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<div class="editorbox"> '''Original Editor '''- [[User:Alan Jit Ho Mak|Alan Jit Ho Mak]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
== Introduction ==
[[File:82F61BB6-C542-4298-B123-D6BC945CD4B9 1 105 c.jpeg|thumb|Physiotherapy for our 4 legged friends]]
Physiotherapy is defined as: "the therapeutic use of physical agents or means, such as [[massage]] or [[Therapeutic Exercise|exercises]], to treat disease or injury".<ref name=":4">Prydie D, Hewitt I editors. Practical Physiotherapy for Small Animal Practice. Chichester: John Wiley & Sons, Ltd, 2015.</ref> The primary purpose of physiotherapy is to restore patients' mobility, function and quality of life. This is achieved by stimulating the healing process to:<ref name=":4" />
# Restore injured tissues
# Improve injured tissues' strength and balance
# Stabilise cardiorespiratory, neurological, and musculoskeletal systems
Physiotherapy is not only a useful adjunct to medicine for people - it is now seen as a viable rehabilitation option for animals to optimise their performance and prevent injuries.<ref name=":4" /><ref>McGowan CM, Stubbs NC, Jull GA. Equine physiotherapy: a comparative view of the science underlying the profession. Equine veterinary journal. 2007 Jan;39(1):90-4.</ref><ref name=":0">McGowan CM. Introduction. In: McGowan CM, Goff L editors. Animal Physiotherapy: Assessment, Treatment and Rehabilitation of Animals. Wiley-Blackwell, 2016. p.1-2</ref>
Animal Rehabilitation (Rehab)/ Physiotherapy is the application of physiotherapy assessment and treatment techniques to the animal patient.  Human Physiotherapists passionate about animal health care obtain advanced education (dependent on country or provincial/state regulations) to translate their skills to specialize in equine, canine, feline, etc.  The goal is to restore and maintain mobility, function, independence and performance.
== History ==
[[File:PA dog walking.jpg|thumb|422x422px|Many people love their four legged friends.]]The first record of animal physiotherapy being practised came from 1939 when Lord Luis Mountbatten asked the Royal physiotherapist, Sir Charles Strong, to treat his [[Basic Equine Handling, Restraint and Training|horses]].<ref>Calatayud M. A royal history of animal physiotherapy. Available from: http://history.physio/a-brief-history-of-animal-physiotherapy/ (accessed 2 January 2021)</ref> Animal physiotherapy evolved as a profession from this point onwards.<ref name=":1" /> The first official animal physiotherapy association, the Association of Chartered Physiotherapists in Animal Therapy (ACPAT), was formed in the United Kingdom in 1985.<ref>Veenman P. Animal physiotherapy. Journal of Bodywork and Movement Therapies. 2006; 10(4): 317-27.</ref> Then, in 2011, animal physiotherapy was recognised as an official subgroup of the World Confederation of Physical Therapy (WCPT).<ref name=":1">Van Der Walt, A. Introduction to Animal Physiotherapy Course. Plus, 2021.</ref>Animal physiotherapy is currently provided to companion animals, farm animals, and wild, live animal species.<ref>Dybczyńska M, Goleman M, Garbiec A, Karpiński M. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9312226/pdf/animals-12-01760.pdf Selected Techniques for Physiotherapy in Dogs.] Animals (Basel). 2022 Jul 8;12(14):1760.</ref>


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== Transferring knowledge of human physiotherapy to other species ==
'''Original Editor''' - [[User:Alan Jit Ho Mak|Alan Jit Ho Mak]]
[[File:Artificial hip in dog.jpeg|thumb|Dog X-ray R artificial hip, on L hip dysplasia  ]]
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}  &nbsp;
For physiotherapists to successfully transfer their assessment and treatment skills to animals, there must be sufficient similarities in structure, function and physiology across species.<ref name=":1" /> There is a growing evidence base to support the notion that these similarities exist.<ref name=":1" />


'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}  &nbsp; 
For instance, it has been found that
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== Introduction ==
Physiotherapy is defined as the therapeutic use of physical agents / means (i.e. massage or exercises) to treat disease / injury.<ref name=":4">Prydie D, Hewitt I editors.Practical Physiotherapy for Small Animal Practice. Chichester: John Wiley & Sons, Ltd, 2015.</ref><ref name=":3">Rivière S. Physiotherapy for cats and dogs applied to locomotor disorders of arthritic origin. Veterinary Focus. 2007;17(3):32-6.</ref> Physiotherapy is considered a useful adjunct to medicine, both for people and animals.<ref name=":4" /><ref>McGowan CM, Stubbs NC, Jull GA. Equine physiotherapy: a comparative view of the science underlying the profession. Equine veterinary journal. 2007 Jan;39(1):90-4.</ref> The primary purpose of physiotherapy is to restore mobility / function and quality of life to patients.<ref name=":4" />


This is often done by stimulating the healing process to restore injured tissues, to improve the balance / strength of the injured tissues and to stabilise the cardiorespiratory, neurological and musculoskeletal systems. Physiotherapy also has an important role in optimising performance and injury prevention in sporting and working animals. Animal physiotherapy is an emerging field<ref name=":0">McGowan CM. Introduction. In: McGowan CM, Goff L editors. Animal Physiotherapy: Assessment, Treatment and Rehabilitation of Animals. Wiley-Blackwell, 2016. p.1-2</ref> and while it can be used to help any type of animal, the vast majority of cases seen in small animal practice are dogs.<ref>Hayes-Davies D. Physiotherapy for the sporting dog. Companion Animal. 2014 Aug 2;19(8):415-22.</ref>[[File:PA dog walking.jpg|thumb|422x422px]]
* Spontaneous canine cancers have similar pathophysiology and clinical presentation to the equivalent [[Oncology|human cancers]].<ref>Schiffman JD, Breen M. Comparative oncology: what dogs and other species can teach us about humans with cancer. Philos Trans R Soc Lond B Biol Sci. 2015; 370(1673): 20140231.</ref>  
* There are similarities in terms of the disease progression of [[osteochondrosis]] in humans, horses and pigs, including <ref>McCoy AM, Toth F, Dolvik NI, Ekman S, Ellermann J, Olstad K et al. Articular osteochondrosis: a comparison of naturally-occurring human and animal disease. Osteoarthritis Cartilage. 2013; 21(11): 1638-47.</ref> Clinical presentation; Changes on [[MRI Scans|MRI]] and [[X-Rays|x-ray]]; Histological appearance of the end-stage lesion; Locations affected.


