Pawsitive Outcomes

 Many physical therapists say they like their jobs because they can work with their hands. But a growing number of PTs really love getting their hands furry every day.

"The dogs absolutely dig this, and they're so excited when that fourth leg starts to actually work and they can chase squirrels again," said Janet Van Dyke, DVM, DACVSMR, and founder of the Canine Rehabilitation Institute, in Wellington, Fla. "They want to come in versus the client that complains."

So do many PTs, who say the field allows them to combine their love of animals and knowledge of physical therapy. "My patients are very responsive to physical therapy. I get more kisses and hugs, not from just my patients, but owners as well," said Amie Lamoreaux Hesbach, MSPT, CCRP, CCRT, at Massachusetts Veterinary Referral Hospital in Woburn.

Hesbach said she wanted to be a veterinarian as a child, but changed her mind when a well-meaning aunt told her she would have to put doggies and kitties to sleep. She went to physical therapy school and didn't get involved in animal rehabilitation until years later, after talking with her pet's veterinarian. He introduced her to two surgeons who were interested in adding a PT to expand the services offered at their animal clinic. "I was very lucky that they were willing to teach me quite a bit, and [we] worked together in co-treating some animals," she said.

Similarly, Krista Niebaum, MPT, CCRT, director of rehabilitation therapy at Scout's House, Menlo Park, Calif., volunteered at an animal hospital in her teens, but didn't think she could handle the emotional downside veterinarians face. She got into canine rehabilitation thanks to a continuing education course and a colleague spotting an online advertisement for what became Scout's House.

Growing, learning community
PTs first started working with animals in the 1960s, mostly with horses, Van Dyke said. The canine side started picking up in the U.S. during the 1990s. Interest is increasing, according to Hesbach, president of the 360-member Animal Rehabilitation special interest group in the American Physical Therapy Association's Orthopaedic Section.

CRI is one of two programs in the U.S. through which PTs can earn certification. As of August, CRI has certified about 185 PTs, which is about 20% of the total graduating group, Van Dyke said. Veterinarians make up about 65% and the rest are vet techs and PTAs, she said. The CRI program has certified PTs from 30 states and eight countries as canine rehabilitation therapists.

Another option for PTs is based at the University of Tennessee in Knoxville and run by Northeast Seminars Inc. So far, including 2010 graduates, the UT program has certified 367 canine rehabilitation practitioners — 72 PTs and PTAs, and 295 veterinarians and vet techs.

Both programs are open to licensed PTs, PTAs, veterinarians and veterinary technicians. Students who have completed one academic year are eligible for the UT program, and receive certification upon finishing their degree programs.

Debbie Gross Saunders, DPT, OCS, MSPT, CCRP, is an instructor in the UT Canine Rehab program, and also runs Wizard of Paws Physical Rehabilitation for Animals in Colchester, Conn. According to Saunders, getting a certification is just the first step. "Then it's really a continuous learning process," she said.

Knowing dog breeds and how they move is very important. "People come in various shapes and sizes, but they're all kind of the same structure," Hesbach said, "where dogs, you have a dachshund, or a bulldog and then you have a Great Dane and Great Pyrenees, and things are completely different with hand holds and how to work with them and what motivates them."

Because dogs can't talk, the PT has to be more creative and a mystery solver, Niebaum said. "Some dogs are so incredibly stoic ... you have to be a little more attuned to the subtle signals that they give," she said. "If you get close to the area of pain, their respiration rate changes, some of them look at you, some look away, some actually do start wagging their tails more."

Niebaum suggests PTs who are interested see if there is a clinic nearby where they can shadow someone who works in canine rehab. She said PTs can check with area veterinary schools to see whether they have rehab departments, such as the ones at University of California-Davis or Michigan State University in East Lansing. CRI and the UT-Northeast programs have lists of certified practitioners on their websites (www.caninerehab institute.com/Find_A_Therapist.html and www.canineequinerehab.com/practitioners.asp).

Four-legged patients
Many of the tools PTs use when working with dogs are the same as those used when working with humans — their hands, theraballs, discs, rolls, balance boards and more. They also use special canine treadmills with a longer belt and underwater treadmills to help with rehab and conditioning. "We get in with the dog, so we're also doing things to facilitate more normal movement patterns, proper muscle timing of contractions," Niebaum said. "So we might be in there tickling a foot to encourage more normal step rhythm or tapping certain muscle groups so they fire that muscle at the proper time or maybe more strongly than they have been."

Saunders uses a lot of laser therapy, especially for post-operative patients, neuromuscular electrical stimulation, ice, heat and other modalities.

Niebaum sees a large number of geriatric canine patients, so similar to humans, she does a lot of work on core stability and leg strength, improving balance and coordination. She often instructs clients on ways to modify their homes for safety.

Hesbach works in a referral center with specialty vets so she gets a mix of referrals from the veterinarians including trauma patients, animals with orthopedic issues or animals undergoing chemotherapy.

Working, police, bomb and agility dogs make up a big part of the work of Carrie Adrian, PT, PhD, CCRP, director of physical therapy services for VCA Animal Hospitals. She also works with geriatric wellness, pain management, orthopedics, neurologic pathologies and post-operative rehab at VCA Alameda East Veterinary Hospital in Denver.

Basic nose work
States are starting to put language into practice acts about collaboration of vets and PTs. Nevada was first in 2004, and then Colorado in 2007, Van Dyke said. Colorado requires PTs to have an additional 120 hours of training specific to animal rehab and then another 120 hours of onsite experience with a PT who already is registered, she said. "Right now we see what happened in Colorado as something of a model for other states to follow," Van Dyke said. The state also requires "veterinary medical clearance" from the animal's vet before a PT can work with the animal.

In New York state, only a vet or vet tech can treat an animal legally, Saunders said. "I've had students of mine go back to school to become a technician or they move out of state."

Hesbach has been working in canine rehab full-time for almost eight years. "I found that the demand was high enough that I was asking my clients to be compliant with follow-ups, and I found that I wasn't available."

Saunders said many PTs are concerned about whether this is a financially viable field. "A human has ACL surgery, it's a no-brainer that they are going in for PT. Probably only still 40% of the vets are referring to rehab," she said. Many PTs subcontract with a veterinarian because it can work out better financially, Saunders said.

The Wizard of Paws clinic sees about 15 to 30 dogs a day. Saunders said she has been in the field for nearly 17 years and has built a good working relationship with referring veterinarians.

According to Van Dyke, canine rehab is very demand driven. A big driver, she said, is the agility mom. "Instead of having two kids in soccer she's got two border collies in agility, and is willing to spend hours every day, weekends at competitions. They want a vet and a PT who know how to keep their dogs fit and at peak performance." Van Dyke sees lots of future job potential, as more people and veterinarians become aware of the demand.

Adrian thinks the field will move toward preventive care. "What I envision is still the collaboration between a board-certified veterinarian as well as a physical therapist who's looking more at a preventative strategy to prevent some of these pathologies especially in our working dogs, in our athletes," she said.


(Source:  todayinpt.com)