Physical Rehabilitation for Veterinary Technicians and Nurses E-Book
88,99 €
Mehr erfahren.
- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Physical Rehabilitation for Veterinary Technicians and Nurses A must-own guide for veterinary professionals specializing in physical rehab Physical rehabilitation is a vital aspect of veterinary medicine. A successful program of rehabilitation is one of the most important determinants of long-term patient outcomes after surgery or serious illness, and veterinary patients are no exception. Veterinary technicians and nurses specializing in physical rehabilitation therefore constitute a potentially critical component of any veterinary practice and/or care team. Physical Rehabilitation for Veterinary Technicians and Nurses provides a clear, accessible overview of this subject for prospective veterinary rehabilitation professionals. Brimming with insights stemming from both research and practical experience, and now updated to reflect a wave of new research since the first edition, this book promises to equip readers with the knowledge required to make themselves indispensable in veterinary practice. Readers of the second edition of Physical Rehabilitation for Veterinary Technicians and Nurses will also find: * Practical tips and tricks connected to the role of a technician on a rehabilitation team * New or updated coverage of subjects including canine fitness, shockwave protocols, underwater treadmill exercises, and many more * Guidance ideal for training programs and certifications from the most important institutes and technician schools Physical Rehabilitation for Veterinary Technicians and Nurses is ideal as an introduction for prospective technicians and nurses, as well as a reference handbook for practicing veterinary technicians and nurses.
Sie lesen das E-Book in den Legimi-Apps auf:
Seitenzahl: 1204
Veröffentlichungsjahr: 2024
Ähnliche
Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Dedication
List of Contributors
Acknowledgments
About the Companion Website
1 Introduction to Physical Rehabilitation for Veterinary Technicians/Nurses
What Is Rehabilitation?
History of Human Physical Therapy
History of Veterinary Physical Rehabilitation
Specifics About Veterinary Physical Rehabilitation
How Do Veterinary Technicians and Nurses Fit In?
Where Can I Become a Certified Rehabilitation Veterinary Technician?
What Is Involved in Becoming a CCRA, CCRVN, CCAT, CCRP, CVMRT or CERA, CERP?
Practice Regulations for Veterinary Technicians
Working in the Physical Rehabilitation Field
Therapeutic Exercises
Manual Techniques
Physical Modalities
Conditions That Can Benefit from Physical Rehabilitation
Conclusion
Resources
References
2 Joining a Rehabilitation Team
Introduction
Becoming a Rehabilitation Technician (Nurse)
The Rehabilitation Patient
Your Team Role as Rehabilitation Veterinary Technician
Working Under Supervision
Future Directions for the Rehabilitation Technician
Conclusions
References
3 Physical Rehabilitation Pain Management and the Veterinary Technician
Introduction
Exercise and Rehabilitation Therapy
Physical Rehabilitation Benefits
Recognition and Assessment of Pain
Behavioral Keys to Look for with Pain
Clinical Metrology Instruments
To Summarize
Rehabilitation as a Treatment of Pain
Canine Rehabilitation
Recognize the Link Between Pain and Weakness
Environmental Modifications
Feline Physical Rehabilitation
Equine Rehabilitation
Conclusion
Resources
References
4 Communicating the Treatment Plan
Introduction
Diagnosis and Progress Assessments
Goals
Adverse Events and Setbacks
Compliance
Communication
Telemedicine
Discussing Finances
Follow‐up
Special Considerations for Working Dogs
Conclusion
Websites
Further Reading
References
5 Manual Techniques in the Clinic
Introduction
Purpose
Manual Examination, Evaluation, and Assessment
Pathoanatomic and Functional Diagnosis
Effects of the Application of Manual Techniques
Precautions, Contraindications, and Red Flags
Outcomes Measurement and Determining the Effectiveness of Manual Therapy
Role of Palpation in Manual Therapy
Manual Technique Selection and Communication
Preparation for the Application of Manual Techniques
Manual Therapy Approaches and Manual Techniques
Neuromuscular Facilitation and Sensory Stimulation Approaches
Conclusion
References
6 Home Exercises:
Introduction
Assessing the Client
Assessing the Patient
Assessing the Resources
Training the Client
Home Exercises
Conclusion
References
7 Supporting the Client and Patient
Introduction
Training
Patient Assessment
Communication
Well‐Being and Workplace Wellness
Conclusion
References
8 Nutritional Counseling
Introduction
Nutritional Assessment
Obesity
Evaluating Weight and Nutrition
Weight Management Program
Osteoarthritis
Weight Reduction
Patient Assessment
Key Nutritional Factors
Conclusion
References
9 Motivating Your Patient
Introduction: Why We Need to Motivate the Rehabilitation Patient
Understanding Animal Psychology
Classical Conditioning Versus Operant Conditioning
Understanding Body Language
Building Motivation and Value Through Food Rewards
Luring, Shaping, and Marking Behaviors
Simple Games: Set Up for Success
Having Intent and Understanding Trust
Home Exercises – Knowing When to Stop
Problem Solving and Dealing with Challenging Patients
Motivating the Client
Conclusions
Resources
References
10 Fitness Conditioning for the Veterinary Technician and Owner
Introduction
Anatomy and Exercise Physiology
Type of Exercise
Strength Training
Endurance Training
Balance/Proprioception/Body Awareness
Flexibility
Mental Fitness
Warm Up and Cool Down
Where to Start?
Functional Evaluation
References
11 The Disabled Patient Part 1: Assistive Devices and Technology
Introduction
History
Which Patients Need Assistive Devices?
Types of Assistive Devices
Custom Orthoses
Custom Prostheses
Summary
References
12 The Disabled Patient Part 2: The Neurological Patient
Introduction
Healing of Nerves
The Neurological Examination
Assessment of Transitions
Evidence‐Based Information About Neurologic Rehabilitation
Nursing Care of Neurological Patients in Clinic
Types of Neurological Conditions
Establishing Goals
Goals
Passive Manual Therapies for Dogs and Cats
Therapeutic Modalities for Dogs and Cats
A Special Word About Cats
Client Education and Support During Home Therapy
Conclusions
References
13 The Disabled Patient Part 3: Special Considerations for the Geriatric Patient
Introduction
The Aging Process
When do Dogs and Cats Qualify as Senior or Geriatric?