== History ==
Moreover, some knowledge relevant to human physiotherapy has come from animal research:  
The first record of animal physiotherapy being practised comes from 1939 when Lord Mountbatten asked the Royal physiotherapist, Sir Charles Strong, to treat his horses.<ref>Calatayud M. A royal history of animal physiotherapy. Available from: http://history.physio/a-brief-history-of-animal-physiotherapy/ (accessed 2 January 2021)</ref> Work in the field evolved from this point on. The first official animal physiotherapy association, the Association of Chartered Physiotherapists in Animal Therapy (ACPAT), was formed in the United Kingdom in 1985<ref>Veenman P. Animal physiotherapy. Journal of Bodywork and Movement Therapies. 2006; 10(4): 317-27.</ref> and, in 2011, animal physiotherapy was recognised as an official subgroup of the World Confederation of Physical Therapy (WCPT).<ref name=":1">Van Der Walt, A. Introduction to Animal Physiotherapy Course. Physioplus, 2021.</ref>


== Transferring knowledge of human physiotherapy to other species ==
* Horses are considered to be appropriate models for research on [[Knee Osteoarthritis|knee osteoarthritis]].<ref name=":1" />  
In order for physiotherapists to be able to successfully transfer their assessment and treatment skills to animals, there must be sufficient similarities in structure, function and physiology across species.<ref name=":1" /> There is a growing evidence base to support the notion that these similarities exist. For example:
* Dogs are the animal model of choice for [[Total Hip Replacement|total hip joint replacements]].<ref>Skurla CP, Pluhar GE, Frankel DJ, Egger EL, James SP. Assessing the dog as a model for human total hip replacement. Analysis of 38 canines cemented femoral components retrieved at post-mortem. J Bone Joint Surg Br. 2005; 87(1): 120-7</ref>
* It has been found that the disease progression of osteochondrosis is similar in humans, horses and pigs. There are similar:<ref>McCoy AM, Toth F, Dolvik NI, Ekman S, Ellermann J, Olstad K et al. Articular osteochondrosis: a comparison of naturally-occurring human and animal disease. Osteoarthritis Cartilage. 2013; 21(11): 1638-47.</ref>
** Clinical presentations
** Changes on MRI and x-ray
** Histological appearances of the end-stage lesion
** Locations affected
* Spontaneous canine cancers have a similar pathophysiology and clinical presentation to the equivalent human cancers<ref>Schiffman JD, Breen M. Comparative oncology: what dogs and other species can teach us about humans with cancer. Philos Trans R Soc Lond B Biol Sci. 2015; 370(1673): 20140231.</ref>
Moreover, some knowledge relevant to human physiotherapy has come from animal research. Horses are considered to be appropriate models for research on osteoarthritis of the knee.<ref name=":1" /> Dogs are the animal model of choice for total hip joint replacements.<ref>Skurla CP, Pluhar GE, Frankel DJ, Egger EL, James SP. Assessing the dog as a model for human total hip replacement. Analysis of 38 canine cemented femoral components retrieved at post-mortem. J Bone Joint Surg Br. 2005; 87(1): 120-7</ref>


== The Role and Scope of Animal Physiotherapists ==
== The Role and Scope of Animal Physiotherapists ==
Animal physiotherapy is continuing to grow and develop as a profession. Animal physiotherapists work alongside a multidisciplinary team, just as they do in conventional physiotherapy. However, in most countries, animal physiotherapists do not have first-line practitioner status. They generally work on referral from a veterinarian.<ref name=":0" /> Thus, there is a legal obligation to communicate with the veterinarian who is in charge of managing the animal patient.
[[File:Horse Physiotherapy.jpeg|thumb|Horse Physiotherapy]]
Animal physiotherapy is continuing to grow and develop as a profession. Animal physiotherapists work alongside a multidisciplinary team, as they do in conventional physiotherapy. However, animal physiotherapists do not have first-line practitioner status in most countries. They generally work on referral from a veterinarian.<ref name=":0" /> Thus, there is a requirement that animal physiotherapists communicate with the veterinarian who is in charge of managing the animal patient.<ref name=":1" />


There also needs to be a positive relationship with the animal’s carers. In the case of horses, this may be a large group, including the horse’s owner, rider, trainer, riding instructor, grooms and stableyard manager. There tends to be fewer carers involved in small animal care, but it is still important that each carer’s role in looking after the pet is understood.<ref name=":1" />
There also needs to be a positive relationship with the animal’s carers. In the case of horses, this may be a large group, including the horse’s owner, rider, trainer, riding instructor, grooms and stable yard manager.<ref name=":1" /> There tend to be fewer carers involved in small animal care, but it is still essential that each carer’s role in looking after the pet is understood.<ref name=":1" />
* NB: There are different legal frameworks for animal physiotherapy across the world. If you are interested in this area of practice, it is essential to understand the legal requirements to practise this sort of physiotherapy in your country<ref name=":1" />
* NB: There are different legal frameworks for animal physiotherapy worldwide. If you are interested in this area of practice, it is essential to understand the legal requirements to practise this sort of physiotherapy in your country<ref name=":1" />
Physiotherapy can be beneficial for animals with a wide range of conditions. It is often indicated post-operatively to correct complications that can occur as a result of surgery. The demand for post-operative animal physiotherapy has kept pace with the growing number of surgical options for small animal patients.<ref name=":0" />
Physiotherapy can be beneficial for animals with a wide range of conditions. It is often indicated post-operatively to correct complications that can occur as a result of surgery.<ref name=":4" /> The demand for post-operative animal physiotherapy has kept pace with the growing number of surgical options for small animal patients.<ref name=":0" />


Like conventional physiotherapy, animal physiotherapy is divided into a wide variety of specialities. In veterinary medicine, the divisions are:<ref>Price H. Introduction to veterinary physiotherapy. Companion Animal. 2014; 19(3): 130-3.</ref>
Like conventional physiotherapy, animal physiotherapy is divided into various specialities. In animal physiotherapy, the divisions are:<ref>Price H. Introduction to veterinary physiotherapy. Companion Animal. 2014; 19(3): 130-3.</ref>
* Musculoskeletal
* Musculoskeletal
* Respiratory
* Respiratory
Line 37: Line 40:
* Neurological
* Neurological
* Sports medicine
* Sports medicine
* Elderly care / geriatrics
* Elderly care/geriatrics
* Developmental problems


