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1.
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.  相似文献   

2.
OBJECTIVE: To determine hip, stifle, and tarsal joint ranges of motion (ROM) and angular velocities during swimming and walking in healthy dogs and dogs with surgically corrected cranial cruciate ligament (CCL) rupture. DESIGN: Prospective clinical study. ANIMALS: 13 healthy dogs and 7 dogs with CCL rupture. PROCEDURE: Dogs with CCL rupture were enrolled in a postoperative aquatic rehabilitation program and evaluated 21 to 35 days after surgery. Dogs were filmed while swimming in a pool and while walking at a fast (1.3 m/s) or slow (0.9 m/s) pace on a treadmill. Maximal angles of extension and flexion, ROM, and angular velocities were calculated. RESULTS: In healthy dogs, swimming resulted in a significantly greater ROM in the hip joint than did walking, but in dogs with CCL rupture, ROM of the hip joint did not vary with swimming versus walking. For dogs in both groups, swimming resulted in significantly greater ROM of the stifle and tarsal joints than did walking, primarily because of greater joint flexion. Stifle joint ROM was significantly lower in dogs with CCL rupture than in healthy dogs, regardless of whether dogs were swimming or walking. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that following surgical management of a ruptured CCL in dogs, swimming resulted in greater ROM of the stifle and tarsal joints than did walking. This suggests that if ROM is a factor in the rate or extent of return to function in these dogs, then aquatic rehabilitation would likely result in a better overall outcome than walking alone.  相似文献   

3.
OBJECTIVE: To report a technique for surgical alteration of the slope of the tibial plateau by a proximal tibial intraarticular ostectomy (PTIO) after injury to the canine cranial cruciate ligament (CCL) and to determine the outcome. STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs (n=52) with CCL injury in 60 stifle joints. METHODS: CCL injury was treated by lateral stifle arthrotomy, removal of CCL remnants, and appropriate meniscal surgery. PTIO was performed to remove a wedge of bone from the proximal aspect of the tibia. The ostectomy site was reduced and stabilized using a bone plate and screws applied to the medial surface of the tibia as well as a craniocaudal positional screw. Dogs were evaluated at 6 weeks, 6, and 12 months by complication assessment, lameness scores, stifle range of motion (ROM), thigh circumference, radiographic assessment, degenerative joint disease (DJD) scores, and surgeon and owner evaluation of function. RESULTS: Lameness scores improved by 6 and 12 months in all but 1 dog. Thigh circumference and DJD were increased at 6 and 12 months. Complications occurred in 20% of dogs with all but 1 occurring perioperatively or within 6 weeks; most common were injury to the long digital extensor tendon (4 dogs) and plate failure (3); 2 other dogs required surgery to treat complications. Most owners (98%) reported that lameness had improved by 12 months; 90% were extremely or very satisfied with the procedure and 90% would have the same procedure performed on another dog. CONCLUSION: PTIO to level the tibial plateau provided a satisfactory clinical outcome in dogs >20 kg with CCL injury and the complication rate was similar to tibial plateau levelling osteotomy (TPLO). Stifle osteoarthritis continued to progress radiographically. CLINICAL RELEVANCE: PTIO represents an alternative to TPLO that does not require specialized surgical equipment.  相似文献   

4.
ABSTRACT

Physical therapy and rehabilitation following orthopaedic surgery in companion animals have become more common and new advancements in this field have been made in recent years. Surgery alone may not return the animal to its previous physical activity or work-related tasks, whether due to concurrent soft tissue trauma, arthrogenic muscle inhibition or osteoarthritis. Rehabilitation therapies following surgery can restore function as well as strength, coordination and balance. Many simple techniques such as cryotherapy and passive range of motion exercises have been shown to improve outcomes following musculoskeletal procedures and may help restore function as well as reduce pain and facilitate healing. Some techniques are more useful during different stages in order to achieve optimum tissue healing and recovery of function. During the first 72 hours, rehabilitation should focus on reduction of inflammation and pain, maintaining joint nutrition and range of motion, and stimulating vascularisation and healing; and may include cryotherapy, passive range of motion exercises, massage and therapeutic exercises. Following the initial recovery period, the goals of rehabilitation also include restoring strength, balance and normal gait patterns, as well as recovery of function. During this period the focus of therapy may shift toward therapeutic exercises, aquatic therapy and increasing activity in the animal. Therapeutic modalities such as neuromuscular electrical stimulation, photobiomodulation (laser therapy), therapeutic ultrasound and extracorporeal shock wave therapy have been reported to reduce pain and inflammation, enhance healing and reduce recovery time in the early and late stages following orthopaedic surgery.  相似文献   

