Getting Started in Physical Rehabilitation
Adapted with permission from the 2015 Tampa AAHA Yearly Conference Proceedings (c) American Animal Hospital Association (aaha.org).
As veterinary technicians, we vow to further our knowledge and competence through a commitment of lifelong learning.1 Physical rehabilitation is an exciting and challenging field in which veterinary technicians can develop new skills and grow in their career development. Over the past decade, awareness of animal physical rehabilitation has increased, and rehabilitation has become a rapidly growing service within veterinary specialty hospitals, referral centers, and primary care practices. Every day, we hear more about laser therapy and underwater treadmills, equipment not traditionally covered in the veterinary technician college curriculum.
Learning more about rehabilitation enables veterinary technicians to better assist supervising veterinarians when physical rehabilitation therapies are recommended. This article aims to answer some basic questions about rehabilitation and how to become certified to work in this field as a veterinary technician.
Overview of Working in Physical Rehabilitation
The greatest asset for effective physical rehabilitation is an educated veterinary team.2 A rehabilitation veterinary technician should work under the direct supervision of a credentialed rehabilitation veterinarian who directs therapy. The larger team may be made up of a credentialed physical therapist, the referring veterinarian, a veterinary specialist (e.g., surgeon, neurologist), a veterinary chiropractor, an acupuncturist, hospital support staff, the owner, and other trained veterinary professionals.3
The duties of a rehabilitation veterinary technician include assisting the supervising therapist in evaluating patients and performing prescribed therapies, keeping patient records up-to-date and accurate, and educating clients on how to perform home exercises. The American Association of Rehabilitation Veterinarians strongly discourages anyone working as a rehabilitation veterinary technician unless the person has graduated from a certified rehabilitation school. Credentialed rehabilitation veterinary technicians can apply prescribed therapeutic exercises and physical modalities, some of which are described below.
Therapeutic exercises are a daily part of the rehabilitation veterinary technician’s routine. The therapist chooses the exercises, and the technician carries them out. Exercises may focus on improving proprioception, balance, speed, endurance, focal strength, pelvic limb function, forelimb function, neurologic function, or land treadmill endurance training.4 Therapeutic exercise equipment includes physioballs, cavaletti rails, balance blocks and discs, weights, tunnels, rocker boards, wobble boards, and treadmills (FIGURES 1 and 2).5
Patient considerations such as motivation, footing, assistive devices, and leash/harness control must be assessed before beginning any exercise program, and therapist/handler body mechanics must be monitored to prevent injury.5 Exercises are designed to address specific impairments, and each is described with a goal, a technique, and a progression.5 Details of therapeutic exercises can be found in recent textbooks (BOX 1); however, to fully understand and perform these therapies, certification in rehabilitation is necessary.
Specialized manual techniques are used extensively in evaluating and treating rehabilitation patients.4 Credentialed technicians are trained in these techniques, which include massage, range of motion (ROM) exercises, and stretching. Massage may involve tapping, stroking, kneading, wringing, or skin rolling motions, either parallel to the muscle fibers or at an angle, and can be performed at a range of pressures (FIGURE 3).4 ROM exercises may be normal, in which a joint moves through its full ROM, or passive. Passive ROM exercises use an external force to move a joint without muscle contraction through its available ROM.6 Stretching techniques are often performed in conjunction with ROM exercises to improve flexibility of the joints and extensibility of periarticular tissues, muscles, and tendons.6
Rehabilitation physical modalities are used as adjuncts to the patient’s treatment plan (FIGURE 4). Physical modalities are used as tools to alleviate pain; improve strength, flexibility, and joint ROM; and aid in tissue healing.7 A brief list of these modalities is presented in BOX 2.
Proper documentation of treatments should be completed each day. Any member of the rehabilitation team should be able to refer to the record and understand the needs and past treatments of each patient.
Because pain plays a role in any patient’s willingness and motivation, each patient’s pain score should be assessed and documented in the medical record during each visit.11
A detailed history should indicate the degree of pain, the disability,12 and how the patient copes with the disability. If changes in a patient’s pain level are noted, the supervising veterinarian should be notified. It is very important for the rehabilitation veterinary technician to remain in open communication with his or her supervisor about anything abnormal or any changes in a patient’s progress. (Pain scales from Colorado State University are available on the Clinic Resources page.)
Clear client communication and education are also essential to successful rehabilitation. The owner/handler must be well educated on the exercise program, especially the home exercise program.5 However, each client’s needs and expectations can vary depending on the time available for home exercises. The client needs guidance for home exercises, and the completion (or not) of home exercises should be documented in the record. Often, printed instructions, as well as verbal and physical directions, need to be provided for the client to completely understand what each exercise entails. This is also documented in the record.
