BVRSMA ADMIN
05-17 17:07
Next Clinical Club: Wednesday 19th May with Rayana Kamal & Hannah Capon 9pm-10pm
BVRSMA ADMIN
05-17 17:08
Papers to be discussed:
BVRSMA ADMIN
05-17 17:08
Effects of Swimming on Functional Recovery after Incomplete
Spinal Cord Injury in Rats
Rebecca R. Smith, Alice Shum-Siu, Ryan Baltzley, Michelle Bunger, Angela Baldini, Darlene
A. Burke, and David S.K. Magnuson
Kentucky Spinal Cord Injury Research Center, Depa
BVRSMA ADMIN
05-17 17:08
Swimming as a Model of Task-Specific Locomotor http://nnr.sagepub.com
Retraining After Spinal Cord Injury in the Rat
David S. K. Magnuson, PhD, Rebecca R. Smith, PhD, Edward H. Brown, MSc,
Gaby Enzmann, PhD, Claudia Angeli, PhD, Peter M. Quesada, PhD, and Darlene Burke, MA
BVRSMA ADMIN
05-17 17:09
Both emailed to all members on 17/05/2021 – please email info@bvrsma.org.uk if you have not receieved this
BVRSMA ADMIN
05-19 20:28
https://rumbletalk-images-upload.s3.amazonaws.com/048fda48fa001eb04dff948daf1245ac/1621452785-bvrsma%20-%20clinical%20club%20-%2019.05%20(1).pdf
BVRSMA ADMIN
05-19 20:28
https://rumbletalk-images-upload.s3.amazonaws.com/048fda48fa001eb04dff948daf1245ac/1621452797-bvrsma%20-%20clinical%20club%20-%2019.05%20(2).pdf
Ed
05-19 21:00
Hi all
Rayana
05-19 21:00
Hello!
Hannah
05-19 21:00
hey
Caroline
05-19 21:01
Hello 🙂
Siobhanmenzies
05-19 21:01
Hi
Sian
05-19 21:01
Hi all
BVRSMA ADMIN
05-19 21:01
Good evening everyone – thank you for joinging us!
BVRSMA ADMIN
05-19 21:03
Welcome to the Clinical Club – for those of you who may not of attended one before, please feel free to ask/comment at any point of the evening. We will be running until 10pm. I will hand over to Rayana & Hannah now to lead the evening, enjopy! Natalie
Hannah
05-19 21:03
Hey guys – so I must admit I am new to this – so be gentle xx
Sian
05-19 21:03
Thanks Nat 🙂
Rayana
05-19 21:03
Me too! Thank you Nat! And thanks to everyone to joining this eve!
Hannah
05-19 21:03
We chose these papers to start discussion regarding people’s practice with neuro rehab
Tracey
05-19 21:04
thank you
Sian
05-19 21:04
Thank you for kicking off our clinical clubs again Hannah and Rayana
KatieJ
05-19 21:04
Hi peeps! Katie here! Roku too!
Mathilde
05-19 21:05
Hi everyone!
Rayana
05-19 21:05
So a big question to begin! The papers conclude that cutaneous feedback used during under water treadmill re-training positively influences the recovery of neurological cases in water. Will this change your approach to neurological case rehabilitation? If so, how?
Hannah
05-19 21:06
We also noted from the paper- the land based no swim training rats had not land based rehab equivalent to compare to. what would that have shown and what could that have been?
Mathilde
05-19 21:07
I think it is very interesting in that it seems to confirm what we would do intuitively : providing lots of sensory stimuation to the paws
Hannah
05-19 21:07
yes-but does that sensory stimm need to be done during activity?
Rayana
05-19 21:08
Yes, we often use different types of surfaces to walk over poles
Hannah
05-19 21:08
and how easy is is to achieve that as a single practitioner land based- what do people do?
Siobhanmenzies
05-19 21:08
Apologies I haven’t had time to read the papers but I’ve been using an UWT for our spinal rehab for many years and find that getting your hands on the patients really makes a difference
Anna
05-19 21:09
ditto that. proprioceptive road. getting owners to put down different surfaces in the house. This is really only in mild neuro rehab cases that I deal with. Non-surgical cases.
Rayana
05-19 21:09
at what stage do you use UWT and how often?
