Proceedings of the 10th International Symposium on Veterinary Rehabilitation and Physical Therapy; and the Summit of the American Association of Rehabilitation Veterinarians; and the American College of Veterinary Sports Medicine and Rehabilitation

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Normal muscle tone or slightly hypotonic flexors muscles, with active postural standing 4 more extensive rehab (Table 1). After improving her muscle stamina ( Table 2) we started ground walking. Initially, the feet had to be placed forward by hand. She voluntarily protracted her foot 26 weeks later, with tactile hamstring cuing. The rehab treatment improved her Olby score from 1 to a 3 [1]. The dog moved her hind legs during sleep and swimming. Table 2 shows her accomplishments. However, 6 additional months of extensive rehab did not improve her scoring beyond Olby 3. This was considered too poor of a performance outcome, thus adipose derived stem cell treatment was suggested. Under general anesthesia fat was harvested at the falciformic ligament and the inguinal region. It was processed with the in-house-kit of Medivet. One ml was added to Nano whiskers and injected in the epidural space. The remainder (2 mL) was given intravenously. Results: Three weeks post-injection, the dog showed neurological improvements (Table 3). After one treatment the dog could walk for 45 min, though she continued to cross the hind legs or walk 'ataxic-like' . During daily walks wheelchair usage was continued to prevent falls, though she walked on all four feet. At home she did not voluntarily utilize all four feet and continued dragging herself forward. After 10 months a second stem cell treatment was suggested. This time the stem cells were given intrathecally and through IV. Following this treatment, she began to walk around the house instead of dragging herself. Outdoors she made less gait deviations. Conclusion: This study has a solid historical control. It is clear that the final results involving improved gait and hind limb muscle recruitment of the dog were achieved following the addition of stem cells treatment to the rehabilitation intervention. Further research is needed to determine if an intrathecal stem cell injection yields varied results from an epidural injection and to determine the best interval between treatments.
Background: Kinematic gait evaluation is increasingly used to assess the effects of exercises on joint motion and the efficacy of treatments for musculoskeletal conditions [1,2]. Recently, several low-cost consumer applications (apps) have become available. The apps measure motion in 2-D, but aim to improve decision making using an economical, available, and easy to use kinematic gait analysis tool. However, the accuracy of these apps has not been evaluated in dogs. The purpose of this study was to compare a consumer movement analysis app to a 3-D kinematic gait analysis system (KGAS). We hypothesized that the two gait analysis systems not be significantly different in the sagittal plane in trotting dogs. Materials and methods: Reflective spheres were attached to anatomic landmarks on ten dogs. Dogs were trotted in a test area while four infrared cameras and an infrared digital camcorder captured kinematic data. Five trials of each side of the dogs were obtained. Images from the infrared cameras were recorded in a KGAS program (Peak Motus, Centennial, CO, USA). Images from the infrared digital camcorder were uploaded to the app (Simi Move, Germany). Maximum flexion, extension, and total range of motion (ROM) were calculated for each trial of the shoulder, elbow, hip, and stifle using the KGAS and the app. Mean joint angles were calculated from the five trials. Total joint ROM was calculated for each trial by subtracting the flexion from the extension angle. Values obtained for the mobile app were compared to the KGAS by paired t test with P values < 0.05 considered significant. Results: Mean joint angles obtained on the app were not significantly different (P > 0.702) from those generated by the KGAS (Figs. 1, 2). 97.5% of the angles measured on the mobile app deviated < 5% from KGAS values, with most of those deviating more than 5% measured during flexion. Although mean ROM calculated by the app exhibited greater deviation than expected, ROM values calculated on the app were not significantly different than actual values (p > 0.283).

Conclusion:
The app performed well and may be an inexpensive method to obtain joint angles, with 97.5% of the measurements from the mobile app accurately identifying maximum joint angles within 5% of the KGAS values. Limitations of this study included artifact from images on the infrared digital camcorder and skin marker movement artifacts during ambulation. Additional studies are required to determine the best protocols and use of this technology in clinical settings.   Background: Canine urethral sphincter mechanism incompetency (USMI) is the most common cause of urinary incontinence in dogs [1,2]. Sex, age when neutered, bladder position, tail docking, breed, body weight, obesity, and urethral length are all risk factors, and the only recognized non-surgical treatment is ongoing medication [1][2][3].
To the authors' knowledge, this paper is the first to posit that palpable lower back pain (LBP) is a potential cause or risk factor for USMI. If LBP is a cause of USMI, it follows that resolution of LBP should result in a reduction or resolution of USMI symptoms. We hypothesize that some dogs presenting with a history of urinary incontinence and concurrent symptoms of LBP, and whom receive treatment for LBP, will demonstrate a corresponding reduction in USMI symptoms.  [1][2][3]. Thermal imaging is a non-invasive method to measure superficial skin temperature and has been used in both human and veterinary medicine for a variety of indications, including to assess duration of cooling after cryotherapy. However, duration of cooling has not been assessed by thermography in the inflammatory setting of a post-operative canine stifle. The purpose of this study was to evaluate the use of thermal imaging to determine changes in surface temperature following TPLO, cryotherapy, and during the rewarming period. We hypothesized that thermal imaging would be useful to assess changes in limb surface temperature, and that the pattern of cooling and rewarming would be similar to invasive methods of measurement.

Materials and methods:
Eighteen client-owned dogs undergoing TPLO surgery were enrolled after obtaining consent. The day after surgery, dogs were placed in a draft-free room with constant temperature and bandages were removed from limbs. Thermographic images were made of the lateral, cranial, and medial aspects of both stifles using a Med2000 thermal imaging camera. Thermal images were taken of the limb after bandage removal until temperature equilibrated 60 min after bandage removal. Cryotherapy was then applied for 20 min using bags of crushed ice. Background: Elastic resistance bands (ERB) have been used in human and veterinary rehabilitation to increase muscle strength. ERB are used in human physical therapy to improve muscle strength and achieve earlier return to function after surgery [1,2], in elderly adults [3], osteoarthritis [4], and stroke injury [5]. Limited data have been published using ERB for veterinary conditions, but they are commonly used for neurologic and orthopedic disease. Studies in veterinary rehabilitation regarding forces generated using different lengths of bands, different stiffnesses, and by stretching to different lengths are lacking. Previous studies have published data for both 100 and 200% elongation values; however, these values may not be applicable in dogs, especially considering the stride length of dogs [6]. The aims of this study were to determine the forces produced with different stiffnesses of colored ERB at 1.25, 1.5 and 1.75 times the original length, and to determine the effects of using two different lengths of ERB (10 cm and 40 cm). We hypothesized that the ERB would behave in linear fashion and that shorter ERB, stiffer ERB, and greater elongation values would generate higher forces.

