Canine therapists are assessment driven and use critical thinking skills to devise an individual treatment plan for each dog in their professional care.
Using assessment and reassessment tools integrated with clinical reasoning skills aims to develop and adapt the individual treatment plan to deliver safe and effective practice for each dog.
Treatment plans consist of a range of integrated treatment techniques, which aim to relieve pain, optimise healing, improve mobility and strength and to restore physical function.
Physical function in the dog is going to specifically relate to their signalment and include day to day canine activities and natural balanced motion, stance, postures and transfers.
In the athletic and working dog the aim is to minimise injuries, optimise performance and elite tasks and ensure the dog is fit for purpose.
Canine Assessment begins with the Veterinary Referral
- Receive a written consent from the referring veterinary surgeon (RVS) which is dated and signed
- Examine the vet case notes, reports and complete relevant Multidisciplinary (MDT) communications
- Owner client; it is ideal to have written consent to proceed as acceptance of your specific Terms + Conditions (T&C), contact your owner to discuss what to expect; you can use a virtual system to build your subjective assessment via the telephone or use a video call. This will include discussing clinical procedures, what to bring and any instructions relevant to your service. This may include the protocols of your Risk Assessment (RA) and access zones if the owner is attending or passing their dog over to you
- Complete relevant record keeping and documentation / vet reports
Risk Assessment (RA)
Currently face to face and hands on treatment are identified as a high risk due to Covid.
Risk assessment has always been important and is currently an essential and required part of canine therapy sessions.
There are two forms of RA, the first is at your leisure of areas you have identified, graded and actioned to lessen the risk of your centre and clinic, so you are prepared ahead.
The second is known as Dynamic Risk Assessment (DRA) which is on the spot DRA responsive to moment by moment of clinical practice.
You need to utilise and record your general RA plan for your booked sessions as well as employ a dynamic risk assessment (DRA) for each dog you see.
Planning is crucial, establish and record your clinic approach to include;
- Evaluation of clinic access / zones. Include restraints, and Health & Safety (H&S) protocols, Personal Protective Equipment (PPE), hand washing facilities and signage
- In your clinic or working area; consider each dog's behaviour in the clinic with / without owner. Establish if the owner present or not? Grade the complexity of the dog using an arbitrary grading system to identify your routine and more complex cases
- Establish your methods and protocols to communicate with each owner; phone, texts, emails, face to face discussion etc
- Consider your staffing levels to ensure safe practice
- Record your emergency procedures you have in place and the results of your "practice runs" (fire drill, exit out of the hydro pool etc)
- Identify the required use of appropriate PPE for each therapist and record this. This will depend on your specific clinical setting and practice
- Work within your specific scope of practice, use appropriate assessment and treatment tools, be safe, ensure your treatment plan is safe, effective and dog centric
- Meet your Duty of Care and professional responsibilities and requirements
Assessment Components: Subjective + Objective
These two assessment components relate directly to the use of SOAP Notes (Subjective, Objective, Assessment, Plan) used widely in the human healthcare system since the 1970's. This is a format now adopted by a significant percentage of therapists working in the veterinary therapy sector.
In the veterinary world the assessment format in gathering information includes using your interpersonal skills and linking this to critical thinking skills to determine an accurate and reliable assessment to support your clinically reasoned pathway to selecting treatment techniques.
You need to gather information from your referring veterinary surgeon, the MDT and your owner in a professional manner, using open questions. The format below is commonly used;
- Hands on examination: palpation / range of motion / special testing (covered in Assessment Part 2, to be released)
Clinical Tip: An open question is a question that allows your owner to give a free-form answer, whereas a closed question is answered with a Yes or No or has a limited set of possible answers.
Processing the information
Your reliable, accurate and valid findings are prioritised into a problem list (needs list) for your individual canine patient / client. This problem list is used to then determine your SMART goal setting, short, mid and long term.
SMART = Specific - Measurable - Achievable - Relevant - Timely
This then leads to you clinically reasoning your selection of treatment techniques and strategies for the individual dog in your professional care.
It does not stop there, as you then need to analysis and evaluate the efficacy of your treatment plan by using reassessment and outcome measures (this is covered in Assessment Part 2).
There is a huge variation in breed conformation and normal motion, as well as underlying canine conditions and problems. This linked to the different canine behaviours in a clinical setting means each dog presents with its own very specific and individual needs. Your assessment will be able to help you establish a prioritised problem list for the individual dog in your professional care.
Breed differences are significant in this amazing species. This means dogs have a wide range of breed normals in their conformation and morphology. Within this species, what is normal motion for one breed may be abnormal in another.
The challenge for canine therapists is to select the optimal movement therapy technique for each dog based on their signalment, assessment findings and their canine behaviours in the clinical setting.
In response to this we need to expand our canine "Therapeutic Toolbox" of assessment and treatment techniques to ensure you have the best selection of clinical tools to use.
