350 Canine Sports Medicine and Rehabilitation
and stretch. The thickness of connective tissue can
increase or decrease along a single nerve (Topp &
Boyd, 2012). For example, where a nerve passes
over bone the connective tissues may be thicker,
providing a measure of protection.
Treatment of peripheral nerve injuries takes
into consideration the cause of the injury—
compression, stretching, or vascular compromise.
Compression injuries can cause numbness,
pain, and muscle weakness (Sunderland, 1978).
Stretching injuries can cause severe functional
deficits as axons rupture before connective tis-
sues can resist the stretch force (Lundborg &
Rydevik, 1973). Such functional deficits can be
seen in diagnoses such as brachial plexus avul-
sions. Vascular injuries are often due to insult to
the highly vascular connective tissues resulting
in interstitial pressure changes causing axon
damage (Spencer et al., 1975). The treatment of
peripheral nerves addresses the cause of the
injury and is chosen to best promote the body’s
natural healing process for the highest level of
functional return. Acute treatment emphasizes
edema control, pain management, and atro-
phy prevention. Subacute treatment uses
modalities to promote nerve healing while
beginning pain‐free functional strengthening
to prevent atrophy and promote nerve heal-
ing. Chronic‐phase treatment emphasizes con-
tinued modalities for nerve healing as well as
therapeutic exercises to return to the highest
level of function. Care is taken to ensure pain
management is provided throughout the
course of treatment as healing nerves often
temporarily increase nerve pain and sensory
anomalies (Table 13.3).
Treatment efficacy and modifications
Throughout the treatment plan, reassessment
of treatment efficacy is completed and treat-
ment interventions modified as needed.
Because each tissue follows a physiological
process and timeframe for healing, these
parameters are used as guidelines to determine
treatment effectiveness. Healing that appears
to be too rapid may be a transition from the
subacute to chronic phase of healing, and not
true physiological healing. Healing that takes
longer than the natural timeframe may indi-
cate incorrect rehabilitation diagnosis, inaccu-
rate application of modalities, misuse of
manual techniques, or incorrect therapeutic
exercise prescription. Complete tissue healing
should occur within a normal physiological
time frame and is followed by a home health
maintenance program to maintain strength,
balance, and endurance gained in the rehabili-
tation process.
Treatment efficacy is a response to thorough
evaluation, development of the problem list,
and implementation of the treatment plan. The
rehabilitation process requires continual reas-
sessment to determine whether progress is
being made within a normal physiological
timeframe. Because of the myriad internal and
external factors affecting the healing process,
including but not limited to response to medi-
cation, diet, comorbidities, home environment,
activity restriction, or home exercise compli-
ance, reassessment is required at each follow‐
up visit to clarify whether new limitations
should be added to the problem list and to
determine whether the current plan of care
requires modification. After reassessment and
treatment plan modifications, portions of treat-
ments such as the application of modalities,
therapeutic exercises, and stretching can be
delegated to support staff. Because of the need
for continual reassessment, protocols, as devel-
oped by the team of veterinary specialists
including a physical therapist, should be used
as treatment guidelines and not as treatment
plans. Using a problem‐based, critical thinking
process throughout the rehabilitation plan of
care will ensure the most efficacious outcomes.Webliography
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