Materials and methods:
Five replicates of cut sections (10 cm and 40 cm) of different colored ERB (Theraband, Akron, OH) (tan, yellow, red, green, blue, and black, with colors arranged from least stiff most stiff ) were placed in an Instron Biomechanical 5969 testing device. Bands were distracted at 3 m/min for 30 cycles at 1.25, 1.5 and 1.75 times the original length and maximal forces per cycle were recorded. Data were analyzed using ANOVA to evaluate different ERB. Mean forces were compared using Tukey's test, and Pearson's correlations were calculated in XLSTAT. Significance was set at P < 0.05.

Results:
The mean forces produced at each elongation length are indicated in Table 1. There was a strong linear correlation of elongation length for each color of ERB (P < 0.05, Table 2). There were significantly lower values measured using the 40 cm versus the 10 cm band length for all colors (Table 3). Conclusion: Stiffer bands (darker colors), and increased elongation values generated greater forces. Shorter length ERB produced greater forces compared to a longer length of similar color. Further studies and calculations are underway to further characterize ERB based on these preliminary data. In addition, formulas may be generated to provide practitioners with information relative to the forces being applied during therapeutic exercises using ERB. Background: Laser therapy is increasingly used in veterinary medicine. Laser therapy, or photobiomodulation, has positive effects on wound healing, joint conditions, and analgesia for chronic and acute pain in people [1][2][3][4], but the effects rely on photon delivery to the appropriate tissues. Chromophores are substances that exist in tissues and reduce laser penetration. The type and thickness of tissues may also alter the penetration of photons through tissues. To our knowledge, no studies have evaluated these variables noninvasively in live dogs. The purpose of this study was to objectively evaluate class IV laser penetration through various tissues in dogs. We hypothesized that an increasing melanin and erythema index, and unclipped hair, would decrease photon penetration. Further, we hypothesized that laser penetration would vary among different tissue types. Materials and methods: Twenty healthy dogs weighing between 15 and 30 kg were included in the study. Laser penetration was evaluated at six sites, including the pinna, triceps muscle, inguinal skin, caudal vertebra and caudal vertebra intervertebral space, distal common calcaneal tendon, and proximal caudal thigh. Tissue thickness, colorimeter measurement including melanin and erythema index, and laser penetration were evaluated prior to and after clipping hair at each designated site. Penetration was measured using a wavelength photodetector placed in a jig positioned 180 degrees from a class IV laser (CTC-12, LiteCure, Newark, DE) aperture at 0.5, 1, 3, and 5 W power settings. Mean laser penetration values were compared using generalized linear mixed models in SAS. Statistical significance was set at P ≤ 0.05  ) and greater melanin index (each unit increased absorbance 0.033%, P < 0.0001) in all tissues. Erythema index did not influence laser penetration (P = 0.273). Tissue type also affected mean laser penetration (Table 1). Conclusion: Unclipped hair decreased laser penetration by approximately 4%. Tissue type and thickness also affected laser penetration, with no penetration through triceps muscle and caudal vertebra. Based on the findings reported here, patients should be clipped prior to therapeutic laser application to improve transmission to tissues, and differences in tissue structure should be taken into account prior to laser application. Future studies are necessary to measure photon penetration to target tissues and to determine the dose of laser for ideal photobiomodulation of cells in live dogs.

A9 Variables affecting class IV laser absorbance
Background: Therapeutic exercises are an essential part of the rehabilitation of musculoskeletal and neurologic conditions, as well as strengthening and conditioning of dogs. Elastic resistance bands (ERB) are used to provide resistance during therapeutic exercise, thereby increasing muscle strength [1]. In humans, muscle activity using surface electromyography (EMG) is used in healthy populations to determine the role and interactions of different muscles during specific tasks as well as in clinical studies to assess muscle dysfunction or maladaptions due to neurologic or musculoskeletal injury or pain. Several studies have evaluated canine muscle activity using needle EMG or surface EMG during walking and trotting on a treadmill at different angles of inclination or declination [2][3][4]. The objective of this study was to evaluate surface EMG muscle activity of the vastus lateralis (VL), biceps femoris (BF), and gluteus medius (GM) muscles during walking and trotting on a treadmill with progressively increasing elastic band resistance in clinically normal dogs. We hypothesized that surface EMG muscle activity would increase with increasing resistance. Materials and methods: Surface EMG (Noraxon, Scottsdale, AZ) was performed during treadmill walking and trotting with 4 different stiffnesses of ERB (Theraband, Akron, OH-Yellow, Red, Green, Blue) secured above the hock. Dogs were acclimated to the treadmill prior to the study. The treadmill velocity was set to a comfortable walk (1.4-2.0 MPH) and trot (3.0-4.1 MPH). The ERB were held at 120-150% elongation based on tensiometer measurements [5]. Raw EMG data was rectified, smoothed and filtered prior to statistical analysis. The means of maximal and mean muscle potentials during 3 gait cycles were compared among the different ERB. Data were analyzed using a mixed model analysis. Significance was set at the P < 0.05 level.

