articles

Selecting physical rehab products for your canine patients

By  | 

The vast number of rehab products on today’s market can make it difficult for pet owners to know what to purchase. Helping clients make well-informed product decisions is not only beneficial to patients, but also prevents costly or damaging mistakes.

Over 85 million families have a pet, according to the 2017-2018 National Pet Owners Survey from the American Pet Products Association. The number of working dogs, or those in canine sports, has also grown. These dogs are involved in everything from hunting and gathering livestock, to patrolling with soldiers, detecting explosives, searching for missing people, providing assistance for the disabled, and competing in dozens of canine sports. Injuries often occur in these dogs, and rehabilitation is needed to bring them back to health, which means the rehab products industry has also grown exponentially. The thousands of rehab products on today’s market may lead to overspending, and/or inappropriate product choices. This means dog owners often look to assistance from veterinary professionals to help make well-informed product decisions based on fit, activity goals, or in many cases, injury prevention or recovery.

You can help guide your clients through the marketplace, avoid costly overstocking, and provide for your patients’ needs by considering the following points:

  • Intended use of assistive product
  • Sizing and style availability
  • Breed-related structural differences
  • Behavioral differences between animals
  • Ease of equipment modification
  • Common orthopedic conditions (e.g. cranial cruciate ligament insufficiency, osteoarthritis, congenital disorders)
  • Common neurological conditions (e.g. intervertebral disc disease, degenerative spinal conditions)
  • Common musculoskeletal conditions (e.g. tendonitis, muscle sprains and strains)

Recommended equipment for a rehab facility

Figure 1: Cavaletti rail equipment helps improve overall joint range of motion and proprioception during movement. Image courtesy of Kristen Hagler.

While the surrounding environment can often provide basic needs for therapeutic exercise through the use of hills, slopes, short flights of stairs, varied terrains and curbs, equipment (Figure 1) that specific for the individual’s exercise goals, and is of the appropriate size for the animal, improves overall efficiency and effectiveness.

What follows is a list of recommended essential items for a rehabilitation facility treating animals of various sizes recovering from injury, in addition to those participating in canine performance sports. Practitioners are encouraged to review the most common conditions seen at their facilities to determine the needs of the surrounding pet population. For example, big cities tend to have larger populations of small breed dogs compared to large or giant breeds, so keeping high numbers of inventory items for larger animals is not wise.

  • Thermal therapy (cryotherapy and heat therapy) to treat multiple sized joints
  • 12” road cones with holes drilled at varying heights
  • Wooden dowels 2’ to 3’ in length, or agility poles for use with road cones
  • Balance cushions or discs of at least two sizes (large and small)
  • Physioballs or peanut-shaped inflated therapy balls of various sizes
  • Training platforms or exercise steps of varying heights
  • Foam wedges
  • Balance boards
  • Balance pods or wedges (air-filled)
  • Balance beam rail or walkway

“Wardrobe essentials” — structural assessment and fit

Structure and function are intimately linked. The recognition of abnormal structural components during rehabilitation therapy or early risk assessment for athletic performance activities may help reduce risk of injury based on structural predispositions. Understanding basic canine anatomy and structural components helps guide treatment for injury or injury prevention, in addition to helping guide selection of equipment based on the animal’s conformation.

Figure 2

The forelimbs bear 60% and the pelvic limbs bear 40% of the total body weight in the dog. As seen in Figure 2, the thoracic limbs are constructed as such to permit significant range of motion, provide lift when jumping and directional changes when running. If problems occur in the spine or pelvic limbs, weight bearing on joints increases due to compensation and, over time, the abnormal postural changes give rise to secondary conditions (Saunders DG. 2005). Structural variation in the thoracic limbs occurs between breeds, with differences in the degree of shoulder layback, length of the humerus, and ratio of humerus to scapula length affecting forelimb structure and ultimate functional capabilities.

