Rehabilitation medicine

The American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR) received approval for specialty status by the American Veterinary Medical Association Council on Education. In a Q&A with DVM Newsmagazine, Janet Van Dyke, DVM, talks about the significance of the specialty designation and the trends with animal rehabilitation.

Serving on the boards of directors of the International Veterinary Academy of Pain Management (IVAPM) and the American Association of Rehabilitation Veterinarians (AARV), Van Dyke is also on the steering committee for the American College of Veterinary Sports Medicine and Rehabilitation. In 2002, she founded the Canine Rehabilitation Institute with intent to train and certify veterinarians, physical therapists, veterinary technicians and physical therapist assistants in canine rehabilitation. Van Dyke lectures nationally and internationally and consults with state veterinary and physical therapy boards on legislative issues related to veterinary rehabilitation.

DVM: How is the growth in sports medicine evolving?

Van Dyke: There are two areas of growth in this area of medicine. Veterinarians and physical therapists want to add a new dimension to their existing practices and will continue to seek out continuing education and certification programs in this area. The new growth is represented by the American College of Sports Medicine and Rehabilitation (ACVSMR), which will provide residencies to people interested in pursuing board certification in this specialty. There will continue to be a great demand for certification programs, as many veterinarians are saying, "I want to do this in practice but don't have time to do a three-year residency."

DVM: What was your response to AVMA's recognition of sports medicine rehabilitation as a new specialty?

Van Dyke: The American Board of Veterinary Specialists sent their approval to the AVMA Executive Committee for final approval this spring. This was a huge step because this is the first new independent college since The American College of Veterinary Behaviorists received approval for their college in 1992. We are very excited at the possibilities that now exist for the specialty of sports medicine and rehabilitation, and congratulate the steering committee whose members worked over seven years to reach this goal.

DVM: What trends do you see in this area of medicine?

Van Dyke: Clients are interested in getting their dogs back to peak performance after injury from various sports.

There is public-driven demand for improved care of the canine patient. One of the big drivers for this is interest in agility — it is hugely popular sport around the world. Many of yesterday's "soccer moms" are today's "agility moms," pursuing this new weekend sport with the same passion they showed in supporting their young soccer stars. It may seem frivolous to the uninitiated, but people attending agility events and agility training classes are spending millions of dollars each year in the U.S. alone. These same people are willing to fly to anywhere in the U.S. to find out how to make their dogs better. Veterinarians are waking up to fact that this owner is willing to drive across town to another veterinarian who offers sports rehab medicine, all the while driving right by my practice. They're realizing the missed opportunity.

Agility is not alone. There are many other sports that involve frequent injuries, such as field trials, flyball and dock diving.

DVM: What are common injuries in canine sports medicine?

Van Dyke: Overall, what we're seeing in a lot of these dogs are front-end injuries: lameness due to injuries to the muscles around the shoulders and soft tissue injuries. Veterinarians now are recognizing and treating soft tissue; in the past, veterinarians were really focused on bone and joint issues — orthopedics — and not focused as much on soft tissue. A physical therapist's strength actually lies in the ability to treat soft tissue injuries. Front-end lameness would have been a reason to retire dogs in the past, because we didn't know what to do with it. Today's client is saying, "No way. We want to get the dogs back up to speed." Today we can find and diagnose injuries around the shoulder and begin to provide treatment protocols, whereas we didn't even know how to find the injuries 10 years ago.

As for treatments, most of what we're involved in are manual therapies. Yet some medical treatments are getting a lot of attention, such as stem cell therapy, which may help speed the rate at which soft tissue injuries can heal.

DVM: How is the treatment approach changing?

Van Dyke: We're incorporating more human physical therapy techniques into the veterinary field, such as Laser, electrical stimulation or ultrasound. These are approaches we've been cognizant of for years, but modalities that we have not put to use in full capacity.

It is important that veterinarians stay on top of sports rehabilitation techniques. They are realizing that if the client says, "You don't know how to diagnose this problem in my dog, so I'm going to go elsewhere," they will begin to lose clients due to inability to solve the mystery for the client. Clients are choosing to take their dogs for surgery to a place where they can get physical therapy as well. Clients definitely are willing to spend the money if it means that their athlete can return to peak performance.

Even in very small practices, such as solo veterinarian practices, you will find more rehabilitation techniques being employed. Some may fear entering this field, believing that they need to retrofit their building to accommodate large hydrotherapy equipment. We are teaching vets and PT's that most of the rehabilitation techniques do not require this large investment. Pain management often can be handled cage side using various physical therapy techniques. Manual therapies and physical modalities can easily be done in the exam room. The most important equipment that the veterinary practice needs, in order to add rehabilitation services for their clients, are well trained staff.