Results:
At the walk and trot, the maximum amplitude of the GM was significantly lower than BF and VL for all ERB (P < 0.05). During the walk, the maximum amplitude increased with progressively increasing resistance of the different ERBs (P < 0.05). At the trot, the GM again had a significantly lower amplitude at all resistances, and the maximum amplitude of the VL and BF increased with increasing resistance of the different ERBs (P < 0.05). Conclusion: Increased muscle activity in the BF and VL can be achieved by use of ERB and muscle activity progressively increases with increasing band resistance at the walk and trot. Specific knowledge of muscle activation patterns during therapeutic exercises should allow practitioners to target specific muscles for strengthening. Radial pressure wave therapy has been used in humans to treat chronic soft tissue injuries, especially tendinopathies. Postulated mechanisms of action include transmission of positive pressure energy through tissue, cavitation, alteration of ion channels, stimulation of nitric oxide pathways, stimulation of angiogenesis, reduction in inflammation, and tissue and nerve regeneration. It is useful in small animal veterinary medicine because it is very well tolerated in unsedated animals, and it provides a viable method to treat pain when non-steroidal anti-inflammatories cannot be used. The purpose of this study is to demonstrate the efficacy of radial pressure wave therapy in treating various chronic pain conditions in dogs. Over a period of 6 months, ten dogs were selected for case studies. They all had pain conditions that were obvious to the owner and had persisted for more than 1 month. The location of pain varied but included shoulder and stifle pain, generalized hindquarter pain, and spine and forelimb pain. All dogs received three treatments approximately 2 weeks apart and efforts were made to ensure there were no changes in medication or exercise during the treatments. The treatment intensity and duration was tailored to the size of the dog and the site treated. The treatments were evaluated by owner reports of changes in demonstrated pain and lameness, and also by veterinary evaluation. No dog required sedation and all dogs except two showed a clear improvement in pain. Background: A previous study found that heart rate (HR) and respiratory rate (RR) increased prior to fatigue with ground treadmill exercise [1]. Little information exists regarding aquatic exercise and the cardiovascular system in pet dogs compared to people [2,3]. Because cardiovascular parameters in pet dogs may differ from those of elite athletes, we collected data from pet dogs. Our main objective was to measure cardiovascular, respiratory, and thermal parameters of dogs undergoing a graded fitness test in an underwater treadmill with three different water levels, and during swimming. We hypothesized that HR and RR would increase during exercise for each condition, and these parameters would peak prior to fatigue. Methods and methods: Fifteen adult dogs, weighing 20-40 kg and of various fitness levels were evaluated. Dogs were acclimated to an underwater treadmill (UWTM) and a swimming pool (SP) prior to data collection. Resting HR; systolic (SBP), diastolic (DBP) and mean blood pressure (MBP); rectal temperature; and RR were obtained. Dogs underwent a graded exercise test in the UWTM at 3 water levels performed in random order, (1) carpus (C), (2) midantebrachium (MA), (3) elbow (E), until mild fatigue. Dogs walked 2 km/h for 5 min, followed by a 1 min rest period to obtain data. Dogs were walked for additional 5 min intervals at increasing velocity (0.5 km/h for each period) until mild fatigue, with 1 min rest periods between sessions. Because velocity could not be controlled during swimming, data were collected every minute, with a 1 min rest period to collect data. Data were analyzed using ANOVA to evaluate changes over time and among groups. Results: Dogs exercised for a mean of 56.3, 58.3, 53.3, and 6.2 min for C, MA, E, and SP, respectively. In general, SP HR was greatest, and C HR was lowest ( Fig. 1). HR increased steadily throughout exercise with minimal indication of fatigue. Similarly, RR gradually increased throughout exercise in all groups, with the greatest RR within 15 min of fatigue in UWTM groups and within 3 min in the SP group (Fig. 2). There were no significant changes in SBP, DBP, MBP, or temperature to indicate fatigue (P > 0.05). Conclusion: Mild increases in HR and moderate increases in RR may be useful to design conditioning protocols to induce mild training stress. Possible recommendations from this graduated exercise test suggest an increase in 10 heartbeats per min, or a RR of 100 may precede exercise fatigue. Background: Dynamic warm-up can improve performance and prevent injuries in human athletes [1]. To our knowledge, no studies have investigated the effects of warm-up in dogs, despite significant injury rates in sports such as agility [2,3,4,5]. We wished to assess the effects of a dynamic warm-up on performance in agility dogs.

Materials and methods:
We recruited 22 agility dogs of varying age and breed. Owners performed their dog's normal pre-agility preparation prior to completing an agility course. Electronic timing equipment provided times to 0.01 s. All runs were videotaped. Owners were randomly divided into a control group (CG) and a warm-up group (WG). The WG received instruction on the dynamic warm-up. The protocol was based on those used in several human studies. It included cardiovascular activity, dynamic stretches, passive stretches, proprioceptive activities and agility activities. Four weeks later, the CG handlers did their normal pre-agility routine. The WG did the dynamic warm-up protocol. The dogs ran the same course as on Day 1. The blinded principal investigator analyzed each video and determined the number of times off task (TOT) for each dog. This included any time a dog paused, went off course, or restarted the weave poles.  [6]. Under light sedation (0.3 mg dexmedetomidine, IM), the patient received 3 treatments of 750 shocks with an energy level of 0.25 mJ/mm 2 using the Storz Duolith ® Vet divided between the medial and lateral areas of the elbows every 2 weeks for 3 treatments. At the end of the series of treatments the lameness score improved to 1/5, quality of life to 450/500 and the pain scale decreased to 2/10. Conclusion: Based on this case study, extracorporeal shockwave therapy should be offered as another treatment option over euthanasia for clients that have a desire to palliate a painful lameness.    appeared to be the limiting factor in the reliability of using the HR to measure exercise intensity. Therefore to record training load data an alternative method would need to be tested, such as continuous monitoring and data capture during the agility trial using technology to log HR.