Figure 3

The perfectly built dog should have an ulna and scapula of equal length and 30 degrees of shoulder layback. Shoulder layback is measured from a line drawn perpendicular to the ground through the point of shoulder and another line drawn to follow the scapular spine (Zink CM. 2008) (Figure 3). The pelvic limbs of the dog are designed to provide propulsion and directional changes while on level surfaces and “drive” the cranial portions of the body forward during activity (Gross D). Variations in pelvic limb angulation can be measured between animals by drawing two perpendicular lines from the ground; one from the ischeal tuberosity of the pelvis and the other from the tarsi perpendicular to the ground then drawing a line along the caudal aspect of the tarsi (Zink CM. 2013). The distance between the two lines is then compared.

Figure 4

Ideally the dog will have an evenly balanced distance between the two perpendicular lines, allowing for larger bony areas available for muscle attachment (Figure 4). In reality however, dogs are not evenly balanced and have either too much or too little rear angulation. There are advantages and disadvantages to having abundant rear angulation. Those with a lot of rear angulation are able to take longer strides and expend less energy, but often are less stable in the rear as it takes tremendous muscular strength and coordination to stabilize the overly angulated rear. As a result, dogs with straighter pelvic limbs tend to be able to turn more sharply than dogs with overly angulated pelvic limbs (Zink CM. 2013).

For humans, our general body shape remains relatively constant and finding the correct fit for an article of clothing is not an insurmountable task. However, for a quadruped animal, getting the right fit for a harness can be challenging. Taking into account basic structural needs, practitioners can help pet owners navigate products such a body harnesses, protective footwear, footing or traction aides and even mobility carts. Assistive technology is an umbrella term that includes assistive, adaptive, and rehabilitative devices for individuals with disabilities and also includes the process used in selecting, locating and using them. Assistive technology can be defined as “any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities” (Nicolson et al., 2012). Determining what a patient needs is determined by the type of injury, the chronic condition being treated, level of independence or need for assistance, prevention of further injury based on environment, and therapeutic or activity goals.

Protective footwear

Protective footwear for animals may serve multiple purposes, including traction for slippery surfaces, and protection from environmental abrasions, such as in the case of neurological injury or a working dog conditions on glass, chemicals or sharp surfaces. Depending on the animal’s level of strength, footwear can help or hinder ambulation. When used for protection against the environment during work, uninjured animals easily accommodate to wearing it.

Figure 5: Balloon type booties may help pets gain traction on slippery flooring and lower injury risk. Image courtesy of Sticky Paws.

Using protective footwear for animals with disability presents challenges in movement, as well as obstruction of proprioception through the foot pads, and general poor fit due to the the patient’s disability. Booties tend to twist, slip distally, or are cumbersome, causing frustration for all involved. Most have Velcro straps at the top and rubberized soles to prevent slipping, and are machine washable (Figure 5).

Customized grip socks are also available and have rubberized tread under the paw surface. These may serve the patient better when on surfaces where traction only is desired. In addition to protective footwear, rubberized coatings are available to increase the nails’ “grip”. It is essential that these items to fit correctly, and that owners are instructed on care and use to prevent the development of sores or ineffective utilization.

All protective footwear should be removed several times daily to assess the skin condition and, if possible, during therapeutic exercise to increase proprioception through the bottom of the pads.

The following features are recommended in protective shoes for dogs:

  • Flexible sole
  • Fabric breathability
  • Grip “zone” for the paws or nails
  • Overall weight (this is especially important for animals with weakness or incoordination)
  • Overall length, and ability to adhere to either the hock or metatarsals
  • Ease of use for caretaker
  • Overall purchase on the plantar/palmar aspect of the paws

At least three different footwear examples should be recommended for dog owners to evaluate. If using a rubberized nail covering, it’s advisable to keep at least one of each available size on hand.