Cognitive Impairment and Other Behavioral Issues
Management Strategies to Improve Quality of Life
Common Presentation
Health Benefits of Rehabilitation for the Geriatric Patient
Physical Rehabilitation and Function
Manual Therapy for the Geriatric Patient
Electrotherapy
Approach to Exercise Therapy
Therapeutic Exercises for Geriatric Patients
Special Considerations for Hydrotherapy
Physical Medicine and Rehabilitation for Patients in Palliative and Hospice Care
Conclusion
Aid Graceful Aging
References
14 The Disabled Patient Part 4: Home Nursing Care
Introduction
Proper Body Mechanics
Goals of Nursing Care
Modifying the Home Environment
Administering Medications to the Disabled Patient
In‐Home Hospice Care
Conclusions
Resources
References
15 Modalities Part 1: Thermotherapy
Introduction
Purpose
Mechanism of Action
Physiologic Effects
Types of Thermotherapy
Veterinary Evidence for Both Hot and Cold Therapy
A Word About Cats
Conclusion
References
16 Modalities Part 2: Laser Therapy
Introduction
Photobiomodulation Physics 101
Laser Safety Classes
Dosage
Photobiomodulation: Proposed Mechanisms of Action
Contraindications and Potential Cautions
Laser Safety in the Clinic
Veterinary Research
Using Laser Therapy in Practice
Conclusions
References
17 Modalities Part 3: Electrotherapy and Electromagnetic Therapy
Introduction
Electrical Stimulation
General Terminology
Medical Terminology
Current Types
Evidence Base in Veterinary Patients
Patient Preparation
Precautions for Electrical Stimulation
NMES for Muscle Strengthening
Electrode Size and Placement for NMES
Neuromuscular Electrical Stimulation for Edema
Electrical Stimulation for Wound Healing
Electrical Stimulation for Pain Control
Pulsed Electromagnetic Field Therapy
Evidence Base in Veterinary Patients
Conclusions
References
18 Modalities Part 4: Therapeutic Ultrasound
Introduction
Physical Principles
Treatment Parameters
Role of the Veterinary Rehabilitation Technician
Clinical Applications
Clinical Reports
Cautions and Contraindications
Maintenance of Equipment
Relevant Scientific Research
Conclusions
References
19 Modalities Part 5: Shockwave Therapy
Introduction
General Terminology
Mechanisms of Action
Indications
Equine Use
Patient Preparation
Treatment Protocol
Adverse Events and Contraindications
Conclusion
References
20 Therapeutic Exercises Part 1: Land Exercises
Introduction
History of Therapeutic Exercise
The Role of Exercise Physiology
Principles of an Exercise Program
Canine Rehabilitation Equipment
Control, Supportive, and Assistive Devices
Walking
Exercise Categories
Case Studies
References
21 Therapeutic Exercises Part 2: Hydrotherapy (Aquatic Therapy)
Introduction
Clinical Evidence
Which Patients Will Benefit?
Equipment
Safety and Maintenance
Protecting Staff and Clients
Patient Assessment
Pool Versus Underwater Treadmill
Pool‐Based Exercises
Treadmill‐Based Exercises
Developing Patient Programs
Promoting Your Business
Conclusion
References
22 Troubleshooting as a Team
Introduction
Case Management
Communicating with Specialists and the Primary Care Veterinarian
Communicating with Team Members
Examples of Case Management
Conclusions
References
23 Equine Rehabilitation
Introduction
Therapeutic Plan Development
Therapeutic Monitoring
Facilities, Equipment, and Personnel
Nutrition
Patient Environment and Mental Status
Therapeutic Modalities
Return to Work
Conclusion
References
24 Adjunctive Therapies: Veterinary Chiropractic
Abbreviations
Introduction
Brief History of Chiropractic Medicine
The Role of Chiropractic in Physical Rehabilitation
The Vertebral Subluxation Complex (VSC)
The Chiropractic Adjustment
Evaluation of the Animal Chiropractic Patient
The Chiropractic Adjustment and the Veterinary Technician
Chiropractic and Cats
Conclusion
References
25 Acupuncture and Traditional Chinese Veterinary Medicine
Traditional Chinese Veterinary Medicine (TCVM) Basics
Five Branches of TCVM
Yin Yang Theory
Five Element Theory
Acupuncture Points
Meridians
Methods of Stimulation
Clinical Applications Associated with Rehabilitation – Dogs and Cats
Clinical Applications Associated with Rehabilitation – Equine
Safety
Role of the Veterinary Rehabilitation Technician
Research
References
26 Adjunctive Therapies: Myofascial Trigger Point Therapy
Introduction
Sensory Component
Motor Component
Autonomic Component
How Do MTrPs Develop
Perpetuating Factors
Evaluation of the Patient
Treatment of MTrPs
Conclusions
References
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 Sample conditions benefiting from physical rehabilitation.
Chapter 3
Table 3.1 Signs of pain in dogs and cats.
Table 3.2 Tools for assessing acute pain in cats.
Table 3.3 Tools for assessing acute pain in dogs.
Table 3.4 Changes in cats indicating pain.
Chapter 4
Table 4.1 Progress assessments.
Table 4.2 Standard learning styles: from http://www.learning‐styles‐online....
Chapter 5
Table 5.1 General systemic effects of the application of manual techniques....
Table 5.2 Normal and abnormal end feels (Physiopedia, n.d.).
Table 5.3 Proposed effects of soft tissue mobilization.
Table 5.4 Grades of peripheral joint and spinal mobilization and manipulatio...
Chapter 10
Table 10.1 Hindlimb kinematics by joint.
Table 10.2 Forelimb kinematics by joint (as compared to walking).
Table 10.3 Targeted exercises by Dr. Julia Tomlinson.
Chapter 13
Table 13.1 How old is my dog in human years?
Table 13.2 How old is my cat in human years?
Table 13.3 Feline Mobility/Cognitive Dysfunction Questionnaire adapted (Gunn...
Table 13.4 Suggestions for improving the environment and increasing access t...
Chapter 15
Table 15.1 Pathophysiologic effects of topical modalities.
Chapter 16
Table 16.1 Modalities laser.
Chapter 17
Table 17.1 Recommended pulse duration for neuromuscular electrical stimulati...
Chapter 23
Table 23.1 Laser dosage recommendations for locations.
Table 23.2 Thermal and non‐thermal effects of radiofrequency therapy.
Table 23.3 Conditions which may benefit from hyperbaric oxygen therapy.
Table 23.4 Contraindications for HBO therapy.
Table 23.5 Sample underwater treadmill program.
Table 23.6 Example back to work plan following resolution of injury.
List of Illustrations
Chapter 2
Figure 2.1 Your team will have developed strategies for teaching, including ...
Figure 2.2 Daily medical rounds are recommended. Parameters are set and reco...
Chapter 3
Figure 3.1 Colorado State University Acute Pain Scale Canine.
Figure 3.3 CSU Acute Pain Scale Equine.
Figure 3.4 Glasgow Composite Pain Scale Canine Short Form.
Figure 3.5 Glasgow Composite Pain Scale Feline.
Figure 3.6 Feline Grimace Scale chart.
Figure 3.7 Severe osteoarthritis deformity rear view.
Figure 3.8 Calvin on a couch electroacupuncture.
Chapter 4
Figure 4.1 Photo of a patient showing signs of stress during a therapy sessi...
Figure 4.2 Reward‐based training as part of a fitness and conditioning progr...
Figure 4.3 A patient performing a crawl exercise for a treat reward.
Figure 4.4 Veterinary technician providing hands‐on instruction in the execu...
Chapter 5
Figure 5.1 Passive range of motion of the stifle into extension.
Figure 5.2 Active stretch “play bow.”
Figure 5.3 Skin rolling.
Chapter 6
Figure 6.1 Application of a cold pack.
Figure 6.2 Teaching passive range of motion.
Figure 6.3 Actively stretching on a Bosu.
Figure 6.4 Active stretching of a large dog using some stairs.
Figure 6.5 Dog can be encouraged to step over various linear objects, such a...
Chapter 7
Figure 7.1 An in‐house training session on photobiomodulation with new staff...
Figure 7.2 Gaiting videos are taken from both the back and side. Videos can ...
Figure 7.3 Therapists can use a pain scale such as The Colorado State Acute ...