=== Musculoskeletal ===
=== Musculoskeletal ===
Most people consider this as 'traditional physiotherapy'. The conditions seen can be split into soft-tissue injuries, such as sprains / strains or ruptures of ligaments, tendons or muscles; bursitis and bone or joint disease, such as osteochondritis dissecans. The injuries may be a result of either a traumatic event or overuse, where the owner cannot recall the specific onset of symptoms.<ref>Goff L, Crook T. Physiotherapy assessment for animals. Animal physiotherapy, assessment, treatment and rehabilitation of animals. UK: Blackwell Publishing. 2007 Jan 1:136-63.</ref>
Injuries or dysfunctions in this area include soft-tissue injuries, such as sprains/strains or ruptures of ligaments, tendons or muscles; bursitis and bone or joint disease, such as osteochondritis dissecans.<ref name=":4" /> Injuries may occur following trauma or be caused by overuse.<ref name=":4" />  


=== Respiratory ===
=== Respiratory ===
This encompasses the acute care of animals in a hospital, specifically for:
Respiratory physiotherapy for animals is usually required if animals are ventilated or for post-anaesthetic recovery.<ref name=":4" /> Respiratory physiotherapy aims to:<ref name=":4" />
* post-anaesthetic recovery
* Manage secretions
* ventilated animals
* Prevent pressure sores
Physiotherapy aims at managing secretions, preventing pressure sores, preventing atelectasis, reducing the work of breathing and optimising the ventilation / perfusion ratio to ensure high oxygen saturation levels.
* Prevent atelectasis
 
* Reduce the work of breathing
These aims are achieved through positioning (for pressure relief, postural drainage or to influence ventilation / perfusion ratio within the lungs), manual techniques such as percussion or vibrations to remove secretions, neuromuscular techniques such as rib springing to increase lung capacity and manual hyperinflation or bagging to improve ventilation and to aid secretion removal.
* Optimise the ventilation/perfusion ratios
Techniques include positioning, manual techniques (i.e. percussion or vibrations to remove secretions), neuromuscular techniques, and manual hyperinflation or bagging.<ref name=":4" />


=== Orthopaedics ===
=== Orthopaedics ===
Physiotherapy following surgery is used to maximise the success of the surgery. By working with the surgeon, recovery can be optimised. Orthopaedic surgeons may have their own protocols for rehabilitation following surgery and knowledge of these protocols is needed by the owner and therapist before embarking on a rehabilitation programme. These protocols provide specific guidance about weight-bearing status and when specific exercises can be introduced.<ref name=":2">Colveiro AC, Rauber JS, Ripplinger A, Wrzesinski M, Schwab ML, Pigatto A, Ferrarin DA, Mazzanti A. Neurological and Orthopedic Diseases in Dogs and Cats Submitted to Physiotherapy. Acta Scientiae Veterinariae. 2020 Oct 13;48.</ref>
Post-operative animal physiotherapy can help to enhance a patient's outcomes following surgery. The physiotherapist should understand a surgeon's protocol before commencing a rehabilitation plan (including the animal's weight-bearing status and when specific exercises should be introduced).<ref name=":4" />


=== Neurological ===
=== Neurological ===
Neurological physiotherapy refers to the rehabilitation of animals following a neurological injury, which can involve a single limb or the whole body. One of the most common neurological dysfunctions in small animals in intervertebral disc disease.<ref name=":2" /> Neurological damage can be managed conservatively or surgically. It may completely resolve or can leave lasting damage.<ref name=":2" />
Neurological physiotherapy is indicated after a neurological injury has occurred. It may involve rehabilitating the whole body or just a single limb.<ref name=":4" /> Intervertebral disc disease is one of the most common causes of neurological dysfunction in small animals.<ref name=":2">Colveiro AC, Rauber JS, Ripplinger A, Wrzesinski M, Schwab ML, Pigatto A, Ferrarin DA, Mazzanti A. Neurological and Orthopedic Diseases in Dogs and Cats Submitted to Physiotherapy. Acta Scientiae Veterinariae. 2020 Oct 13;48.</ref> Neurological injuries may be managed conservatively or surgically, but the amount of initial damage can majorly impact the long-term recovery outcomes.<ref name=":4" /> Common treatments for neurological and orthopaedic dysfunction include:<ref name=":2" />
 
* Massage
The amount of initial damage usually has a significant impact on the ultimate recovery. Massage, stretching, passive joint mobilisation, and neuromuscular electrical stimulation (NMES) are some of the most commonly used treatments for both neurological and orthopaedic dysfunctions.<ref name=":2" /> Long-term solutions to permanent damage sometimes have to be sought, such as using wheels, harnesses or splints, to support the animal's everyday activities.
* Stretching
* Passive joint mobilisation
* Neuromuscular electrical stimulation (NMES)
Sometimes animal physiotherapists will need to consider if long-term assistive solutions are required, such as providing an animal with wheels, harnesses or splints. These can enhance the patient's ability to continue performing daily activities.<ref name=":4" />


=== Sports medicine ===
=== Sports medicine ===
The preparation of an animal for athletic activity is extremely important and requires physical training, skill training and cardiovascular training. Modalities that reduce recovery time and encourage a return to full fitness are considered vital to protect what are considered “valuable assets”.<ref>Doyle A, Horgan NF. Perceptions of animal physiotherapy amongst Irish veterinary surgeons. Ir Vet J. 2006; 59(2): 85-89. </ref>
Animal physiotherapists are also involved in training animals for athletic or sporting activities.<ref name=":4" /> Interventions that reduce recovery time and encourage a return to full fitness are vital to protect what is considered “valuable assets”.<ref>Doyle A, Horgan NF. Perceptions of animal physiotherapy amongst Irish veterinary surgeons. Ir Vet J. 2006; 59(2): 85-89. </ref> Animal physiotherapists must also be able to guide owners about appropriate conditioning programmes (specific to both the sport's and the animal's requirements).<ref name=":4" />  


Animal physiotherapists can help to guide owners on conditioning programmes that are both sports- and animal-specific. Different sports will place very different demands on animals. For instance, the endurance capability of a sled dog is very different to the speed of a racing greyhound. The rehabilitation of sports injuries is also extremely important as often these animals are not lame, but subtle changes in muscle tightness can affect their performance.
=== Elderly care/geriatrics ===
 
