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 endocrinopathies.

Feline endocrinopathies (excluding diabetes mellitus) include hyperthyroidism, hypothyroidism, acromegaly, hyposomatotropism, diabetes insipidus, hyperadrenocorticism, primary sex hormone-secreting adrenal tumors, primary hyperaldosteronism, pheochromocytoma, hypoadrenocorticism, hyperparathyroidism, and hypoparathyroidism. Each of these conditions will be discussed including their prevalence, cause, clinical signs, diagnosis, treatment options, and prognosis.     

Feline ureteral obstructions Part 1: medical management

Feline ureteral obstructions are an increasingly recognised and challenging diagnostic and management problem. Many cats with ureteral obstructions are critically ill at the time of diagnosis, especially if there is dysfunction of the contralateral kidney. They may present with varying severities of acute kidney injury, electrolyte disturbances, and may have comorbidities such as heart disease that complicate perioperative and long‐term management. Medical management, which may consist of rehydration and restoration of intravascular volume with intravenous fluid therapy, osmotic diuresis, ureteral muscle relaxation, and antimicrobials for infection, is important in feline ureteral obstruction patients. Despite medical management, many cats with ureteral obstructions will require decompression of the obstructed kidney to relieve pressure‐nephropathy and restore urine flow. However, some cats may be too unstable for traditional medical management and require more emergent intervention to relieve the obstruction and address the life‐threatening sequelae to acute kidney injury, such as hyperkalaemia and fluid overload. Both surgical and interventional methods to address ureteral obstructions have been described in veterinary medicine, though debate continues as to the ideal approach.     

Feline endodontics.

One misconception in veterinary medicine is that fractured teeth do not need to be treated, or treatment should consist of extraction only. Two common causes of endodontic disease in the cat are fractures and secondary to cervical line lesions. Endodontic technique can be useful in returning a diseased tooth to normal, pain-free function. Conventional endodontics can be used to treat fractured canine teeth or partially destroyed molars. Surgical endodontics is useful in cases in which an apical seal cannot be established by conventional methods. Pulp capping can preserve a vital tooth as an alternative to extraction.     

Feline malocclusion.

Modern feline malocclusion is the result of altered dento-facial proportions from the normal occlusion. The development of the brachycephalic and dolichocephalic head types has resulted in displaced dentition with accompanying soft-tissue trauma.     

Feline cytauxzoonosis.

Cytauxzoon felis is a protozoan hemoparasite of wild and domestic cats. In domestic cats, it causes severe clinical disease with high mortality.     

Feline lameness.

Feline lameness is an increasingly recognized clinical problem. Today's veterinary practitioner must be comfortable with his/her ability to diagnose the various conditions responsible for lameness in the cat and be able to discuss the significance of their findings with the client. Disease of the feline musculoskeletal system can be grouped into broad categories, including: trauma, arthritis, infectious causes, developmental disorders, neoplasia, and muscular problems. Specific diseases from each of these categories will be discussed, particularly those that differ in their presentation or clinical behavior from that same disease in the canine patient.     

Feline herpesvirus.

Feline herpesvirus infection is extremely common and may lead to recurring ocular disease in the adult cat. Recognition of the history and clinical signs that are consistent with FHV-1 infection is critical because diagnostic tests may be negative. Although a variety of treatment options are available, no one therapy is successful in every cat, and a small percentage of cats respond poorly to any treatment.     

Feline hypertrophic cardiomyopathy: an update.

HCM continues to be a challenging disease for veterinarians. Acute cases with ATE or CHF are difficult to manage, and we still lack the tools to advise owners well with regard to their pet's prognosis. Nevertheless, it appears that the historical view of HCM as a serious disease with a poor prognosis is now being adjusted to accommodate the apparently large numbers of asymptomatic cats with much longer survival times. Although there is evidence of a genetic cause of the disease in at least several families of cats, no disease-associated mutation has been found to be causative of feline HCM. Prophylactic treatment of asymptomatic or mildly affected cats continues to be empiric, but a randomized, double-blind, placebo-controlled, multicenter study on chronic therapy of symptomatic HCM cats should provide new guidance for practitioners managing these cases.     

Feline caliciviral disease: experimental immunoprophylaxis.

An attenuated feline calicivirus (FCV) was administered intramuscularly to specific-pathogen-free cats. Vaccination did not cause signs of illness. Oropharyngeal replication of attenuated FCV was not detected, nor was there evidence of virus transmission to contact-control cats. Antiviral neutralizing antibody was present in the serum of all vaccinated cats 7 days after they were given the 2nd intramuscular dose of immunogen. Vaccinated and control cats were challenge exposed to aerosols of a virulent FCV strain. All controls developed severe pneumonia and died within 7 days after this challenge exposure. In the vaccinated cats, signs of illness were absent or minimal; pulmonary lesions were milder and less extensive than those in the control cats. Feline calicivirus was isolated from ocular, nasal, and oropharyngeal swabbings from both control and vaccinated cats after viral challenge. Results indicate protective immunity to FCV disease can be induced by intramuscular administration of an attenuated FCV.     

Feline arterial thromboembolism: an update.

ATE remains a devastating complication of cardiac disease. Despite some improvements in our understanding of the underlying causes and clinical features of this disease, short-term management remains a challenge, and mortality is high. Long-term mortality is primarily attributable to the severe underlying cardiac disease. Many questions remain to be answered regarding the ideal management approach for feline ATE. The authors' preferred diagnostic and therapeutic approaches for these difficult patients are detailed in Box. 1.