Conceptual Overview of Physical Therapy, Veterinary Medicine, and Canine Physical Rehabilitation

David Levine, Caroline P. Adamson and Anna Bergh

The purpose of this chapter is to provide a conceptual framework outlining the general practice of canine physical rehabilitation and physical therapy. Background information regarding the professions of physical therapy and veterinary medicine is included to assist professionals from each discipline to understand the history, educational requirements, and current practice of each profession. Methods to effectively bridge the gap between the physical therapy and veterinary professions are addressed, with models for collaborative practice outlined.

Physical Therapy as a Profession

History of the Physical Therapy Profession in the United States

Physical therapy began in the United States in the early 1900s and focused on treatment of acute anterior poliomyelitis, which reached its peak during the first 2 decades of the twentieth century. At this time physical therapy was not a true occupation; however, the foundations for the profession were developed. Some of these early applications of physical therapy included exercise, massage, and certain physical agent modalities.¹ The need for physical rehabilitation during and immediately following World War I served to further enhance the emerging field of physical therapy. From its origins, physical therapy has focused on restoring maximal function to individuals with disabilities.

Formal training in physical therapy began around 1918 and was developed by cooperative efforts between the office of the Surgeon General and personnel in civilian institutions. Individuals who completed these training courses were given the title of reconstruction aides, the earliest title of physical therapists.¹ Many of these individuals worked in the military during this time. The first national organization was the American Women’s Physical Therapeutic Association, which was founded in 1921. In 1922 this name was changed to the American Physiotherapy Association, and in 1947 to the American Physical Therapy Association (APTA).¹ Throughout the 1940s physical therapy continued to evolve and focused on treating patients who had contracted polio or those injured in World War II. This was a period of major growth in physical therapy, and because of the shortage of physical therapists, many more had to be trained during this time. From the 1940s to the present, physical therapy has gradually become a more autonomous and scientifically based profession. Physical therapy is an accepted medical intervention, and approximately 750,000 people are treated by physical therapists in the United States each day.²

The American Physical Therapy Association

The APTA is a national professional organization representing more than 71,000 physical therapists, physical therapist assistants, and students in the United States.³ Membership in the APTA is not mandatory for physical therapists practicing in the United States, and currently more than 172,000 physical therapists are licensed in the United States.

Major responsibilities of the APTA are monitoring and improving physical therapy education, practice, and research and educating the general public about the role of physical therapy in health care. The APTA political action committee (PAC) is one of the largest health care PACs in the nation. It was formed to empower the physical therapist profession to be more involved in the determination of federal laws and policies.

Physical therapists practice in many settings, including hospitals, school systems, private practices, extended care facilities and nursing homes, home health agencies, academic institutions, research centers, and government agencies. The APTA has 19 specialty sections, which represent various areas in physical therapy. These include acute care aquatic physical therapy, cardiovascular and pulmonary, clinical electrophysiology and wound management, education, federal physical therapy, geriatrics, hand rehabilitation, health policy and administration, home health, neurology, oncology, orthopedics, pediatrics, private practice, research, sports physical therapy, and women’s health. A physical therapist may become board certified by the American Board of Physical Therapy Specialties (Diplomate, ABPTS) in one of seven areas (cardiopulmonary, clinical electrophysiology, geriatrics, neurology, orthopedics, pediatrics, and sports physical therapy).

The orthopedic section of the APTA houses the animal physical therapist special interest group, which was formed in 1998 and has quickly grown to more than 400 members. The goals of this group are to:

• Promote physical therapy

• Share information

• Collaborate with other health professionals

• Develop educational programs

• Foster research

• Create guidelines for practice

• Encourage appropriate legislative changes

• Establish a national network

• Protect professional practice

Physical Therapist and Physical Therapist Assistant Education

The current entry-level physical therapy degree is a master’s or doctoral degree. In the past, the entry-level degree was a bachelor’s degree. The APTA supports changing the entry-level degree to the doctoral level by the year 2020. There are approximately 200 APTA-accredited physical therapy educational programs in the United States, which graduate roughly 5700 physical therapists each year. Every physical therapist must pass a national licensing examination. Additional requirements for practice vary from state to state.

Physical therapist assistants complete a 2-year associate’s degree from an APTA-accredited program. This training prepares them to provide therapeutic interventions that have been delegated by their supervising physical therapist, but assistants cannot evaluate or prescribe treatment. Requirements for licensure vary from state to state, as do the continuing education requirements.