Like humans, Pets live longer, so increasing numbers of animals present with age-related issues.<ref name=":4" /><ref name=":3">Rivière S. Physiotherapy for cats and dogs applied to locomotor disorders of arthritic origin. Veterinary Focus. 2007;17(3):32-6.</ref> Appropriate therapeutic interventions can help to slow down conditions such as arthritis and reduce an older pet's discomfort.<ref name=":3" /> It is important to remember that these older patients, like their human counterparts, often present with other co-morbidities, which can complicate the rehabilitation process.<ref name=":4" /><ref>Cottriall S. The geriatric canine and physiotherapy. Companion Animal. 2014; 19: 296-300. </ref> A holistic management approach, including diet, exercise, environmental considerations, and pain relief, can help to ensure that these animals stay comfortable and maintain their function for longer.<ref name=":4" />
=== Elderly care / geriatrics ===
As pets (and owners) are living longer, there are increasing numbers of arthritic animals presenting for treatment. These animals often have other co-morbidities, such as diabetes, that can complicate the rehabilitation process.<ref>Cottriall S. The geriatric canine and physiotherapy. Companion Animal. 2014; 19: 296-300. </ref> A holistic management approach will help to ensure that these animals can stay comfortable and maintain their function for longer.


=== Developmental problems ===
=== Developmental problems ===
A large number of young animals are seen with genetic / developmental problems, and they benefit greatly from physiotherapy to support their joints. Conditions such as hip and elbow dysplasia are often seen. Physiotherapy, including hydrotherapy,<ref>Preston T, Wills AP. A single hydrotherapy session increases range of motion and stride length in Labrador retrievers diagnosed with elbow dysplasia. The Veterinary Journal. 2018; 234: 105-10.</ref> can improve their quality of life and prevent further problems or surgeries such as total hip replacements.
Animal physiotherapists see many young animals with genetic or developmental problems (e.g. hip and elbow dysplasia).<ref name=":4" /> Physiotherapy management, including hydrotherapy,<ref>Preston T, Wills AP. A single hydrotherapy session increases the range of motion and stride length in Labrador retrievers diagnosed with elbow dysplasia. The Veterinary Journal. 2018; 234: 105-10.</ref> can enhance these animals' quality of life, and long-term may reduce the likelihood of needing surgery (such as total hip replacements).<ref name=":4" />


== Evidence to Support the Use of Physiotherapy in Animals ==
== Evidence to Support the Use of Physiotherapy in Animals ==
While there are not many well-designed studies to support the use of physiotherapy in animals, massage is one area that has been researched in more detail. It has been proposed that because of similarities in physiology and anatomy between humans and certain animals, massage may confer similar benefits in animals as it does in people. Several studies have explored this hypothesis and found that:<ref>Corti L. Massage therapy for dogs and cats. Top Companion Anim Med. 2014; 29(2): 54-7. </ref>
While not many well-designed studies support the use of physiotherapy in animals, massage is one area that has been researched in more detail. It has been proposed that because of similarities in the physiology and anatomy between humans and other animals, massage may confer similar benefits in animals as it does in people. These benefits include: encouraging relaxation, reducing pain and muscle tension, enhancing venous and lymphatic circulation, and stimulating the nervous system.<ref name=":3" /> Several studies have explored these hypotheses and found that:<ref>Corti L. Massage therapy for dogs and cats. Top Companion Anim Med. 2014; 29(2): 54-7. </ref>
* Manual lymph drainage can reduce experimentally-induced lymphoedema in rats when compared to a control group<ref name=":1" />
* Manual lymph drainage can reduce experimentally-induced lymphoedema in rats when compared to a control group<ref name=":1" />
* Massaging the caudal thigh muscles of horses increases range of motion when compared to a sham treatment<ref>Hill C, Crook T. The relationship between massage to the equine caudal hindlimb muscles and hindlimb protraction. Equine Vet J Suppl. 2010; (38): 683-7. </ref>
* Massaging the caudal thigh muscles of horses increases the range of motion compared to a sham treatment<ref>Hill C, Crook T. The relationship between massage to the equine caudal hindlimb muscles and hindlimb protraction. Equine Vet J Suppl. 2010; (38): 683-7. </ref>
* The use of relaxing massage may help to calm and relax racehorses and improve race performance<ref>Kowalik S, Janczarek I, Kędzierski W, Stachurska A, Wilk I. The effect of relaxing massage on heart rate and heart rate variability in purebred Arabian racehorses. Anim Sci J. 2017; 88(4): 669-77. </ref>
* Relaxing massage may help calm and relax racehorses and improve race performance<ref>Kowalik S, Janczarek I, Kędzierski W, Stachurska A, Wilk I. Relaxing massage affects heart rate and heart rate variability in purebred Arabian racehorses. Anim Sci J. 2017; 88(4): 669-77. </ref>


== Differences between humans and animals ==
== Differences between humans and animals ==
Despite the similarities between humans and animals discussed above, there are also important differences (i.e. quadruped vs biped). It is important to understand the comparative anatomy and biomechanics of each species in order to determine the best treatment option.<ref name=":1" /> 
Despite the similarities between humans and animals discussed above, there are also many differences. Animal physiotherapists must have a good understanding of each species' comparative anatomy and biomechanics to establish an effective treatment plan.<ref name=":1" /> 
 
Pathogenesis can be different even in shared pathologies or dysfunctions:
* In humans, cruciate ligament ruptures are an acute injury more common in athletes, but in dogs they are the result of chronic disease processes.<ref>Griffon DJ. A review of the pathogenesis of canine cranial cruciate ligament disease as a basis for future preventive strategies. Vet Surg. 2010; 39(4): 399-409. </ref> Therefore, post-operative rehabilitation occurs in the context of chronic deconditioning<ref name=":1" />
* In humans, there are dynamic fluctuations in intervertebral disc disease, but in dogs (particularly chondrodystrophic (i.e. short legged phenotype) dogs like dachshunds), the disc calcifies and if disc material extrudes, surgery is almost always recommended<ref name=":1" />


