Laurie's Blogs.

A question was asked of me about treatment planning and delegation, and my thoughts on the subject.  The following is my reply.

You first have to be conscious / specific about your GOALS... i.e. what do you want to accomplish at that particular time:

• Pain / Inflammation / Swelling?
• Joint ROM / Muscle Flexibility?
• Strengthening?
  •  Gross muscle strengthening (i.e. UWT)
  •  Specific muscle strengthening (targeted exercises or NMES)
  •  Balance, coordination, motor control & timing
  • Increased proprioception?
  • Owner education?
  • Neurophysiologic stimulation (for nerves, for pain)?
  • Tissue healing (stimulation)?
  • Neuro rehab / retraining?
  • Building confidence?
  • Etc...

What can you justifiably delegate to an assistant?

• Modalities, therapeutic exercise, ROM, UWT, Stretches, Massage, Owner education

What has to be done by the therapist (Vet / PT supervisor)?

• Pathofunctional diagnosis, treatment planning, Mobs / Manips,  Acup / dry needling, re-evaluation & treatment progressions

Thoughts on planning:

• For a PROGRESSING CASE (i.e. relatively straight forward - post-op cruciate for example):  you should plan on changing your therapy every 3 - 4 appointments or every 2 weeks.   That being said, if the dog is doing UWT or Therapeutic exercise, then there should be incremental increases to the time/duration/speed/difficulty with EACH session).  However, when I say every 3 - 4 session or every 2 weeks, I mean that you should be adding to or changing their home program, you may add or remove therapies (i.e. NMES, or laser), you may suggest harder / different exercises for IN clinic too.  And essentially, you need to re-evaluate that all is progressing at these time frames.  If not... you need to assess what is going on!

For MAINTENANCE CASES (i.e. OA  joints / old dog stuff)... you would want to re-evaluate every 2 - 3 appointments (especially in the beginning) so that you could change the plan / therapy selection if your treatments are not helping / the animal is not changing.  In this scenario (old dog / OA-type of case) I see that you have two real choices... exercise-based therapy (i.e. UWT) or modality-based therapy (i.e. laser, acup, + manual therapy).  It really boils down to your gut instinct as to which route you should go.  We often do a short lasering before the UWT... but I really do like to do modality/acup/manual therapy for most of my old guys - and let the owners walk them as their exercise.  That’s me.  I see improvements, and I like the rapport I establish with clients.

Thoughts on when to Re-evaluate:

•  
  • Every 2 weeks if delegation of the case was appropriate
  • Every 2nd appointment is the case is rapidly progressing or you need to evaluate your therapy selection or diagnostic presumption (i.e. a neuro case, or a new case - especially where ’rehab’ made the diagnosis, a difficult or challenging case.
  • Cases needing manual therapy (or acupuncture) need to be seen by the therapist (DVM or PT) either every appointment or every second appointment if modalities (etc) are appropriate to be done in between.