A Systematic Review of Complementary and Alternative Veterinary Medicine in Sport and Companion Animals: Electrotherapy

Electrotherapy modalities are currently used in the treatment of animals, but the evidence base supporting their use has not yet been systematically reviewed. Cochrane guidelines, as adapted by the Swedish Agency for Health Technology Assessment and Assessment of Social Services, were followed for this systematic review. A literature search regarding all currently known electrotherapy modalities applied to horses, dogs, and cats was conducted for the years 1980-2020 using three databases: CABI, PubMed, and Web of Science Core Collection. Of the 5385 references found, 41 articles were included in the review: 13 papers on pulsed electromagnetic field therapy (PEMFT), 7 on neural electrical muscle stimulation (NEMS), 5 on transcutaneous electrical nerve stimulation (TENS), 4 on static magnets, 3 on interference, 2 each on percutaneous electrical neural stimulation (PENS), bioelectricity, and diathermy, and 1 each on micro-pulsed stimulation, capacitive coupled electrical stimulation, and microwave therapy. The literature per modality was limited in quantity (mean 3.7 papers). Half of the articles were assessed to have a high risk of bias (20 high, 7 moderate, and 14 low). The existing literature used a spectrum of indications and treatment parameters, which makes comparisons and drawing conclusions to support the use of these modalities in clinical practice challenging. The current scientific evidence is not sufficient to support the clinical effects of electrotherapies for any clinical indication in horses, dogs or cats. The selected suggestive results warrant further high-quality research on PEMFT, NEMS, TENS, and PENS.

Movement Caused by Electrical Stimulation of the Lumbosacral Region in Standing Horses

Electrical stimulation is commonly used as a modality for physical therapy in human and veterinary medicine. However, studies measuring the movement generated by electrical stimulation in horses are rare. The present study therefore evaluates the range of movement provoked by a commercially available physical therapy unit (FES310) and contrasts it with the movement generated by manually induced pelvic inclination (back rounding). Ten horses were tested on three measurement days over one week. Electrical stimulation was applied via a back treatment pad (belonging to the FES310 system) containing six electrodes (three on either side of the spine) placed over the lumbosacral region. This system produced a pulsed, biphasic electrical stimulation in a rectangular waveform which was gradually increased to a maximum of 10 volts. Before and after electrical stimulation testing, manual pelvic inclination was achieved by pressure on two points lateral to the root of the tail. Muscle tone and lameness were evaluated before and after treatments. Skinfold thickness, body condition score, and body mass were measured to detect possible confounding factors. Using kinematics, the angle ranges during movement of ten three-dimensional angles of the trunk, the pelvis, and the hind limbs were further analyzed. Movement was produced with manual stimulation in every tested individual on all measurement days and with electrical stimulation on at least one measurement day. The electrical stimulation led to significantly (P < .05) smaller angle ranges which were 15 %-57 % of the median of the manually stimulated movement. Strong positive correlations between angle ranges of the electrically generated movement were found for the hind limbs implicating their involvement in the movement created. Correlations between skinfold thickness, body condition score, and body mass with the angle ranges were weak and not significant. Before and after electrical and manual stimulation, muscle tone and lameness were similar. In the present study, both electrical and manual stimulation were proven to produce significant trunk and hind limb movement. Within this study's electrical stimulation treatment protocol, the movement generated by electrical stimulation was significantly less than the movement caused by manual pelvic inclination. However, electrical stimulation could easily be applied over a longer period and in a higher frequency than it would be possible for manual pelvic inclination. This treatment shows potential for stabilization and or mobilization of the lumbosacral region, although its efficiency as a therapeutic tool and its effect on specific orthopedic problems and is to be evaluated in further research.

