Principles and Practice of Therapeutic Exercise for Horses

Physical therapists are an integral component of the medical team in human health care. They are backed by a solid foundation of basic science and clinical research. Veterinarians have only recently begun to incorporate physical therapy into clinical practice, but without formal research that validates therapeutic interventions specific to equine patients. The purpose of this article is to present a series of therapeutic exercises adapted for horses based on knowledge and experience of human physical therapy, equine biomechanics, and the types of movement dysfunction commonly seen in the performance horse. Injuries, lameness and musculoskeletal pain syndromes, frequently encountered in equine practice, are disorders that may be successfully addressed with physical therapy. Incorporating standard therapeutic interventions based on clinical success in humans, basic science research, or expert opinion is possible with the understanding that these techniques will ultimately be accepted or refuted when their success or failure is formally documented. This review is designed to stimulate discussion and encourage research that will add to the knowledge base and lead to effective therapeutic protocols in the equine patient.     

Guidelines for safe and effective use of NSAIDs in dogs

NSAIDs are the most widely used analgesics in veterinary medicine, and all have some toxic potential. The most common adverse class effects are gastrointestinal, renal, hepatic, and coagulation disorders. When treating chronic pain associated with osteoarthritis, the effectiveness of NSAIDs can be enhanced by physical therapy, use of chondroprotective agents, certain adjunctive drugs, and diet and exercise to control weight. To treat acute perioperative pain, NSAIDs are more effective when used preemptively, in the context of balanced (multimodal) analgesia, and in well-hydrated patients with normal blood pressure and renal function. Screening and monitoring to identify high-risk candidates for NSAID treatment should include a physical examination and patient history, identification of preexisting diseases or conditions, obtaining baseline and periodic hematologic and clinical chemistry values, and ensuring that other NSAIDs or contraindicated drugs are not used concurrently. When switching a patient from one NSAID to another (when no side effects have been seen), a washout period of 5 to 7 days minimizes chances for adverse drug interactions. Informing clients of the potential adverse effects of NSAID therapy and signs of NSAID toxicity greatly increases the likelihood of safe use of this class of drugs.     

Veterinary Neurologic Rehabilitation: The Rationale for a Comprehensive Approach

The increase in client willingness to pursue surgical procedures, the heightened perceived value of veterinary patients, and the desire to provide comprehensive medical care have driven the recent demand of using an integrative treatment approach in veterinary rehabilitation. Physical therapy following neurologic injury has been the standard of care in human medicine for decades, whereas similar rehabilitation techniques have only recently been adapted and utilized in veterinary medicine. Spinal cord injury is the most common neurologic disease currently addressed by veterinary rehabilitation specialists and will be the primary focus of this review; however, research in other neurologic conditions will also be discussed. Of particular interest, to clients and veterinarians are techniques and modalities used to promote functional recovery after neurologic injury, which can mean the difference between life and death for many veterinary patients.The trend in human neurologic rehabilitation, often regardless of etiology, is a multimodal approach to therapy. Evidence supports faster and improved recoveries in people after neurologic injury using a combination of rehabilitation techniques. Although the primary neurological disorders researched tend to be spinal cord injury, peripheral neuropathies, allodynia, multiple sclerosis, and strokes—many correlations can be made to common veterinary neurological disorders. Such comprehensive protocols entail gait training activities in combination with neuromuscular electrical stimulation and directed exercises. Additionally, pain-relieving and functional benefits are bolstered when acupuncture is used in addition to rehabilitation. Studies, both laboratory and clinical, support the use of acupuncture in the management of neurologic conditions in small animals, specifically in cases of intervertebral disc disease, other myelopathies, and neuropathic pain conditions. Acupuncture’s ability to promote analgesia, stimulate trophic factors, and decrease inflammation, including neuroinflammation, make it an alluring adjunct therapy after neurologic injury.Although there is limited research in veterinary medicine on physical techniques that expedite recovery after neurologic injury, there are sparse publications on clinical veterinary research suggesting the benefits of acupuncture, rehabilitation, and LASER in dogs with intervertebral disk disease. Accordingly, due to the relative lack of evidence-based studies in veterinary neurologic rehabilitation, much of the data available is human or laboratory-animal based, however, evidence supports the utilization of an early, comprehensive treatment protocol for optimal neurologic recovery. The rationale for why an integrative approach is critical will be detailed in this review; in addition, literature on specific physical rehabilitation techniques that have evidence of improved recoveries after neurologic injury, will be addressed.     