A16
Effects of chiropractic on static and dynamic muscle parameters in 6 sport horses Background: Chiropractic has become widely used in equine practice, however little objective data exists supporting the efficacy of this modality in horses [1,2]. Non-invasive methods of assessment of muscle function have been validated in horses [3,4]. Bioimpedance analysis (BI) uses measurements of current through cell membranes and tissue interfaces to infer information regarding the degree of contraction and health of the selected muscle [3]. Acoustic myography (AMG) analyzes the low frequency sounds created during muscular activity and uses them to determine the way in which the central nervous system recruits and uses the active fibers in a muscle (efficiency, E), the number of active muscle fibers (spatial summation; S) and the frequency with which they contract (temporal summation, T) [5]. The objective of this study was to assess the effect of chiropractic treatment on static bioimpedance (BI) and dynamic acoustic myography (AMG) of paired muscle groups in healthy sport horses. We hypothesized that chiropractic would affect BI and AMG variables. Materials and methods: Recordings were taken before and at 24, 48 and 72 h after chiropractic treatment of six healthy, client-owned horses by a veterinarian certified in veterinary chiropractic. BI of trapezius, latissimus dorsi, longissimus dorsi and gluteus medius muscles were recorded at rest; AMG data were collected from paired gluteus medius, longissimus dorsi and latissimus dorsi muscles at walk and trot in a straight line. Data were screened for significance (P = 0.05) using RMANOVA and Dunnett's test. Gait abnormalities were assessed subjectively and objectively (Lameness Locator ™ ) and sensitivity at superficial acupuncture points was recorded at all time points. Results: All horses tolerated the procedures well. Sensitivity at acupuncture points was present initially in 5/6 horses and was abolished immediately after chiropractic in all five. Signs of mild lameness were detected objectively in all horses prior to chiropractic and throughout the course of the study. BI: Bioimpedance scores for the left trapezius muscle were significantly altered at 24 and 72 h. AMG: The balance score of the gluteus medius muscle at walk was significantly affected by time, as was its efficiency at the trot.
Conclusion: This small pilot study reveals that objective measurements of muscle function improve following chiropractic, lasting for at least 72 h post-treatment. This warrants further investigations in a larger number of subjects and in additional muscle groups.  [2]. Facial features are currently used to assess pain on horses post-surgeries and induced pain, but not specifically with local inflammation [4,5]. The objective of this study is to investigate if facial expressions are able to detect pain originated from local inflammation in horses submitted to implantation of biopolymers. Materials and methods: Six horses were submitted to surgical implantation of a biopolymer blend PLA/PCL, which was performed in the neck board subcutaneous space. The horses were sedated with detomidine (0.01 mg/kg), and an anesthetic button was made with lidocaine (2%). Horses' faces were recorded with a video camera 1 h before, 24 and 48 h after the procedure, for 5 min. Two 30-s video clips of the right profile of the head/face of the horse were extracted from the videos [4]. The videos were given three scores levels (0, 1 and 2) with the high score representing the maximum pain expression for each facial feature evaluated (ears position, orbital tightening, inner brow raiser, eye tightness, nostril dilated, tension of the muzzle and tonus of the masticatories muscles; Fig. 1). Cutaneous hyperalgesia was evaluated by von Frey monofilaments (VFM), which were applied in four different points around the implantation site. The mechanical threshold is determined by the diameter of the filament at which a behavioural response is obtained. This value was converted to kg/force [6]. If there was no aversive response with the smaller diameter (0.432 mm), the larger filament was applied until the animals demonstrated an aversive response or the larger diameter filament was used (1.143 mm). We performed three Principal Components Analyses (PCA), one for each sampling time (1 h before, 24 and 48 h after procedure) using all face scores. For each PCA we extracted the scores of each animal in representative dimensions (eigenvalues ≥ 1). The score that the PCA algorithm provides is a vector that concentrates the values of all variables included in the PCA referring to the same dimension. Then, the extracted face scores (EFS) and VFM data from each sampling time were compared using the Friedman test (P < 0.05). Relation between EFS and VFM was estimated with Pearson correlation. Results: Nociceptive threshold 1 h before the procedure was lower than 24 and 48 h after the procedure (P = 0.002; Fig. 2). There were no differences between the sampling time for EFS (P = 0.562; Fig. 3  Background: PBM is an expanding field and recent human studies focus on its effects to reduce DOMS [1]. To the author's knowledge, no such study has been carried out in animals, specifically the equine species. This investigation aimed to compare two doses from both a class IIIb and class IV laser to determine if PBM had any effect on equine DOMS.

Materials and methods:
A randomised crossover Latin square design was used with five horses. Pressure algometry tested nociception of 5 points on both sides of the horse located across the biceps brachii, longissimus dorsi and gluteus medius muscles. A baseline reading was taken prior to an underwater treadmill session as a controlled exercise protocol (CEP), 20 min with water to the level of the lateral styloid process. Treatment groups received laser intervention before CEP whilst the control group received sham laser. A further 4 days of data collection followed the exercise day with recordings taken at the same time. A 2-week washout period was implemented between conditions. Laser parameters are detailed in Table 1.
A two-way repeated measures ANOVA was used to test significance of treatments, with studentized residuals to check for outliers. Results: Points 1, 2 and 3 (gluteus medius) showed a significant 2-way interaction between time and treatment, F(16,464) 2.506, (P < 0.005). At 24 h post exercise, all doses improved compared to control, however, only CL4_L (P < 0.005) and CL4_H (P < 0.05) doses showed a positive significant difference. Furthermore, at 48 h post exercise only the CL4_H remained positively significant (P < 0.05) compared to the control.

Conclusion:
Overall PBM has shown possible inhibition of equine DOMS in the gluteal region, with both class IV doses showing significance. There is speculation from this study that different doses and devices may be required in different muscle areas in order to provide optimum results. This follows patterns in human studies [1]. There were limitations to this study as horse activity varied, as did coat color (all, however, had dark skin) with some being clipped. With no previous research of the effects of PBM on equine DOMS, dosages were calculated and speculated from human research, possibly affecting their efficacy. PBM can be a promising treatment to inhibit equine DOMS, but more studies on its action and determining dosage parameters are required. Background: There is significant scientific support for the importance of the rider's interactions with the back musculature of the horse [1][2][3][4]. However, objective effects of the rider on the muscle tissue have not been reported to date. Acoustic myography (AMG) is a non-invasive measurement of the low frequency sounds created during muscular activity which has been validated in horses and can generate information regarding the way in which the central nervous system recruits and uses the active fibers in a muscle (efficiency, E), the number of active muscle fibers (spatial summation; S) and the frequency with which they contract (temporal summation, T) [5,6]. These measurements can then be added to give a total 'ESTi' score for each muscle. The objective of this prospective controlled experimental study was to assess the effects of the rider on the longissimus dorsi muscle fibers in the saddle support area in healthy sport horses at the walk. We hypothesized that the rider would increase acoustic myographic variables of the longissimus muscle under the saddle. Materials and methods: Six healthy, client-owned sports horses were instrumented with a commercial acoustic myographic system (CURO ® MyoDynamik ApS, Denmark). Sensors were placed on the longissimus dorsi in the saddle support area at the level of the 15th thoracic vertebra. The horse's own saddle and a standard saddle pad were routinely secured with a girth and AMG recordings were taken before and during ridden exercise at the walk in a straight line with an approximately 65 kg experienced rider. Data was screened for significance (P = 0.05) using a paired t-test. Results: All horses tolerated the procedures well. The rider induced significant and immediate increases in E, T and ESTI scores of the longissimus muscle under the saddle bilaterally (Table 1).