5.
This case report describes the successful management of two horses with medial carpal collateral ligament injury. This is a rare cause of forelimb lameness and existing reports indicate a poor prognosis for return to athletic function with conservative management. Both horses were treated with a combination of box rest with controlled exercise and high-intensity laser therapy (HILT). Both horses returned to previous athletic function, one at Grand Prix level dressage and one at Novice level eventing. With appropriate management, the prognosis for carpal collateral ligament injury may be good. From this report, it is unclear whether a rehabilitation program including HILT offers improved prognosis compared with a rehabilitation program alone.  相似文献   

6.
Many problems in the hip area show movement dysfunctions of the hip joint in combination with the lumbar spine, sacroiliac joint, neurodynamic structures, and the muscular systems. Muscle strain injuries pertinent to the canine hip have been reported in the iliopsoas, pectineus, gracilis, sartorius, tensor fasciae latae, rectus femoris, and semitendinosus muscles. Physical diagnoses of this type of injury require palpation skills and the ability to specifically stretch the suspected musculotendinous tissue. Treatments shall incorporate modalities, stretches, specific exercises, and advisement on return to normal activity. Canine hip dysplasia (CHD) is a common finding in many large breed dogs. Physical treatments, preventative therapies, and rehabilitation could have a large role to play in the management of nonsurgical CHD patients with the goal to create the best possible musculoskeletal environment for pain-free hip function and to delay or prevent the onset of degenerative joint disease. Osteoarthritic hip joints can benefit from early detection and subsequent treatment. Physical therapists have long utilized manual testing techniques and clinical reasoning to diagnose early-onset joint osteoarthritis and therapeutic treatments consisting of correcting muscle dysfunctions, relieving pain, joint mobilizations, and advisement on lifestyle modifications could be equally beneficial to the canine patient. As well, sacroiliac joint dysfunctions may also afflict the dog. An understanding of the anatomy and biomechanics of the canine sacroiliac joint and application of clinical assessment and treatment techniques from the human field may be substantially beneficial for dogs suffering from lumbopelvic or hindlimb issues.  相似文献   

7.
The prognosis for returning horses with open joint injuries to athletic function is most closely related to the duration of the injury prior to treatment. Prompt diagnosis and appropriate therapy should yield a favorable result. Delayed diagnosis or inappropriate therapy that allow the wound to progress to an infected state makes the likelihood of return to athletic function poor. Refractory joint infection can occur despite early diagnosis and prompt appropriate therapy. The development of these infections is undoubtedly increased by tissue loss and gross contamination. Appropriate antibiotics given long term probably play the most significant role in resolving joint sepsis. When the refractory nature of the infection is accompanied by cartilage loss and bone proliferation, aggressive treatment by open drainage, synovectomy, and arthrodesis of the joint should be considered.  相似文献   

8.
When medical therapy and surgical treatments of an injured joint fail to return the animal to athletic performance or comfortable use of the limb, arthrodes is is a final option for some joints.Arthrodesis refers to the surgical fusion of a joint, resulting in bony ankylosis. Successful arthrodesis requires debridement of the articular cartilage through the calcified cartilage layer, exposing the subchondral bone; alignment of the joint into a weight-bearing position; and stabilization. The methods by which these steps are accomplished are variable, depending on the individual joint.There are currently accepted methods for arthrodesis of several joints in the horse; however, not all joints are amenable to arthrodesis. Case selection is an important aspect of performing arthrodesis procedures in horses.  相似文献   