Urodynamic testing in the diagnosis of small animal micturition disorders

Urodynamic testing provides a quantitative assessment of the function of the small animal lower urinary tract. Most commonly these techniques are utilized to assess urethral tone (urethral pressure profile or UPP) and bladder detrusor muscle function (cystometrogram or CMG). A UPP may be indicated in cases of canine and feline micturition disorders. Examples include suspected primary sphincter mechanism incontinence (PSMI), ureteral ectopia, other congenital abnormalities, suspected neurological disorders, and mechanical or functional urethral obstruction. A UPP can be performed effectively utilizing human dedicated equipment. A CMG may be indicated to assess detrusor function in all of the above cases as well as cases of suspected atonic or infiltrated urinary bladder. This procedure can also be performed using the same human equipment. These tests are useful not only in providing an accurate diagnosis, but also in providing a sensitive prognostic indicator for clinical outcome of micturition disorders with and without pharmacological or surgical therapy. A leak pressure point may also be established in dogs with urinary incontinence, and may be even more sensitive than a UPP to predict clinical incontinence in some cases.     

一例犬糖尿病的诊断与治疗

犬糖尿病是犬的常发疾病,其临床症状为多饮、多食、多尿、体重下降。持续的血糖升高导致机体代谢紊乱,出现如白内障、胰腺炎、肾上腺皮质机能亢进等继发症,对犬的生活质量及生命健康造成严重的威胁。论文对1例Ⅰ型糖尿病犬进行详细分析,通过测量血糖、尿糖确诊为糖尿病,并通过实验室检查包括血细胞计数、血清生化检测及血气分析,排除并发症。治疗过程与主人共同配合,使用外源性胰岛素结合食物疗法与运动疗法。目前该犬的血糖稳定并接近正常值,身体状况得到改善,生活质量提高,主人对治疗效果满意。持续治疗方法是根据犬的身体情况及血糖变化适当调整胰岛素的剂量。     

Equine rehabilitation therapy for joint disease.

The principles of physical rehabilitation therapy can be applied to the horse to provide a reduction in discomfort and dysfunction associated with the various forms of joint disease. Physical agents,such as ice, heat, electricity, sound, light, magnetic fields, compression, and movement, can be used by the rehabilitation therapist to attempt to control pain, reduce swelling, and restore optimal movement and function in the affected joint. The equine therapist's attention is focused not only on the affected joint but on the body as a whole to manage secondary or compensatory problems.     

Inhalation therapy. Oxygen administration, humidification, and aerosol therapy

In addition to receiving treatment for the primary disease, patients with advanced respiratory disorders may benefit from other forms of respiratory support. This article discusses three techniques of inhalation therapy that will aid in maintaining an optimal pulmonary environment and in normalizing arterial oxygenation. The role of aerosol therapy in direct intrapulmonary administration of pharmaceuticals is also discussed.     

