"Essential Facts of Physiotherapy in Dogs and Cats - Rehabilitation and Pain management"

with educational video on DVD ''
Co-Authors: Barbara Bockstahler, David Levine, Darryl Millis, 301pp (plus DVD); £44.43;
BE VetVerlag Babenhausen, 2004

ISBN 3-938274-08-3

Review

(in Vet Times UK, 03/06)

THIS is a well-structured and lovingly-written textbook about small animal physiotherapy, directed towards veterinary surgeons and fledging animal physiotherapists.

Easy to read and understand, the first three chapters cover small animal physiotherapy, lead­ing to basic concepts of physical therapy and finally the patho-physiology of pain.

Included is pain classification, assessment and management, as well as a very useful and extensive list of analgesics for use in dogs and cats. As this text­book is a co-operation of Euro­pean and transatlantic specialists/ authors, you may not be familiar with some drugs.

Chapter four covers the examination of the physical ther­apy patient. This is very much in line with a thorough clinical examination that veterinary prac­titioners will perform on a daily basis, but with special considera­tion of posture and gait.

Assessments of how the animal will sit or lie down, rise to a stance, as well as examin­ing walking and trotting and the employment of turns, are explained to help uncover subtle signs of lameness or neurological deficits. Further to assessment by palpation, more specific tests, such as the Kibler test {skin fold rolling test) and the spinal process manoeuvre {to detect reduced spinal mobility and treatment for vertebral block­ades), are covered.

What makes this book so useful and practice-orientated are the numerous well-chosen photographs and illustrations that are particularly helpful in chapter five and describe the most com­mon physiotherapeutic modalities, including:

Massage. How to conduct a massage session, massage tech­ niques such as stroking, knead­ ing, friction, circular pressure, shaking and percussion.

Therapeutic exercises. These include passive thera­peutic exercises (PTE) -including passive range of  motion (PROM) exercises, which are often combined with other exercises like stretching, flexor reflex exercise and bicycling movements; assisted therapeutic exercises (AssisTE), such as weight shifting/perturbation exercises, the use of balance boards, physio rolls and Swiss balls (balance and movement promotion in different planes), side-bending (with the help of treats) and cervical flexion and extension; active therapeutic exercises (ATE), including slow (leash) walks, treadmill walking (encouragement of use of limb and early gait patterning), stair climbing and sit to stand exer­cises {strengthening of the gluteal muscles which is particularly useful in dogs with hip dysplasia where full extension of the coxofemoral joint is painful), wheel harrowing {improve the use of forelimbs), so-called dancing exercises (improve use and strength of rear limbs), cavaletti rails (icrease stride length, limb use and active range of motion of joints), pole weaving (encourage lateral bending of the spinal column and encourage weight shifting), shake hands exercise (strengthening of the muscles of the thoracic limb and active elbow joint flexion), controlled ball playing (improve strength and speed).

Electrical stimulation (elec­trotherapy). Including transcu-taneous electrical nerve stimula­tion (TENS), with the aim to preserve muscle contractility until nerve regeneration has occurred in mainly flaccid par­alysis cases. The placement of electrodes with electrode pads (E-pads) is shown in detail for all suggested treatment areas. Commercially available and highly portable devices are des­cribed, hence there is a brief chapter on home treatment.

Therapeutic ultrasound. Treatment of diseased and dys­functional joints with the goal to reduce pain, improve elasticity of fibrous structures and increase blood flow - particularly useful in patients with dorsal muscle tension due to spondylosis/spondyloarthrosis.

Extracorporeal shock wave therapy (ESWT).  Providing short-term analgesic effect leading to increased mobility- particularly useful for patients suffering from coxarthrosis, gonarthrosis, cubarthrosis and tendinopathies. As in previous chapters contraindications are listed for treatment modalities.

Aquatic therapy. Most practitioners will be familiar with this form of therapy and may regu­larly refer to the many treatment centres that have mushroomed over the last few years. Gait patterning, proprioceptive training and improvement/preservation of joint range of motion are just some indication samples.

Thermotherapy. Superficial heat in the form of hot packs and infrared heat lamps, but cryotherapy is also covered.

The practice relevance is underlined by the DVD accom­panying the book and demon­strates, in detail, physiothera­peutic examination, massage techniques, exercise therapies, electrotherapy, extracorporeal shock wave therapy and underwater treadmill applications.

As chapter five concludes with general protocols and treatment plans, chapter six consists of suggested physiotherapy pro­grammes for many orthopaedic and neuromuscular conditions. For example, under the heading "Postoperative joint rehabilitation" after lateral fabella-tibial suture stabilisation a postoperative rehabilitation protocol from day one to three would target pain by means of cryotherapy in the form of cold packs (as well as the painkiller of your choice), joints (through passive range of motion exercises), muscles (through massage of the affected limb and possibly other muscle groups  for relaxation).

From day four to 14, post-surgery pain would be treated using TENS through segmental stimulation, joints would be treated using cryotherapy, thermotherapy, PROM exercises. therapeutic ultrasound and mus­cle and limb function would be targeted through massage and specific active exercises.

This exemplary postoperative protocol includes other treatment options two to four weeks after surgery and again is amended from five to eight weeks after surgery. As these treatment plans are so detailed, and mostly so easy to follow and apply, you may wish to start implementing them in practice, as there is no need to invest in expensive equipment or train­ing. Indeed, the final chapter discusses just that - the economic implications of physiotherapy in a practice situation, including a price structure for chargeable services.

A practical view on feline physical rehabilitation, rehabil­itation of the geriatric patient and a subchapter on obesity/ weight management in physi­otherapy completes the penultimate chapter,

In my view, this is the best hands-on book on small animal physiotherapy available. While Levine and Millis' "Canine Rehabilitation and Physiotherapy" is another excellent source of information, it does not actually teach you step-by-step in the way this book does in many places. The omission of an index is the only criticism of note.

I predict a surge of interest in animal physiotherapy thanks to this gem of a book.

Frank Busch

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