Practical Physiotherapy for Veterinary Nurses

Donna Carver

• Publisher: Wiley-Blackwell
• Year: 2015
• ISBN:
  9781118711347
• Edition: 1
• Topic: Medicine
• Subtopic: Veterinary Medicine

Reflecting a rapidly growing area of interest in veterinary practice, this practical, pocket-sized guide to small animal physiotherapy has been designed for quick reference, providing the ideal guide for busy practice veterinary nurses when they really need it.

• Reflects the need for a text in this rapidly growing area of interest, providing the first on this topic for veterinary nurses
• Designed in a pocket-sized format so that VNs can carry it around for quick reference
• The author has ideal experience for this field, having worked as both a veterinary nurse and an animal physiotherapist
• This book is accompanied by a companion website which contains videos and self-test questions and answers

CHAPTER 1
Musculoskeletal physiotherapy

Introduction

Gait analysis or assessment is a skill that requires close observation of the patient at walk and trot, to determine the cause and location of the lameness. A start point is to become familiar with a normal gait pattern, taking into account breed variations (i.e. dachshund vs bull mastiff). Once you are familiar with normal gait pattern, any deviation from this can be recognised.

Animals should be on a loose lead at walk and trot to observe for anatomical symmetry (normal gait pattern). Animals should be observed in a straight line towards, and then a straight line away from the observer. Pay particular attention to how the animal turns to both the left and right side – this may show reluctance to transfer weight onto the affected limb, or that the animal has issues with balance. The observer should then view the animal moving from both left and right sides. Subtle lameness may not readily be observed at walking pace; however, at trot the animal will only have one thoracic limb and one pelvic limb in contact with the ground, and these limbs will be placed under greater pressure meaning a lameness may be easier to detect.

Videoing the gait pattern, then slowing it down on playback, may be a useful way to detect lameness.

Gait analysis

Observe muscle symmetry, weight-bearing (paw and toe position) and conformation at rest.

Observe gait in a quiet area at walk and trot; thoracic limb lameness is often associated with head bobbing. When the animal takes its bodyweight through the painful thoracic limb the head will bob upwards in an attempt to unload the ground reaction force passing through the limb.

Pelvic limb lameness can be observed by a hiking up in the gluteal region in an attempt to offload or shift weight from the painful limb; this may be towards the contralateral pelvic limb, or forwards usually towards the contralateral thoracic limb. Lameness in pelvic limbs may also present with a bunnyhopping gait pattern. This may be related to a reduction in pelvic limb power, often observed with stair climbing or running. The bunnyhopping gait pattern may also be related to a reduced range of motion within the coxofemoral joint, which would be confirmed on physical examination.

Lameness is a general term used to describe an abnormal gait pattern; it may be:

• Congenital – chondrodystrophic abnormalities, i.e. valgus (lateral deviation of the distal limb), often seen in dachshunds.
  Or
• Pathological – related to a disease process such as osteoarthritis, which can affect any breed but is often seen in larger breeds.

Scoring systems are often used to grade the degree of lameness, and in veterinary practice a typical 1–10 scale is used where 1/10 would indicate barely lame, whereas 10/10 would indicate non-weight-bearing lameness. The scale is very subjective, as only descriptive terms are allocated to the very mildest and most severe lameness. If one observer rated lameness as 4/10, then a second observer may rate the same lameness as 6/10; does this indicate the lameness is progressing? This is why it is important to obtain a full and accurate history from the owner, who will probably observe the animal’s gait every day and be able to state if the lameness is improving, staying the same, or deteriorating. A simpler alternative scoring 0–5 system is available (Table 1.1).

Table 1.1 Lameness scoring scale.

From Summer-Smith (1993). Reproduced with permission from Elsevier.

Score	Description
0	Normal
1	Reduced weight-bearing through affected limb in stance
2	Mild lameness at trot
3	Moderate lameness at walk and trot
4	Intermittently carries limb, lame in trot
5	Non-weight-bearing lameness

Elbow dysplasia gait analysis findings include abduction of the affected limb in an attempt by the patient to reduce the amount of bodyweight passing through the elbow joint. This will be most evident when the animal is ambulating on hard ground as the concussive forces passing through the elbow joint will be greater.

Flicking of the carpal joints is also evident with elbow dysplasia; this is a compensatory mechanism for the reduced range of motion, especially elbow flexion, that is characteristic of advanced elbow dysplasia. The condition is often bilateral, so it is important to observe how the animal turns (weight transfer) and observe (or ask the owner about) functional activities such as how or if the animal is able to descend stairs or jump from the car; this will increase load on the elbow joint and will be uncomfortable for the animal so he may avoid these functional activities.

Hip dysplasia gait analysis findings may include a short stride length; this is usually shown as reduced hip extension and can be readily observed as the animal climbs stairs as a weak or short hip extension/push-off. The reduction in hip extension is a characteristic of hip dysplasia, with associated osteoarthritis and joint remodelling.

Adduction of the affected limb is also evident. This can be due to weakness in the hip flexor muscle groups, and may also be associated with secondary osteoarthritic changes and compensatory coxofemoral joint remodelling. As discussed ear...

Table of contents

• Cover
• Title Page
• Table of Contents
• Acknowledgements
• About the companion website
• CHAPTER 1: Musculoskeletal physiotherapy
• CHAPTER 2: Neurology
• CHAPTER 3: Respiratory physiotherapy
• CHAPTER 4: Hydrotherapy
• APPENDICES
• Abbreviations
• References
• Self-assessment answers
• Index
• End User License Agreement