Educational backgrounds of both physical therapists and physical therapist assistants do not include any formal training in the rehabilitation of animals. Animal anatomy may be studied during undergraduate education, but most likely this will be anatomy of the cat. Application of physical therapy to animals is not included in standard curricula; however, a few physical therapy programs now offer elective coursework in this area.

Veterinary Medicine as a Profession

History of the Veterinary Profession

The first college of veterinary medicine was established at Lyon, France. The first college of veterinary medicine in the United States was established at Iowa State University in the 1800s. The initial emphasis in veterinary medicine was on agricultural production and livestock. Gradually the emphasis on the treatment of individual animals shifted to herd management. The emergence of companion animals as members of the family, combined with the shift in agricultural demand, has resulted in the development of small-animal and equine practice as the predominant emphasis in veterinary medicine. Furthermore, the explosion of knowledge in small-animal medicine and surgery, combined with the era of specialization, has resulted in improved health care for pets. One area that has been neglected until recently is the rehabilitation of animals with chronic ailments and following surgery. The goals of this new area are to increase function, improve the ultimate outcome of patients following major surgery, and enhance the quality of life.

The American Veterinary Medical Association

The national professional organization that represents the approximately 84,000 veterinarians in the United States is the American Veterinary Medical Association (AVMA).⁴ The AVMA is responsible for evaluating and credentialing veterinary medical education, administering the national board examination for veterinarians, and overseeing the various specialty colleges (currently there are 21). The American College of Veterinary Sports Medicine and Rehabilitation, American College of Veterinary Surgeons; American College of Veterinary Internal Medicine, neurology subspecialty; American College of Veterinary Emergency and Critical Care; American Board of Veterinary Practitioners; American College of Veterinary Behaviorists; and American College of Veterinary Nutrition are specialty colleges or boards whose members are likely to treat patients that may benefit from rehabilitation. Examples of other related organizations include the American Academy of Veterinary Acupuncture and the American Veterinary Chiropractic Association.

Veterinarians undergo broad training that includes studying diseases of large, small, and exotic animals. Veterinarians undergo training in making medical diagnoses, with the aim to identify the pathophysiologic nature of the condition and its subsequent treatment. Currently, the American College of Veterinary Sports Medicine and Rehabilitation has received approval by the American Board of Veterinary of Specialties, which oversees specialties of the AVMA. Training in this area is relatively limited, although a number of colleges now offer courses or lectures in physical rehabilitation.

Veterinary and Veterinary Technician Education

Veterinarians usually have an average of 4 years of undergraduate education, followed by 4 years of professional curriculum at an AVMA-approved college. Currently there are 33 approved colleges of veterinary medicine in the United States and Canada graduating approximately 2100 veterinarians yearly.⁴ In addition, there are now 13 non-Canadian foreign colleges of veterinary medicine that are approved by the AVMA. Veterinarians are required to pass national and, in some cases, state board examinations to practice. Some graduate veterinarians pursue additional training in the form of general internships and residencies in specialties. Specialty certification requires an internship or equivalent training, completion of a formal 2- to 3-year residency program, publication and research requirements, and successful completion of a certifying examination. There are currently 21 specialties recognized by the AVMA.

Veterinary technicians complete at least 2 years at an AVMA-accredited program and receive at least an associate’s degree. There are currently nine distance learning programs in veterinary technology accredited or in the process of accreditation by the AVMA Committee on Veterinary Technician Education and Activities. In approximately 40 states and provinces, veterinary technicians are certified, registered, or licensed.⁵ Candidates are tested for competency through an examination that may include oral, written, and practical portions. A state board of veterinary examiners or the appropriate state agency regulates this process. A national examination is available; however, requirements vary by individual states. Veterinary technician specialty organizations recognized by the North American Veterinary Technician Association include the Academy of Veterinary Emergency Critical Care Technicians, Academy of Veterinary Technician Anesthetists, Academy of Veterinary Surgical Technicians, Academy of Veterinary Dental Technicians, Academy of Internal Medicine for Veterinary Technicians, Academy of Equine Veterinary Nursing Technicians, Academy of Veterinary Nutrition Technicians, and the Academy of Veterinary Behavior Technicians.⁶

Veterinary and veterinary technician programs do not typically include any course work in physical rehabilitation. Although most veterinarians and veterinary technicians have a basic understanding of the rehabilitation process, they generally do not receive any formal training in this area. Application of physical rehabilitation to animals is not included in the standard curricula; however, a few veterinary programs now offer lectures or even elective courses in this area.

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