Figure 7.4 CSU Acute Pain Scale Feline.
Figure 7.5 Weekly case meetings give the patient care team an opportunity to...
Figure 7.6 Ineffective communication style fails to engage the client during...
Figure 7.7 The therapist uses several communication styles to engage the cli...
Figure 7.8 A combination of verbal and non‐verbal communication skills is es...
Figure 7.9 A therapist demonstrates home exercises via Zoom. The client then...
Figure 7.10 A self‐care plan can help mitigate burnout and compassion fatigu...
Chapter 8
Figure 8.1 AAHA Canine Body Condition Score.
Figure 8.2 AAHA Feline Body Condition Score.
Chapter 9
Figure 9.1 Soft food takes time to consume when dispensed on a lick mat (abo...
Figure 9.2 Patient undergoing shockwave therapy. He is wearing ear muffs and...
Figure 9.3 A low‐matted table for examination and therapy in a quiet room wi...
Figure 9.4 Poster showing dog behavioral postures.
Figure 9.5 Poster showing cat fear and anxiety postures.
Figure 9.6 A feline patient being lured into a stretch using freeze‐dried me...
Figure 9.7 Luring a patient from a sit into a standing position for examinat...
Figure 9.8 International Veterinary Academy of Pain Management (IVAPM) pet p...
Chapter 10
Figure 10.1 Happy dog.
Figure 10.2 Forelimb weight shifting placement.
Figure 10.3 Hindlimb weight shifting placement.
Figure 10.4 Swimming dog.
Figure 10.5 Weight pulling dog.
Figure 10.6 Dogs in harness pulling.
Chapter 11
Figure 11.1 Sling for geriatric dog.
Figure 11.2 Therapy ball and sling‐assisting standing.
Figure 11.3 Dr. Tomlinson with a patient in a Hoyer lift.
Figure 11.4 A patient in an assistive harness on a treadmill for gait patter...
Figure 11.5 A patient with malformed, painful feet being sized for, and wear...
Figure 11.6 An old milk crate can be modified to create a step using a woode...
Figure 11.7 Thermoplastic sheet for devices.
Figure 11.8 Neck brace for an Irish Wolfhound.
Figure 11.9 A stifle orthosis.
Figure 11.10 A forelimb prosthesis.
Figure 11.11 A wound complication from an orthosis.
Chapter 12
Figure 12.1 Neurological examination form from the Journal of the American V...
Figure 12.2 Hemistanding. The therapist uses their legs to support the trunk...
Figure 12.3 Cookie stretch to aid transition. Voluntary movement for a treat...
Figure 12.4 Lateral to sternal transition as demonstrated by Jenn Panko.
Figure 12.5 Sternal to sit transition as demonstrated by Jenn Panko.
Figure 12.6 Coupage is gentle percussion over the thoracic following the lun...
Figure 12.7 Coupage on both sides of chest.
Figure 12.8 Manual expression of the bladder is a learned skill that the reh...
Figure 12.9 Use of a Hoyer lift to support a large patient.
Chapter 13
Figure 13.1 Jack, 17‐year‐old Shepherd cross courtesy Anne Dunnavant Bialkow...
Figure 13.2 Jack, 17‐year‐old Shepherd cross courtesy Anne Dunnavant Bialkow...
Figure 13.3 Jack, 17‐year‐old Shepherd cross courtesy Anne Dunnavant Bialkow...
Figure 13.4 McLovin, French Bulldog, approximately 10 years old, courtesy Me...
Figure 13.5 Lou, adopted as street cat, age unknown. When adopted became a h...
Figure 13.6 Ellie, geriatric canine in Dr Julia Tomlinson’s rehabilitation p...
Figure 13.7 A frail canine patient, the patient is 15 years old. She has nor...
Figure 13.8 Carlton, barn cat, adopted, age unknown. Cause of death abdomina...
Figure 13.9 Carlton, barn cat, notice lack of grooming as he deteriorated....
Figure 13.10 McLovin, French Bulldog, approximately 12 years old, courtesy M...
Figure 13.11 Kippy, 18‐year‐old Cocker Spaniel, courtesy of Linda Silverstei...
Chapter 14
Figure 14.1 Use of proper body mechanics.
Figure 14.2 Absorbent diaper/potty pads.
Figure 14.3 Handmade sling.
Figure 14.4 Help ’Em UpTM Harness.
Figure 14.5 Correct way to lift a dog in sling or harness.
Figure 14.6 PawzTM boots.
Figure 14.7 Paw Friction by Pawtology.
Figure 14.8 Dr. Buzby’s ToeGrips™.
Chapter 15
Figure 15.1 Kari Koudelka with a patient in the Bioelectric Whirlpool.
Figure 15.2 Jake the dog in a Back On Track heat reflective sheet.
Figure 15.3 Ice Gel Pack.
Figure 15.4 GameReady Cryotherapy Compression.
Figure 15.5 Boot for cryotherapy in a horse.
Chapter 16
Figure 16.1 The output of a laser may be concentrated in a small spot or spr...
Figure 16.2 (a) and (b) Wavelength‐specific safety glasses. The picture on t...
Figure 16.3 This patient could not tolerate safety goggles, so a soft, blue ...
Figure 16.4 This patient is being treated on a table that is not stainless s...
Figure 16.5 The laser probe should always be perpendicular to the target tis...
Figure 16.6 In long‐haired animals, especially, other than when treating ver...
Figure 16.7 This patient is relaxed and enjoying her laser treatment. If pos...
Chapter 17
Figure 17.1 A portable NMES unit on a patient. The accuracy of electrode pla...
Figure 17.2 The use of NMES following hemilaminectomy surgery. Notice that a...
Figure 17.3 Placement of the electrical pads prior to additional tape placem...
Figure 17.4 Shows use of pads that do not require taping because they have a...
Figure 17.5 Image of an Assisi Loop used for targeted PEMF.
Figure 17.6 A patient on a PEMF bed.
Chapter 18
Figure 18.1 A 3‐cm sized ultrasound transducer head.
Figure 18.2 Ultrasound gel used a coupling agent.
Figure 18.3 Treating a flexor tendon injury with indirect coupling, the pati...
Figure 18.4 Maya, a two‐year‐old Cockapoo having her Achilles tendon treated...
Figure 18.5 A feline patient undergoing ultrasound treatment of her neck mus...
Chapter 19
Figure 19.1 A shock wave (left) and an ultrasound wave (right) showing press...
Figure 19.2 PiezoWave Vet shockwave machine and coupling gel. PiezoWaveVet™ ...
Figure 19.3 Treatment of a horse for kissing spine disease Treating a horse ...
Figure 19.4 Treatment of donkey lumbosacral disease Treatment of donkey for ...
Figure 19.5 An example of Shockwave coupling gel.
Figure 19.6 Treatment of canine shoulder with probe head Treatment of canine...
Figure 19.7 Feline treatment of elbow with shockwave.
Figure 19.8 Feline treatment of elbow with shockwave.
Chapter 20
Figure 20.1 Patient on a BOSU
®
ball working on proprioceptive training....
Figure 20.2 Cavaletti poles are a great strengthening exercise for dogs and ...
Figure 20.3 A dog working on core strength on blocks.
Figure 20.4 A cat on a Mini Trampoline.
