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.     

Feline Physiotherapy and Rehabilitation: 1. Principles and potential

Practical relevance: Physiotherapy is highly valued within human medicine and relatively well established for canine patients. Despite a popular misconception that feline patients will not cooperate with such treatment, physiotherapy is now increasingly being performed with cats. With cat ownership increasing in many countries, and an emergence of specialist physiotherapy practitioners, there is demand for effective postoperative and post-injury rehabilitation for any cat with compromised physical function due to injury, surgery or disease. Clinical challenges: While physiotherapy and rehabilitation are potentially beneficial for cats, due to their independent nature feline patients certainly present a greater challenge in the pursuit of effective therapy than their canine counterparts. Audience: This two-part review article is directed at the primary care veterinary team. The benefits of physiotherapy and the various treatment modalities available to the qualified veterinary physiotherapist, as well as the non-specialist veterinarian and veterinary nurse or technician, are examined in this first part. Evidence base: The benefits of human physiotherapeutic intervention are well documented, and there is good evidence for the effectiveness of most treatment modalities. Animal studies are still in their infancy, although some preliminary studies in dogs have shown good results.     

Feline Physiotherapy and Rehabilitation: 2. Clinical application

Practical relevance: There is an increasing demand for effective postoperative and post-injury rehabilitation for any cat with compromised physical function due to injury, surgery or disease. Clinical challenges: The design of a suitable rehabilitation programme that will assist the recovery process, as well as ensure the return of neuromusculoskeletal control to the highest levels of function possible, requires a good understanding of feline behaviour, accurate assessment of the cat's condition and the correct implementation of a range of physiotherapeutic modalities. Audience: This two-part review article is directed at the primary care veterinary team. The clinical application of a variety of physiotherapeutic modalities in the rehabilitation of cats is examined in this second part. Evidence base: Although evidence supporting the benefits of physiotherapy and rehabilitation with cats is sparse, many techniques, treatments and rehabilitation regimens successfully used on human patients are being readily adapted for animal use. Treatment recommendations described in this review are primarily based on the author's experience, and that of colleagues, except where specific reference is made to published evidence.     

Feline thyroid storm.

Thyroid storm is a syndrome described in human medicine to define a multisystemic disorder resulting from organ exposure to excessive levels of thyroid hormone. This form of acute thyrotoxicosis, although uncommon, can be life threatening and is a significant cause of mortality in human emergency rooms. Although thyroid storm is a well-recognized clinical entity in human medicine, it has not been described in veterinary medicine. This article discusses the human syndrome and defines a similar syndrome in hyperthyroid veterinary patients. The clinical signs of and treatment modalities for feline thyroid storm are also presented.     

兽用喹诺酮类药物发展动态

综述了兽用喹诺酮类药物—包括国内外已上市的、尚在开发中的以及人用药可转化为兽用药三个部分的品种,并对在我国尚未上市的兽用喹诺酮类药物的药理作用及用途作了简介。     

Techniques for objective outcome assessment

Companion animal rehabilitation, a collaborative practice of physical therapy and veterinary medicine, can only demonstrate the effectiveness of its theories, techniques, interventions, and modalities through evidence-based practice, utilizing standardized, reliable, and valid outcome measures, correlated with objective diagnostic data. This essay examines existing and potential objective outcome measures utilized in companion animal rehabilitation and physical therapy regarding pain, vital signs, body condition and composition, range of motion, muscle strength, inflammation, functional mobility, and gait. Discussion is included of the traditional disablement model and the evolution of the physical therapy diagnosis, prognosis, and plan of care.     

Senior veterinary students' perceptions of using role play to learn communication skills

Recent studies of veterinary practice have suggested a correlation between well-developed communication skills and job satisfaction, career retention, customer satisfaction, decreased lawsuits, and financial remuneration for veterinarians. Veterinary educators are under growing pressure to teach functional communication skills to veterinary students; however, the methods employed have not been well evaluated. In this study we have evaluated veterinary student's attitudes to learning communication skills by participating in role play. The study indicates that experiential learning modalities such as role play are perceived as effective by students, despite reluctance to participate and some discomfort surrounding participation.     

Cancer immunotherapy for the veterinary patient.

