Be patient!
Sling, towel, harness, cart?
Walk SLOWLY

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Independent Ambulation
Here comes that LEASH.
Hills, high grass, S -curves.
Again BE PATIENT!
Walk SLOWLY!
Ramp up 10 -20% each week?

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Inclines/Declines
Pelvic vs. Thoracic
Declines also allow for FLEXION of pelvic limbs

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Image

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Variable surfaces
Egg -crates, Foam Rubber, Air Mattress
Couch cushions
Stairs – 5-7 steps, 2-4x a day for starters

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Advanced Core Strength

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Treadmills!
Easy to train to.
Always supervised – leash/harness
Pattern the gait (diagnostic too)
Glide out the pelvic limbs
Flat first, then inclined or declined
Can add in resistance bands

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Other activities
Pole weaving, tunnels, pulling weight
Ankle weights
Syringe cap (on contralateral foot)
Cavaletti rails
Over/under
Natural stride length
Ladder might work

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"Progress?
Start with 3 -4 simple exercises
Add 10 -20% each week
Painful? Pause, address, start back up slowly
Re-measure – girth, stance analyzer, goniometer
Smartphone apps (MapMyRun.com)
Help! – Omega-3, Adequan, Dasuquin
Ask for help

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Feline TherEx
Laser pointers (help with stretching)
Feather toys
Wheelbarrowing
Cavalettis
Discs/Couch Cushions
Land treadmill
UWT

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What you learned today
Be inventive
Be safe, patient
Write it down!
Give them achievable goals
Some rehab is better than none at all!

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Contact info
VOSM - Veterinary Orthopedic & Sports Medicine Group
drmattbrunke@gmail.com
10975 Guilford Rd
Annapolis Junction, MD 20701
(240)-4400-295 (office)
www.vosm.com
drbrunke.wordpress.com