Front Matter

Chapter 18 Rehabilitation for Geriatric Patients 459

association with aging, without an underlying
disease condition (sarcopenia) (Freeman, 2012).
Identifying the cause of muscle atrophy plays
an important role in determining appropriate
exercises, especially in choosing concentric or
eccentric exercises (see the therapeutic exercise
discussion later in this chapter).
Muscle atrophy leads to loss of strength in
the tendons, which leads to decreased support
for the joints to counteract weight‐bearing
forces. This, in turn, leads to increased stress
on the bone and cartilage. Studies have shown
a decline in the number of chondrocytes of
aging patients due to cell senescence and
decreased ability to respond to growth factors.
Additionally, the water content of the cartilage
declines with age, all leading to thinning of
the cartilage layer (Martin & Buckwalter, 2003;
Loeser, 2010). Age‐related thinning of carti­
lage and increased stress on the joints due to
loss of muscle strength predispose the geriat­
ric patient to eburnation of subchondral bone
and the onset of osteoarthritis, one of the most
common musculoskeletal conditions seen in
geriatric patients.
While we do not recognize osteoporosis as a
common condition in dogs, their bones can
become more brittle with age due to infiltration
of fat into the bone marrow and thinning of the
cortex (Beaglehole et al., 2001).

Arthritis/degenerative joint disease

Arthritis or degenerative joint disease (DJD) is a
common problem of geriatric rehabilitation
patients, often secondary to a congenital condi­
tion such as elbow or hip dysplasia, an injury,
or excessive wear and tear. Symptoms include
discomfort, lameness, restricted mobility, and
muscle atrophy. Muscle atrophy may be pre­
sent due to disuse secondary to pain from
orthopedic causes such as DJD or an injury.
Pain from arthritis, synovitis, and DJD leads
to a decreased desire to move and be active.
This decreased activity can contribute to weight
gain, and loss of lean body mass. Rehabilitation
therapies can help decrease pain, and encourage
weight loss, appropriate nervous system func­
tion, joint movement, and muscular strength.
Hydrotherapy sessions may be beneficial in
improving strength and mobility. An exercise
program, passive range of motion (PROM), and

massage can be taught as a home program or

can be performed regularly in the practice.

Laser therapy, spinal manipulative therapy

(chiropractic), acupuncture, and other modali­

ties may be useful in pain management.

Hip joint osteoarthritis is common in geriat­

ric patients. The pain caused by the changes in

the joint and periarticular tissues due to osteo­

arthritis leads to decreased range of motion

(ROM), which results in functional shortening

and decreased flexibility of the hip joint stabi­

lizer muscles, such as the pectineus. With

decreased ROM all hip joint muscles are less

active and atrophy. The rehabilitation therapist

has many therapeutic exercise options that can

be used to address these issues.

Specific exercises such as backwards walking

and side‐stepping are very beneficial to help

strengthen the pectineus, biceps femoris, and

gluteal muscles that often atrophy or become

weakened in older patients, especially those

with hip joint and lumbar spine arthritis.

Behavioral and cognitive changes

Behavioral issues may develop in geriatric

patients, including decreased interaction

with the client other people and animals,

house‐soiling, altered sleep cycles, restlessness,

disorientation, anxiety, altered appetite, vocali­

zation, and aggression. Each of these issues

might have other causes, or they might be signs

of cognitive dysfunction syndrome (CDS)

(Hoskins, 2003).

CDS is a progressive neurodegenerative

disorder associated with cognitive and behavio­

ral changes. Therapy for CDS has included anti­

oxidant therapy, fatty acid supplementation,

mitochondrial cofactor supplementation, phos­

phatidylserine, Ginkgo biloba (a monoamine oxi­

dase (MAO)‐A and MAO‐B inhibitor) that

increases dopamine levels and protects neurons

against apoptosis, and drug therapy with sele­

giline (an MAO‐B inhibitor) (Landsberg, 2006).

Araujo and colleagues (2008) showed improve­

ment in short‐term memory in aged Beagles

using phosphatidylserine, Ginkgo biloba, vitamin

E, and pyridoxine.

Cognitive decline is seen along with several

neurodegenerative changes in the brain in geri­

atric dogs. Documented changes in the brain