Gracie Law – Apollo Veterinary Physiotherapy & Hydrotherapy

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Gracie Law

Client ID : 22454

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Clinical History

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Clinical History

Type	Record Summary
Hydro 12-10-2023	Observations : No changes this week, no concerns and happy with Gracie. Assessment : No trigger points located today. Paraspinal tone feels good. H/L joint RoM good, no crepitus observed. Treatment Plan : Weekly hydrophysio therapy sessions SESSION 4/6 Harness Size : XX Small Water Height : 5″ x 3, swim x 1 (10s), 5″ x 2 Speed: : L1.2 Duration: : 30s Repetitions: : 5 Rest Duration: : 2m Rest Period Interventions: : BLACK SMALL HARNESS CC rythmical stabilisations S2S in treadmill 3LS PPP Movement Shaping Techniques : Swam Gracie for the first time, she was unexpectedly very chill, primarily swam with forelimbs with minor kicks behind, will try again next session as long as no prolonged fatigue after this weeks session and focus on using hind limbs during swim.
Hydro 06-10-2023	Observations : When Gracie usually leaves her bed, she is sometimes wobbly, however recently, she appears more balanced and stable! Assessment : One acute TP bilaterally T10 region Hypotonic hamstrings and hypotrophic medial thigh mm. Sartorius hypertonic Minimal thoracolumbar sway present Treatment Plan : Weekly hydrophysio therapy sessions Harness Size : XX Small Water Height : 5″ x 5 Speed: : L1.2 Duration: : 30s Repetitions: : 5 Rest Duration: : 2m Rest Period Interventions: : BLACK SMALL HARNESS CC rythmical stabilisations S2S in treadmill 3LS PPP Movement Shaping Techniques : Much better in treadmill, less stressed and jumping. May incorporate swimming in future sessions if Gracie appears comfortable and happy to swim.
Hydro 29-09-2023	Observations : Noticed Gracie is the best she has ever been so far, not noticed any limping or wobbliness, however Gracie is cheeky and tries to climb on the furniture when Clare leaves the room. She is supervised as much as possible. Assessment : No TP’s in paraspinals present. Hypotrophic medial semitend and semimem. Hypotonic hind limb mm. Treatment Plan : Weekly hydrophysio therapy sessions Harness Size : XX Small Water Height : 5″ x 4 Speed: : L1 Duration: : 20s Repetitions: : 3 Rest Duration: : 2m Rest Period Interventions: : BLACK SMALL HARNESS CC rythmical stabilisations S2S in treadmill 3LS PPP Movement Shaping Techniques : Both hind limbs knuckling response immediate post-hydro. Can jump up as soon as hydrotherapist isn’t looking! Likes to be held in her rest breaks
Hydro 21-09-2023	Observations : Going well with S2S at home. No longer working on balance and core exercises, just S2S and massage. Using uneven terrain and angulations on 30 minute walk to George the 5th park with lots of hills. Gracie has lots of triggers at home and at mothers house including door bell, bird feeder, etc so she is restricted from going on the sofa during the day, restricted going up and down the stairs and now in a crate at night. Can jump off things if she is triggered as not thinking about things, so trying hard to restrict that with baby gates everywhere. Assessment : No TP’s in paraspinals present. Hypotrophic medial semitend and semimem. Hypotonic hind limb mm. Treatment Plan : Weekly hydrophysio therapy sessions Harness Size : XX Small Water Height : 5″ x 3 Speed: : 0.5 -1 Duration: : 20s Repetitions: : 3 Rest Duration: : 2m Rest Period Interventions: : BLACK SMALL HARNESS CC rythmical stabilisations S2S in treadmill 3LS PPP Movement Shaping Techniques : Both hind limbs knuckling response immediate post-hydro.
Physio 15-09-2023	Observations : Owner went on holiday with Gracie and she thinks she may have overdone the walking as her front right leg was lame. Nikos checked her over and can’t see anything to worry about – performed an xray of the leg when under sedation for her teeth – had 7 more removed. He agreed hydrotherapy would help to strengthen her up. Assessment : Acute TP’s lumbar paraspinals bilateral – needs to develop more muscle to support the spine. Manual Treatments Delivered : Effleurage paraspinals Spinal stretches Therapeutic exercise plan put in place Electrotherapy Delivered : LASER 5 x 4J application