9.
OBJECTIVE: To evaluate the literature reporting surgical interventions pertaining to canine cranial cruciate ligament (CCL) injury using an evidence-based medicine paradigm. STUDY DESIGN: Systematic literature review. METHODS: An on-line bibliographic search through Medline, PubMed, Veterinary Information Network, and Commonwealth Agricultural Bureau Abstracts was performed during August 2004. Two hundred and forty resources of information were identified. Studies were compared and evaluated with regard to study design (retrospective, prospective, randomization), surgical technique, short- and long-term follow-up, and evidence classification. RESULTS: Twenty-eight resources qualified to assist with evidence classification. No class I or class II studies were present, 5 studies were categorized as a class III and 23 studies were categorized as a class IV. Seventeen studies were retrospectively designed and 11 studies were prospectively designed. Proposed results ranged from a wide variety of subjective findings including clinical impression, radiographic analysis, synovial fluid analysis, gross pathology, and histopathology. Objective results, although infrequent, included force plate analysis and cadaveric biomechanical testing. CONCLUSIONS: At this time, the application of evidence-based medicine in analyzing the current available evidence suggests that there is not a single surgical procedure that has enough data to recommend that it can consistently return dogs to normal function after CCL injury. The requirement for assessing and categorizing the available evidence becomes increasingly important as more data becomes available and the quality of research improves. CLINICAL RELEVANCE: An evidence-based medicine paradigm did not provide sufficient evidence favoring 1 surgical technique for management of canine CCL injury.  相似文献   

10.
OBJECTIVE: To determine the effects of early postoperative rehabilitation on limb function in dogs after surgery for ruptured cranial cruciate ligament (RCCL). DESIGN: Prospective clinical study. ANIMALS: 51 client-owned dogs. PROCEDURE: Dogs weighing between 20 and 40 kg (44 to 88 lb) that had RCCL and medial meniscal injury were studied. After removal of the RCCL and complete medial meniscectomy, the stifle joint was stabilized by use of a lateral retinacular stabilization technique. Twenty-five dogs were included in a postoperative rehabilitation group, and 26 dogs were included in an exercise-restricted group. Limb function (peak vertical force [PVF] and vertical impulse [VI]) was determined before surgery and 6 months after surgery, using force platform gait analysis. RESULTS: Prior to surgery, mean PVF and VI in affected limbs were similar between groups. Six months after surgery, PVF and VI were significantly increased in dogs of both groups. However, PVF and VI in dogs in the rehabilitation group were significantly greater than those of dogs in the exercise-restricted group. At this time, differences in limb function (as measured by PVF and VI) between the repaired and normal limbs were not evident in dogs in the rehabilitation group. Conversely, limb function in the repaired limb of dogs in the exercise-restricted group was still significantly less than that of the normal limb. CONCLUSION AND CLINICAL RELEVANCE: Dogs that have surgery for RCCL and a torn medial meniscus benefit from postoperative rehabilitation; rehabilitation should be considered part of the postoperative management of these patients.  相似文献   