Figure 20.5 Land treadmills can be used with feline patients.
Figure 20.6 Dog working hind limb muscles on uneven surface.
Figure 20.7 Diagonal leg lifts: This is a core strengthening exercise. As th...
Figure 20.8 Stairs can work many different muscle groups.
Figure 20.9 Assisted standing is a good exercise for neurological patients....
Figure 20.10 A cat on a rocker board.
Chapter 21
Figure 21.1 Pool entry.
Figure 21.2 Pool entry side view.
Figure 21.3 Dog swimming in pool.
Figure 21.4 Weight bearing is reduced by 15% if the water is filled to the l...
Figure 21.5 Harness for controlling patient in underwater treadmill and keep...
Figure 21.6 Fender floats prevent patients from placing their limbs on the s...
Figure 21.7 A flotation device is used to support the patient’s head during ...
Figure 21.8 Swimming in open water – in this case, a lake.
Figure 21.9 If multiple dogs are entering the pool/lake at the same time dur...
Figure 21.10 Whirlpool bath for a neurologically impaired dog.
Figure 21.11 Dawn H. Rector, LVT, VTS (physical rehab), CCRP, CVPP, CCFT say...
Figure 21.12 Dawn H. Rector with a liliger swimming.
Figure 21.13 Wendy Davies BS CVT, CCRVN, VTS‐Physical Rehabilitation in unde...
Figure 21.14 Wendy Davies supervising a cat walking in an underwater treadmi...
Chapter 22
Figure 22.1 Rounds in this clinic are scheduled daily (Tomlinson). Communica...
Figure 22.2 A dog with an almost plantigrade stance of the left rear due to ...
Figure 22.3 An articulating tarsal and foot orthosis (Orthopets) placed on t...
Figure 22.4 Quadriceps stretch.
Figure 22.5 Custom cervical brace (Therapaw).
Chapter 23
Figure 23.1 Therapeutic monitoring equipment. From top to bottom: goniometer...
Figure 23.2 (a) Inertial sensor system used for gait evaluation. (b) Quantit...
Figure 23.3 Cold salt water spa.
Figure 23.4 Neuromuscular electrical stimulation application for muscle stre...
Figure 23.5 Low level laser therapy application.
Figure 23.6 Radiofrequency therapy application.
Figure 23.7 Whole body vibration.
Figure 23.8 In‐ground underwater treadmill.
Figure 23.9 Ground cavaletti poles laid in random fashion to improve proprio...
Figure 23.10 Ground cavaletti poles laid in a radius to encourage joint moti...
Figure 23.11 Therapeutic band application to improve core muscle strength.
Figure 23.12 Equine Kinesiology taping.
Chapter 24
Figure 24.1 Dr. Downing adjusting an equine pelvis.
Figure 24.2 Dr. Downing performing adjustment with minimal restraint.
Figure 24.3 Hand position for stabilizing the thoracics during an adjustment...
Figure 24.4 Adjusting the patient when the table can be used to stabilize th...
Chapter 25
Figure 25.1 Dr. Carolina Medina placed acupuncture needles in the co‐author,...
Figure 25.2 Calming point needle was placed on JimmyCat’s head.
Figure 25.3 JimmyCat models electroacupuncture needles and machine.
Figure 25.4 JimmyCat shows acupuncture needles attached to the electrostimul...
Figure 25.5 Jake from Canine Case Study undergoes acupuncture and electro‐ac...
Figure 25.6 Cricket from Feline Case Study receives acupuncture treatment fo...
Figure 25.7 Cricket receives electro‐acupuncture treatment.
Figure 25.8 Cricket resting and dozing during acupuncture treatment.
Chapter 26
Figure 26.1 Schematic showing The Expanded Integrated Trigger Point Hypothes...
Figure 26.2 Example of Flat Palpation in a dog for the presence of MTrPs.
Figure 26.3 Example of flat palpation on a horse for the presence of MTrPs....
Figure 26.4 Pincer palpation on a dog.
Figure 26.5 Dry Needling of a Horse for Treatment of MTrPs by Mrs. Angela St...
Figure 26.6 Dry Needling of a Dog for Treatment of MTrPs by Dr. Douglas Stra...
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Dedication
List of Contributors
Acknowledgments
About the Companion Website
Begin Reading
Index
WILEY END USER LICENSE AGREEMENT
Pages
iii
iv
v
xxv
xxvi
xxvii
xxix
xxxi
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
407
408
409
410
411
412
413
414
415
416
417
418
419
420
421
422
423
424
425
426
427
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449
450
451
452
453
454
455
456
457
458
459
460
461
462
463
464
465
466
467
469
470
471
472
473
474
475
476
477
479
480
481
482
483
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
501
502
503
504
505
506
507
508
509
510
511
512
513
514
515
516
517
518
519
520
521
522
523
524
525
526
527
528
529
Physical Rehabilitation for Veterinary Technicians and Nurses
Second Edition
Edited by
Mary Ellen Goldberg
Veterinary Technician Specialist- lab animal medicine (Research anesthesiaretired), Veterinary Technician Specialist- (physical rehabilitation-retired) Veterinary Technician Specialist- (anesthesia & analgesia) – H Veterinary Medical Technologist, Surgical Research Anesthetist-retired Certified Canine Rehabilitation Veterinary Nurse, Certified Veterinary Pain Practitioner
and
Julia E. Tomlinson
Diplomate, American College of Veterinary Sports Medicine & Rehabilitation (Specialist)Twin Cities Animal Rehabilitation & Sports Medicine ClinicVROMP | Veterinary Rehabilitation & Orthopedic Medicine Partners practice 12010 Riverwood Dr, BurnsvilleMN, USA
Copyright © 2024 by John Wiley & Sons, Inc. All rights reserved.
Published by John Wiley & Sons, Inc., Hoboken, New Jersey.Published simultaneously in Canada.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per‐copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750‐8400, fax (978) 750‐4470, or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748‐6011, fax (201) 748‐6008, or online at http://www.wiley.com/go/permission.
Trademarks: Wiley and the Wiley logo are trademarks or registered trademarks of John Wiley & Sons, Inc. and/or its affiliates in the United States and other countries and may not be used without written permission. All other trademarks are the property of their respective owners. John Wiley & Sons, Inc. is not associated with any product or vendor mentioned in this book.
Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
For general information on our other products and services or for technical support, please contact our Customer Care Department within the United States at (800) 762‐2974, outside the United States at (317) 572‐3993 or fax (317) 572‐4002.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic formats. For more information about Wiley products, visit our web site at www.wiley.com.
Library of Congress Cataloging‐in‐Publication DataNames: Goldberg, Mary Ellen, editor. | Tomlinson, Julia, 1972– editor.Title: Physical rehabilitation for veterinary technicians and nurses / edited by Mary Ellen Goldberg and Julia E. Tomlinson.Description: Second edition. | Hoboken, New Jersey : Wiley‐Blackwell, [2024] | Includes bibliographical references and index.Identifiers: LCCN 2023048979 (print) | LCCN 2023048980 (ebook) | ISBN 9781119892410 (paperback) | ISBN 9781119892427 (adobe pdf) | ISBN 9781119892434 (epub)Subjects: MESH: Physical Therapy Modalities–veterinary | Animal TechniciansClassification: LCC SF925 (print) | LCC SF925 (ebook) | NLM SF 925 | DDC 636.089/5822–dc23/eng/20240102LC record available at https://lccn.loc.gov/2023048979LC ebook record available at https://lccn.loc.gov/2023048980
Cover Design: WileyCover Images: Courtesy of Julia E. Tomlinson, Steve Adair, Mary Ellen Goldberg and Wendy Davies
Dedication
This book is dedicated to my granddaddy and my mother.