Evaluation of the anatomic effect of physical therapy exercises for mobilization of lumbar spinal nerves and the dura mater in dogs

OBJECTIVE: To adapt and standardize neural tissue mobilization exercises, quantify nerve root movement, and assess the anatomic effects of lumbar spinal nerve and dural mobilization in dogs. ANIMALS: 15 canine cadavers. PROCEDURES: 5 cadavers were used in the preliminary part of the study to adapt 3 neural tissue mobilization physical therapy exercises to canine anatomy. In the other 10 cadavers, the L4 to L7 nerve roots and the dura at the level of T13 and L1 were isolated and marked. Movements during the physical therapy exercises were standardized by means of goniometric control. Movement of the nerve roots in response to each exercise was digitally measured. The effects of body weight and crownrump length on the distance of nerve root movement achieved during each exercise were also assessed. Each exercise was divided into 4 steps, and the overall distance of neural movement achieved was compared with distances achieved between steps. RESULTS: Neural tissue mobilization exercises elicited visible and measurable movement of nerve roots L4 to L7 and of the dura at T13 and L1 in all cadavers. CONCLUSIONS AND CLINICAL RELEVANCE: The physical therapy exercises evaluated had measurable effects on nerve roots L4 to L7 and the dura mater in the T13 and L1 segments. These exercises should be evaluated in clinical trials to validate their efficacy as primary treatments or ancillary postsurgical therapy in dogs with disorders of the thoracolumbar and lumbosacral segments of the vertebral column.     

Approach to the patient in respiratory distress

Respiratory distress is a very common presenting complaint in emergency practice. It is essential that the clinician rapidly determine the underlying cause of the clinical signs using physical examination findings and nonstressful diagnostic tests. Oxygen therapy will often stabilize a patient, allowing for a more complete physical examination and diagnostics, including thoracocentesis, thoracic radiographs, and blood collection for laboratory analysis. The disease processes that cause respiratory distress can be grouped according to anatomic location: the airways, pulmonary parenchyma, pleural space, or thoracic wall. The choice of diagnostic and therapeutic techniques will be dependent on the suspected anatomic origin of disease. Techniques useful in diagnosing airway disorders include oral examination, cervical and thoracic radiographs, fluoroscopy, and bronchoscopy. Therapeutic techniques include intubation and tracheostomy. For parenchymal disease, thoracic radiographs, echocardiography, ultrasound of the thorax, and transtracheal or endotracheal wash can be useful. When the disease process is in the pleural space, thoracocentesis can be both diagnostic and therapeutic. Chest tube placement may be necessary for continuous removal of air or fluid from the pleural space. Monitoring of the respiratory patient can involve serial physical examination, pulse oximetry, and arterial blood gas analysis. It is essential to minimize stress on patients with respiratory distress because decompensation can occur easily, leading to respiratory arrest.     

Pyometra

Pyometra is a relatively uncommon diestral uterine disorder seen primarily in older bitches and queens. The incidence of pyometra appears to be increasing, especially in younger animals, as a result of increasing use of estrogen and progesterone for mismating and for certain medical disorders. The clinical signs of pyometra and abnormalities on physical examination are dependent on the patency of the cervix and how quickly the client recognizes the problem. Ovariohysterectomy is still the treatment of choice; however, prostaglandin F2 alpha as a medical alternative in the management of pyometra is gaining more and more acceptance. The goal of prostaglandin F2 alpha therapy is to salvage the reproductive tract in the young breeding bitch or queen in the hopes of obtaining future litters. The results have been very promising, especially for bitches or queens with open-cervix pyometra. Prostaglandin F2 alpha appears to offer the owner a reasonable alternative in the management of pyometra.     

The use of erythropoietin.

EPO is a hematopoietic growth factor produced in the kidney that stimulates erythropoiesis. It effectively treats hypoproliferative anemia associated with CRF, improving quality of life in these patients. Other uses that are poorly characterized in veterinary medicine include treatment of cancer patients on chemotherapy, hematologic disorders, and anemic FeLV-infected cats as well as preoperative conditioning for elective surgeries that may involve significant blood loss. Careful monitoring of therapy is necessary for optimal results. Several complications are associated with rHuEPO therapy. The production of anti-rHuEPO antibodies is the most significant and can be a life-threatening event. Alternatives to human EPO are being sought to provide beneficial effects while avoiding antibody formation.     