The ability of the immune system to protect against tumor development and to attack malignant cells once they arise has been recognized for more than 50 years. Since this time, our understanding of the complex relation between the immune system and the development of cancer has increased dramatically, largely because of improvements in the tools used to study tumor immunology at the molecular level. These advances are leading to the development of increasingly sophisticated and effective immunotherapeutics for human and veterinary oncology patients; indeed, some forms of immunotherapy already have a place alongside more conventional treatment modalities, such as surgery, radiation therapy, and chemotherapy.     

Implementing a simulated client program: bridging the gap between theory and practice

INTRODUCTION: This paper outlines the design and implementation of an innovative communication skills training program at the Ontario Veterinary College (OVC). Based upon the body of research in human medical education reporting effective results through the use of standardized patients (SPs) for this type of training, an experiential learning laboratory using simulated clients (SCs) and patients was introduced to first-year veterinary students. METHOD: One hundred and four first-year students were assigned to 12 groups of eight or nine students plus a facilitator. Each student interacted with a simulated client and a patient while being observed by peers and a facilitator. The Calgary-Cambridge Observation Guide (CCOG) was used to guide students and facilitators with performance standards and feedback. Assessment strategies were utilized. RESULTS: Implementation of this program required extensive resources, including funding, expertise, facilitator training, time allotment in an already overburdened curriculum, and administrative and faculty support. Preliminary assessment revealed high student and facilitator satisfaction. The potential of this program for student education and assessment was recognized, and it will be expanded in years 2 and 3 of the DVM (Doctor of Veterinary Medicine) curriculum. CONCLUSIONS: Medical educators have created resources, including skills checklists and experiential learning modalities, that are highly applicable to veterinary medical education. Ongoing evaluation of the program is essential to determine whether we are meeting expectations for communication competency in veterinary medicine.     

Proximal isovelocity surface area variability during systole in dogs with mitral valve prolapse

The proximal isovelocity surface area (PISA) principles and methodology have been described in human and veterinary medicine with special emphasis given to the ease and speed for the quantification of mitral regurgitation. Although limitations have been described in both human and veterinary medicine, in the case of veterinary medicine, clinical examples have not been well defined and in some cases have not been individually presented. The objective of this paper is to illustrate in a qualitative manner the echocardiographic existence of the dynamic behavior and variability of mitral regurgitation in dogs with mitral valve prolapse, a factor to be taken into consideration as a limitation inherent to the PISA technique.     

控制兽药残留 保障食品安全

概述兽药残留产生主要种类和原因,描述其对人类及其环境的危害,分析了预防措施,并对我国残留监控工作进行展望。     

The modified Triadan system: nomenclature for veterinary dentistry.

Recently the issue has been raised concerning the nomenclature for describing dentition in the veterinary dental patient. Several methods for referencing teeth have been utilized, leading to confusion concerning an acceptable system that is interchangeable between species. The Modified Triadan System is introduced and offers a simple, accurate, "userfriendly" veterinary dental nomenclature system. This article describes how the system evolved and its advantages for the veterinary dentist.     

我国兽用生物制品制造工职业技能鉴定实践与思考

介绍了我国兽用生物制品行业人力资源、职业技能鉴定体系工作情况,分析了兽用生物制品制造工职业技能鉴定工作开展的特点及其在兽用生物制品生产中的作用,对兽用生物制品行业职业技能鉴定工作的方向及未来进行了思考,以期为兽药行业职业技能鉴定工作提供参考。     

Nosocomial infections.

Nosocomial infections and antimicrobial resistance are topics that have been intensely studied in human medicine because of their significant impact on human health. In recent years, concerns have been raised that the use of antibiotics in veterinary medicine, animal husbandry, and agriculture may be contributing to the development of resistance in common bacterial species affecting human beings. Although there is inadequate proof at this time that the resistance is transmitted from animals to people, if antibiotics continue to be used indiscriminately in veterinary medicine, veterinarians may find themselves facing regulations restricting the use of some antibiotics. Nosocomial infections have been reported in veterinary medicine and are likely to increase in prevalence with the increase in intensive care practices in many hospitals. Prolonged hospitalization and the use of invasive devices and procedures increase the risk of nosocomial disease. As in human medicine, organisms isolated in the nosocomial infections reported in veterinary patients have an increasingly broad spectrum of antimicrobial resistance. Despite these findings, the use of empiric and prophylactic antibiotic therapy is still widespread in veterinary medicine. Nosocomial infections and antimicrobial resistance may have a serious impact on the future of [table: see text] veterinary medicine, because the cost and ability to treat our patients may be affected by the loss of access to or effectiveness of antimicrobial drugs. Despite the millions of dollars spent on research to reduce the incidence of nosocomial infections in human patients, the strategies that have consistently proven successful are simple and inexpensive to implement. The most important factor in preventing nosocomial infections is improving the hygiene practices of health care providers. Hand-washing or the use of disposable gloves can dramatically reduce the transmission of bacteria between patients. Aseptic technique should be used in the placement and management of all invasive devices. All staff members should be educated on the risks and symptoms associated with nosocomial infections so that cases can be detected early and treated appropriately. We in the veterinary profession have the opportunity to learn from the experiences of the human medical profession and can take steps to prevent the escalation of nosocomial infections and their impact on our profession.     