Additional areas of education include topics such as aquatic therapy, canine orthotics and prosthetics, orthopedic and neurologic rehabilitation, canine sports medicine, pain management, nutrition, and working with geriatric patients.
How to Become a Certified Rehabilitation Veterinary Technician
A certified rehabilitation veterinary technician is a certified, licensed, or registered veterinary technician who has completed a prescribed curriculum to receive the designation of CCRA (Certified Canine Rehabilitation Assistant), CCRP (Certified Canine Rehabilitation Practitioner), Certified Equine Rehabilitation Assistant (CERA), or CVMRT (Certified Veterinary Massage and Rehabilitation Therapist).
Currently, 4 certification programs in the United States offer these respective titles (BOX 3). Each program involves formal educational courses and wet labs, and each school has its own curriculum. The cost is relatively expensive for a veterinary technician, but certification allows veterinary technicians to command a higher salary.
Only certified, licensed, or registered veterinary technicians are accepted into the existing rehabilitation certification programs. In the approximately 40 states and provinces in which veterinary technicians are certified, registered, or licensed, candidates are tested for competency through an examination that may include oral, written, and practical portions. This process is regulated by a state board of veterinary examiners or the appropriate state agency. Every state is unique and maintains its own regulations with respect to the practice of veterinary medicine. Practice acts, legislated by states and provinces, often define the responsibilities of veterinary technicians. These responsibilities and duties depend in part on the type of employment the individual chooses. Standards for practice acts can be found on websites of the North American Veterinary Technician Association (navta.net) and the American Association of Veterinary State Boards (aavsb.org).
Veterinary assistants who are interested in becoming certified, licensed, or registered veterinary technicians should investigate the State Practice Act of their home state to see what practicing as a veterinary technician encompasses.
A rehabilitation veterinary technician’s job is complex and fulfilling. There are advancements in veterinary medicine daily, and animal physical rehabilitation is on the cutting edge.
Many conferences offer specific tracks of learning in physical rehabilitation, such as the North American Veterinary Community Conference, WVC, and the American Animal Hospital Association Conference. If you enjoy exercise, training, massage, and recovery, then you may want to consider this field.
- North American Veterinary Technician Association. Veterinary Technician Code of Ethics. 1987. https://c.ymcdn.com/sites/www.navta.net/resource/collection/946E408F-F98E-4890-9894-D68ABF7FAAD6/navta_vt_code_of_ethics_07.pdf. Accessed January 2016.
- Sprague S. Introduction to canine rehabilitation. In: Zink MC, Van Dyke JB, eds. Canine Sports Medicine and Rehabilitation. Ames, IA: John Wiley & Sons; 2013:83.
- Levine D, Adamson CP. Conceptual overview of physical therapy, veterinary medicine, and canine physical rehabilitation. In: Millis DL, Levine D, Taylor RA, eds. Canine Rehabilitation and Physical Therapy. St. Louis, MO: Saunders/Elsevier; 2004:18.
- Coates J. Manual therapy. In: Zink MC, Van Dyke JB, eds. Canine Sports Medicine and Rehabilitation. Ames, IA: John Wiley & Sons; 2013:100.
- McCauley L, Van Dyke JB. Therapeutic exercise. In: Zink MC, Van Dyke JB, eds. Canine Sports Medicine and Rehabilitation. Ames, IA: John Wiley & Sons; 2013:132-156.
- Millis DL, Levine D. Range of motion and stretching exercises. In: Millis DL, Levine D, eds. Canine Rehabilitation and Physical Therapy. 2nd ed. Philadelphia, PA: Elsevier; 2014:431-446.
- Niebaum K. Rehabilitation physical modalities. In: Zink MC, Van Dyke JB, eds. Canine Sports Medicine and Rehabilitation. Ames, IA: John Wiley & Sons; 2013:115-128.
- Hanks J, Levine D, Bockstahler B. Physical agent modalities in physical therapy and rehabilitation of small animals. Vet Clin North Am Small Anim Pract 2015;45:29-44.
- Levine D, Watson T. Therapeutic ultrasound. In: Millis DL, Levine D, eds. Canine Rehabilitation and Physical Therapy. 2nd ed. Philadelphia, PA: Elsevier; 2014:328-339.
- Millis DL, Saunders DG. Laser therapy. In: Millis DL, Levine D, eds. Canine Rehabilitation and Physical Therapy. 2nd ed. Philadelphia, PA: Elsevier; 2014:359-378.
- American Association of Rehabilitation Veterinarians. Model Standards for Veterinary Physical Rehabilitation Practice. 2011. rehabvets.org/model_standards.lasso. Accessed January 2016.
- Davies L. Chapter 11. In: Egger CM, Love L, Doherty T, eds. Canine Rehabilitation in Pain Management in Veterinary Practice. Ames, IA: John Wiley and Sons; 2014:134.