Front Matter

Chapter 18 Rehabilitation for Geriatric Patients 461

Obesity

Obesity is exacerbated by some of the medical
issues that can be common to the senior/
geriatric dog, such as those that lead to
decreased mobility and activity. The concern

about obesity is not only the mechanical

stresses that the extra weight places on an

obese animal’s musculoskeletal frame, but also

because adipose tissue produces adipokines,

including leptin, a hormone that promotes the

thoracic limb flexion bilaterally, tension noted on

palpation of biceps tendons bilaterally; decreased

muscle tone and mass of quadriceps and hamstring

muscle groups bilaterally; no crepitus of hip or sti-

fle joints; Sensitivity to palpation at T7 and L–S

junction with heat palpable at L–S; hypomobile

thoracic and lumbar spine. Slight positive tibial

thrust tests bilaterally, negative cranial drawer tests

bilaterally.

Gulick girthometry: Initial measurements: Left and

right pelvic limbs (mid‐femur) = 46 cm, proximal to

patella = 37 cm, mid‐tibia (distal to tibial crest) = 18

cm. Left and right thoracic limbs distal humerus = 23

cm. Abdominal girth = 84 cm.

Diagnosis: Lumbosacral disease, spondylosis, osteo-

arthritis/DJD in bilateral stifles and hip joints, obe-

sity‐induced/aggravated musculoskeletal strain and

weakness.

Assessment and rehabilitation plan:

Primary objectives:

(1) Weight loss and weight management: Decrease

treats by half; substitute commercial treats

with dried fruit chips, baby carrots, raw green

beans; decrease calories by 1/3 and replace the

volume of food reduced with 2× that volume

of plain, canned pumpkin.

(2) Pain and inflammation management: Continue

current omega‐3 and glucosamine/chondroi­

tin supplements; consider adding methylsul­

fonylmethane (MSM). Provide protocol for

continuing injectable PSGAGs. NSAIDs as

prescribed by rDVM with follow‐up blood‐

work by rDVM. Recommended laser therapy,

spinal manipulative therapy, PROM, thera­

peutic massage (including instruction for

home therapeutic massage).

(3) Improve mobility and neuromuscular function:

Gait retraining. Once inflammation and pain

are managed, continue periodic veterinary

spinal manipulative therapy, PROM, and

massage; add therapeutic exercises, increase

length of daily leash walks as tolerated, and

begin hydrotherapy via underwater treadmill

to enable gait retraining. Consider carpeting

stairs to improve traction.

(4) Maintain and improve strength and mobility:

improve posture/topline and core muscle

strength and flexibility. If doing well,

increase home exercise and underwater tread­

mill programs.

Re‐evaluate every 4 weeks as indicated.

Therapeutic exercises:

(1) Sit‐to‐stands—initially, patient unable to hold

a sit, but gradually (within 2 months of ther­

apy) became able to do so

(2) Rhythmic stabilization

(3) Standing leg lifts—three‐legged stands initially

(4) Standing with front feet on balance disc:

weight shifting and rhythmic stabilization

(5) Tummy tickles to encourage dorsiflexion of

lordotic spine

(6) Cookie stretches

(7) Cavalettis—starting at 5 cm high

(8) Side‐stepping added after 12 weeks

(9) Backwards walking—progressed to backwards

step‐ups after 16 weeks.

Case summary:

Measurements after 6 months of rehabilitation ther-

apy: Left and right pelvic limbs (mid‐femur) = 53

cm; proximal to patella = 39 cm; mid‐tibia (distal to

tibial crest) = 19 cm; left and right thoracic  limbs

distal humerus = 23 cm; abdominal girth = 75 cm.

NOTE: the limb circumferences remained constant

at the 6‐month values, while the patient’s weight

continued to decrease.

Weight: Initial = 117 lbs (girth = 84 cm)

At 4 months of rehabilitation = 103 lbs (girth = 76 cm)

At 6 months of rehabilitation = 99 lbs (girth = 75 cm)

At 12 months of rehabilitation = 96.6 lbs (girth = 74 cm)

Clients were very compliant, implementing diet

changes and the therapy plan. Patient lost 26 lbs,

regained mobility, was able to resume longer walks,

and had improved quality of life.