Recommended footwear and traction product companies include:

  • PawzTM
  • Cushy-Paw SlippersTM
  • Ruffwear bootsTM and Bark’N Boot linerTM
  • Lewis Brand Vented Rubber Dog BootsTM
  • FoufoudogTM
  • Dr Buzby’s ToeGripsTM
  • MediPawTM
  • Handicapped PetsTM
  • TheraPawTM
  • DogLeggsTM
  • Sticky PawsTM
  • Woodrow WearTM Power Paws

Assistive harnesses

Animals may require the aid of an assistive device for a variety of reasons, such as temporary post-surgical recovery, weakness secondary to age, or for activities carrying certain physical risk (e.g. hiking or swimming). Length of use, the handler’s ability to put on the harness, and the animal’s life stage should all be taken into consideration when choosing an appropriate assistive device.

Post-operative patients require assistance getting in and out of enclosures or cars, or geriatric patients requiring assistance getting up and down off the floor, each require a different harness style. The post-operative patient will likely only require a harness for several weeks until the surgical area is healed and there’s a lower risk of surgical failure from slipping or falling; therefore, a lightweight, simply-designed abdomen sling-style harness is most appropriate for short periods of use.

Figure 6: The Ruffwear™ Webmaster™ is a harness with the handle in the middle of the animals back — ideal for providing assistance during movement. Image courtesy of Kristen Hagler.

Geriatric patients require significantly more physical assistance for essential daily activities and will likely continue to use the harness throughout the remainder of their lives. When choosing a harness for patients with disability, professionals should consider harness handle placement and patient needs. The most ideal location for a handle is near the thoraco-lumbar junction just behind a dog’s center of gravity, behind the shoulder blades. This location helps handlers guide animals into a standing position from lying down by providing forward momentum and preventing overcompensation in the thoracic limbs (Figure 6).

Animals with an even higher degree of disability, low strength in the pelvic limbs or amputation of a limb, may require assistance from two lift points over the shoulders and hips. While abdominal sling-style harnesses are useful, they produce vertical lift against the abdominal region, including the bladder, and lumbar spine (Figure 7). A more ideal lift location point is directly under the pelvic region, because the sacrum helps distribute pressure points.

Figure 7: The HelpEm UP Harness™ provides assistance through the sternum and underneath the pelvis, so less strength is needed by a handler. Image courtesy of Blue Dog Designs. HelpEm Up Harness™

Using a supportive harness will also help patients with motor function keep from falling, as well as providing the benefits of gait repatterning and strengthening. In addition to handle locations, slings and harnesses may be fitted for the forelimbs, hindlimbs, or both (Figure 8). They should have long, hand-held straps attached to allow proper body mechanics for the handler, thereby avoiding personal injury when supporting the pet.

Assistive harnesses should not obstruct movement, or protraction or retraction of a limb. They should allow voiding and have a soft lining against the animal’s skin to avoid sore development. Most importantly, they should be washable, and animals should be given periods throughout the day when they’re not wearing them.

Having a variety of assistive devices in a clinical setting is advisable to help owners decide what will work for their needs, in addition to their dogs’. The following are recommended as essential items for the clinical setting:

  • GingerLead SlingTM (Abdomen slings)
  • Figure 8: The HelpEm Up Harness™ provides assistance to both the front and rear legs for pets with higher levels of disability or weakness. Image courtesy of Kristen Hagler.

    FourFlags Quick LIftTM (Abdomen slings)

  • RuffWearTM Webmaster or Front Range (Thoracic harness)
  • HelpEm UpTM harness (Two lift point harness system)
  • Walkabout harnessTM and Handicapped PetsTM (Forelimb support, hindlimb and abdomen support harnesses)

Mobility carts

While mobility carts serve a smaller population of animals, in a clinical setting they are extremely useful for multiple reasons. They provide alternative options for clients with severely disabled dogs, act as therapeutic aids when performing therapeutic modalities, allow functional independence for impaired animals, and aid in ambulation (Figure 9). They are normally suggested for paretic or paralyzed animals, those with severe arthritis or obesity, and may be used with other devices such as protective shoes and assistive harnesses. Some animals with long-term balance issues may also benefit from a mobility cart.

Figure 9: Mobility carts are use for animals with severe disabilities which make movement with a harness assistive device extremely difficult. Image courtesy of Kristen Hagler.

