Some of the common goals of early limb use exercises are to improve active pain-free range of motion; muscle mass and muscle strength to allow weight bearing, balance, and performance of activities of daily living; lameness; aerobic capacity; and weight loss and to help prevent further injury.1-4 The focus on patients that have serious afflictions with limited to no weight bearing on the affected limbs centers on early limb use and is the topic of this chapter. As patients are able to bear weight and begin to use their limbs, the emphasis shifts to improving proprioception and balance for patients with neurologic conditions or those recovering from joint injury or surgery, as described in Chapter 28. Finally, as patients improve with an approach to maximal expected function, the emphasis should be on strength, speed, and joint motion exercises, which are the focus of Chapter 30. The animal should be encouraged to support its body weight as it is able, and the therapist gives only the necessary assistance to maintain the standing position (Figure 29-2, A). While supporting the animal, the handler slowly releases tension on the assistive device, allowing the animal to continue weight bearing as much as it is able. Alternatively, it may be easier for the therapist to support the patient manually with a hand placed on the ventral pelvis to maintain the rear limbs in a normal position, preventing inappropriate crossing or a base narrow stance. Because the animal is encouraged to accept and support a portion of its weight, strength, balance, coordination, and proprioception are challenged. If the dog begins to collapse, the sling is gently pulled up to assist the patient back into the standing position and the exercise is repeated (Figure 29-2, B). It is important to place the limbs in a square standing position to give neuromuscular feedback and to also allow the animal to stand in a stable fashion. Nonambulatory patients may benefit from placement in a body sling or harness to provide support for standing (Figure 29-4). It may be easier to use a lift device in conjunction with a sling to help support larger patients (Figure 29-5). An advantage of a sling is that the patient is able to maintain a body position with the limbs placed under the body in a standing position with partial or complete support of body weight, which provides an opportunity for limb strengthening and early proprioceptive training. Frequent episodes of supported standing also help to relieve pressure on bony prominences and may reduce the chances of decubital ulcer formation and pulmonary complications. Excessive congestion of the lungs that may result from spending long periods in lateral recumbency may be prevented with early implementation of standing in a sling. The body sling must be adjusted properly so that respiration is not compromised and the limbs are not compressed in the openings of the sling. Proper padding is also important for comfort. The skin should be inspected after each session in the sling to identify areas of potential skin irritation or breakdown. Rubber bungee cords may be used to secure the sling to the supporting frame. This may aid in the facilitation of weight bearing and movement during the sling sessions. The elasticity of the cord permits some gentle up-and-down movement that encourages the animal to safely bear partial weight on its limbs. It also may allow some attempts to move forward, backward, and side to side. A gentle bouncing motion may be manually introduced by the therapist to initiate rhythmic stabilization of muscle groups throughout the trunk and limbs.
Therapeutic Exercises
Early Limb Use Exercises
Standing Exercises
Assisted Standing Exercises
Figure 29-1 Support while standing is beneficial for patients with limited ability to stand and bear body weight. A sling may be used to provide support for maximal assisted standing of a patient.
Figure 29-2 Tetraparesis or other conditions causing weakness in multiple limbs. A, Use of a sling to help provide support for standing. B, As the patient begins to fatigue and attempts to sit, the therapist lifts the dog back into a standing position.
Aquatic Standing
Aids for Assisted Standing
Body Slings
Figure 29-4 A sling that may be used to assist standing. Standing helps the patient develop stamina and endurance with minimal assistance required from a therapist.You may also need
Full access? Get Clinical Tree
Therapeutic Exercises: Early Limb Use Exercises
Only gold members can continue reading. Log In or Register a > to continue