Rehabilitation for Nonambulatory, Hospitalized Dogs & Cats

Quality of life for a nonambulatory veterinary patient can be greatly improved with a well-designed rehabilitation plan and excellent supportive care. While professional physical therapy by a certified rehabilitation practitioner is highly recommended, the basic physical therapy and rehabilitation techniques discussed here can be performed in most veterinary practices. Physical therapy and rehabilitation are interchangeable terms; rehabilitation will be used in this article.

Rehabilitation Techniques

Massage reduces tissue damage and helps warm up and loosen tight muscles before passive range of motion (PROM) exercises and stretching are attempted. Massage can also alleviate anxiety and discomfort and help the patient relax. The appropriate rate, rhythm, pressure, and duration of massage are determined on an individual basis. Effleurage (ie, stroking) can help assess the patients pain response and muscle tone so attention can be focused on the areas in need.

Gently massage the muscles of the affected limb for 1 to 2 minutes¹ using the palm of the hand. Begin distally and move along the limb medially and laterally before returning to the starting point. Use smooth movements and apply light-to-moderate pressure.

PROM exercises help maintain joint health when a patient is unable to move his or her legs. Although PROM exercises are beneficial for muscle tone, they are not a good option for patients with muscle atrophy.¹ The patient may be in lateral recumbency or in a standing position for PROM exercises. Each joint should be gently flexed and extended through the patients normal range of motion for 10 to 20 repetitions, 3 to 5 times daily.¹ For patients with muscle atrophy, proprioceptive neuromuscular facilitation (PNF) can help reeducate and stimulate ingrained patterns. PNF techniques stretch and contract the muscles to encourage more advanced rehabilitation of affected muscles.²

Therapeutic exercises focus on strengthening hip and stifle extensors and begin reeducating muscles needed for balance and proprioception. Assistive devices include exercise balls, Cavaletti rails, and slings.

• Exercise balls can be used to help patients stand or to increase their ability to bear weight on pelvic or thoracic limbs. (See Figure 1.) The size of the ball should allow the patient to keep all 4 feet on the ground. When the patients front and hind limbs are supported, he or she can be gently bounced up and down or rolled back and forth. Standing exercises are preferably performed for 2 to 5 minutes 3 times daily, but should be discontinued at the point of fatigue.² Ensure the patients legs are in a normal standing position, as this helps prevent knuckling and promotes weight bearing.

Figure 1

  Exercise peanut

• Cavaletti rails facilitate strength training and proprioception and increase range of motion and stride length. The goal is for the patient to walk over the rails without touching or knocking them over. Ladders, logs, or PVC piping can be used if professional rails are unavailable.

• Slings can be used with recumbent paraparetic patients (ie, patients that have lost the use of only their front or back limbs). Slings provide support while helping reeducate the affected limbs and reduce any edema. They are also helpful for patients with secondary respiratory problems, and allow patients to be in a sternal position for feeding and any necessary bladder care. Many sling support devices are availablechoose the appropriate device according to the patients size, neurologic status, and treatment needs. Always check a patients comfort level and ensure the sling is not causing any sores or irritation. (See Figure 2.)

Hydrotherapy provides wide-ranging joint and muscle activity in a non-weight-bearing setting (eg, pool or tub with an electric pump or jets to create waves for resistance). Patients should always be supported in the thoracic region even when flotation devices are used. Therapy should be limited to 5 minutes per day. An underwater treadmill can also be used for patients with muscle atrophy or an injury that limits their range of motion (eg, fibrocartilaginous embolism, intervertebral disk disease).² (See Figure 3.)

Figure 3

Underwater treadmill

Supportive Care

In addition to specific exercises, provide patients with the following care to support their rehabilitation.

• Keep the patient clean and dry at all times, both for hygiene and comfort. Provide thick bedding and turn the patient from side to side every 4 to 6 hours to prevent pressure sores.

• Bladder care may be necessary because these patients are frequently incontinent and may be predisposed to urinary tract infection, urine scald, and damage to the detrusor muscle, ureter, and kidneys.

• Adequate nutrition is necessary for patients to maintain strength and stamina during rehabilitation. Patients not eating should receive IV fluids to maintain hydration and prevent electrolyte imbalance.¹

• Pain control is essential because pain affects all aspects of treatment and nursing care (eg, eating, strengthening exercises) and decreases a patients drive and ability to perform tasks needed for overall recovery.

Conclusion

A patients rehabilitation plan should begin as soon as his or her condition has stabilized. Always consider all aspects of patient care and adjust the plan to each individual patient.