The pathogenesis of diseases can be very different between animals and humans, even in shared pathologies or dysfunctions.<ref name=":1" /> For example:
* In humans, [[Anterior Cruciate Ligament (ACL)|cruciate ligament]] ruptures are an acute injury more common in athletes, but in dogs, they are the result of [[Chronic Disease|chronic disease]] processes.<ref>Griffon DJ. A review of the pathogenesis of canine cranial cruciate ligament disease as a basis for future preventive strategies. Vet Surg. 2010; 39(4): 399-409. </ref> Therefore, post-operative rehabilitation for cruciate ligament repair in animals occurs in the context of chronic deconditioning<ref name=":1" />
* In humans, there are dynamic fluctuations in [[intervertebral disc]] disease. Still, in dogs, particularly chondrodystrophic (i.e. short-legged phenotype) dogs like dachshunds, the disc calcifies, and surgery is almost always indicated if disc material extrudes.<ref name=":1" /> As mentioned above, intervertebral disc disease is one of the most common causes of the cause of neurological dysfunction in small animals.<ref name=":2" />
<div class="row">
  <div class="col-md-6"> {{#ev:youtube|UKXVyNFe31k}}<ref>Southpaws Specialty Surgery for Animals PTY LTD. Cruciate Disease in Dogs Explained With Animation. Available from: https://www.youtube.com/watch?v=UKXVyNFe31k [last accessed 4/1/2021]</ref> </div>
  <div class="col-md-6"> {{#ev:youtube|7OgOSwNL9Qs}}<ref>Southeast Veterinary Neurology. What is Intervertebral Disk Disease(IVDD) in Dogs?. Available from: https://www.youtube.com/watch?v=7OgOSwNL9Qs [last accessed 4/1/2021]</ref> </div>
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== Human-Animal Dyad ==
== Human-Animal Dyad ==
The human-animal dyad refers to the relationship between a human caregiver and the animal. This can mimic a parent-child relationship. The dog–human attachment bond, for instance, is said to include all four features of attachment bonds that arise in human caregiver–infant relationships:<ref>Payne E, Bennett PC, McGreevy PD. Current perspectives on attachment and bonding in the dog-human dyad. Psychol Res Behav Manag. 2015; 8: 71-9. </ref>
[[File:07631C2A-0BA0-40B7-BEFE-3F6C039F090B 1 105 c.jpeg|thumb|354x354px|Dog–human attachment bond]]
The human–animal bond (or dyad) is "the mutually beneficial and dynamic relationship between humans and other animals, modulated by reciprocal behaviours that are essential to the health and wellbeing of both subjects involved."<ref>Scopa C, Contalbrigo L, Greco A, Lanatà A, Scilingo EP, Baragli P. Emotional Transfer in Human-Horse Interaction: New Perspectives on Equine Assisted Interventions. ''Animals (Basel)''. 2019; 9(12): 1030.</ref> This dyad can mimic a parent-child relationship. The dog–human attachment bond, for instance, includes all four features of attachment bonds that arise in human caregiver-infant relationships:<ref>Payne E, Bennett PC, McGreevy PD. Current perspectives on attachment and bonding in the dog-human dyad. Psychol Res Behav Manag. 2015; 8: 71-9. </ref>
# Proximity seeking
# Proximity seeking
# Separation related distress
# Separation-related distress
# Safe-haven effect
# Safe-haven effect
# Secure base effect
# Secure base effect
When assessing animal patients, it is important to remember that all of the information about an animal comes directly from the owner, even when using validated pain measures.<ref name=":1" /> The carer's own personality traits and emotions can have a significant impact on the animal.<ref name=":1" /> For instance, owners who tend to catastrophise and have higher pain-related anxiety are more likely to catastrophise about their animal’s pain levels or disability.<ref name=":1" /> Pain neuroscience education for the owner, therefore, plays an important role in treatment of the animal.<ref name=":1" />
A study by Schöberl and colleagues reinforces this notion of attachment. This study found that dogs considered as either a “social partners” or a“meaningful companions” of their owners had lower morning salivary cortisol control values than other dogs.<ref>Schöberl I, Wedl M, Bauer B, Day J, Möstl E, Kotrschal K. Effects of owner-dog relationship and owner personality on cortisol modulation in human-dog dyads. ''Anthrozoös. 2012; 25''(2): 199–214.</ref>
 
When assessing animal patients, it is important to remember that all the information about an animal comes directly from the carer. Moreover, the carer's personality and emotions can significantly impact the animal.<ref name=":1" /> Neuroticism is, for instance, positively associated with pain catastrophising and pain-related anxiety.<ref>Kadimpati S, Zale EL, Hooten MW, Ditre JW, Warner DO. Associations between Neuroticism and Depression in Relation to Catastrophizing and Pain-Related Anxiety in Chronic Pain Patients. PLoS One. 2015; 10(4): e0126351. </ref> Owners who display these characteristics are more likely to catastrophise about their animal’s pain levels or disability.<ref name=":1" /> A study by Pettersson notes that both dogs' and their carers' oxytocin and cortisol levels are related to the ways in which the owner interacts with the dog and the behaviours that stem from this interaction.<ref>Petersson M, Uvnäs-Moberg K, Nilsson A, Gustafson LL, Hydbring-Sandberg E, Handlin L. Oxytocin and Cortisol Levels in Dog Owners and Their Dogs Are Associated with Behavioral Patterns: An Exploratory Study. Front Psychol. 2017; 8: 1796.</ref> Pain neuroscience education for the owner, therefore, plays an important role in animal treatment.<ref name=":1" />


In the case of horses, research shows that there is a high degree of emotional contagion. Emotional contagion is defined as: “the phenomenon of an automatic adoption of an emotional state of another person”.<ref>Singer T, Tusche A. Understanding others: brain mechanisms of theory of mind and empathy. In: Glimcher PW, Fehr E editors. Neuroeconomics: Decision making and the brain. London: Elsevier, 2014. p.513-32</ref> In animal physiotherapy, it refers specifically to the animal reflecting the emotional state of conspecifics (i.e. a member of the same species), or of other animals / individuals in their environment.<ref name=":1" /> Horses have been found to demonstrate emotional contagion when observing human-horse interactions.<ref>Trösch M, Pellon S, Cuzol F, Parias C, Nowak R, Calandreau L et al. Horses feel emotions when they watch positive and negative horse-human interactions in a video and transpose what they saw to real life. Anim Cogn. 2020; 23(4): 643-53.</ref>
In the case of horses, research shows that there is a high degree of emotional contagion. Emotional contagion is “the phenomenon of an automatic adoption of an emotional state of another person”.<ref>Singer T, Tusche A. Understanding others: brain mechanisms of theory of mind and empathy. In: Glimcher PW, Fehr E editors. Neuroeconomics: Decision making and the brain. London: Elsevier, 2014. p.513-32</ref> In animal physiotherapy, it refers to the animal reflecting the emotional state of conspecifics (i.e. a member of the same species), or of other animals/humans in their environment.<ref name=":1" /> Horses have been found to demonstrate emotional contagion when observing human-horse interactions.<ref>Trösch M, Pellon S, Cuzol F, Parias C, Nowak R, Calandreau L et al. Horses feel emotions when they watch positive and negative horse-human interactions in a video and transpose what they saw to real life. Anim Cogn. 2020; 23(4): 643-53.</ref>