Conclusion:
This study reveals that the rider induces significant changes in objective measurements of muscle function of the longissimus muscle of the horse under the saddle. Particularly the muscle becomes more efficient, with a higher frequency of muscle fiber activation in response to the rider's weight. This has significant implications on the training and rehabilitation of horses under saddle and warrants further investigations in a larger number of subjects and in additional muscle groups. Acknowledgements: Adrian Harrison for assisting in data collection and processing.  Background: Craniosacral therapy is a form of manual therapy using gentle palpation to release fascial restrictions between the cranium and the sacrum. It is described in the literature that craniosacral therapy may influence the autonomous nervous system, but the underlying mechanism is not known. Thermography is a non-invasive diagnostic technique based on the caption of the infrared radiation emitted from the body and transforming it in a map of superficial body temperature. The temperature of the skin has a direct relationship with its blood flow, which is under the influence of the autonomous nervous system. An increased sympathetic tone can lead to cold extremities due to peripheral vasoconstriction (Fig. 1). This case study assessed the effect of craniosacral therapy on the cold limbs of a horse by means of thermographic evaluation. Materials and methods: A 9-year-old, Brasileiro de Hipismo mare with a decrease temperature in both front limbs was evaluated. Craniosacral therapy was performed for 60 min (Fig. 2). Thermographic evaluation using a Thermographic Camera FLIR T530, was performed before, every 10 mins during the treatment, and 30 min after the treatment, i.e., 90 min from the first evaluation. Results: Before the craniosacral therapy session, the mare had a marked decrease in skin temperature in both front limbs (mean 71.78 °F or 22.16 °C). After the session started, the evaluations showed that the temperature of the limbs began to increase in a proximal to distal pattern, and continued to increase reaching a normal temperature (mean 87.26 °F or 30.71 °C) 30 min after the session the end of the session, i.e., 90 min from the first evaluation. There was an increase in temperature of an average of 15.48 °F or 8.6 °C between the first and the last evaluation. Conclusion: Craniosacral therapy could be used to increase superficial skin temperature by improving peripheral circulation in the limbs.

Consent for publication:
The authors confirm that they have written informed consent to publish from the person in Fig. 3.  with carpus valgus on the left front limb. In both cases, a 20 cm tape Vetkin Tape ® was applied with 30% stretch over the medial aspect of the affected limb to support the carpal colateral medial ligament. A 10 cm tape for the two anchors was wrapped over the ends of the tape to avoid detachment. The tape was changed every 5 days and the foals were reevaluated at 15 days of the treatment. The angles were measured in the pictures by ImageJ software.

Results:
The degree of angular limb deformity improved in both cases during the 15-day treatment period. The angle of the carpus gradually approached a normal value from day 1 to day 15. The angle change in Case 1 was from 153 to 180 (Fig. 1), and in Case 2 was from 162 to 177 degrees (Fig. 2). Conclusion: Kinesiology taping could be a potential non-invasive and inexpensive treatment for angular limb deformities in foals. Further research is warranted.
Background: A 17-year old Lusitano horse was evaluated at Espaço Equus Rehabilitation Center after a nine-month history of rest due to a rupture of the Peroneus tertius in the left hindlimb. Ultrasound examination at arrival showed an enlargement of the Peroneus tertius near its origin, with hypoechoic areas and diffuse edges. The horse presented with decreased maximal flexion (140 degrees) of the left tarsus during movement, as measured by a smart phone app (Hudl Technique) developed for biomechanical evaluation and measurement of joint angles during exercise.

Materials and methods:
To establish the ability to flex the left tarsus, two treatments were implemented: Therapeutic laser (Respond System Luminex ® ) 20 J/cm 2 to address the healing of the lesion and a program of exercises with progressive intensity to address the flexion of the tarsus and strengthen of the limb. The exercises consisted in stimulation of tarsal flexion, using different techniques over 1 month: gentle stimulation with a whip, hand walking, ridden exercises, tactile stimulator of the pastern, walking over poles, cavalettis and kinesiology tapping (VetkinTape ® ) during exercise. Results: After 30 days, the ultrasound examination showed the Peroneus tertius with normal size and echogenicity and also well-defined edges. The biomechanical evaluation showed that the flexion of the tarsus improved substantially: the maximum flexion angle of the hock at walk went from 140° to 57°. Conclusion: According to the literature the lesion of the Peroneus tertius takes several months to heal, and when near its origin, it carries a  poor prognosis [1,2]. Despite of the poor prognosis for the lesion site, this case has an excellent outcome in a short time (1 month) considering the previous time without evolution (9 months). This study highlights the value of adding a program of therapeutic exercises during the healing of this type of injury.
Background: Meniscal tears are common as stifle soft tissue injuries in the equine species. Cranial horn of the medial meniscus and the cranial meniscotibial ligament are the most often injured [1]. These lesions can be frequently accompanied by articular degenerative changes [2], resulting in poor sportive prognosis in the equine athlete [3]. In humans, it has been postulated that knee osteoarthrosis following meniscal injury could be due to biomechanical alteration [4] or proprioceptive disabilities attributable to the loss of mechanoreceptors (MCR), the role of the meniscus in joint stabilisation being not only mechanical [5].
In horses, a proprioceptive innervation has already been highlighted in the cranial horn of the medial menisci [6] but to our knowledge, until now, none studies have been performed in its cranial ligament. Our objective was to highlight an eventual proprioceptive innervation in the equine cranial meniscotibial ligament of the medial menisci ( Fig. 1).

