Leaders knead rehabilitation, therapy rules

SACRAMENTO, CALIF. — As physical therapy takes root in animal healthcare, veterinary regulators and the profession's leaders scramble to create guidelines to restrict lay and untrained practitioners.

It's a form of rehabilitation that's attained value within the human sector but, until recently, took a back seat as an adjunct to traditional veterinary medicine. Now client demand is growing, prompting the veterinary profession to address the complementary therapy branded animal physical rehabilitation.

At least that's what California's veterinary leaders call it. Title protection bars expanding the term "physical therapy" to animals because state law defines it as a human medical treatment. At presstime, the California Veterinary Medical Association's (CVMA) Board of Governors was considering the level of veterinary supervision required for non-DVMs to practice the modality on animals. Its proposal will go to the California Veterinary Medical Board (CVMB) this year.

Yet while talks concerning the modality's addition to veterinary practice play out in California, Nevada leads the way. In 2004, veterinary officials added a certification process for physical therapists that allows them to practice animal rehabilitation provided they complete additional training and register with the Nevada State Board of Veterinary Medical Examiners. The move prompted the American Association of Veterinary State Boards' (AAVSB) vote to mirror the provision in its model practice act last year.

Still, most state practice acts fail to sanction physical therapy on animals outside of veterinary medicine's direct purview. Contrary to AAVSB, the American Veterinary Medical Association's model act makes no direct exceptions for the modality, and even California refuses to give therapists leeway when it comes to practicing on animals.

State law bars physical therapy outside of the veterinary-client-patient relationship, CVMA Executive Director Valerie Fenstermaker says, but the modality needs to be categorized and defined. With no clear description, it's difficult to distinguish a comfort massage from a therapeutic one, she says. And although CVMB shut down two rehabilitation practices last year, an Internet search reveals plenty more currently receive animal patients.

"We want animal physical rehabilitation in the practice act so it's clear and can be enforced," Fenstermaker says. "It's interesting to look at this whole issue because there is a demand for animal physical rehabilitation. Still, there is not a therapist in California who can legally practice on animals. It isn't even a profession."

Single goal

That might sound harsh, but it does not mean California's 18,000 physical therapists aren't highly trained professionals. Charged with helping patients restore normal physical movement, physical therapy licensure requires clinical training and a master's degree, stimulating many physical therapists to go on to earn doctorates. High standards for education and licensure have earned the profession placement in the mainstream human medical arena, which the California Physical Therapy Association (CPTA) expects will translate to veterinary medicine. Roughly 1 percent of its members work directly with veterinarians, CPTA Chief Staff Executive Patricia Evans says, prompting the profession's desire to collaboratively amend the state's veterinary and physical therapy practice acts to spell out physical therapy's role among animal patients.

"I think veterinarians' concern is our concern as well; people treating animals need to be qualified," she says. "We don't have any requirements yet in the state, which also allows anybody to say they can do animal physical therapy. I'm really hoping that through this collaborative effort that our national association is fostering, it will at least eliminate the doubts and concerns about physical therapists."

Education, training

While few question the length of training involving human medicine, no accreditation guidelines exist for physical therapy programs geared toward human health. Dr. Dick Schumacher, chairman of the California Physical Therapy Task Force and former CVMA executive director, notes the profession's success in veterinary medicine can only be achieved when veterinarians and therapists work together. He favors maintaining a DVM's direct supervision of a patient receiving animal physical rehabilitation.

"The truth is that physical therapists are not educated in the physiology of animals, and veterinarians are not trained to provide physical therapy services," Schumacher says. "Unless you're trained in both, you shouldn't be doing it independently."

Evans predicts an accreditation mechanism will one day emerge. In the meantime, the American Board of Veterinary Specialties is considering animal physical rehabilitation as a boarded specialty.

A case for rehabilitation

If that happens, Darryl Millis might be first in line for diplomate status. Millis, DVM, dipl. ACVS, CCRP, ranks one of the nation's top rehabilitation experts and runs the only institution-tied animal physical therapy certification outlet in the country, which he created a decade ago by teaming up with a physical therapist. Now the professor of orthopedic surgery with the University of Tennessee's veterinary college reports 1,500 people currently are involved in the $5,500 canine course considered the premier program for animal rehabilitation. Whether enrollees are veterinarians, technicians, physical therapists or physical therapist assistants, the post-graduate education is the same: seven courses followed by a two-day examination and 40 hours of required time in the field working with a veterinarian or program graduate.

It's rigorous, which makes it more unfortunate when rehabilitation gets lumped in with aromatherapy and acupuncture, Millis says. "When people graduate, it's something to be proud of. The type of training we offer is cutting edge, based on a lot of research that's been done," he says.

Still, Millis supports direct veterinary supervision when it comes to animal rehabilitation and frowns on states such as Utah and Montana, which permits physical therapy via referral. A collaborative approach offers better care and serves to monitor animal physical rehabilitation, which now appears everywhere, he says.

"As veterinarians become more familiar with rehab, they'll be the primary educators," Millis predicts. "Practice acts will be seen as more protective of diagnosis and treatment. For this reason, I would classify physical therapy not as alternative but complementary. It dovetails nicely with traditional veterinary medicine."