DVM: How did the Canine Rehabilitation Institute get its wings?

Van Dyke: The company was started in 2002 as a collaboration with Dr. Christine Zink (PhD, Dipl. ACVP), a boarded veterinary pathologist at Johns Hopkins University, College of Medicine, who is very involved in canine sports medicine. She and I were attending a veterinary continuing education course together and started discussing the need for veterinarians to understand canine sports rehabilitation medicine and to learn it from a practical perspective. We believed it would be helpful to learn from people in running busy rehabilitation practices so our graduates could build on their own skill sets to include the art, science and business of canine rehabilitation in their practices.

We started putting our heads together and recruiting faculty members for our group. We were pleasantly surprised as we began talking to prospective faculty, and we found they were immediately receptive, asking, "How many days do I get to teach?" or, "How do I get involved?" We were up and rolling by mid-2002, putting together the curriculum, coordinating schedules and testing the exam process. Our first course was offered in mid-2003.

In that first year we held five classes, gradually ramping up over the next two years to offering at least one class every month. At this point, we have 12 faculty members, some of whom teach one subject one day; others teach up to six days in a row.

DVM: Are courses available for veterinarians, veterinary technicians and physical therapists only?

Van Dyke: No, just this year we started a new process of educating veterinary students. We became involved with Colorado State University on a three-pronged approach. We are able to offer our certification courses at the college.

In addition, our goals were to help CSU grow the rehabilitation service in their small-animal teaching hospital and to get more students involved in rehabilitation. We didn't want rehabilitation to remain a curiosity that occurred down the hallway; we wanted it to be more of a mainstream skill set for students. CSU agreed. It was a bit challenging to staff and equip the facility during the economic downturn. CSU was able to get creative, recruiting Dr. Jessica Rychel who could work on their pain-management service while also creating the rehabilitation service, which launched last September. Now that CSU had a rehabilitation practice on-site in the veterinary school, I said to the clinical sciences director, Dr. Paul Lunn, "Now we're ready to educate our students."

When we submitted our proposal for the 20-hour elective, the curriculum committee immediately approved it. We worked diligently to secure funding for the course as the veterinary school could not add any programs due to financial constraints. Pfizer was generous enough to back the student elective as a pilot program. We ran the program this spring, and 26 students attended. We received great reviews from the students, which was wonderful, but we are now receiving kudos from veterinarians in clinics. They noted that the students coming out of these rehab classes were coming out with skill sets enabling them to better assess patients. It was important for us to hear that the clinicians appreciated the value of the program.

We hope to be able to offer this elective every semester at CSU and would like to expand this program to additional veterinary colleges in the U.S. and the UK. We are in discussions with Pfizer to assist us with this endeavor.

DVM: What are your present and future goals with regard to the Canine Rehabilitation Institute?

Van Dyke: We'd like to continue to teach students at CSU and elsewhere. This will involve training the faculty at other veterinary colleges so that they can offer similar electives. We want to get students to have basic exposure in third year, so they can be prepared in their 4th year to work with clients and patients in need of rehabilitation. With the advent of the American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR) our goal is to assist veterinary schools in offering residencies in sports medicine/rehabilitation. We will, of course, continue to offer our certification programs.

DVM: How many professionals have graduated from your program?

Van Dyke: We have a graduate database of 850 people; about three-quarters of which are veterinarians with the balance equally represented by physical therapists and veterinary technicians. We have graduates from 11 countries from nearly every state in the Union. The typical class is 26 to 32 attendees. Our certification program consists of 15 class days with a six-day introduction, second six-day module of intense coursework and a three-day elective in neuro-rehabilitation or sports medicine.

The Institute also offers CE courses, covering rehabilitation topics such as pain management, splinting and bracing, business management and nutrition.

Our coursework grew out of what graduates need to know to incorporate canine sports rehabilitation in practice. The introduction course covers anatomy, biomechanics and surgical pathology with an early introduction to modalities and therapeutic exercise. We help veterinarians to begin to approach their canine patients in the same way that a human physical therapist approaches a human patient. We also introduce the business side of canine rehabilitation.

The second module for veterinarians and physical therapists is designed to teach how to evaluate the patient and to create the treatment plan. We have a separate second module for veterinary technicians as they cannot do diagnostics and need to spend more time learning how to do the hands-on, time-consuming work of canine rehabilitation We focus in the technicians' second module on what they need to do to make the rehab practice as efficient as possible by focusing on client communication, therapeutic exercise and physical modalities. This allows the veterinarian and physical therapist to focus on patient evaluation and program design.