Understanding these relationships, as well as having an awareness of animal behaviour enables the physiotherapist to approach and handle animal patients in a safe and effective way.<ref name=":1" />
Understanding this human-animal dyad and having an awareness of animal behaviour enables the physiotherapist to approach and handle animal patients safely and effectively.<ref name=":1" />


== Summary ==
== Summary ==
* Animal physiotherapy is a growing area of practice
* Animal physiotherapy is growing as an area of practice
* While research is limited at present, there is evidence of sufficient interspecies similarities to support the use of human techniques on animals
* While research is limited at present, there is evidence of sufficient interspecies similarities to support the use of human physiotherapy techniques on animals
* Physiotherapy can be beneficial to all animals, but the choice of treatment can be limited by the presence of co-morbidities
* The behaviour of an animal, the level of understanding of the owner and their emotions can influence the outcome of physiotherapy interventions
* The behaviour of an animal, the level of understanding of the owner and their emotions can influence the outcome of physiotherapy interventions


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[[Category:Animal Physiotherapy]]
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Latest revision as of 21:03, 24 January 2023

Original Editor - Alan Jit Ho Mak Top Contributors - Alan Jit Ho Mak, Jess Bell, Tarina van der Stockt, Lucinda hampton, Kim Jackson, Ewa Jaraczewska, Rucha Gadgil and Aminat Abolade

Introduction[edit | edit source]

Physiotherapy for our 4 legged friends

Physiotherapy is defined as: "the therapeutic use of physical agents or means, such as massage or exercises, to treat disease or injury".[1] The primary purpose of physiotherapy is to restore patients' mobility, function and quality of life. This is achieved by stimulating the healing process to:[1]

  1. Restore injured tissues
  2. Improve injured tissues' strength and balance
  3. Stabilise cardiorespiratory, neurological, and musculoskeletal systems

Physiotherapy is not only a useful adjunct to medicine for people - it is now seen as a viable rehabilitation option for animals to optimise their performance and prevent injuries.[1][2][3]

Animal Rehabilitation (Rehab)/ Physiotherapy is the application of physiotherapy assessment and treatment techniques to the animal patient.  Human Physiotherapists passionate about animal health care obtain advanced education (dependent on country or provincial/state regulations) to translate their skills to specialize in equine, canine, feline, etc.  The goal is to restore and maintain mobility, function, independence and performance.

History[edit | edit source]

Many people love their four legged friends.

The first record of animal physiotherapy being practised came from 1939 when Lord Luis Mountbatten asked the Royal physiotherapist, Sir Charles Strong, to treat his horses.[4] Animal physiotherapy evolved as a profession from this point onwards.[5] The first official animal physiotherapy association, the Association of Chartered Physiotherapists in Animal Therapy (ACPAT), was formed in the United Kingdom in 1985.[6] Then, in 2011, animal physiotherapy was recognised as an official subgroup of the World Confederation of Physical Therapy (WCPT).[5]Animal physiotherapy is currently provided to companion animals, farm animals, and wild, live animal species.[7]

Transferring knowledge of human physiotherapy to other species[edit | edit source]

Dog X-ray R artificial hip, on L hip dysplasia

For physiotherapists to successfully transfer their assessment and treatment skills to animals, there must be sufficient similarities in structure, function and physiology across species.[5] There is a growing evidence base to support the notion that these similarities exist.[5]

For instance, it has been found that

  • Spontaneous canine cancers have similar pathophysiology and clinical presentation to the equivalent human cancers.[8]
  • There are similarities in terms of the disease progression of osteochondrosis in humans, horses and pigs, including [9] Clinical presentation; Changes on MRI and x-ray; Histological appearance of the end-stage lesion; Locations affected.

Moreover, some knowledge relevant to human physiotherapy has come from animal research:

The Role and Scope of Animal Physiotherapists[edit | edit source]

Horse Physiotherapy

Animal physiotherapy is continuing to grow and develop as a profession. Animal physiotherapists work alongside a multidisciplinary team, as they do in conventional physiotherapy. However, animal physiotherapists do not have first-line practitioner status in most countries. They generally work on referral from a veterinarian.[3] Thus, there is a requirement that animal physiotherapists communicate with the veterinarian who is in charge of managing the animal patient.[5]

There also needs to be a positive relationship with the animal’s carers. In the case of horses, this may be a large group, including the horse’s owner, rider, trainer, riding instructor, grooms and stable yard manager.[5] There tend to be fewer carers involved in small animal care, but it is still essential that each carer’s role in looking after the pet is understood.[5]

  • NB: There are different legal frameworks for animal physiotherapy worldwide. If you are interested in this area of practice, it is essential to understand the legal requirements to practise this sort of physiotherapy in your country[5]

Physiotherapy can be beneficial for animals with a wide range of conditions. It is often indicated post-operatively to correct complications that can occur as a result of surgery.[1] The demand for post-operative animal physiotherapy has kept pace with the growing number of surgical options for small animal patients.[3]

Like conventional physiotherapy, animal physiotherapy is divided into various specialities. In animal physiotherapy, the divisions are:[11]

  • Musculoskeletal
  • Respiratory
  • Orthopaedics
  • Neurological
  • Sports medicine
  • Elderly care/geriatrics
  • Developmental problems

Musculoskeletal[edit | edit source]

Injuries or dysfunctions in this area include soft-tissue injuries, such as sprains/strains or ruptures of ligaments, tendons or muscles; bursitis and bone or joint disease, such as osteochondritis dissecans.[1] Injuries may occur following trauma or be caused by overuse.[1]

Respiratory[edit | edit source]

Respiratory physiotherapy for animals is usually required if animals are ventilated or for post-anaesthetic recovery.[1] Respiratory physiotherapy aims to:[1]