Logistics of companion animal rehabilitation.

Setting up rehabilitation services presents several challenges to the veterinary practitioner. Members of the rehabilitation team need to have a solid knowledge base of acute and chronic orthopedic and neurologic disorders and a knowledge of rehabilitation principles and applications.The working environment has to be adapted to patients with limited mobility, specific equipment and supplies are to be used, and a fee structure should be implemented. This article reviews these logistic aspects of companion animal rehabilitation.     

Nontraditional approaches to pain management.

The word nontraditional in the context of this article implies those modalities not normally taught in veterinary medical schools. This word has the same definition of Complementary and Alternative Medicine (CAM) as put forth by the Harvard medical school. CAM is a field of medicine that has enjoyed a recent increase in popularity in both human and equine medicine, particularly in regard to pain management. Some of the more recognized modalities include acupuncture, herbalism, and homeopathy. A brief discussion regarding the theory, scientific evidence and use of these therapies in the treatment of pain will be discussed.     

Chlorambucil-induced myoclonus in a cat with lymphoma

Chlorambucil is an alkylating agent commonly used in veterinary oncology for conditions including lymphoma. Chlorambucil neurotoxicity has been well recognized in human patients. Onsets of central nervous system signs, such as myoclonus, tremors, muscular twitching, agitation, and tonic-clonic seizures, have been reported in humans and laboratory animals treated with chlorambucil. This case of a cat with intestinal lymphoma represents the first veterinary patient reported to have chlorambucil-induced neurotoxicity. Neurotoxicity should be considered a potential side effect of chlorambucil therapy in veterinary patients.     

New chemotherapy agents in veterinary medicine.

Several anticancer drugs have been added to the therapeutic armamentarium in recent years. Some of these agents are traditional drugs with a long history of use in human oncology. Increased sophistication in clinical trial design in veterinary oncology has allowed the incorporation of agents previously viewed as excessively toxic. Other agents have been developed more recently. This article summarizes the veterinary experience with two older alkylating agents, lomustine and streptozocin, and newer compounds ifosfamide and gemcitabine. The published literature regarding veterinary use of these agents is limited, and the reader is advised to contact a veterinary oncologist for current guidelines when contemplating use of these agents.     

Polyglycolic acid sutures in general practice

Dexon, polyglycolic acid polymer, which has been used in the human field for several years, has recently been introduced to the veterinary profession. Comparisons are made between this material and other sutures, primarily catgut, in a wide variety of surgical procedures. Advantages gained with this material from general use in one practice are given.     

Contrast ultrasound: general principles and veterinary clinical applications

The concept of contrast enhancement has significantly extended the usefulness of ultrasound imaging in human medicine and medical research over the past decade. The persistence and efficacy of ultrasound contrast agents has been improved and specific imaging sequences have been developed. Contrast ultrasound provides Doppler and grey-scale enhancement. Doppler examinations are improved when studying deep or small vessels and vessels with low flow velocities. Specific contrast imaging sequences allow detection of tissue enhancement with grey-scale ultrasound which enables assessment of tissue perfusion. Major clinical applications of contrast ultrasound in the human medicine field are the heart, the parenchymal organs such as the liver, spleen and kidneys, and vascular applications. Many other interesting applications have been identified and beside their diagnostic value, intensive research is currently investigating the use of ultrasound contrast agents for therapeutic applications such as targeted delivery of drug- or gene-loaded microbubbles. In the last few years, contrast ultrasound has also been introduced in veterinary medicine. Its usefulness has been shown in diseases of the liver, spleen, kidney, pancreas, lymph nodes and superficial tumours. In the present article, an overview of the physical principles, imaging techniques and image analyses is presented. In addition, a literature review details the current use in veterinary medicine and areas of potential utilization are discussed.