Your choice of techniques need to meet the fundamental concept of being safe and relevant to the dog. Understanding the "why" of your choice of each technique and exploring the underpinning knowledge of functional anatomy, canine biomechanics, canine behaviours and feedback signals in a clinical setting, are all equally important for safe and effective practice.
Your expanding Therapeutic Toolbox of clinical techniques need to respond to each dog's assessment and reassessment and treatment outcomes.
Clinical Tip: It's all about using a clinically reasoned pathway to deliver safe and effective treatment plans, working with the dog. Avoid applying techniques onto the dog like a technician, therapists use a range of critical thinking skills and caring treatment plans, working with the consent of the vet, owner and dog.
In the human world therapists refer to the subjective part of the assessment, whereas in the veterinary world this is commonly described as the history taking.
Why is this so important to best practice?
This is the first component in your referred canine case you need to build and includes;
- Personal details (usually collected on the veterinary referral form)
- Drug History (DH)
- Social History (SH)
- Past Medical History (PMH)
- Present Medical Condition (PMC)
Usually you would have the PMC first and build the history around this information. History taking is crucial to best practice to ensure you are making informed decisions using critical thinking skill and following a clinical reasoned pathway.
What types of information do you need to gather?
Personal details of patient to include:
Canine patient / client name, owner’s name, address, mobile and land line details, email address, veterinarian and practice, date of referral / consent, details of discussion of patient.
Dog's signalment: name, age, gender, breed, coat colour plus additional information of the dog's role and if they are entire or not. Find out about the dog's temperament and personality, muzzle use / their behaviours at the vets?
Drug History (DH)
Current record of medication plus any neutraceuticals.
Social History (SH)
Ask open questions about their dog's behaviours in the clinical setting and generally, how are they with other dogs / children / people in general? How do they cope in new environments? How are they at the vets? Are they noise sensitive? (thunder, fireworks, sudden bangs)
There is a myriad of questions you can ask the owner; do not overwhelm your owner and steer the discussion carefully. Move from area to area in a mindful and calm way.
Clinical Tip: Using pertinent interpersonal skills, appropriate terminology and effective communication skills will empower your owner to feel a part of the process. Building this confidence and trust with your owner will result in collecting information that accurately represents the dog's life, challenges and needs.
Areas to explore may include:
- Home environment, flooring, use of stairs, jumping up or onto furniture, access in / out of home / garden, feeding station and times, travel car (where + in / out), use of garden, free access or monitored
- Exercise regime; when, how often, who with? friends, own pack, other dogs, what restraints? On / off lead, percentage, does the dog pull on lead / harness
- Role / activities; general, athletic, with owners, training
- Kennel mates / pack; interaction, exercise,
- Temperament / behaviours; with family, other dogs, stress points, related to enjoyment and fun activities
- Sensitivities; noise sensitive? touch sensitive
Past Medical History (PMH)
This is a record of each dog's past medical history and if the PMH is lengthy / complicated, it's useful to use a time line / bullet points to clarify the information.
Registered Veterinary Surgeons (RVS) hold copies of the dogs's PMH and often forward these on with their consent form. If you do not receive it then it's useful to request this from your vet, plus helps build a professional rapport between you.
Detailed complex issues and series of dates may be a challenge for the owner to remember at your consultation, so the PMH file from your vet is extremely helpful in gathering accurate information.
Also ask about the dog's past general health and condition: to include any signs of systemic disease, any previous trauma, operations, past hydrotherapy / physiotherapy treatment and result.
Present Medical Condition (PMC)
Current general health and condition: to include any signs of systemic disease, any current treatment from other professionals
Main presenting problem of patient / reason for accessing your services / the expectation of owner?
Progression of complaint; onset, duration, acute / chronic, changes seen with exercises, changes seen after rest, response in different weather conditions / humidity / do they feel their dog is in pain? or in discomfort? any known triggers.
It's a good idea to get your owner to point to the affected area / limb to eliminate confusion.
Owner’s impression of pain / lameness / dysfunction: With lameness ask if other limbs have been involved, whether lameness has increased / decreased in severity, is lameness worse in AM or PM, has there been a traumatic event, how long the dog has been lame, are there lameness changes with weather / exercise, have there been any other previous related diagnosis or treatments.
Clinical Tip: Consider if there is a difference between the owner and their dog's needs?
As you are asking your open questions as part of your history taking, it's really useful to observe the animal in the clinic space simultaneously to provide you with important additional information that may include;
Overall condition and demeanour;
Observe the animal’s appearance, condition, conformation, weight and temperament.
Start as the dog enters your clinic and observe the dog's behaviour and responses. Is the dog alert, inquisitive, unsure, ahead or behind the owner.........
Signpost to Hub 4: Canine Behaviour
If the dog settles down and then arises, see the posture compared to the usual transfer sequence for that breed, noting which limbs are used for weight bearing into stance. Evaluate and discuss transitions with the owner.