  • Manage secretions
  • Prevent pressure sores
  • Prevent atelectasis
  • Reduce the work of breathing
  • Optimise the ventilation/perfusion ratios

Techniques include positioning, manual techniques (i.e. percussion or vibrations to remove secretions), neuromuscular techniques, and manual hyperinflation or bagging.[1]

Orthopaedics[edit | edit source]

Post-operative animal physiotherapy can help to enhance a patient's outcomes following surgery. The physiotherapist should understand a surgeon's protocol before commencing a rehabilitation plan (including the animal's weight-bearing status and when specific exercises should be introduced).[1]

Neurological[edit | edit source]

Neurological physiotherapy is indicated after a neurological injury has occurred. It may involve rehabilitating the whole body or just a single limb.[1] Intervertebral disc disease is one of the most common causes of neurological dysfunction in small animals.[12] Neurological injuries may be managed conservatively or surgically, but the amount of initial damage can majorly impact the long-term recovery outcomes.[1] Common treatments for neurological and orthopaedic dysfunction include:[12]

  • Massage
  • Stretching
  • Passive joint mobilisation
  • Neuromuscular electrical stimulation (NMES)

Sometimes animal physiotherapists will need to consider if long-term assistive solutions are required, such as providing an animal with wheels, harnesses or splints. These can enhance the patient's ability to continue performing daily activities.[1]

Sports medicine[edit | edit source]

Animal physiotherapists are also involved in training animals for athletic or sporting activities.[1] Interventions that reduce recovery time and encourage a return to full fitness are vital to protect what is considered “valuable assets”.[13] Animal physiotherapists must also be able to guide owners about appropriate conditioning programmes (specific to both the sport's and the animal's requirements).[1]

Elderly care/geriatrics[edit | edit source]

Like humans, Pets live longer, so increasing numbers of animals present with age-related issues.[1][14] Appropriate therapeutic interventions can help to slow down conditions such as arthritis and reduce an older pet's discomfort.[14] It is important to remember that these older patients, like their human counterparts, often present with other co-morbidities, which can complicate the rehabilitation process.[1][15] A holistic management approach, including diet, exercise, environmental considerations, and pain relief, can help to ensure that these animals stay comfortable and maintain their function for longer.[1]

Developmental problems[edit | edit source]

Animal physiotherapists see many young animals with genetic or developmental problems (e.g. hip and elbow dysplasia).[1] Physiotherapy management, including hydrotherapy,[16] can enhance these animals' quality of life, and long-term may reduce the likelihood of needing surgery (such as total hip replacements).[1]

Evidence to Support the Use of Physiotherapy in Animals[edit | edit source]

While not many well-designed studies support the use of physiotherapy in animals, massage is one area that has been researched in more detail. It has been proposed that because of similarities in the physiology and anatomy between humans and other animals, massage may confer similar benefits in animals as it does in people. These benefits include: encouraging relaxation, reducing pain and muscle tension, enhancing venous and lymphatic circulation, and stimulating the nervous system.[14] Several studies have explored these hypotheses and found that:[17]

  • Manual lymph drainage can reduce experimentally-induced lymphoedema in rats when compared to a control group[5]
  • Massaging the caudal thigh muscles of horses increases the range of motion compared to a sham treatment[18]
  • Relaxing massage may help calm and relax racehorses and improve race performance[19]

Differences between humans and animals[edit | edit source]

Despite the similarities between humans and animals discussed above, there are also many differences. Animal physiotherapists must have a good understanding of each species' comparative anatomy and biomechanics to establish an effective treatment plan.[5] 

The pathogenesis of diseases can be very different between animals and humans, even in shared pathologies or dysfunctions.[5] For example:

  • In humans, cruciate ligament ruptures are an acute injury more common in athletes, but in dogs, they are the result of chronic disease processes.[20] Therefore, post-operative rehabilitation for cruciate ligament repair in animals occurs in the context of chronic deconditioning[5]
  • In humans, there are dynamic fluctuations in intervertebral disc disease. Still, in dogs, particularly chondrodystrophic (i.e. short-legged phenotype) dogs like dachshunds, the disc calcifies, and surgery is almost always indicated if disc material extrudes.[5] As mentioned above, intervertebral disc disease is one of the most common causes of the cause of neurological dysfunction in small animals.[12]
[21]
[22]

Human-Animal Dyad[edit | edit source]

Dog–human attachment bond

The human–animal bond (or dyad) is "the mutually beneficial and dynamic relationship between humans and other animals, modulated by reciprocal behaviours that are essential to the health and wellbeing of both subjects involved."[23] This dyad can mimic a parent-child relationship. The dog–human attachment bond, for instance, includes all four features of attachment bonds that arise in human caregiver-infant relationships:[24]

  1. Proximity seeking
  2. Separation-related distress
  3. Safe-haven effect
  4. Secure base effect

A study by Schöberl and colleagues reinforces this notion of attachment. This study found that dogs considered as either a “social partners” or a“meaningful companions” of their owners had lower morning salivary cortisol control values than other dogs.[25]

When assessing animal patients, it is important to remember that all the information about an animal comes directly from the carer. Moreover, the carer's personality and emotions can significantly impact the animal.[5] Neuroticism is, for instance, positively associated with pain catastrophising and pain-related anxiety.[26] Owners who display these characteristics are more likely to catastrophise about their animal’s pain levels or disability.[5] A study by Pettersson notes that both dogs' and their carers' oxytocin and cortisol levels are related to the ways in which the owner interacts with the dog and the behaviours that stem from this interaction.[27] Pain neuroscience education for the owner, therefore, plays an important role in animal treatment.[5]

In the case of horses, research shows that there is a high degree of emotional contagion. Emotional contagion is “the phenomenon of an automatic adoption of an emotional state of another person”.[28] In animal physiotherapy, it refers to the animal reflecting the emotional state of conspecifics (i.e. a member of the same species), or of other animals/humans in their environment.[5] Horses have been found to demonstrate emotional contagion when observing human-horse interactions.[29]

Understanding this human-animal dyad and having an awareness of animal behaviour enables the physiotherapist to approach and handle animal patients safely and effectively.[5]

Summary[edit | edit source]

  • Animal physiotherapy is growing as an area of practice
  • While research is limited at present, there is evidence of sufficient interspecies similarities to support the use of human physiotherapy techniques on animals
  • The behaviour of an animal, the level of understanding of the owner and their emotions can influence the outcome of physiotherapy interventions