Cart fitting can be challenging and time-consuming, but this improves with equipment familiarity. Mobility carts can be either completely custom made for the animal, requiring multiple measurements and custom fabrication, or semi-custom made, where equipment parts can be interchanged to generally fit the animal’s needs. It’s also necessary to consider the overall weight of the equipment, its ease of transportation in vehicles or within the household, the overall wheel base if the cart is to be used in the home, and the handler’s ability to place the animal properly in the cart.

For most practitioners, it is not extremely beneficial to keep a wide variety of mobility carts in the clinical setting because properly fitting dogs to the carts is extremely important, and storage takes up critical space. It is, however, recommended that you offer at least two manufacturer examples (e.g. semi-custom and custom) and two size options (e.g. small and large) to help clients visualize using the equipment. While several companies manufacture mobility carts, the following are listed based on the author’s experience:

  • Doggon’ WheelsTM
  • Eddie’s Wheels for PetsTM
  • K9 cartsTM
  • Walkn’ WheelsTM

Fitness vs. function

Therapeutic exercise involves specific movement patterns prescribed for a patient with the goals of injury recovery and/or preventing further injury. They are performed gradually to return a patient to the highest level of function possible. Physical rehabilitation reverses various physical conditions associated with injury or dysfunction. Activity is generally performed in a controlled stepwise manner with regular assessment intervals to ensure that functional progress and therapeutic goals are being met, and the animal is being restored to a desired level of physical function.

Body systems respond to physical stress by undergoing adaptations that ultimately improve their functioning. Rehabilitation is the process of applying stress to healing tissue in accordance with specific stresses that the tissue will face on return to a particular activity.

Although rehabilitation exercise may appear similar to conditioning, it’s not the same. When exercises are performed to enhance an already learned skill or activity, or to improve performance during activity, they are considered fitness training or conditioning exercises. Activity increases occur as soon as the animal demonstrates proficiency, and successes are measured during competition or performance of the sport. Exercises are typically performed at home in between skill training classes. In contrast, therapeutic exercises are done in a clinical setting with a trained professional, and are for patients recovering from injury.

Conclusion

By understanding basic canine anatomy and structural components, as well as the needs of your practice’s population, you can help guide your clients through the assistive technology marketplace, provide for your patients’ needs, and avoid costly overstocking.

References

Dale RB. Physical Rehabilitation of the Injured Athlete, 4th Edition. Edited by James R. Andrews, Gary L. Harrelson, Kevin E. Published 2012 by Elsevier-Saunders, 42.

Goldberg ME, Tomlinson JE. The Disabled Patient 1: Assistive Devices and Technology.  Physical Rehabilitation for Veterinary Technicians and Nurses, 1st Edition. Edited by Mary Ellen Goldberg, Julia E. Tomlinson. Published 2018 by John Wiley & Sons, Inc. 148-150.

Gross, DM. “Introduction to Small Animal Physical Therapy”. In Woodman, RM ed. Canine physical therapy – orthopedic physical therapy. Connecticut: Wizard of Paws, 2002, 8.

McDonald JW, Sadowsky C “Spinal‐cord injury”. Lancet 359, 2002, 417–425.

Nicolson A, Moir L, Millsteed J. “Impact of assistive technology on family caregivers of children with physical disabilities: a systematic review”. Disabil Rehabil Assist Technol, 2012, 7(5):345–349.

Rafferty A. Davidson JR. Home Exercises. Physical Rehabilitation for Veterinary Technicians and Nurses, 1st Edition. Edited by Mary Ellen Goldberg, Julia E. Tomlinson. Published 2018 by John Wiley & Sons, Inc. 83.

Saunders DG, Walker JR, Levine D. “Joint Mobilization In Vet Clinics of North America”. Small An Practice, 2005, 1295.

Zink CM. Introduction to the Agility Dog. The Agility Advantage – Health and Fitness for Canine Athletes. Clean Run Productions, LLC. South Hadley, MA. 2008; 6-11.

Zink MC. “What Is a Canine Athlete?” In Zink CM, Van Dyk JB, eds. Canine Sports Medicine and Rehabilitation. Wiley-Blackwell, 2013.