Observe the dog as it moves freely around your clinic before and notice if the dog is stiff on rising and then improves with movement.
Observe at rest and in a number of different gaits prior to your palpation, so you do not change the results through your hands on examination.
At rest observe for;
General condition, weakness, limb trembling, asymmetry of regions of limb can be due to muscle atrophy, asymmetry of head and neck, limb position and paw position / contact, nail wear / abrasions, weight bearing, muscle mass and conformation. Consider key bony landmarks and compare right to left.
Clinical Tip: It's very common for dogs with a lameness or gait abnormality to bear less weight on the affected limb. Note the paw position, if it's in full contact with the ground, the depth of the crease of the paw and the spread of the digits. Compare left to right plus forelimb to hindlimb.
Observe the chosen gait patterns around the clinic and movement choices after the dog rises up and has been observed in stance.
Preferably use a large enclosed area with a non slip surface (safety, no distractions for dog and able to observe off leash). Evaluate the dog's general conformation for it's breed. Ensure no distractions as this may alter your assessment evaluation.
Elect the dog's gait pattern / s to assess and evaluate your choice. Use an appropriate gait assessment to match the signalment of the dog.
Observe the dog moving directly away / toward you, as well as from both sides and circling in both directions. Complete on two different types of surface. NB. Only do this if the dog can achieve this! Take great care not to overexert your senior dog or your canine patient that is clearly in pain and lame.
Look for lameness indicators like a head nod, pattern of footfall, stride length, limb carriage, joint motion, tail position / movement, side bending of spinal column and compare left to right.
Clinical Tip: Abnormal proprioception, dragging of nails, knuckling over may indicate a neurological involvement or a proprioceptive loss from chronic injury.
WALK is a slow 4 beat symmetrical gait, so each limb can be evaluated individually.
The dog’s head will nod up when the affected leg is placed on the ground in FL lameness and the head will nod down when the affected leg is placed on the ground if there is HL lameness. This is due to the dog trying to reduce the weight and force on its affected leg.
TROT is a symmetrical 2 beat diagonal gait with 2 suspensions, with approximately double the force and joint angle movement in this gait.
Trot is the most commonly used gait pattern for lameness evaluation.
LOPE / GALLOP is a useful gait to select for suspected elbow disease (ED) if the dog is able to tolerate this gait. However, pain is often a limiting factor. As an assessment tool it is less useful than walk or trot as it is an asymmetrical gait, plus the increased speed of motion makes effective evaluation difficult when observing using the naked eye.
Clinical Tip: Consider using video footage to capture the gait pattern for your records and evaluation; use slow motion and you can repeat play ++ without causing the dog any distress, discomfort or pain.
Most phones now have a recording capacity and many phones have high quality camera and video capacity. There are many great apps now available which offer good "slow mo packages", which is very helpful in observing and analysing gait patterns.
Please check your GDPR responsibilities if you use your phone to store client confidential data, rather than capture it. Establishing and using good practice protocols on downloading this information into a secure password protected database is important. You will require to keep GDPR / video permissions from the dog's owner on file as well.
Clinical Tool to Assess Lameness
Assess lameness using a lameness score system to compare lameness over time. This is an important clinical outcome assessment tool (score 0 to 5 or 0 to 10).
Score using 0 to 5:
0 walks normal / trots normal
1 is slight intermittent lameness
2 an obvious weight bearing lameness
3 is a severe weight bearing lameness
4 is an intermittent non weight bearing lameness
5 is a continuous non weight bearing lameness
Check out this useful link for Canine Gait Analysis. https://todaysveterinarypractice.com/wp-content/uploads/sites/4/2016/05/2016-0304_Rehab-Gait-Analysis.pdf
Why is it important to have separate lameness scores for trot and walk?
- Usually dogs are less lame in walk than trot, as less force is placed on the weight bearing limb
- Provides a more specific gait assessment
- Useful to identify subtle problems that may be evident in certain gait patterns
Hercock, C.A. et al. Validation of a client‐based clinical metrology instrument for the evaluation of canine elbow osteoarthritis. Journal of Small Animal Practice, 2009, 50: 266-271.
Hudson, J.T. et al. Assessing repeatability and validity of a visual analogue scale questionnaire for use in assessing pain and lameness in dogs. American Journal of Veterinary Research, December 2004, Vol. 65, No. 12 , Pages 1634-1643.
Ladha, C. et al. GaitKeeper: A System for Measuring Canine Gait. Sensors 2017, 17, 309.
Manera, M.E. et al. Static Posturography: A New Perspective in the Assessment of Lameness in a Canine Model. 2017. PLoS ONE 12(1): e0170692.
Sharkey, M. The challenges of assessing osteoarthritis and postoperative pain in dogs. AAPS Journal. 2013;15(2):598-607. doi:10.1208/s12248-013-9467-5
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