Materials and methods:
Menisci were harvested, maximum 48 h post mortem, from one mare of 6 years old in an autopsy room. Death was not related with any locomotor problems. Serial cryosections were processed for immunohistochemistry and incubated in a range of primary antibodies directed against high molecular weight neurofilaments (anti-NFH), and Schwann cells (anti-GFAP). These antibodies were revealed with a species-specific secondary antibody bearing a fluorescent label. Nuclei were stained with DAPI. Common criteria found in the literature, in order to identify the different types of mechanoreceptors, were included in Table 1 [6][7][8][9][10].
Results: On all sections analysed (n = 44), 36 nervous profiles were found with only one Golgi-like corpuscle observed (Fig. 2). As agreed with criteria found in Table 1, this corpuscle was found isolated. It exhibits a fusiform shape, shows a dense axonal arborisation with which Schwann cells established numerous close contacts. Corpuscle was about 279 µm long and 88 µm wide, estimated with Image J software. No Pacini, neither Ruffini were observed. Conclusion: These preliminary results suggest that the cranial ligament of the equine medial menisci is innervated and possess a proprioceptive innervation. A young horse was chosen as it was postulated that number of MCR decrease with age [11]. Nevertheless in this horse, only one Golgi-like corpsucle was found; this MCR is active during extreme movement [12]. Increase of sample, followed  by functional studies, would be interesting in order to assess the role of the proprioceptive innervation of this ligament in the equine stifle stability. Trial registration: Not applicable. This is not a research study that "prospectively assigns human participants or groups of humans to one or more health-related interventions to evaluate the effects on health outcomes." Background: Observation of posture by physiotherapists forms part of standard assessment procedure and includes visual analysis of spinal alignment, conformation and the relative position of thoracolumbar (TL) and lumbosacral (LS) spinal regions. A relationship between equine TL posture and back pathology has been reported following veterinary diagnostic imaging. However in clinical practice measurement using imaging e.g. radiographs is not practical. Objective measurement of posture using sagittal view photographs are considered reliable. This study aimed to determine if there were any differences in spinal posture between horses with and without back pain. Fig. 1 Anatomical location of the cranial ligament of the equine medial meniscus (black arrow). MM, ML medial, lateral meniscus

Fig. 2 Type 3 corpuscle or Golgi-like corpuscle
Materials and methods: Sagittal view digital photographs were taken of 71 horses (mean age 12.5 ± 6.2 years; mean height 155.2 ± 12.2 cm; 42 geldings and 29 mares), in a neutral square stance, with a smartphone camera (8 megapixels). TL and LS angles were measured from the photographs using ImageJ. TL angle was formed from the highest point of withers to the lowest dorsal aspect of the TL region to the tuber sacrale. A smaller TL angle related to relative extension compared to a larger TL angle. LS angle was formed from the lowest point of the dorsal aspect of the TL region to the tuber sacrale to the head of tail; a smaller LS angle related to relative flexion compared to a larger LS angle. Data were divided into back pain/no back pain groups based on assessment by a Chartered Physiotherapist and owner assessment, to determine if differences existed between horses with and without back pain (alpha: P < 0.05). Data were also explored for cluster analysis to examine for posture in sub groups. Results: Horse with back pain had smaller TL angles (n = 38; mean 148.0 ± 3.20) than horses with no back pain (n = 33; mean 150.0 ± 3.80; t 70 = 2.41, P = 0.019). There was no difference in the LS angle between groups (t 70 = 1.33, P = 0.187). Cluster analysis identified four clusters and determined that horses with a larger TL and LS angle were less likely to have back pain. Conclusion: Thoracolumbar extension is associated with over-riding dorsal spinous processes (ORDSP) and therefore it could be hypothesised that horses with a smaller TL angle are at increased risk of ORDSP or vice versa for larger TL angles. Diagnostic imaging would be required to confirm this. Assessment of posture should be included in equine physiotherapists' assessment of horses with back pain. This simple method of objectively recording TL and LS angles could be used within routine assessment in clinical practice.

A26
The Background: The ideal goal of equine rehabilitation following injury or surgery is to return the horse to a level of function that either meets or exceeds the previous performance level and monitoring progress is important within rehabilitation. Outcome measures (OM) are used extensively in human practice and research, especially patient reported outcomes (PRO) and objective tests of clinical signs. PROs generally consist of a series of questions and observation of functional tasks, use of which may be challenging in equine practice. The aim of this study was to evaluate the knowledge of, and use, of OMs in equine musculoskeletal rehabilitation, to identify OMs used and clinician opinion regarding OM use in practice. Materials and methods: An online questionnaire was used to investigate how those involved with the treatment and training of horses measure progress and outcomes during a rehabilitation. The questionnaire collected demographic data including qualification and during of experience within equine rehabilitation. The respondent was asked to define an OM and indicate their use, method of selection and analyzing OM data. The final section requested opinions on the benefits and barriers to OM use in equine rehabilitation and further comments. Results: 107 practitioners responded, comprising 51 Chartered Physiotherapists and 20 Physiotherapists without prior human training, with an average of 9.25 years in equine practice. 82.2% reported using OMs. When asked to define an OM, 72.5% of Chartered Physiotherapists and 40% of Physiotherapists without prior human training, matched a pre-set definition correctly. The benefits of OM use were reported consistently as a method of objectively monitoring progress and used to adapt treatment plans. The barriers to OM use were lack of OM validation and reliability and time constraints. However the OMs reported to be used were mainly subjective such as visual assessment of lameness, palpation and observation of muscle symmetry.

Conclusion: Confusion exists regarding what an OM is and although
OM use is reported it often refers to subjective assessment methods. Based on this information from a small group of professionals it would appear that there are limiting factors to the use of OMs in equine rehabilitation. This is primarily a lack of available OMs specific for equine rehabilitation. More work is needed to develop practically applicable outcome measures for specific professionals who are involved in the rehabilitation of equines.