Pneumonitis associated with occult heartworm disease in dogs

Nine of 69 dogs with occult heartworm disease (13%) had allergic pneumonitis characterized by consistent clinical and radiographic signs. Although the clinical signs were severe, the degree of radiographic pulmonary arterial abnormalities was mild. Corticosteroid therapy resulted in rapid resolution of clinical and radiographic signs; thiacetarsamide therapy was then given without complications. This syndrome may not be recognized as heartworm-associated and may be confused with other disorders, some being associated with a poor prognosis and requiring different therapy.     

Effects of caloric restriction and a moderate or intense physiotherapy program for treatment of lameness in overweight dogs with osteoarthritis

OBJECTIVE: To evaluate the effects of a weight reduction program combined with a basic or more complex physical therapy program including transcutaneous electric nerve stimulation on lameness in overweight dogs with osteoarthritis. DESIGN: Nonblinded prospective randomized clinical trial. Animals-29 adult overweight or obese dogs with a body condition score of 4/5 or 5/5 and clinical and radiographic signs of osteoarthritis. PROCEDURES: A weight-loss program was initiated for all dogs. One group received caloric restriction and a home-based physical therapy program. The other group received the identical dietetic protocol and an intensive physical therapy program including transcutaneous electrical nerve stimulation. Lameness was assessed clinically and by kinetic gait analysis on a treadmill with 4 force plates to measure symmetry of ground reaction forces (GRFs) of the affected and contralateral limbs in bimonthly intervals for 6 months. RESULTS: Significant weight loss was achieved in both groups; however, greater weight reduction was attained by dogs treated with caloric restriction and intensive physiotherapy. Mobility and symmetry indices of GRFs were improved after 6 months; the best outcome was detected in the group receiving energy restriction combined with intensive physical therapy. CONCLUSIONS AND CLINICAL RELEVANCE: Caloric restriction combined with intensive physical therapy improved mobility and facilitated weight loss in overweight dogs. The combination of dietetic and physical therapy may help to improve the health status more efficiently than dietetic treatment alone.     

Nutritional factors in bovine gastrointestinal disease

Gastrointestinal disorders may be prevented through proper nutrition. Attention should be placed on establishing optimum feeding programs for cattle in all stages of the life and production cycle. Normal reticuloruminal development in calves and maintenance of gastrointestinal function in adult cattle is dependent upon adequate nutrition. Nutrition is also an important part of therapy of many gastrointestinal disorders.     

Tremor syndromes in dogs: Diagnosis and treatment

Tremor is frequently associated with a variety of diseases in human beings and animals. Unlike humans beings, however, many tremor disorders of animals resist strict classification and have poorly defined aetiologies. In dogs, generalised tremor is more commonly recognised than tremor localised to one body area. History and clinical presentation remain important in the differential diagnosis of these disorders. Appropriate therapy for several of these syndromes can result in long term control or resolution of tremor.     

Troubleshooting the diabetic small animal patient

Effective troubleshooting for a diabetic small animal patient starts with the initial diagnosis of diabetes. Preempting trouble with a thorough and complete history, physical examination, laboratory assessment, and extensive and thoughtful client education before discharge, are crucial first steps toward avoiding trouble altogether. As problems arise, careful consideration of the many variables that contribute to effective diabetic control is necessary. As monitoring strategies evolve and treatment options expand, the clinician's ability to accurately assess and adjust the glycemic control in his or her troubled diabetic patient improves. Common causes of trouble in diabetic patients are reviewed and various strategies for the diagnosis and management of these disorders are discussed in this article. Every effort was made to draw from recently published reports of clinical cases. Few diseases will tie together owner, patient, and therapy as intimately as diabetes mellitus, and few problems will be solved without fully considering all potential factors.     