Generation of Domains for the Equine Musculoskeletal Rehabilitation Outcome Score: Development by Expert Consensus

Simple Summary

Within rehabilitation, measurements taken before, during and after treatments are used to judge patient progress and the effectiveness of prescribed treatments. To know which measurements to use for a given health condition, practitioners must have knowledge of what should be measured, which measurement tools are available and accurate, alongside what they intend to measure. Composite outcome measures (OMs) are tools which use grouped measurement tests to monitor patient progress; they have been tested for a variety of human and canine conditions but none have been designed or tested for use in physical rehabilitation in horses. This study asked leading equine veterinarians, physiotherapists and researchers which measures should be included in an OM for use in the rehabilitation of horses. Using a process to evaluate agreement, ten areas of measurement were included in the final model: lameness, pain at rest, pain during exercise, behaviour during exercise, muscular symmetry, performance/functional capacity, behaviour at rest, palpation, balance and proprioception. Existing reliable tests used to measure these areas were evaluated and potential new measures discussed and now should be taken forward to testing as a composite outcome score to see if they are effective in measuring effectiveness of treatment.

Abstract

Outcome measures (OMs) are a requirement of professional practice standards in human and canine physiotherapy practice for measurement of health status. Measures such as pain and functional capacity of specific regions are used to track treatment impact and can be used to develop optimal management strategies. To achieve comparable patient care in equine physiotherapy, OMs must be incorporated into practice; however, no reliable and valid OMs exist for equine rehabilitation. This study utilised the experience and opinion of a panel of experts working in the equine rehabilitation sphere to gain consensus on the core areas (domains) to be included in a model, to lead to an OM scale for horses undergoing rehabilitation. The Delphi method and content validity ratio testing was used to determine agreement with domains reaching the critical value required for inclusion. The expert panel agreed on ten domains to be included in the OM scale: lameness, pain at rest, pain during exercise, behaviour during exercise, muscular symmetry, performance/functional capacity, behaviour at rest, palpation, balance and proprioception. An OM with these domains would provide a holistic objective assessment tool which could be used by equine rehabilitation professionals in clinical practice.

Recovery from muscle weakness by exercise and FES: lessons from Masters, active or sedentary seniors and SCI patients

Many factors contribute to the decline of skeletal muscle that occurs as we age. This is a reality that we may combat, but not prevent because it is written into our genome. The series of records from World Master Athletes reveals that skeletal muscle power begins to decline at the age of 30 years and continues, almost linearly, to zero at the age of 110 years. Here we discuss evidence that denervation contributes to the atrophy and slowness of aged muscle. We compared muscle from lifelong active seniors to that of sedentary elderly people and found that the sportsmen have more muscle bulk and slow fiber type groupings, providing evidence that physical activity maintains slow motoneurons which reinnervate muscle fibers. Further, accelerated muscle atrophy/degeneration occurs with irreversible Conus and Cauda Equina syndrome, a spinal cord injury in which the human leg muscles may be permanently disconnected from the nervous system with complete loss of muscle fibers within 5-8 years. We used histological morphometry and Muscle Color Computed Tomography to evaluate muscle from these peculiar persons and reveal that contraction produced by home-based Functional Electrical Stimulation (h-bFES) recovers muscle size and function which is reversed if h-bFES is discontinued. FES also reverses muscle atrophy in sedentary seniors and modulates mitochondria in horse muscles. All together these observations indicate that FES modifies muscle fibers by increasing contractions per day. Thus, FES should be considered in critical care units, rehabilitation centers and nursing facilities when patients are unable or reluctant to exercise.

Electrophysical Therapies for the Equine Athlete

A good rehabilitation program takes into account the possible causes for the injury. Once the underlying cause of the injury is determined, a veterinarian can construct an appropriate rehabilitation plan and use the available electrophysical therapies to their greatest effect. Treating the horse correctly for the type and location of injury, and the stage of rehabilitation of the tissue, helps ensure full rehabilitation success. This article discusses when and how to use the most common electrophysical therapies in horses including transcutaneous electrical nerve stimulation, neuromuscular electrical stimulation, functional electric stimulation, pulsed electromagnetic field therapy, therapeutic ultrasound, laser therapy, shockwave therapy, and vibration therapy.