Medical History

The medical history should consist of general information and history of presenting problem. Signalment, species, diet, vaccination status, allergies, pre-existing problems, pre-existing surgeries or injuries and activity level of the patient should be noted. The history of the presenting problem should be thoroughly documented. An important part of the history is the patient’s diet. Animals in rehabilitation have an increased need for protein to strengthen and build muscle and heal from injury [4]. The therapist should be able to evaluate the suitability of the patient’s diet with consideration for rehabilitation, weight loss if appropriate, and determine the optimum number of calories required for health and healing.

Physical Examination

A complete physical examination should be performed on all rehabilitation patients. This would include current body weight and Body Condition Score (BCS) as well as vitals and pain score. The ability to assess pain in an individual patient is essential before beginning any form of rehabilitation. Patients with significant pain cannot perform therapeutic exercise as effectively, and rehabilitation becomes unpleasant for the patient, client, and therapist if the exercises make the patient uncomfortable [5]. To avoid this, each patient should be pain scored appropriately. Several validated pain scales exist for scoring both acute and chronic pain (See Chapter 18). The rehabilitation team should select one acute and one chronic pain scale and use these appropriately with each patient. Both pharmacologic and non-pharmacologic therapies may be instituted for pain control throughout rehabilitation [6]. For more information on animal pain consult www.ivapm.org.

TCVM Examination

Many integrative practitioners are trained in Traditional Chinese Veterinary Medicine (TCVM). TCVM emphasizes individualized treatment by using a unique theory and terminology to diagnose and treat a wide range of health problems in animals. Two concepts that are unique and fundamental to TCVM are Qi (usually translated as “vital energy”) and Yin and Yang [7]. Qi flows through the body to maintain proper functioning of body systems towards health and wellbeing. Yin and Yang are the harmony of all the opposite and complementary forces that make up all aspects and phenomena of life, and when they are in balance, the body is in harmonious and healthy state. Disharmony or imbalance of Qi and/or Yin and Yang cause disease and illness. Additionally, the Wu Xing or Five Elements is another unique theory that is central to the practice of TCVM. It describes stages of the constantly moving cycle between Yin and Yang in nature and is used to explain the body’s physiology [7]. The Five Elements include Wood, Fire, Earth, Metal and Water. Each Element is associated with a number of characteristics, such as certain body organs, a color, a taste, an emotion, a constitution, and a season of the year (Table 13.2) [7]. Prior to treatment, a TCVM practitioner will complete a detailed assessment based on the four diagnostic methods to evaluate the patient’s condition, including observing (tongue, mental attitude, appearance and color of feces and urine), hearing/smelling (vocal, odor of body, feces, and urine), asking (history, diet, and environmental interaction), and touching/palpating (pulse, integument, nails, muscle, meridians, and acupoints) [7]. The practitioner will then determine a TCVM pattern diagnosis based on examination findings, followed by formulation of an individualized treatment plan that may include acupuncture, herbal therapy, food therapy, and Tui-na (Chinese Medical Massage).

Posture Examination

Abnormalities in posture may give you clues to both neurological and orthopedic problems.

Table 13.3 lists common postural abnormalities and possible diagnoses.

Gait/Movement /Lameness Examination

All rehabilitation patients should have an assessment of gait and movement and a lameness evaluation to determine which limb or limbs are affected. This gait examination should be performed prior to manipulation. Remember that patients may have orthopedic or neurological lameness [9, 10] Before watching a patient ambulate, assessment of symmetry is critical. Static stance analyzers, pressure walkways or force plates can objectively measure the amount of weight placed on each limb. Slow motion video may also be helpful [9]. Figure 13.1 demonstrates an abnormal posture.

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