My paternal grandfather, John G. Richardson Sr, taught me about loving animals. When I was a little girl, I followed granddaddy everywhere. We went on walks to feed horses, mules, dogs, cats, squirrels, ducks, and birds. He told me about animals he had owned. Granddaddy died on August 9, 1970. I was 13 years old. I wish he could have seen how his influence affected me.
My mother, Eleanor Straub Richardson, was a nurse during WWII. She used her GI bill to get degrees in nursing education so she could teach. My mother was the kindest, most loving person I have ever known. I could never even hope to provide care that mother did for her patients, but I could have no better role model of what a nurse provides and advocates for her charges. Her students loved her and told me over the years that mother represented all the traits a nurse embodies. I hope in some small measure, I would have made her proud.
Mary Ellen Goldberg
This book is dedicated to the amazing team of veterinary technicians that I work with both in my own clinic, and those I have collaborated with in writing, teaching, and case discussion. The founding members of the veterinary technician specialty (VTS) in rehabilitation hold a dear place in my heart and I am so grateful to them for sharing their knowledge and expanding the skills of veterinary technicians worldwide.
Julia E. Tomlinson
List of Contributors
Steve AdairEquine Performance andRehabilitation CenterUniversity of TennesseeVeterinary Medical CenterKnoxville, TNUSA
Jessy BaleEssex Animal HospitalEssex, OntarioCanada
Kara M. BurnsAcademy of Veterinary NutritionTechniciansIndependent Nutritional ConsultantLafayette, INUSA
Deana CappucciWest Delray VeterinaryDelray Beach, FLUSA
Tracy A. DarlingDirector of Canine OperationsNational Disaster Search Dog FoundationSanta Paula, CAUSA
Jacqueline R. Davidson (she/her/hers)Clinical ProfessorSmall Animal Clinical Sciences, Collegeof Veterinary Medicine & BiomedicalSciencesTexas A&M UniversityCollege Station, TXUSA
Wendy DaviesRehabilitation and Regenerative MedicineUniversity of FloridaGainesville, FLUSA
Robin DowningThe Downing Center for Animal PainManagement, LLCWindsor, COUSAandAffiliate FacultyColorado State University College ofVeterinary MedicineFort Collins, COUSA
Pádraig EganEast Neuk Veterinary ClinicScotland
Mary Ellen GoldbergVeterinary TechnicianSpecialist‐ lab animal medicine(Research anesthesia‐retired)Veterinary Technician Specialist‐(physical rehabilitation‐retired)Veterinary Technician Specialist‐(anesthesia & analgesia) ‐ HVeterinary Medical TechnologistSurgical Research Anesthetist‐retiredCertified Canine RehabilitationVeterinary NurseCertified Veterinary Pain Practitioner
Amie Lamoreaux HesbachEmpowerPhysioMaynard, MAUSA
Janice L. HuntingfordEssex Animal HospitalEssex, OntarioCanadaandAssistant ProfessorChi UniversityReddick, FLUSA
Sherri JerzykSmall Animal Clinical Sciences, Collegeof Veterinary Medicine & BiomedicalSciencesTexas A&M UniversityCollege Station, TXUSA
Stephanie KubeNeurologist/neurosurgeonAdvanced Veterinary Specialty Center ofNew EnglandWalpole, MAUSA
Carolina MedinaElanco Animal HealthFort Lauderdale, FLUSA
Darryl MillisThe College of Veterinary MedicineUniversity of TennesseeKnoxville, TNUSA
Megan NelsonTwin Cities Animal Rehabilitation &Sports Medicine ClinicBurnsville, MNUSA
Evelyn OrenbuchOrenbuch Veterinary RehabilitationMarietta, GAUSA
Cynthia M. OttoDirector, Penn Vet Working Dog CenterProfessor of Working Dog Sciences &Sports MedicineUniversity of PennsylvaniaSchool of Veterinary MedicinePhiladelphia, PAUSA
Dawn PhillipsUniversity of TennesseeCollege of Veterinary MedicineKnoxville, TNUSA
Dawn RectorThe College of Veterinary MedicineUniversity of TennesseeKnoxville, TNUSA
Megan RidleyIntegrative Pet CareChicago, ILUSA
Angela StramelAdvanced Care Veterinary ServicesCarrollton, TXUSA
Douglas StramelAdvanced Care Veterinary ServicesCarrollton, TXUSA
Julia E. TomlinsonTwin Cities Animal Rehabilitation &Sports Medicine ClinicBurnsville, MNUSAandVeterinary Rehabilitation and OrthopedicMedicine PartnersSan Clemente, CAUSA
Elizabeth E. WaalkTwin Cities Animal Rehabilitation &Sports Medicine ClinicBurnsville, MNUSA
Sam WarrenTwin Cities Animal Rehabilitation &Sports Medicine ClinicBurnsville, MNUSA
Melissa WeberTwin Cities Animal Rehabilitation &Sports Medicine ClinicBurnsville, MNUSA
Erin WhiteSportVet Canine Rehabilitation andSports MedicineTallahassee, FLUSA
Renée YacoubIntegrative Pet CareChicago, ILUSA
Acknowledgments
The completion of this text would not have been possible without the talents of many people who need to be thanked.
Atul Ignatius David, Dr. Rituparna Bose, and Susan Engelken, all of John Wiley & Sons, Inc. need to be thanked for their help and advice to produce this book.
All our contributing authors and providers of images have contributed their time and knowledge beyond the “call of duty.” This text is truly a joint effort that would not have been possible without each of our colleagues’ efforts. Thank you for sharing your knowledge and experience.
We wish to thank the Academy of Physical Rehabilitation Veterinary Technicians (APRVT), which has elevated the role of veterinary technicians in physical rehabilitation practice. Many of our authors are members of APRVT.
Finally, to veterinarians performing physical rehabilitation and schools that certify veterinary technicians and nurses in physical rehabilitation, we wish to say thank you for your work and for improving the lives of our veterinary patients.
The Editors
About the Companion Website
This book is accompanied by a companion website:
www.wiley.com/go/goldberg/physicalrehabilitationvettechsandnurses
The website includes videos.
1Introduction to Physical Rehabilitation for Veterinary Technicians/Nurses
Mary Ellen Goldberg
Veterinary Technician Specialist‐ lab animal medicine (Research anesthesia‐retired), Veterinary Technician Specialist‐ (physical rehabilitation‐retired), Veterinary Technician Specialist‐ (anesthesia & analgesia) – H, Veterinary Medical Technologist, Surgical Research Anesthetist‐retired, Certified Canine Rehabilitation Veterinary Nurse, Certified Veterinary Pain Practitioner
CHAPTER MENU
What Is Rehabilitation?
History of Human Physical Therapy
History of Veterinary Physical Rehabilitation
Specifics About Veterinary Physical Rehabilitation
How Do Veterinary Technicians and Nurses Fit In?
