The line from the movie “Field of Dreams” that promises, “If you build it, they will come,” doesn’t always hold true in real life. James St. Clair, DVM, laughs when he repeats it. Four years ago, he spent $150,000 to open a canine rehabilitation center, outfitting a 2,500-square-foot building with cold laser and electrical stimulation machines, underwater and land treadmills, balance balls and, for good measure, a swimming pool. Nobody came. Today, he continues his private practice in one storefront in Meriden, Conn., while successfully operating TopDog Canine Rehabilitation Center and Fitness in another. He’s reconfigured it into a compact 600 square feet and, except for the pool, offers the original services using a certified canine rehabilitation practitioner and a massage therapist. He and other entrepreneurs are promoting franchises. He counsels veterinarians wanting to enhance their practices with rehab services and publishes TopDog Home Therapy Booklets for clients. The hard-won lesson: “If done right, done well and if you start slow and don’t go overboard initially, the money will follow,” Dr. St. Clair says. “Obviously, adding this kind of service is a huge benefit to a practice. The potential is enormous.” For the past decade, animal rehabilitation has dwelled in the quiet corners of veterinary medicine, surfacing only for the occasional gee-whiz photo of dogs splayed on balance balls. “The field is in its infancy, but it’s becoming the buzz word in veterinary medicine,” says Janet B. Van Dyke, DVM, founder of the Canine Rehabilitation Institute in Wellington, Fla. “Pet owners expect to have this level of care and want to know where to get it. Practices lose business when they don’t have these therapies.” The growth in the use of physical therapy for small animals–dogs and, to some extent, wary cats–has only begun, says David Levine, PT, Ph.D., CCRP, at the University of Tennessee’s department of physical therapy. “It’s gone a lot more mainstream,” he says. “It’s not a cure-all. It’s one more service we can offer clients. It has benefits in preventive medicine, conditioning, weight control, post-surgical healing and non-surgical treatment of conditions such as arthritis.” Advocates acknowledge that clinical studies of animal rehabilitation have been limited. “There’s not a lot of original research because it’s such a new field, but more scientific-based studies are coming out,” says Jacqueline R. Davidson, DVM, ACVS, at Louisiana State University’s School of Veterinary Medicine. “The basis for a lot of the work we do is extrapolated from studies on people.” Business-savvy general practitioners would be wise to take advantage of the trend, experts say. They’re unanimous in identifying education as the most critical element to success. . “It’s most important to get proper training so you know what you’re doing,” Levine says. “People have been doing rehabilitation for dogs and horses for post-surgery and a lot of chronic conditions for a long time. We started formal training in the mid-’90s, and it took on a life of its own.” Tennessee offers a certificate program that awards graduates the CCRP designation: Certified Canine Rehabilitation Practitioner. “It doesn’t really matter the toys, the equipment, you have,” Davidson says. “You can start with nothing. If you know how to assess animals, do muscle strengthening, increase range of motion—most of that you can do with your own eyes and hands. The main thing is knowledge.” Julia Tomlinson, DVM, owner of Twin Cities Animal Rehabilitation Clinic in Burnsville, Minn., urges taking a course. “You need to know what you’re getting into,” Dr. Tomlinson says. “This is not the sort of thing you can practice off and on. You have to do a lot of cases to keep learning.” At the same time, the experts don’t hesitate to issue these caveats: • Resist buying big-ticket equipment initially. “The biggest mistake is spending a lot of money for expensive equipment before you know how to use it,” Van Dyke says. “A minor piece of equipment like an electrical muscle stimulator can make a big difference in a dog’s comfort and improvement after surgery.” • St. Clair estimates that launching a rehab center would cost $8,000, excluding salaries, while others say it can be done with as little as $1,000 or less. • “You could buy an inexpensive video camera to evaluate gait,” Davidson says. “You can buy hot packs, cold packs, therapeutic balls, a wobble board, steps—some you can make yourself. If you feel clients are getting interested, you can gradually increase your investment in equipment. One high-end piece of equipment would be an underwater treadmill.” • Don’t ignore the nature of your caseload. It will help determine the services you’ll provide, Levine says. A practice with a lot of surgeries will naturally want to provide post-op rehabilitation. • Don’t let techs diagnose physical therapy cases. They’re not trained or licensed for it. However, if you have a certified therapist or practitioner on staff—and you should so you can continue to build the general practice up front—leave much of the actual rehab work to him or her. It’s time consuming. • Develop a care plan for each patient. “There isn’t a formula for each case: ‘This much time on the treadmill, and in eight weeks, they’re back to fitness,’ ” Tomlinson says. “It doesn’t work that way. Individual animals respond differently.” In the end, the advice from St. Clair, who “built it and they didn’t come” but re-built it and they came, sets the standard: “Focus on good medicine and profitability will follow.” Evidence of Rehab’s Growth The signs that animal rehabilitation is poised for greater growth in veterinary medicine are unmistakable. Veterinary conferences increasingly present continuing education on the topic. At the American Veterinary Medical Assn. convention this past summer, Louisiana State’s Jacqueline R. Davidson, DVM, ACVS, taught daylong CE sessions, including post-op rehabilitation, improving conditioning and fitness and starting rehab with minimal investment. At the same time, Janet B. Van Dyke, DVM, of the Canine Rehabilitation Institute partnered with Colorado State University’s College of Veterinary Medicine and Biomedical Sciences to present a two-day seminar on the business aspects of starting and managing a canine rehabilitation center. The institute has certification programs leading to the title of certified canine rehabilitation therapist for veterinarians and physical therapists and certified canine rehabilitation assistant for veterinary technicians and physical therapist assistants. Ten of the nation’s veterinary schools have sent veterinarians or vet techs to the University of Tennessee to be trained as certified canine rehabilitation practitioners. Louisiana State has an elective course in physical therapy, as do other schools, Davidson says. “I don’t know of any schools offering stand-alone rehabilitation education in its veterinary curriculum, but there’s greater awareness of its value.” “The future will hopefully find more veterinarians coming onboard with physical therapy,” says Julia Tomlinson, DVM. “We need to take ownership and govern where it’s going.” Toward that end, she founded the American Assn. of Rehabilitation Veterinarians. The fledgling group has 70 members, most in private practice. For the Mobility-Impaired, Try a Wheelchair Rental Why buy when you can rent? Barbara Parkes, co-founder of K9 Carts West in Langley, Wash., this year began allowing customers to rent pet wheelchairs instead of buying them. Many dogs need mobility assistance for only two or three weeks after an injury or surgery, she says, so a short-term rental is often the cheaper choice. K9 Carts West’s standard two-wheel cart for a 50-pound dog runs $185 for three weeks’ use, plus shipping and a $79 deposit. A four-wheel cart for the same canine costs $240, plus shipping and a $99 deposit. Two-wheel carts work for dogs that have good forelimb strength, and the four-wheelers are for animals that need complete body support. Rentals give owners more options for assisting their paralyzed or ambulatory pets, and the results Parkes sees make her smile. “The joy, the happiness, for the owners is fabulous,” she says. Parkes suggests that with increasing interest in animal rehab, such centers might follow her move and offer a rental carts. “Five carts will fit probably 90 percent of all breeds,” she says. Some dogs may not do well in a wheelchair. Parkes has found that the terrier group, particularly the West Highland and the Scottie, along with “fiercely independent” or obese dogs tend to give the carts the paws-down. “But 99.9 percent of dogs,” she says, “you put them in a cart and they’re off and running.” Betty Liddick is a writer and editor in Venice, Fla. <HOME>
