Front Matter

148 Canine Sports Medicine and Rehabilitation

Of note, when using TUS to promote flexibility,
some debate exists regarding the best time to
apply a stretch force. In general, stretching
should be performed during the final minutes
of TUS and immediately following (Chan et al.,
1998; Knight et al., 2001), although some studies
suggest that the stretching window may last up
to 15 minutes after the ultrasound treatment
has been completed (Draper et al., 1995; Rose et al.,
1996; Morishita et al., 2014b).
As with any piece of therapeutic equipment,
the quality of the TUS unit is important. As
noted above, a lower BNR is desirable as this
corresponds to a higher quality crystal and a
more uniform ultrasound beam. A higher
BNR may cause the patient more discomfort,
leading to the inability to achieve a therapeu­
tic effect. It is also important to note that there
are studies demonstrating variation between
manufacturers regarding the time needed to
achieve the same level of tissue heating (Gange
et al., 2016) so it is important to become famil­
iar with the performance of each unit (Geetha
et al., 2014). Regular calibration is vital for
guaranteeing the intended treatment is indeed
rendered. Artho and colleagues tested 83 TUS
units being used in clinic settings. Of those,
39% were found to be outside the calibration
standard for at least one output setting (Artho
et al., 2002).

Precautions and contraindications

Caution should be used when applying TUS
over fractures, in areas of decreased circulation,
over areas of decreased pain and/or tempera­
ture sensation, and on sedated or anesthetized
animals.
TUS use should be avoided over cardiac
pacemakers, thrombi, the lower trunk during
pregnancy, the eyes or testes, open epiphyseal
plates, or the spinal cord after laminectomy, as
well as in areas of malignancy, infection, or
bleeding. More recent evidence also cautions
against the use of TUS in demyelinating condi­
tions (Aydin et al., 2016).
Finally, as with any heating modality, care
should be taken to avoid tissue burns. These
may occur when the selected intensity is too
high, the treatment time is too long, or the
transducer is held in place.

Electrical stimulation

The two forms of electrical stimulation (ES)

most often used in canine rehabilitation are

neuromuscular electrical stimulation (NMES)

and transcutaneous electrical nerve stimulation

(TENS).

Neuromuscular electrical

stimulation (NMES)

NMES is primarily used to address muscular

weakness associated with both orthopedic and

neurological diagnoses. It causes a muscle con­

traction by depolarizing the motor nerve with

an electrical current delivered via electrodes

placed on the skin. There are two types of

NMES units: portable, battery‐operated units

and electric line‐powered units. For most canine

rehabilitation applications, portable units pro­

vide sufficient output to achieve the desired

therapeutic effect (Figure  7.12). Regardless of

the type, most NMES units offer the same treat­

ment parameters although the terms used to

describe each may vary.

Parameters of treatment

Amplitude

Amplitude, or intensity, describes the total

magnitude of the electrical wave and is meas­

ured in milliamperes (mA). Increased ampli­

tude results in a stronger contraction as more

Figure 7.12 Patient receiving neuromuscular electrical

stimulation (NMES) via a portable, battery‐operated unit.