Where Can I Become a Certified Rehabilitation Veterinary Technician?
What Is Involved in Becoming a CCRA, CCRVN, CCAT, CCRP, CVMRT or CERA, CERP?
Practice Regulations for Veterinary Technicians
Working in the Physical Rehabilitation Field
Therapeutic Exercises
Manual Techniques
Physical Modalities
Conditions That Can Benefit from Physical Rehabilitation
Conclusion
Resources
References
As veterinary technicians, we vow to further our knowledge and competence through a commitment to lifelong learning (NAVTA, 1987). Over the past 15–20 years, awareness of animal physical rehabilitation has increased, and rehabilitation has become a rapidly growing service within veterinary specialty hospitals, referral centers, and primary care practices. Every day, we hear about laser therapy and underwater treadmills, equipment that was not traditionally covered in the veterinary technician’s college curriculum. Learning more about rehabilitation enables the veterinary technician to better assist the supervising veterinarian when physical rehabilitation therapies are recommended. This chapter aims to answer some questions about rehabilitation for veterinary technicians and nurses.
What Is Rehabilitation?
Physical rehabilitation is the treatment of injury or illness to decrease pain and restore function (American Association of Rehabilitation Veterinarians, 2023). Rehabilitation is used to address acute injuries and chronic injuries or diseases. Rest alone after injury usually does not relieve the problems caused by inflammation and spasm; for example, a muscle in spasm may not have adequate blood supply to heal. Protective mechanisms in place in the body following injury alter movement of the whole musculoskeletal system and increase strain in other areas. Physical rehabilitation should commence as soon as is possible for the patient and caregiver (Table 1.1).
Table 1.1 Sample conditions benefiting from physical rehabilitation.
Source: Adapted from Sharp (2008).
Orthopedic
Neurological
General
Post‐operative rehabilitation (e.g., stifle or hip surgery, arthrodesis, amputation, and ligament/tendon repair)
Post‐operative rehabilitation (e.g., decompressive surgery and reconstructive surgery)
Pain management
Acute and chronic soft tissue injuries, involving muscle and fascia, tendon, joint capsule, or ligament (limbs or trunk)
Central or peripheral nerve injuries
Athletic/working dogs (performance problems, improving strength and endurance)
Arthritis (long‐term management)
Fibrocartilaginous embolism, spinal shock
Obesity
Developmental orthopedic diseases (e.g., hip dysplasia, elbow dysplasia)
Degenerative nerve disease (e.g., myelopathy, polyneuropathies)
Depression
Trauma and wound care
Balance/vestibular problems
Senior care
Nervous system trauma
History of Human Physical Therapy
International (Physiosite, 2015)
Physicians like Hippocrates and later Galenus are believed to have been the first practitioners of physical therapy, advocating massage, manual therapy techniques, and hydrotherapy. In 460 BC, Hector practiced hydrotherapy – which is Greek for water treatment. In 1894, Great Britain recognized physiotherapy as a specialized branch of nursing regulated by the Chartered Society of Physiotherapy. The first emergence of physiotherapy as a specialist discipline was in Sweden in 1913, when Per Henrik Ling founded the Royal Central Institute of Gymnastics (RCIG) for massage, manipulation, and exercise. In the following two decades, formal physiotherapy programs were established in other countries, led by the School of Physiotherapy at the University of Otago in New Zealand (1913). From 1950, chiropractic manipulations were also introduced, this was initially most common in Great Britain. A subspecialty of orthopedics, within physiotherapy, also emerged at about the same time.
United States of America (APTA, 2015; Moffat, 2003)
Physical therapists formed their first professional association in 1921, called the American Women's Physical Therapeutic Association. In 1922, the association changed its name to the American Physiotherapy Association (APA). In the 1930s, APA introduced its first “Code of Ethics,” men were admitted, and membership grew to just under 1,000. With the advent of World War II and a nationwide polio epidemic during the 1940s and 1950s, physical therapists were in great demand. The association's membership grew to 8,000. By the late 1940s, the association had changed its name to the American Physical Therapy Association (APTA). APTA represents more than 90,000 members throughout the United States. A national professional organization, APTA's goal is to foster advancements in physical therapy practice, research, and education. Currently, 213 institutions offer physical therapy education programs, and 309 institutions offer physical therapist assistant education programs in the United States.
History of Veterinary Physical Rehabilitation
Physical rehabilitation for animals has been practiced since the 1980s. In biomedical research, the use of animal models in treatment protocols is common, and this includes research in the field of physical rehabilitation. From the late 1980s and throughout the 1990s, several groups helped to increase interest in canine and equine physical rehabilitation. These groups include the American Veterinary Medical Association (AVMA), the American College of Veterinary Surgeons (ACVS), and the formation of the Animal Physical Therapist Special Interest Group (APT‐SIG) within the APTA. Success with human patients receiving post‐operative physical therapy has galvanized the veterinary community into developing physical rehabilitation techniques that can be implemented for animal patients (McGonagle et al., 2014). In June 1993, the APTA issued a position statement that “endorses the position that physical therapists may establish collaborative, collegial relationships with veterinarians for the purposes of providing physical therapy services or consultation (APTA, 1993).” In 1996, “Guidelines for Alternative and Complementary Veterinary Medicine” were adopted by the AVMA House of Delegates (AVMA, 2000). New guidelines were adopted by the AVMA House of Delegates in 2001 (AVMA, 2001). Training in animal physical rehabilitation was established by a group at the University of Tennessee (McGonagle et al., 2014). This training and certification course was, and still is, provided for veterinarians, veterinary technicians, physical therapists, and physical therapy assistants (see below).
The International Association of Veterinary Rehabilitation and Physical Therapy (www.iavrpt.org) became an official association in July 2008 and is a collaborative association of veterinarians, technicians, physical therapists, and other allied health professionals. Veterinarians interested in rehabilitation in the United States are encouraged to join the American Association of Rehabilitation Veterinarians, founded in 2007 (www.rehabvets.org). Veterinary technicians can become members of the AARV as associate members, as can other allied health professionals.
In 2010, the American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR) was approved by the American Association of Specialty Veterinary Boards (AASVB) to establish and maintain credentialing and specialty status for veterinarians who excel in sports medicine and rehabilitation. A veterinarian can become board‐certified in either canine or equine specialties under this college; more details can be found at their website, www.vsmr.org.
Veterinary technicians can take one of several certification courses in animal rehabilitation. For those technicians who are already certified in physical rehabilitation, a veterinary technician specialty group has been formed. This group is under the umbrella and direction of the National Association of Veterinary Technicians in America (NAVTA) and is called the Academy of Physical Rehabilitation Veterinary Technicians. This specialty certification will allow veterinary technicians and nurses to possess the credential for VTS‐physical rehabilitation. The Mission Statement of the Academy is, “We are credentialed rehabilitation veterinary technicians providing assistance in physical rehabilitation, encouraging veterinary technicians to further education, while improving the quality of animals’ lives.”
Specifics About Veterinary Physical Rehabilitation
The American Association of Rehabilitation Veterinarians produced a model set of guiding principles for the ideal practice of veterinary physical rehabilitative medicine (AARV, 2014). These model standards state:
Patient care in the rehabilitation facility should be under the authority, supervision, or approval of a licensed veterinarian certified in rehabilitation therapy.