Paralysis of a Shetland colt caused by drug intoxication resolved completely with Equiter ® Method of Equine Physical Therapy and Rehabilitation
Eliana Speziale Equiter ® Center for Horse Rehabilitation, San Giuliano Terme, Tuscany, Italy Correspondence: Eliana Speziale (elispez14@gmail.com) Acta Veterinaria Scandinavica 2019, 61(Suppl 1):A27 Background: Horses often suffer neurological damage due to poisonings caused by plants, feed additives, mycotoxins, herbal supplements, metal and minerals, or pesticides. In this case, a newborn colt was poisoned by a veterinary who administered an overdose (ten times the dose) of Depomycin im. (penicillin and streptomycin). The colt developed a fever, cough, and lost the ability to breathe just after birth. The colt was catatonic, could not stand in quadruped station, had no suck reflex, and did not indicate a desire to live.

Materials and methods:
The colt's lung infection and drug-induced intoxication was treated for 15 days with: • Cobactan 4.5% ev (fourth generation cephalosporin) • Meflosyl ev (anti-inflammatory) The colt was treated from a physical rehabilitation approach for progressive caudal-to-cranial rigidity due to progressive muscular atrophy generated by disuse and neurological damage. Atrophy caused by compression of the sciatic nerve caused medial dislocation of both patellae and hyperextension of the hind legs was also treated. The colt's daily physical rehabilitation program followed Equiter ® procedure which is a structured mix of: deep massage therapy, myofascial release, structural digitopressure, muscles release, active and passive joint and body mobilization, exercises with poles and cavaletti and free exercise. Conclusion: Cooperation between the veterinary therapies and Equiter ® Physical Therapy and Rehabilitation Program restored both proprioceptive and movement control in the 15 day old Shetland pony over approximately a two-month time frame. With physical rehabilitation becoming an accepted part of comprehensive care in equine and companion animals, the zoo medicine community has also recognized the potential opportunities for this set of treatment modalities, due in large part to the success of animal training to allow cooperation and interaction. Woodland Park Zoo (WPZ) began exploring the benefits of physical rehabilitation for occasional patients in the 1980s. In 2012, WPZ developed a formal physical rehabilitation pilot program with the goal of increasing offerings throughout the zoo for animals with injuries, arthritis and mobility concerns. In order to objectively identify gait disturbances and track response to treatment, as well as create a common language across zoo teams, the Mobility Assessment Scoring System (M.A.S.S) was developed and adopted by the zoo staff. Based on common canine gait analysis scores, our M.A.S.S. stresses the application potential across species. In the 5 years of the pilot program, rehabilitation therapy has successfully been provided for a broad range of species ranging from lizards to gorillas. Based on the success of this pilot program, the WPZ Whole Health Initiative has been created as a collaboration between WPZ and SOUND Veterinary Rehabilitation Center as means of elevating the program with engagement of specialists in the field of veterinary rehabilitation. Goals of this initiative include advancing chronic pain management options for geriatric zoo animals and increasing the scope of rehabilitation services to include fitness and conditioning as a form of behavioral enrichment. With enthusiastic participation by zoo staff we have found our treatments to be effective across range of species. Charts for assessment of mobility, locomotion and adapted disability index were instituted (Tables 5 and 6). Results: With maintenance therapy, the spider monkey utilized arm and hand movements daily for feeding and play. He was observed functioning happily as a member of his troop.

Conclusion:
The above treatment plan allowed veterinary staff and animal keepers to create an observable improvement in the spider monkey's chronic pain without compromising his quality of life, therefore indicating multimodal analgesics, physical rehabilitation techniques and acupuncture can be effective treatments for spidermonkeys with chronic elbow dysplasia.     Table 5 Modified cincinnati orthopedic disability index for a non-human primate Table 6 Scoring system for assessing mobility and locomotion for non-human primate and no narrowed disc spaces. The goals were to increase muscle mass, improve hind limb function, restore ambulation, and resolve the pododermatitis. Interventions included oral antibiotics (Baytril 100 mg/mL, 0.05 mL po every 24 h for 2 weeks) and anti-inflammatories (Metacam 0.5 mg/mL-0.3 mL po every 24 h) for inflammation and discomfort. PROM of both hind limbs, aquatic therapy, therapeutic laser to the sacral spine and hips (3.5 J/cm 2 ), as well as bilateral tarsus in the area of pododermatitis (2.4 J/cm 2 ), walking short distances, aquatic therapy ( Fig. 1) and "dancing" (Fig. 2). Rehabilitation lasted 21 days for a total of 10 sessions. Conclusion: By discharge, the subject regained full range of motion, had no discomfort in any limb (Table 1), and was able to ambulate independently. Per subjective evaluation, the subject gained muscle over his spine and hind limbs. The pododermatitis also resolved. Trial registration: Not applicable.  (Fig. 1). The guinea pig was lame in this left forelimb (4/4), lacked sensation distal to L elbow joint, and was in 7/10 pain at initial evaluation. The objective was to prevent amputation of the guinea pig's left forelimb.