Physio 28-07-2023	Observations : Exercises are not hugely successful – not very motivated. She used to be able to jump from sitting onto the sofa – now she has to take a run up. She can climb the stairs and has done every now and then, but largely will wait to be carried. You can tell she isnt as strong as she was. Saw Nikos last week – still has some muscle tightness. Not particularly worried about her. Assessment : Can sit square & push herself back up Crepitus L/stifle in flexion & in retraction – unsure whether patella luxating. This is the same this session too. Asked owner whether she has noticed this leg skip and she has done this but owner has only noticed it once. Acute TP’s lumbar paraspinals bilateral Treatment Goals: Stretches to help ease spinal tension Core strength exercises HL stabilising exercises Manual Treatments Delivered : Effleurage paraspinals Spinal stretches Therapeutic exercise plan put in place Therapeutic Exercise Programme: In Clinic + Home Prescription : SPINAL TENSION – Light circular massage away from the spine for approx. 5-10 minutes in the evening – heat pack to be used to help relax the muscle tension – Followed by spinal stretches – cheese spread is good as holds it for a bit longer. Nose passed bottom, 3 reps each side. CORE STABILITY & LIMB STRENGTH: – 5 x sit to stand – get her to stand in front of an object so that she can’t move forward when you ask her to stand back up. Only reward the stand, not the “sit”. – FITBONE BALANCING: gentle weight shifting in standing by following a food lure. Standing square then lifting one front paw up & bending under to stop putting weight through it. Advance to sit to stands on the fitbone also. PROPRIOCEPTION: OBSTACLE COURSE Treats thrown down over towels with cushions etc UNDULATING TERRAIN & MIXTURE OF TERRAINS Harder terrain is fine as long she is walking controlled WALK OVER GROUND POLE: this can be umbrella, broom handle e.g., and ensure you put the pole on a non-slip surface. 12cm gap – figure of 8 over & through the poles. Electrotherapy Delivered : LASER 2 x 4J application Treatment Plan : Advised that neuro rehab can take a long time – up to 1 year for full recovery really. We can use hydrotherapy to help build the muscle & improve spinal control. To speak with Nikos r.e. HLs & assessing when under for teeth in September.
Physio 28-07-2023	Observations : NOTES FROM LAST SESSION 23/06/23 7 weeks post op yesterday. Went to the specialists last week – very pleased with her recovery. Said she can essentially go back to normal – stay on the lead for next 2 months. Gently increase her exercise duration over the next 2 months. Owner has got a carry bag that she fits in to walk with on longer walks, especially when they go away in August. Surgeon said that she can walk upstairs in 2 months also, just to avoid walking down the stairs permanently. Assessment : No proprioceptive deficit, just muscular weakness. Can sit square & push herself back up Mild heat lateral aspect L/TL epaxials though no spinal pain or discomfort Crepitus L/stifle in flexion – unsure whether patella luxating. Will assess again next time. Acute TP’s R/lumbar paraspinals LH mild neuro deficit – 2 x 1s knuckling delay Treatment Goals: Stretches to help ease spinal tension Core strength exercises HL stabilising exercises Manual Treatments Delivered : Effleurage paraspinals Spinal stretches Therapeutic exercise plan put in place Therapeutic Exercise Programme: In Clinic + Home Prescription : SPINAL TENSION – Light circular massage away from the spine for approx. 5-10 minutes in the evening – Followed by spinal stretches – cheese spread is good as holds it for a bit longer. Nose passed bottom, 3 reps each side. CORE STABILITY & LIMB STRENGTH: – 5 x sit to stand, she must sit square in front of pole at level 2. Move the lure downwards in front of the pole to get her to stand. Only reward the stand, not the “sit”. – FITBONE BALANCING: gentle weight shifting in standing by following a food lure. Standing square then lifting one front paw up & bending under to stop putting weight through it. Advance to sit to stands on the fitbone also. PROPRIOCEPTION: OBSTACLE COURSE Treats thrown down over towels with cushions etc UNDULATING TERRAIN & MIXTURE OF TERRAINS Harder terrain is fine as long she is walking controlled WALK OVER GROUND POLE: this can be umbrella, broom handle e.g., and ensure you put the pole on a non-slip surface. 12cm gap – figure of 8 over & through the poles. Electrotherapy Delivered : LASER 2 x 4J application
Referral 01-07-2023	A referral was made by Nikolaos Dafermos at Dafne Veterinary Hospital on 19/05/2023. The diagnosis was L2L3IVDD 4/5/2023. You can download the referral here.

Treatment Invoices

Date	Type	Rate	Action
01-07-2023	Administrative	£Administrative_0	Generate Receipt