Initial examination and diagnosis should be determined by a licensed veterinarian with rehabilitation certification.
The rehabilitation treatment plan should be formulated and the case managed by a licensed veterinarian with rehabilitation certification, or a combination of these veterinarians, in consultation with an appropriately licensed physical therapist certified in animal rehabilitation.
No technician/assistant (certified or otherwise) shall manage a rehabilitation patient.
There shall be a formal policy in place to monitor and evaluate patient responses to care.
The practice shall use individualized rehabilitation and therapy plans, including fitness plans.
For patients with concurrent conditions, clients shall be advised early during care of the opportunity to request a second opinion or referral to a specialist for treatment of these conditions.
The rehabilitation practice shall regularly update the patient’s primary care veterinarian as well as any other veterinarian involved with the patient’s current care.
A summary of the initial rehabilitation evaluation findings should be sent to the referring veterinarian at the earliest opportunity, preferably within 24 hours of the evaluation.
The patient shall be discharged back into the care of the primary veterinarian once therapy is complete.
When referring a patient for additional workup, appropriate referral communication (such as a letter, email, or phone conversation) shall occur and should be properly documented in the patient's record.
Evaluation for pain shall be part of every patient visit.
Practice team members shall be trained to recognize pain and work in collaboration with the veterinarian to provide appropriate pain management, including physical and pharmaceutical modalities.
Since medical and emergent issues may arise during treatment, and pain management monitoring needs to be addressed by a veterinarian, having the rehabilitation veterinarian on site is ideal. A plan must be in place to address emergent care medical issues and pain management in the absence of direct (on‐site) veterinary supervision.
Practice team members should be trained to identify causes of pain, levels of pain, medications, and physical methods used to control pain.
Pain scores should be documented in the medical record at each visit.
Pain management techniques should be used when the presence of pain in a patient is uncertain.
Clients should be adequately educated to recognize pain in their pets.
Clients should be adequately educated about the possible effects of any dispensed analgesic, including adverse events.
Tentative diagnoses and medical plans, or their subsequent revisions, shall be communicated to clients at the earliest reasonable opportunity.
A rehabilitation veterinarian should have current knowledge of veterinary‐approved diets, nutraceuticals, supplements, as well as knowledge and skills in weight loss and weight‐management programs.
Nutritional assessment and counseling should be part of routine care.
Recommended continuing education requirements:
Each veterinarian should have a minimum of 15 hours of continuing education every 2 years, specifically in veterinary rehabilitation topics.
Each veterinarian should have a minimum of 20 hours per year of documented continuing education in the field of veterinary medicine.
Each veterinary technician should have a minimum of 10 hours of documented continuing education in the field of veterinary rehabilitation every 2 years.
Each veterinary technician should have a minimum of 10 hours of documented continuing education in the field of veterinary technology every 2 years.
Each physical therapist should have a minimum of 15 hours of documented continuing education in the field of veterinary rehabilitation every 2 years.
Each physical therapist should complete continuing education in their own field as recommended by their governing state board.
How Do Veterinary Technicians and Nurses Fit In?
Veterinary technicians must complete either a 2‐ or 4‐year program in the United States. Veterinary nurses are the primary para‐veterinary workers in the United Kingdom. They assist vets in their work and have a scope of autonomous practice within which they can act for the animals they treat, which can include minor surgery. Registered veterinary nurses (RVNs) are bound by a code of professional conduct and are obliged to maintain their professional knowledge and skills through ongoing continuing professional development (RCVS, 2023). In the United States, in approximately 40 states, veterinary technicians are certified, registered, or licensed (Levine et al., 2014). Veterinary technician programs do not include extensive coursework in physical rehabilitation.
Most continuing education courses offered at international, national, and local meetings offer physical rehabilitation lectures and hands‐on laboratories. The AARV provides a full day of lectures at the North American Veterinary Conference, and the ACVSMR offers lectures (canine and equine) at this conference and a program in conjunction with the ACVS annual symposium.
Where Can I Become a Certified Rehabilitation Veterinary Technician?
The greatest asset for effective physical rehabilitation is an educated veterinary team (Sprague, 2013). A rehabilitation technician is a certified, licensed, or registered veterinary technician who has completed a prescribed curriculum to receive the title of Certified Canine Rehabilitation Veterinary Nurse (CCRVN), Certified Canine Rehabilitation Practitioner (CCRP), or Certified Veterinary Massage and Rehabilitation Therapist (CVMRT). There are currently five certification programs available for veterinary technicians in the United States that offer the respective titles.
The Canine Rehabilitation Institute offers the Certified Canine Rehabilitation Assistant (CCRA) program for veterinary assistants or those who do not possess a license as a credentialed veterinary technician; CCRVN for those who are a credentialed veterinary technician; and the Certified Canine Rehabilitation Therapist (CCRT) program for veterinarians and physical therapists at training facilities in Missouri and Colorado (http://www.caninerehabinstitute.com).
Northeast Seminars offers the Certification in Companion Animal Therapy (CCAT) for veterinarians, licensed veterinary technicians, physical therapists, physical therapist assistants, and occupational therapists at North Carolina State University (https://www.ncsuvetce.com/canine‐rehab‐ccat/).
University of Tennessee offers the CCRP, or Certified Equine Rehabilitation Practitioner (CERP), for veterinarians, physical therapists, and veterinary technicians at The University of Tennessee (https://www.u‐tenn.org/ccrp/ and https://vahl.vet/).
Healing Oasis offers the CVMRT program for licensed veterinarians, licensed or certified veterinary technicians, licensed physical therapists, licensed nurses, and/or licensed/certified massage therapists at their facility in Wisconsin (http://www.healingoasis.edu/VMRT‐program).
Animal Rehabilitation Institute offers Certified Equine Rehabilitation Assistant (CERA) offered to Veterinary Technicians and Physical Therapist Assistants (https://animalrehabinstitute.com/open‐enrollment‐2/).
What Is Involved in Becoming a CCRA, CCRVN, CCAT, CCRP, CVMRT or CERA, CERP?
Formal educational courses and wet labs are involved in all the certification courses. Each school has its own curriculum. The cost is relatively expensive for a veterinary technician, but this certification may allow the veterinary technician to command a higher salary. You must be an LVT, CVT, and RVT to attend most of the courses. The best way to investigate the programs is to visit the webpages listed below:
http://www.caninerehabinstitute.com
https://www.ncsuvetce.com/
https://www.u‐tenn.org/ccrp/
and
https://vahl.vet/
http://healingoasis.edu/veterinary‐massage‐rehabilitation‐therapy‐program
https://animalrehabinstitute.com/about‐ari/
Practice Regulations for Veterinary Technicians
Candidates for certified, registered, or licensed veterinary technician are tested for competency through an examination which may include oral, written, and practical portions. Every state is unique and maintains its own regulations with respect to the practice of veterinary medicine. Practice acts, legislated by states and provinces, often define the responsibilities of the veterinary technician. These responsibilities and duties are dependent in part on the type of employment the individual chooses. The current standards include obtaining an associate or bachelor’s degree from a program accredited by the AVMA’s Committee on Veterinary Technology and Education Activities (CVTEA), a passing score on the veterinary technician national examination by the American Association of Veterinary State Boards (AAVSB), and a varying number of continuing education hours within the renewal process.