Siobhanmenzies
05-19 21:09
Even using a scrunchie on the leg or k tape
Hannah
05-19 21:09
yes – I have minimal experience but what I do has been incredible – I will not have access to UWTM and wonder how much harder it is to achieve the same effects
Sian
05-19 21:10
I agree Siobhan, but have to be honest being part of a well established rehab team had not considered the difficulties that would meet a single practitioner with this Hannah-good point to make. These patients, whether big or small do normally require a fair amount of hands on input
Anna
05-19 21:10
Sorry Siobhan – what do you mean by a k tape?
Tracey
05-19 21:10
HI I am new to this should I be hearing you?
Mathilde
05-19 21:10
to Tracey, no, just typing…
Hannah
05-19 21:10
no it is all text based xx
BVRSMA ADMIN
05-19 21:10
Tracey: there is no volume it is text discussion regarding the papers.
Hannah
05-19 21:10
Kinesiology tape xx
KatieJ
05-19 21:11
i think as long as your are encouraging prop awareness whether its land based (prop track) vs. TM vs. UWT as long as stimulation is provided aka water vs. ktape vs. scrunchie you more or less getting a very similar effect in upregulating the neuromuscular activation of desired groups
Anna
05-19 21:11
thanks Hannah
Siobhanmenzies
05-19 21:11
Usually within days of surgery if there is no catheter in.
Sorry in another meeting – gotta go
Hannah
05-19 21:12
does anyone know whether there is a need for the somatosensory stimm to coincide with wanted movement
Mathilde
05-19 21:12
This is what the paper seems to suggest
KatieJ
05-19 21:12
indeed
Grace
05-19 21:13
I feel the UWT is invaluable to retraining the neuro cases. The hands on but also different options to alter how they are functionally progressing with their gait pattern from like you say K tape, or body wraps to encourage core engagement rather than pulling through their backs. So many options and really important to assess each session as find that as the case progresses so many different factors and variables which all accumulate to the final result
Hannah
05-19 21:13
it would have been interesting if the lanbased rats that receoved no swim training experienced the same intensive course of somatosensory stimm with grooming, access to differet terrains etc
Siobhanmenzies
05-19 21:13
I would think dynamic input would be best. Multitasking ..
Rayana
05-19 21:14
For those who have access to both UWT and land treadmill, do you alternate the sessions on a weekly basis? What sort of plan do you follow?
Hannah
05-19 21:16
the paper discusses the difficulties of supporting neuro cases without the buoyancy of water -has anybody got tips they can share on how they navigate that without UWTM?
Mathilde
05-19 21:17
As long as the dog is not too big, I use hind limb harnesses to support them in a normal walking position
Sian
05-19 21:17
You can use slings and hoists-and plenty of hands! Easier with your smaller patients-key is to make sure you still have enough support whilst encouraging weight bearing and dynamic movement
jane
05-19 21:17
@ Hannah I used a sink or plastic box before I had a uwtm
Sian
05-19 21:18
Does anyone have any experience with the use of swimming with these type of neuro case vs UWT?
Grace
05-19 21:18
It all depends on the case and what you are trying to functionally achieve with them. Obviously in the very early days when conscious stepping is minimal and we are using the water as a buoyancy aid, which without a UWT then you are going to have replicate this with bodies support with sling/help em up harness. Main focus at this point is strengthening their ability to hold their own weight but also stimulating their neuro circuits with proprioceptive aids – different mats, pinching etc.
Grace
05-19 21:18
Also find the peanut balls brilliant – particularly if one man band for the support
Kate Rew
05-19 21:19
I agree. The effect of buoyancy upon a dog’s limbs increases the degree of flexion and this increased flexion has a subsequent effect upon spinal movement with changes to spinal movement in terms of pelvic flexion, axial rotation and lateral bending. The effects are diffrent depending on water height and method ie swiming vs UWTM. Hydrotherapy alters spinal movement and care must be exercised in dogs with low back pain and sciatica vs neuro cases
Grace
05-19 21:19
definitely!
Hannah
05-19 21:19
Having no access to UWTM and watching neurodeficit dogs walking with owners – I always wonder how much influence the poor gait, drag, horrendous gaits they do 99% of the time with their owners is infuenced by a good gait training session with a therapist 1% of the time.
