Rehabilitation and physiotherapy: what do the terms mean?

Well-planned and executed physiotherapy is essential for the successful rehabilitation of neurological and orthopaedic patients. Long gone are the days when we heeded the words of renowned surgeons who claimed that their patients did not need any rehabilitation because the procedure was without complications and the body would heal itself. For this reason, the importance of physiotherapy in veterinary medicine is growing. Physiotherapy is also needed in the management of old and obese dogs because, thanks to the development of veterinary medicine, dogs are living to a greater age and, like the human population, dogs are overweight to some extent. Last but not least, physiotherapy is in demand due to the development of canine sports medicine. As in other veterinary disciplines, this field has its specialists in the western world. In our country, this field is still in its infancy, although people who understand physiotherapy are slowly but surely increasing, and there is already the possibility, within the Czech Republic, to achieve some education. In order to clarify some of the terms, I am mixing the words rehabilitation and physiotherapy here, and also in order to sort out how to distinguish the real experts from the others, let's read through these pages. In medicine, rehabilitation (from Latin rehabilitatio = restoration) means the restoration, improvement and preservation of the function of individual systems through the application of various physical influences, with the aim of returning an individual to normal life after illness or trauma. This application of physical stimuli to various organs and tissues, which has a healing effect on the body, is called physiotherapy. By physical influences, we mean mechanical action (massage, passive joint movement), the use of water (hydrotherapy), heat (thermotherapy), and others, see below. Rehabilitation by its very title is a much broader term, and therefore also includes all the little things around the patient's recovery. These would-be ancillary but very important parts include pain medication, provision of appropriate nutrition and drinking, control of elimination (bladder control and emptying is very important in paralysed patients), positioning of the immobile patient, prevention of pressure sores, provision of aids to support or suspend the patient (chest harnesses, harnesses for pelvic limbs, straps and nets for suspension), protection of arms from damage, fixation collars, braces and prostheses, wheelchairs for paralysed patients and amputees, but also care of scars and unhealed wounds, and last but not least, motivating the patient and ensuring his/her good mental condition. Physiotherapy, as we know it classically, will help in the recovery of orthopaedic and neurological diseases after injuries, fractures, diseases of joints, tendons, ligaments and muscles, paralysis of the limbs caused by prolapse of the intervertebral disc or other spinal cord diseases, will help improve the management of chronic diseases such as arthrosis. In veterinary medicine, a rehabilitation plan is also part of the treatment for patients with various disabilities of the brain and balance apparatus, similar to those in humans. Physiotherapy can stop or alleviate muscle atrophy, keep joints mobile, help speed return to normal physiological function, affect optimal metabolic output, reduce analgesic doses and in some cases may be the only therapeutic solution. In sports medicine, in turn, physiotherapy helps individuals to get fit, in recovery after exercise and plays a role in the prevention of many injuries. Rehabilitation, without perhaps realising it ourselves, is of course also used in other branches of clinical medicine as a result, and so the physiotherapist must master the function of other organs and have an understanding of their diseases. In rehabilitation it is important to understand how the nervous system works in a nutshell, how the whole musculoskeletal system relates to it. It is also important to know the pathophysiology of individual processes (generally how inflammation, degeneration, tumors, vascular events, what happens after trauma, ...) and diseases, what pain is, and then we can properly understand which treatments will be beneficial for our patient. The neurological examination should reveal the degree of dysfunction of the nervous system and muscles. The emphasis here is on both localizing the problem and making a definitive diagnosis (cause of the problem). It is always necessary to set a goal to be achieved. Is it possible to achieve a complete cure, or do we have to reckon with certain consequences and, if so, are they compatible with a good quality of life for this patient? We also need to know the condition of the entire musculoskeletal system, bones, joints and ligaments. For example, in a patient with paralysis of one pelvic limb and hip dysplasia in the other limb, we must expect arthrosis to develop more rapidly due to overloading of the limb. Important information is also needed on the state of the cardiovascular and respiratory systems so that, for example, we do not expose the cardiac patient to unnecessary overload. If we want to plan a rehabilitation programme, we always try to understand, at least in a nutshell, the daily routine of the owner and the dog, the living space and the activities it performs, what the future should be (return to normal exercise, sport, workload, ...). There is also the question of how to motivate individual patients, something different applies to each one, not every dog is trusting from the start, others even show aggressive elements out of fear. So we have to include dog psychology in our rehabilitation program. Physiotherapy methods using various physical variables, as we mentioned in the introduction, include: massage, passive joint movements, joint mobilisation, stretching, active movement therapy (assisted exercise and walking, balance exercises, self-movement therapy on various surfaces and using obstacles, or conditioning walking, trotting, etc.). Here we use our hands and movement therapy aids (balancing aids, cavalcade and slalom obstacles, natural materials). In my opinion, this is the most important part of the rehabilitation. Separately, there is the so-called physical therapy, which includes methods that use other physical variables: hydrotherapy (using water for walking and swimming in water or on an underwater walking belt), electrotherapy (TENS, ENM - electrical neuromuscular stimulation, galvanic currents), thermotherapy (heat and cold), magnetotherapy (pulsed magnetotherapy), laser, therapeutic ultrasound and shock waves. Each of the treatments has its indication (use) and contraindication (prohibition of use) for specific cases, disabilities or diseases. We will write about this in the next chapters.

MVDr. Aleš Tomek, Dipl. ECVN