Practical applications of topical therapy for allergic, infectious, and seborrheic disorders

Topical therapy is extremely important in the management of allergic, infectious, and seborrheic disorders. It can be used as a sole therapy or adjunctive therapy for these disorders, often minimizing the need for systemic therapy. In allergic diseases, pruritus can be decreased by removing allergen, desensitizing the skin or other antipruritic effects. Many agents can also maintain or replace moisture to the skin and have emollient effects. When used for infectious conditions, topical therapy can decrease microbial counts and reduce surface colonization of microbes and help to prevent relapses. Antiseborrheic products function by normalizing keratinocyte turnover rates by reducing epidermal division (keratoplastic), normalizing keratinization, and increasing desquamation (keratolytic). There are many different topical vehicles and modes of application: shampoos, whirlpools, soaks, rinses, sprays, lotions, gels, creams, and ointments. Shampoos are often the most practical and effective. The practitioner needs to become familiar with many active ingredients to learn what products are indicated for specific diseases.     

Review of Equine Hyperbaric Medicine

Hyperbaric oxygen therapy appears to be a promising adjunctive treatment for a variety of equine disorders, including laminitis and other ischemic injuries. Hyperbaric oxygen (HBO) is a high-dose oxygen inhalation therapy that is achieved by having the patient breathe 100% oxygen inside a pressurized hyperbaric chamber. The delivery of oxygen to the tissues is through respiration because there is insufficient absorption of oxygen through the skin. The benefits of HBO are derived from both the physiologic and pharmacologic effects of high-dose oxygen. HBO is based on two physical factors related to the hyperbaric environment: mechanical effects of pressure and increased oxygenation of tissues. The use of HBO by veterinary medical hospitals is in its infancy. Our clinic has currently treated more than 250 patients in our HBO chamber. Patients included pregnant animals as well as neonatal foals, with no adverse effects noted. Patients have been pressurized from 1.5 to 3 ATA (ATM absolute) ranging from 60 to 90 minutes at treatment pressure (depth). Hagyard Equine Medical Institute has used HBO as adjunctive therapy for fungal disease (fungal pneumonia); thermal burns, carbon monoxide, smoke inhalation; closed head injuries; ileus; central nervous system edema/perinatal asphyxia; peripheral neuropathies; sports injuries (exertional rhabdomyolysis); cellulitis; compartment syndrome; and ischemic injuries (laminitis). In carefully selected patients, the addition of HBO therapy to standard measures may improve clinical outcomes. Further research is needed in the field of equine HBO medicine.     

Diagnostic Approach to Small Animal Bleeding Disorders

A well-designed and executed diagnostic approach to patients with bleeding disorders is critical to determine disease etiology and guide therapeutic measures. This systematic process begins with a comprehensive history and physical examination, followed by laboratory tests of primary hemostasis (platelet enumeration, platelet function testing, and von Willebrand factor assays), secondary hemostasis (prothrombin time, activated partial thromboplastin time, activated clotting time, and individual factor deficiencies), and fibrinolysis (fibrinogen activity, thrombin time, fibrin degradation products, D-dimers), dependent on the clinical picture. Equally valuable are proper specimen collection, handling, and storage methods, which provide reliable and reproducible result interpretation. This review will emphasize the common diagnostic tools and blood sampling techniques important to the workup of hemostatic diseases as well as provide an overview of advanced clinical and research methods and equipment available to assist our bleeding veterinary patients, including thromboelastography/thromboelastometry, calibrated automated thrombogram, and the thrombin-antithrombin assay.     

Potential uses of recombinant human factor VIIa in veterinary medicine.

In human beings, rFVIIa has been used successfully to promote hemostasis in patients with various bleeding disorders. Patients with hemophilia, thrombocytopenia, and thrombocytopathy have been effectively and safely treated as well as patients with severe trauma or surgery resulting in profuse bleeding and patients with impaired liver function. Given these successes, the possibility of using rFVIIa in veterinary medicine is appealing. The clinical indications and uses in veterinary medicine would be similar, but there are currently two major obstacles: immunogenicity and cost. If these problems can be addressed, rFVIIa may become a valuable and indispensable therapy, especially in the emergency and critical care settings. The use of rFVIIa could allow for successful treatment of otherwise intractable bleeding as well as decrease the number of blood transfusions needed.