11.
The purpose of this study was to evaluate a new method of internal fixation technique for pastern arthrodesis. Pastern arthrodeses are performed commonly in horses with chronic osteoarthritis of the pastern joint or, in cases of acute traumatic injury to the pastern, in which the weightbearing bony column must be restored. Chronic osteoarthritis of the pastern is a frequent cause of lameness in the equine athlete and is evidenced by chronic lameness localised to the pastern joint, and supported radiographically by periosteal proliferation and loss of joint space. Nonsurgical and surgical treatments have both been described in the literature. Complications following pastern arthrodesis have been reported on several occasions and appear to focus on excessive periarticular exostoses and increased time in a cast due to prolonged time to bony fusion. The hospital records of horses presenting for pastern arthrodesis to the Rood and Riddle Equine Hospital in Lexington, Kentucky, were reviewed and 22 met criteria for inclusion in the study. Horses with chronic osteoarthritis of the proximal interphalangeal joint or horses with an acute traumatic injury to the pastern undergoing pastern arthrodesis with one of the following techniques were included in the study. Horses with severe comminution of the middle phalanx were excluded. Three 5.5 mm cortical bone screws placed in lag fashion alone or in combination with a 4 or 3 hole dynamic compression plate affixed with 4.5 mm cortical bone screws were compared. A lower limb fibreglass cast was applied in all cases. Period in cast, time to return to intended use, complications encountered and outcome were evaluated. Seven of the 8 hindlimbs treated with the combination technique became sound. Three out of 6 of the front limbs treated with the combination technique became sound. Four of the 5 horses with hindlimbs, and one of the 2 with front limbs, treated with screws only returned to their intended use. The type of internal fixation did not appear to influence the overall number of horses returning to the intended level of performance. The period spent in cast and the time to return to soundness were decreased in horses operated on using the combination technique. We concluded that, in the immediate postoperative period, the combination of the parallel screw technique with a dorsally-applied dynamic compression plate provides the most stable and secure fixation, minimising motion, expediting bone remodelling and therefore favouring rapid fusion of that joint.  相似文献   

12.
OBJECTIVES: To investigate changes in concentrations of insulin-like growth factors I (IGF-I) and II (IGF-II) and the expression of IGF-binding proteins (IGFBP) in synovial fluids from dogs with naturally occurring osteoarthritis (OA) of the canine stifle joint secondary to cranial cruciate ligament (CCL) rupture. STUDY DESIGN: Prospective study with synovial fluid sampling from diseased and contralateral unaffected joints at 0, 1.5, and 5 months. SAMPLE POPULATION: Eleven dogs with unilateral CCL deficiency, with unaffected contralateral joints. METHODS: IGF-I and IGF-II concentrations in synovial fluids were estimated by radioimmunoassay at 0, 1.5, and 5 months; Western ligand blotting was performed for intact IGFBPs at 0, 1.5, 5, and 9 months. Both stifle joints were radiographed at 0, 7, and 13 months. RESULTS: The IGF system is altered after CCL rupture and during development of early OA. Mean IGF-I and IGF-II concentrations in index stifle joints at study entry were 201.6 microg/mL and 345.7 microg/mL, respectively, compared with 57.7 microg/mL and 79.4 microg/mL, respectively, for contralateral joints. Index joint IGF concentrations increased after surgical treatment and then declined, although they remained higher than contralateral joints. Index joints had increases in IGFBP-3 and -4, and a decrease in IGFBP-2 expression compared with contralateral joints. CONCLUSIONS: Although IGF concentrations are increased in canine OA, alterations in IGFBP profiles may limit the tissue availability of IGF. CLINICAL RELEVANCE: Manipulation of the IGF system may provide an opportunity for novel treatments of OA in dogs.  相似文献   

13.
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.  相似文献   

14.
This prospective clinical study investigated the activity of matrix metalloproteinases (MMPs) in stifle synovial fluid (SF) of 13 dogs with acute cranial cruciate ligament (CCL) rupture, and the effect of a postoperative doxycycline treatment. MMP-2, 3, 9 and 13 activities were compared with respect to the time of sampling (preoperatively or 1 month after surgical stabilisation) and the type of postoperative adjuvant treatment (doxycycline or not). No significant activity was detected for both MMP-3 and MMP-13. MMP-2 and MMP-9 activities were found to be significantly highly increased in SF of CCL ruptured stifles compared to control stifles of unaffected dogs. No significant effect from surgical stabilisation and postoperative doxycycline treatment on MMP-2 and MMP-9 activities was found, indicating that doxycycline may not be an appropriate postoperative medical treatment after CCL rupture.  相似文献   