References[edit | edit source]

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 Prydie D, Hewitt I editors. Practical Physiotherapy for Small Animal Practice. Chichester: John Wiley & Sons, Ltd, 2015.
  2. ↑ McGowan CM, Stubbs NC, Jull GA. Equine physiotherapy: a comparative view of the science underlying the profession. Equine veterinary journal. 2007 Jan;39(1):90-4.
  3. ↑ 3.0 3.1 3.2 McGowan CM. Introduction. In: McGowan CM, Goff L editors. Animal Physiotherapy: Assessment, Treatment and Rehabilitation of Animals. Wiley-Blackwell, 2016. p.1-2
  4. ↑ Calatayud M. A royal history of animal physiotherapy. Available from: http://history.physio/a-brief-history-of-animal-physiotherapy/ (accessed 2 January 2021)
  5. ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 Van Der Walt, A. Introduction to Animal Physiotherapy Course. Plus, 2021.
  6. ↑ Veenman P. Animal physiotherapy. Journal of Bodywork and Movement Therapies. 2006; 10(4): 317-27.
  7. ↑ Dybczyńska M, Goleman M, Garbiec A, Karpiński M. Selected Techniques for Physiotherapy in Dogs. Animals (Basel). 2022 Jul 8;12(14):1760.
  8. ↑ Schiffman JD, Breen M. Comparative oncology: what dogs and other species can teach us about humans with cancer. Philos Trans R Soc Lond B Biol Sci. 2015; 370(1673): 20140231.
  9. ↑ McCoy AM, Toth F, Dolvik NI, Ekman S, Ellermann J, Olstad K et al. Articular osteochondrosis: a comparison of naturally-occurring human and animal disease. Osteoarthritis Cartilage. 2013; 21(11): 1638-47.
  10. ↑ Skurla CP, Pluhar GE, Frankel DJ, Egger EL, James SP. Assessing the dog as a model for human total hip replacement. Analysis of 38 canines cemented femoral components retrieved at post-mortem. J Bone Joint Surg Br. 2005; 87(1): 120-7
  11. ↑ Price H. Introduction to veterinary physiotherapy. Companion Animal. 2014; 19(3): 130-3.
  12. ↑ 12.0 12.1 12.2 Colveiro AC, Rauber JS, Ripplinger A, Wrzesinski M, Schwab ML, Pigatto A, Ferrarin DA, Mazzanti A. Neurological and Orthopedic Diseases in Dogs and Cats Submitted to Physiotherapy. Acta Scientiae Veterinariae. 2020 Oct 13;48.
  13. ↑ Doyle A, Horgan NF. Perceptions of animal physiotherapy amongst Irish veterinary surgeons. Ir Vet J. 2006; 59(2): 85-89.
  14. ↑ 14.0 14.1 14.2 Rivière S. Physiotherapy for cats and dogs applied to locomotor disorders of arthritic origin. Veterinary Focus. 2007;17(3):32-6.
  15. ↑ Cottriall S. The geriatric canine and physiotherapy. Companion Animal. 2014; 19: 296-300.
  16. ↑ Preston T, Wills AP. A single hydrotherapy session increases the range of motion and stride length in Labrador retrievers diagnosed with elbow dysplasia. The Veterinary Journal. 2018; 234: 105-10.
  17. ↑ Corti L. Massage therapy for dogs and cats. Top Companion Anim Med. 2014; 29(2): 54-7.
  18. ↑ Hill C, Crook T. The relationship between massage to the equine caudal hindlimb muscles and hindlimb protraction. Equine Vet J Suppl. 2010; (38): 683-7.
  19. ↑ Kowalik S, Janczarek I, Kędzierski W, Stachurska A, Wilk I. Relaxing massage affects heart rate and heart rate variability in purebred Arabian racehorses. Anim Sci J. 2017; 88(4): 669-77.
  20. ↑ Griffon DJ. A review of the pathogenesis of canine cranial cruciate ligament disease as a basis for future preventive strategies. Vet Surg. 2010; 39(4): 399-409.
  21. ↑ Southpaws Specialty Surgery for Animals PTY LTD. Cruciate Disease in Dogs Explained With Animation. Available from: https://www.youtube.com/watch?v=UKXVyNFe31k [last accessed 4/1/2021]
  22. ↑ Southeast Veterinary Neurology. What is Intervertebral Disk Disease(IVDD) in Dogs?. Available from: https://www.youtube.com/watch?v=7OgOSwNL9Qs [last accessed 4/1/2021]
  23. ↑ Scopa C, Contalbrigo L, Greco A, Lanatà A, Scilingo EP, Baragli P. Emotional Transfer in Human-Horse Interaction: New Perspectives on Equine Assisted Interventions. Animals (Basel). 2019; 9(12): 1030.
  24. ↑ Payne E, Bennett PC, McGreevy PD. Current perspectives on attachment and bonding in the dog-human dyad. Psychol Res Behav Manag. 2015; 8: 71-9.
  25. ↑ Schöberl I, Wedl M, Bauer B, Day J, Möstl E, Kotrschal K. Effects of owner-dog relationship and owner personality on cortisol modulation in human-dog dyads. Anthrozoös. 2012; 25(2): 199–214.
  26. ↑ Kadimpati S, Zale EL, Hooten MW, Ditre JW, Warner DO. Associations between Neuroticism and Depression in Relation to Catastrophizing and Pain-Related Anxiety in Chronic Pain Patients. PLoS One. 2015; 10(4): e0126351. 
  27. ↑ Petersson M, Uvnäs-Moberg K, Nilsson A, Gustafson LL, Hydbring-Sandberg E, Handlin L. Oxytocin and Cortisol Levels in Dog Owners and Their Dogs Are Associated with Behavioral Patterns: An Exploratory Study. Front Psychol. 2017; 8: 1796.
  28. ↑ Singer T, Tusche A. Understanding others: brain mechanisms of theory of mind and empathy. In: Glimcher PW, Fehr E editors. Neuroeconomics: Decision making and the brain. London: Elsevier, 2014. p.513-32
  29. ↑ Trösch M, Pellon S, Cuzol F, Parias C, Nowak R, Calandreau L et al. Horses feel emotions when they watch positive and negative horse-human interactions in a video and transpose what they saw to real life. Anim Cogn. 2020; 23(4): 643-53.
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