A rehabilitation veterinary technician should be working under the direct supervision of a credentialed rehabilitation veterinarian who directs therapy. The larger team may be made up of a credentialed physical therapist, the referring veterinarian, a veterinary specialist (surgeon, neurologist, etc.), a veterinary chiropractor, acupuncturist, hospital support staff, the owner, and other trained veterinary professionals.
Working in the Physical Rehabilitation Field
The duties of the rehabilitation veterinary technician include assisting their supervising veterinarian in evaluations and in performing therapies. Therapies that the technician can provide include application of prescribed physical modalities and therapeutic exercises. Part of patient care is ensuring patient records are up‐to‐date and accurate. Proper documentation of treatments should be completed each day. Any member of the rehabilitation team should be able to refer to the record and understand the needs and past treatments of each patient. Clear client communication and education are also necessary. Chapter 2: Joining a Rehabilitation Team goes into detail about the role of each team member.
Pain plays a role in any patient’s willingness and motivation. A patient’s pain score should be assessed and documented in the medical record during each visit (AARV, 2014). A detailed history should indicate the degree of pain and the disability (Davies, 2014). How does the patient cope with the disability? If changes in a patient’s pain level are noted, the supervising veterinarian should be notified. It is very important for the rehabilitation veterinary technician to remain in open communication with their supervisor about anything abnormal or any changes in progress. Chapter 3 will address pain management through physical rehabilitation.
Much of the certified veterinary rehabilitation technician’s day is like any other LVT, RVT, or CVT. Animal patients are admitted, housed appropriately, and kept clean. Often during the day, patients are taken outside so they can relieve themselves. Records are pulled for the therapist (veterinarian or physical therapist). Patient forms must be in order, records sent from the referring veterinarian are available, and equipment is clean, orderly, and ready for use. Assisting the therapist with their patients and listening to them is all part of the routine. At this point, any veterinary technician could fill this position. What sets the veterinary technician apart who is certified in rehabilitation?
Therapeutic Exercises
Therapeutic exercises are a daily part of the veterinary technician’s routine. The owner/handler must be well educated on the exercise program, especially the home exercise program (HEP). The supervising veterinarian chooses the exercises, and the technician carries them out. Exercises target proprioception and balance, specific muscle groups, overall pattern of gait, and overall strength and endurance. Therapeutic exercise equipment includes physioballs, cavaletti rails, balance blocks and discs, weights, tunnels, rocker boards, wobble boards, treadmills, air mattresses, and planks (Coates, 2013). Patient considerations such as motivation, footing, assistive devices, and leash/harness control must be assessed prior to beginning any exercise program, and therapist/handler body mechanics must be monitored to prevent injury. Exercises are designed to address specific impairments, and each is described with a goal, a technique, and a progression (McCauley and Van Dyke, 2013). In order to fully understand the therapies, certification at one of the rehabilitation schools is necessary.
Manual Techniques
Specialized manual techniques are used in evaluating and treating the patient. Types of techniques the technician is trained in are:
“Massage – Effleurage consists of long, slow strokes, generally light to moderate pressure, usually parallel to the direction of the muscle fibers. Petrissage involves short, brisk strokes with moderate to deep pressure, parallel, perpendicular, or diagonally across the direction of the muscle fibers. It may include kneading, wringing, or skin rolling. Tapotement is rhythmic, brisk percussion often administered with the tips of the fingers, primarily used as a stimulating stroke to facilitate a weak muscle, and cross‐friction massage involves applying moderate pressure perpendicularly across the desired tissue. Pressure is maintained in such a way that the finger does not slide across the skin, but rather takes the skin with it” (Coates,
2013
).
Normal range of motion (ROM) is the full motion that a joint may be moved through. Passive range of motion (PROM) motion of a joint that is performed without muscle contraction within the available ROM, using an external force to move the joint (Millis and Levine,
2014a
,
b
).
Stretching techniques are often performed in conjunction with ROM exercises to improve flexibility of the joints and extensibility of periarticular tissues, muscles, and tendons (Millis and Levine, 2014a, b).
Physical Modalities
Physical modalities are often used as part of the patient’s treatment plan. Physical modalities are used as tools to manage pain, weak muscles, inflexibility, limited joint range of motion, and aiding in tissue healing (Niebaum, 2013). The modalities mentioned are not presented in detail.
Physical modalities include:
Superficial thermal agents
– hot (thermotherapy) and cold (cryotherapy).
Neuromuscular electrical stimulation (NMES)
– usually used to address muscular weakness.
Transcutaneous electrical nerve stimulation (TENS)
– used for pain relief.
Therapeutic ultrasound
– a deep heating technique used for rehabilitating musculoskeletal conditions (Levine and Watson,
2014
).
Photobiomodulation
– (not surgical lasers) is used to accelerate wound healing, promote muscle regeneration, treat acute and chronic pain, chronic and acute edema, and neurologic conditions (Millis and Saunders,
2014
).
Extracorporeal shock wave therapy (ESWT)
– benefits include increased bone, tendon, and ligament healing, accelerated wound healing, anti‐bacterial properties, and pain relief (Niebaum,
2013
).
Pulsed electromagnetic field therapy (PEMF)
– can induce biological currents in the tissue. The Food and Drug Administration (FDA) has approved it as safe and effective for the treatment of fractures and their sequelae (Rosso
et al
.,
2015
). The main therapeutic purpose is for enhancement of bone or tissue healing and pain control (Millis and Levine,
2014a
,
b
).
Additional areas of education include topics such as aquatic therapy, canine orthotics and prosthetics, rehabilitation of the orthopedic and neurologic patient, canine sports medicine, pain management, nutrition, and geriatric patients.
Conditions That Can Benefit from Physical Rehabilitation
A range of therapies are used to achieve one or more of the following functional goals:
Speed recovery from injury or surgery
Increase mobility and flexibility
Improve endurance and agility
Decrease pain
Maintain function and prevent further problems
Enhance quality of life (QoL)
Physical rehabilitation helps an individual who has had an illness or injury to achieve the highest level of function, independence, and QoL as possible (Sharp, 2008). The success or otherwise of any surgery is as much down to the rehabilitation carried out as to the surgical technique performed.
Rehabilitation offers numerous physiological benefits to patients, including:
Increased blood flow and lymphatic drainage to the injured area
Reduction of pain, swelling, and complications
Increased production of collagen
Prevention of contractions and adhesions
Promotion of normal joint biomechanics
Prevention of other injuries
Prevention of or reduction in muscle atrophy
Improved function and quality of movement
Conclusion
A rehabilitation veterinary technician’s job is complex and fulfilling. There are advancements in veterinary medicine daily, and animal physical rehabilitation is on the cutting edge. Specialized rehabilitation equipment is helpful, but much can be achieved without it. Physical rehabilitation is rewarding even with minimal equipment; all you need is a rehabilitation team.
Resources
Romich, J.A. (2021).
Anesthesia, Analgesia, and Pain Management for Veterinary Technicians
, 1e. Boston, MA, USA: Cengage Learning.
Albi, M., Holden, J., Ensign, S. et al. (2020).
Anesthesia and Pain Management for Veterinary Nurses and Technicians
, 1e. Florence, OR: Teton NewMedia.
Bockstahler, B., Levine, D., Maierl, J. et al. (2019).