Rayana
05-19 21:19
How often do you initially recommend UWTM?
Kate Rew
05-19 21:20
Sorry my spelling is appalling!
Mathilde
05-19 21:21
Hannah, I think this is a bit pessimistic…Many owners are trying very hard to help their dogs, and I think we can get some very good improvement by seeing them reguarly, 2/3 times a week
Sian
05-19 21:21
Hannah-I think successful rehab of these cases can be very dependent on how much compliance you can achieve with at home physio support/exercise therapy from owners
Grace
05-19 21:22
completely agree Hannah, retraining state of mind is just as important, if allowed to drag 99% you are going to get nowhere. Individual motivation of the dog is a key factor on if you get them walking. But equally agree with Mathilde, owners can be phenomenal, getting them involved in the rehab can make a massive difference
Sian
05-19 21:22
but if you can get owners on board early on with appropriate physio/exercise we find most are an asset to their recovery and will work very hard to support the work we are doing in clinic
Rayana
05-19 21:22
On this subject…- What owner directed exercises for neurological cases are people recommending? Any new ones to share?
Hannah
05-19 21:23
I have less experience in the rehab setting, this more from first opinion work where maybe the owners are not so engaged?
KatieJ
05-19 21:23
Kinda side bar back to the paper, something we should also be considering is how the rats were injured. The lesion both how the type of trauma, extent of trauma, location along the spinal cord of trauma will also impact input and recovery. If you have a tetraplegic patient from a hit by car, that is a different consideration than say an FCE. Just want to bring to light in reviewing the case study that cause of injury and degree of injury is important too when making our treatment plan. poor rats.
Grace
05-19 21:23
I have had clients only be able to afford only one treatment every 4 weeks and but with intensive home physiotherapy plans, and a very committed owners, they will get them walking
Tracey
05-19 21:23
AROM will be enhanced with sensory stimm and although in the pool the hydrostatic pressure will provide this it is not focused to provide a natural stimulation the animal would feel during walking etc.
Mathilde
05-19 21:23
It is also important to keep in mind that these dogs fatigue extremely quickly and it is not physically possible to ask them to try to walk all the time. They have to have down time as well. Even if that means that they will drag a bit.
Sian
05-19 21:23
It can often be interesting to see how different patient personality traits can have an effect on their recovery as well (not scientific) even with all the right input e.g your Dachshund that is just happy to be nursed and carried
Sian
05-19 21:24
sorry guys, struggling to keep up reading and typing so my comments are out of sync! 😀
Rayana
05-19 21:24
That is so true Sian! Some pets seem more motivated to ‘get up on their feet’ again, particularly if they have competition at home.
Sian
05-19 21:25
Katie-I agree, it is a consideration that did not receive much focus (though I did skim read late in the day I’m afraid)
Mathilde
05-19 21:26
Going back to the papers, I thought it was very interesting that they found swimming training is task specific. The rats that recovered swimming were not better at walking
Hannah
05-19 21:26
I agree Katie – I didnt know if they would have been left with instability in the spine as well as contusion
Tracey
05-19 21:26
We have a plate for the UWT not sure if anyone else uses this but it is great for focusing on the hind limbs only, as we have probably all seen the pugs/french bulldogs going 90mile an hour with the forelimbs and the hindlimbs scating along
KatieJ
05-19 21:27
exactly…orthopedic and soft tissue with neuro considerations all wrapped up in one event
Hannah
05-19 21:27
yes Tracey I have used a plate – really helpful
Sian
05-19 21:27
We also have a plate
Rayana
05-19 21:28
Please can you explain how the plate works- does it just encourage hind leg motion?
Hannah
05-19 21:28
again with the papers- do people use specific scales to monitor progression?
Hannah
05-19 21:29
the plate is for the forelimbs to stand on
Hannah
05-19 21:29
so that they are not having to walk on the moving band
KatieJ
05-19 21:29
I like the Modified Tarlov Scale for Hindlimb motor function. That’s been my reference for progression. let me find it and ill post. brb
Tracey
05-19 21:30
I would like to see this too
Sian
05-19 21:30
The plate can allow you to focus gait training on the hind limbs, whilst keeping the forelimbs static
Grace
05-19 21:30
Plate is essentially placed underneath the fore limbs essentially meaning only hindlimbs on the belt so focusing training the hindlimb movement only. We have a plate that can also raise the front feet up which means weight is distributed backwards which is really useful in those cranially shifted frenchies that handstand!!