15.
SUMMARY Three surgical techniques, grouped as intra-articular techniques, extra-capsular techniques and fibular head transposition, were used for repair of the cranial cruciate ligament (CCL)-deficient stifle in 113 dogs over a 4 year 4 month period. The clinical outcome of the techniques were compared using information provided by the owners and physical examination. Regardless of surgical technique, 85.7 to 91.0% of dogs showed clinical improvement after surgery. However, less than 50% of dogs became clinically sound on the operated leg and 9.0 to 14.3% of dogs remained persistently lame on the operated leg. No statistical association was found between result after surgery and age, body weight, sex, duration of injury before surgery, association with injury, tibial plateau angle, degree of radiographic osteoarthritis before surgery or the presence of concurrent medial meniscal injury. On physical examination, extra-capsular techniques appeared superior to the fibular head transposition in terms of joint stability and limb function. Concurrent medial meniscal injury necessitating meniscectomy existed in 48.0% of cases. Twenty-two percent of dogs ruptured their contralateral CCL at an average of 14 months after the first.  相似文献   

16.
Radiation therapy has been used to treat animal cancers for more than 100 years. Clinical experiences and experimental results have been widely published and provide a basis for the recognition of radiation therapy as an integral component of multimodal cancer management in veterinary oncology. As the expectations of pet owners and the demand for treatment of companion animals with cancer have increased, veterinary oncology itself has undergone dramatic advances in the past several decades both in terms of improved diagnostics and treatments, including increased accessibility of radiation therapy. Synchronous with development of the specialism of veterinary radiation oncology, confusion and controversy have arisen with regard to distinguishing between different types of radiotherapy and methods of treatment delivery. Importantly, the confusion extends beyond semantics, and includes opinionated debate about defining which forms of therapy (if any at all) are optimal for a given patient. This exemplifies how, despite marks of maturity including age and a robust publication history, the field of veterinary radiation oncology is in some ways still in its infancy. The purpose of this article is to review the evidence base for daily (fine) fractionation versus weekly (coarse) hypofractionation in veterinary oncology, using selected tumour types as examples.  相似文献   

17.
Senior dogs and cats with orthopedic injuries and diseases often require a treatment plan that differs from that of younger patients. Injured bone and soft tissues tend to heal more slowly in the geriatric patient. The older animal is likely to have a less competent immune system and may have compromised metabolic and endocrine function. Pre-existing musculoskeletal problems may make ambulation difficult for an animal convalescing from a new orthopedic problem. Special attention is often needed when treating these patients for fractures, joint instability, infection, and neoplasia. In general, issues that should be addressed in the geriatric patient include reducing intraoperative and anesthesia time, enhancing bone and soft tissue healing, return to early function, control of postoperative pain, physical therapy, and proper nutrition.  相似文献   

18.
This retrospective study evaluated the incidence of meniscal injury in cats with cranial cruciate ligament (CCL) ruptures. Medical records for cats diagnosed with CCL ruptures treated by a lateral fabellotibial suture (LFS) were reviewed for signalment, history, physical examination and surgical findings. Ninety-five cats (98 stifles) met the inclusion criteria. The incidence of meniscal injuries in feline CCL deficient stifles was 67%. Isolated medial meniscal injuries were found in 55 stifles (56%), isolated lateral meniscal injuries were found in 5 stifles (5%), and lateral and medial meniscal injuries were found in 6 stifles (6%). There was no correlation between the presence of a meniscal injury and age, breed, sex, weight, duration of lameness, presence of concurrent medial patellar luxation, degree of degenerative joint disease, or presenting side of lameness. Given the high rate of meniscal pathology in cats with CCL ruptures, exploratory surgery for meniscal assessment and concurrent stifle stabilization should be considered in feline patients.  相似文献   

19.
Elbow luxation is a common orthopedic injury in the ferret. The injury is usually caused by trauma but can also occur spontaneously. The most successful treatment involves a combination of surgical and medical intervention. Surgical treatment includes open reduction of the elbow joint and stabilization with orthopedic implants. Medical treatment includes external coaptation, analgesia, and prevention of infection. Owner compliance also plays an important role in return to full function of the luxated ferret elbow joint.  相似文献   

20.
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