464 Canine Sports Medicine and Rehabilitation
Cardiopulmonary disease
The stability of the cardiovascular system
should be evaluated in the geriatric rehabilita
tion patient. Cardiopulmonary changes in
elderly patients include declining cardiac out
put, decreased elasticity with concurrent fibro
sis of the pulmonary tissue, and decreased
cough reflexes. Pulmonary secretions often
have increased viscosity, leading to difficulty
expelling air and reduced resistance to respira
tory disease (Goldston, 1995).
Cardiovascular and respiratory conditions
more commonly encountered in geriatric
patients include endocardiosis, cardiomyopa
thy, arrhythmias, pulmonary fibrosis, laryngeal
paralysis, neoplasia, pneumonia, and bronchi
tis. Symptoms of coughing, abdominal swelling
(due to ascites), exercise intolerance, syncope,
dyspnea, or cyanosis are all indications of
potential cardiac disease.
Dogs with laryngeal paralysis may present
with stridor, respiratory distress, or changes in
their bark. Loss of function of the recurrent
laryngeal nerve, which innervates the muscles
that abduct the arytenoid cartilages, results in
upper airway obstruction. Caution should be
used with these patients during therapeutic
exercise sessions and when in the underwater
treadmill to avoid compromising air exchange
secondary to exertion or excitement.
Parenchymal pulmonary conditions that
might be encountered in geriatric rehabilitation
patients include pulmonary fibrosis, pneumo
nia, or neoplasia. Pulmonary fibrosis is an inter
stitial lung disease overrepresented in West
Highland White Terriers (Norris et al., 2005).
Exercise intolerance, coughing, and dyspnea
are the most common clinical signs. Pneumonia
often has an infectious (viral or bacterial) ori
gin, and can be incited by aspiration. Chronic
bronchitis, most commonly seen in older small‐
breed dogs, is characterized by exercise intoler
ance and a slowly progressive cough.
Renal disease
Chronic renal disease is commonly encoun
tered in older patients. Renal blood flow and
the reserve of healthy renal glomeruli
decline with age (Goldston, 1995). Patients with
compromised renal reserves are more sensitive
to insults such as dehydration and should not
be overworked in the physical rehabilitation
environment.Urinary and fecal incontinenceUrinary and fecal incontinence may occur sec
ondary to resistant urinary tract infections,
neuropathies, reduced sphincter control, or
hormonal imbalance. Neurological conditions,
especially of the caudal lumbosacral plexus
(including lumbosacral stenosis) often have
side effects of decreased urinary and anal
sphincter control. Sanitary concerns should be
addressed in these patients when determining
appropriate treatments. Many rehabilitation
facilities will not allow incontinent patients in
the underwater treadmill or pool. These
patients should be evaluated for urine scald or
irritation of the perineal area. Clients can be
taught how to express the urinary bladder or
stimulate bowel movements (e.g., cotton swab
bing the rectum) to maintain a sanitary elimina
tion schedule.
Incontinence can be a primary reason for
clients to have a geriatric dog euthanized
(AHA, 2006) If continence can be improved, a
dog’s quality of life can be changed signifi
cantly. Therapies to improve continence often
address improving neuromuscular function
relating to the caudal lumbosacral plexus,
including veterinary spinal manipulative ther
apy, acupuncture (see Chapter 22), and laser
therapy (see Chapter 7).
Animals unable to completely empty their
bladders are more prone to urinary tract infec
tions. Regular urinalyses and urine cultures
should be performed to evaluate appropriate
antibiotics to treat urinary tract infections while
aiming to prevent the development of antibiotic
resistance. It is prudent to avoid putting
patients with resistant urinary tract infections
in the underwater treadmill or therapy pool.Neurological and neuromuscular
conditionsA study of the mortality of dogs in North
America published in 2011 revealed that diseases