Mathilde
05-19 21:30
To Katie and Hannah, the hemilaminectomy was done on only one space so there should not be any instability associated
Tracey
05-19 21:30
using bands on the hind limbs provide greater stimulation
Hannah
05-19 21:30
ok cool- x
Hannah
05-19 21:30
i havent used bands – would like to learn
KatieJ
05-19 21:31
https://rumbletalk-images-upload.s3.amazonaws.com/048fda48fa001eb04dff948daf1245ac/1621456577-Modified-Tarlov-Scale.png
Grace
05-19 21:31
Tracey yes bands also do very well, find it very much depends on the dog as to which they respond to 🙂
Grace
05-19 21:31
that smiley face emoji is terrifying – apologies!
Tracey
05-19 21:32
Ha ha its ok
Hannah
05-19 21:32
thanks Katie J
Sian
05-19 21:32
😀 that’s probably the look the dachhys would have when they see the bands!
Grace
05-19 21:32
pahaha
Grace
05-19 21:33
poor dachys
Sian
05-19 21:33
We had a client make us some velcro straps to place around the the feet/hock level that often work very well (Grace has also made some of these…..I think??)
Hannah
05-19 21:33
when using scrunchies and other stimm devices have people got an amount of time per day that they should be used?
Grace
05-19 21:34
yep 🙂 love the velcro straps use them routinely for the neuro cases for consistent stimulation, often works well when adjusting water level and strap level within one session to constantly stimulate their proprioceptive awareness
Sian
05-19 21:34
I think we advise using them whilst completing exercises (can include walks depending on stage of recovery) but not to keep them on all of the time
Mathilde
05-19 21:34
I tend to do 5 min several times a day, during exercises and walking
Tracey
05-19 21:35
Re homework exercises a battery operated toothbrush starting from the op site and down the hindlimbs and under the paw and back. I also use Rocktape during rehab work and given for immediate post op cases.
Grace
05-19 21:35
yes completely agree with sian. Like mathilde said earlier, they need down time and constant stimulation then makes them void as they are then used to them and no point
Rayana
05-19 21:36
The electric toothbrush idea is great Tracey!
Sian
05-19 21:36
We love an electric toothbrush!
Grace
05-19 21:37
Harnesses – what are your favourites to recommend to clients?
Tracey
05-19 21:37
cheap as chips from good old home bargains and owners love them its so easy
Hannah
05-19 21:38
i like orthopets
Mathilde
05-19 21:38
help em up or I have had one designed
Grace
05-19 21:38
is that just for front support or connection at the back Tracey?
Sian
05-19 21:38
Where did you go for a designed harness Mathilde?
jane
05-19 21:39
HEU or what the owner has and then add a ginger lead
Grace
05-19 21:39
I love the help em ups but again sometimes price is limiting for clients already struggling with finances
Sian
05-19 21:39
We did like the akela for a more affordable option-but really struggling to get them at the moment
Tracey
05-19 21:40
Sorry Grace I was messaging about the toothbrush, I give the owners a choice of harness that would be suitable and let them decide with their budget in mind
jane
05-19 21:40
Agree re price so loan out so they can see how they get on first
Mathilde
05-19 21:40
One of my clients makes leads and harnesses for assistance dogs etc.
Tracey
05-19 21:42
Can I just say this is so great….really loving it and feel a friendly team vibe from this club
Rayana
05-19 21:43
Absolutely! Great to hear other people’s experiences!
Grace
05-19 21:43
definitely!
Mathilde
05-19 21:43
https://rumbletalk-images-upload.s3.amazonaws.com/048fda48fa001eb04dff948daf1245ac/1621457318-1621457017226.jpeg
Sian
05-19 21:43
It’s great to have more people here!
Tracey
05-19 21:43
For those that dont have an UWT do you start the neuro cases on the ramp and use stimulation mats
Grace
05-19 21:43
they look awesome Mathilde!
Mathilde
05-19 21:44
Yes, she does a good job! all hand made…
Sian
05-19 21:44
great contact to have
Tracey
05-19 21:44
wow amazing does she accept orders?