Materials and methods:
Interventions included removal of the dressing, oral antibiotics (Trimethoprim sulfa 30 mg/kg PO BID) and NSAIDs (Metacam 0.3 mg/kg PO SID), surgical debridement of necrotic tissue as needed (Figs. 2a and b, 3), daily wet-to-dry dressings until wound showed healthy granulation tissue, dry dressings with silver sulfadiazine cream every other day to promote epithelialization, laser (3 J/ cm 2 ), hydrotherapy modalities, and proprioception training. Rehabilitation spanned 12 visits. Results: The guinea pig was able to avoid amputation and experienced a return of all sensation in the left forelimb. By the end of treatment, he exhibited 1/4 pain. Lameness also decreased to 1/4. Conclusion: After 12 sessions of rehabilitation, amputation of the left forelimb was avoided. Lameness decreased from 4/4 to 1/4. Trial registration: Not applicable.  Background: Elite athletes are exposed to high training loads and increasingly demanding competition calendars. Increases in training intensities are performed to improve performance [1], often exceeding the physical and psychological limit. The incorrect load management is an important factor for the development of overtraining syndrome (OTS) [4], caused by an imbalance in the cycle training-recovery, resulting in performance reduction [3] in human and equines. Behavioral indicators have great sensitivity and can be an effective tool for diagnosis/prevention of nonfunctional overreaching (NFOR) and OTS. Studies with rats submitted to overtraining protocols (OP) and behavioral disorders were not found in literature.  (Fig. 2). There was no difference in EPM. Adrenosomatic index increased for NFOR and FOR in MPT-7 in relation to the SED group (F = 7.205, P < 0.001) and a reduction of the NFOR index after MPT-9 was observed (P = 0.006), which correlated with performance in both moments (MPT-7: P = 0.03; R = − 0.754; MPT-9: P = 0.004; R = 0.94) (Fig. 3). MPT-8 and 9 data were not shown.    Athletic dogs possess the capacity to produce large amounts of metabolic heat during exercise, but have a poor capacity for dissipation of that heat compared to other athletic mammals. As a result, overheating and heat related injury is a major cause of exercise-related morbidity in dogs. The objective of this study was to evaluate the relative efficacy of three post-exercise cooling methods in dogs with exercise-induced heat stress. Nine athletically-conditioned dogs were exercised at 10 km/h for 15 min on a treadmill in an environmental chamber at 30 °C three times on separate days. The dogs were cooled using one of three methods: Control cooling (consisting of resting in front of a fan), cooling on a 4 °C cooling mat, and partial immersion in a 30 °C water bath for 5 min. Ambient temperature during cooling was 30 °C, and dog temperature was recorded every 2 min using a radiotelemetry gastrointestinal capsule. Time-weighted heat stress (AUC of the temperature x time curve) was lower for immersion cooling compared to cooling mat and control. The mean duration required to lower gastrointestinal temperature to 39 °C was 16 min for immersion cooling, 36 min for cooling mat, and 48 min for control cooling. Immersion into a water bath decreases postexercise time-weighted heat stress in dogs and provided the most rapid cooling of the three methods evaluated, even if the water temperature is relatively warm. The cooling mat was superior to cooling using only air movement, but not as effective as immersion. Rehabilitation of tendon injuries often involves the application of cold therapy and heating is occasionally done to help increase collagen extensibility in fibrotic tissues. The application of alternating cold and hot (contrast therapy) is widely used in humans; however, its utility in equine rehabilitation is largely unknown. The objectives of this study were to evaluate the time-temperature profiles during 15 min heating/cooling cycles using an automated contrast therapy device, assess if the equipment could achieve therapeutic temperatures (< 15 °C and > 40 °C) surrounding the flexors tendons, and determine the effect of the sequence of therapy (i.e. hot-cold-hot versus cold-hot-cold). It was hypothesized that the superficial tissue structures would reach therapeutic temperatures during both heating and cooling cycles. Four adult horses with no diagnosed tendinopathies were used. Fine-wire temperature probes were placed on the skin and implanted in 3 locations within the metacarpus in both forelimbs: subcutaneously and deep to the superficial (SDFT) and deep digital flexor tendons (DDFT). Data was captured at 15 s intervals over 7 hot-cold cycles. Minimum and maximum temperatures, slopes and areas under the time-temperature curve were calculated. The applied contrast therapy was consistently able to apply therapeutic cold and heat to tissues superficial to the DDFT, as hypothesized. Temperatures deep to the DDFT were inconsistent, depending on the horse and the treatment cycle. These results help define the physiologic responses of combined tissue heating and cooling within the equine distal limb. Future studies are needed to define treatment protocols for optimal rehabilitation of distal limb injuries in horses.
Background: Polyacrylamide hydrogel (PAAG) a was recently used to successfully treat osteoarthritis (OA) in horses; however no long-term field-study was performed. We hypothesized that lameness scores would improve significantly in OA joints after treatment with PAAG, and that PAAG has a lasting effect. Another objective was to describe the preliminary observations of the mechanisms of action of a PAAG in OA joints. Materials and methods: Forty-three horses with OA in one joint were included in this study [1]. Horses were injected with 2 ml of PAAG into the affected joint and were followed up at 1, 3, 6, 12 and 24 months. Efficacy of PAAG was evaluated by blinded clinical assessment of lameness [1]. For the mechanisms of action of PAAG in OA joints, a randomized controlled study was conducted on an OA knee model in goats: treatment group (intraarticular PAAG), control group (intraarticular saline) [2,3]. Magnetic Resonance Imaging (MRI) was performed prior and post-surgery [2,3]. Gross pathology and histopathology, including immunohistochemistry for nerve endings, were performed on both knees [2,3]. Joint capsule elasticity of the knees was measured on both groups [2,3]. Results: At 1, 3, 6, 12 and 24 months follow-up, 59%, 69%, 79%, 81% and 82.5% of horses were non-lame respectively [1]. There was a significant decrease in lameness grade from baseline to 1, 3, 6, 12 and 24 months [1]. For the mechanisms of action, MRI showed reduction followed by stabilization of OA lesions after PAAG treatment [2,3]. Histopathology showed that intraarticular PAAG injection added to the thickness of the synovial membrane; PAAG was integrated into the synovial membrane [2,3]. Nerve endings were intact with normal morphology and numbers [2,3]. Joint capsule elasticity investigation showed that treated knees had a higher elasticity when compared to control knees [2,3]. Conclusion: PAAG significantly alleviated lameness in OA joints. No adverse effects were observed [1]. PAAG induced a significant decrease in joint effusion in OA joints. PAAG is a promising, lasting and safe new treatment for OA in horses. Preliminary observations of the mechanisms of action of PAAG on OA joints were: 1. Pathology and joint capsule elasticity suggest that PAAG by acting on synovial membrane may reduce overall joint capsule stiffness, a major source of pain in OA. 2. MRI and pathology revealed stabilization of OA lesions in PAAG treated goats, possibly caused by the high viscosupplementation of PAAG. Trial registration Danish Council for Animal Experimentation: 2010/561-1890 and 2011/561-2021.
Results: Data were collected from 207 handlers of agility dogs with digit injuries and 874 handlers of agility dogs without digit injuries. Factors associated with increased odds of injury included Border Collie breed (OR, 2.3), medium to long nails (OR, 2.3), absence of front dewclaws (OR, 1.9), and greater weight to height ratio (OR, 3.9). Odds of injury decreased with increasing age of the dog (OR, 0.8).
Conclusion: Several factors were associated with increased risk of digit injury in agility dogs suggesting that agility dogs should not have healthy dewclaws removed, should maintain lean body mass, and should have nails trimmed short for training and competition. Future biomechanical research and prospective clinical studies are important to confirm training and environmental recommendations to decrease risks of injury.