Grace
05-19 21:45
with the pool vs UWT do people have a preference on either, do you tend to start with one and move to another or g
Grace
05-19 21:46
*or do you have a particular favourite
Mathilde
05-19 21:46
Travey : I’ll have to speak with her. I did the design so it is a shared venture…but you can email me direct if you want.
Mathilde
05-19 21:46
Tracey sorry
Tracey
05-19 21:47
I always start with homework and UWT
Mathilde
05-19 21:47
so does anyone of you do or recommend swimming for these neuro cases? I always say no but I know this is not everybody’s case
Tracey
05-19 21:48
Thanks Mathilde will do…you should go into production we are so very limited in correct support harnesses
Ed
05-19 21:48
Tuckered out this evening so listening in but not much use contributing!
Grace
05-19 21:49
I am an UWT girl through and through because I love the results we get with it so am interested to hear the other side as not got access to a pool
jane
05-19 21:49
Grace depends on the injury, but some with high tone struggle in the uwtm so have then swum but very particular about providing plenty of support
Grace
05-19 21:51
interesting! do you find it easier to break the high tone in the pool? and how do you provide more support?
Sian
05-19 21:52
Does anyone know if there have been any studies looking at the use of UWT specifically vs swimming?
Tracey
05-19 21:53
Most clients ask for hydrotherapy pool especially those who have pets that have swam before but once they see the benefits they get the UWT. Pool great for those with high tone and needing more extension
Sian
05-19 21:54
Do any of you have experience with swimming and ongoing issues with recurring lameness (generally not spinal specific)?
Mathilde
05-19 21:55
what do you mean Sian? swimming causing lameness?
jane
05-19 21:55
it seems to help to reduce tone for some – for small / medium dogs I’ve just increased the level in the uwtm so then swimming, learned some different handholds at k9hs & greyfriars
Tracey
05-19 21:56
Find the pool the preferred choice for ED but not HD – as the dogs pull through the pool and tend to avoid extension with hip issues so tuck them in and float
Grace
05-19 21:56
tracey that interesting but can completely see that! clever dogs!
Hannah
05-19 21:57
tracey – yes there has been studies showing that x
jane
05-19 21:57
Sian – yes I think it all depends on the therapist, I’ve one dog that keeps niggling its shoulder in one pool but is fine elsewhere and having seen the videos of both I’m pretty sure its down to technique
Mathilde
05-19 21:59
I am still puzzled that some papers seem to show that training is task specific (most of them) so we should really make them walk and have at least some work agains gravity, and some other papers that show that any training is better than nothing…
jane
05-19 22:00
Being a control freak I like the uwtm but I really think its down to the therapist and their ability to clinically reason and review
Mathilde
05-19 22:00
Good point Jane. Tailoring to the patient is probably the best wat of getting the best outcome
Tracey
05-19 22:01
Thank you all so much I am off to bed now…I have a diabetic dog that thinks its best to get up at 3am to be fed!
lowri davies
05-19 22:01
Thre are a number of papers by DeLeon that highlight the negative impact of swimming on walking
Hannah
05-19 22:01
I thought the paper wasnt able to represent a real scenario as no case would only have hydro and no land based homework – but I was also surprised at the the result from all that swim training and it offering no benefit with walking
Hannah
05-19 22:02
lowri so would you avoid the pool in total?
BVRSMA ADMIN
05-19 22:03
Great discussions guys and some really interestng points to think about – Rayana & Hannah do you want to conclude the evening?
BVRSMA ADMIN
05-19 22:03
Thank you everyone for joinging us 😀
Rayana
05-19 22:04
Many thanks everyone! Great discussion and ideas
Mathilde
05-19 22:04
This smiley face is even scarier! Thanks everyone.
Hannah
05-19 22:04
Thank you everyone for contributing – I think it really inspires the multitude of ways to help these cases
KatieJ
05-19 22:04
thank you all! very helpful and interesting! Thank you Hannah and Rayana!
Grace
05-19 22:04
Thank you every one 🙂
Ed
05-19 22:05
cheers guys
jane
05-19 22:05
Thanks everyone, sorry that as usual I’m about 12+ posts behind
Sian
05-19 22:05
😀 great discussion-thanks all! Nos da x