TheraPaws Session Report
917 West Foothill Boulevard, Upland California 91759 (909) 300-5264
Date
-
Month
-
Day
Year
Date
Pet/Owner Name
First Name
Last Name
Supervising Veterinarian
First Name
Last Name
Purpose of visit
Please Select
20-50-minute session
80-minute session
Other
Objective(s)
Rehabilitation (with veterinarian indirect supervision)
Therapeutic Exercise
Manual Therapy (Massage, Stretch, ...)
Waist Watchers Program
Senior Enrichment
Home Exercise Program
Owner Education/Consult
Other
Subjective: Owner(s) Observations
Owner Compliance
Please Select
excellent
good
fair
poor
Specific Barriers to Therapy Outcomes
Body Condition Score (0-9, 9=obese)
Please Select
2 too thin
3 too thin
4 ideal
5 ideal
6 too heavy
7 too heavy
8 too heavy
9 too heavy
Body Fat Index Risk
Please Select
Low - 16-25% body fat
Moderate - 26-35% body fat
High - 36-45% body fat
Serious - 46-55% body fat
Severe - 56-65% body fat
Extreme - 65% body fat
Weight
Muscle Condition Score (1-4, 1=marked atrophy)
Please Select
1 - severe
2 - moderate
3 - mild
4 - normal
Lameness Scale at a Walk (0-5, 0=normal)
Please Select
0=normal
1=slight, intermittent lameness
2=obvious weight bearing lameness
3=severe weight bearing lameness
4=intermittent non-weight bearing lameness
5=continuous non-weight bearing lameness
Lameness Scale at a Trot (0-5, 0=normal)
Please Select
0=normal
1=slight, intermittent lameness
2=obvious weight bearing lameness
3=severe weight bearing lameness
4=intermittent non-weight bearing lameness
5=continuous non-weight bearing lameness
Neurologic Grading (0-5, 0=normal)
Please Select
0-Normal
1-Pain: not severe enough to result in any neurological dysfunction.
2-Paresis with or without pain: as the lesion becomes more severe the degree of paresis and/or proprioceptive deficits becomes more severe.
3-Plegia: total loss of voluntary movement in the affected limbs (and/or tail).
4-Plegia with loss of voluntary urinary function.
5-Plegia with loss of voluntary urinary function and loss of conscious perception of painful stimuli ('deep pain perception') in the affected limbs (and/or tail).
Simple Pain Scale (observed from joint palpation, touch avoidance, vocalization, limping or improper gait)
Please Select
0=no pain
1=signs of mild pain
2=signs of moderate pain
3=signs of severe pain
4=client will not allow therapist to palpate area of pain
Stance Analysis: weight bearing % left front/right front/left rear/right rear
Conformation
Conformation of Pelvic Limbs
normal
straight (Lateral)
over angulation (lateral)
post-legged (lateral)
straight
base wide
base narrow
cow hocked
sickle hocked
down in pastern
slipped hocks
weak weight bearing
other (see in "Additional Comments")
Conformation of Topline
normal
lordotic
kyphotic
low head carriage
sloped
assymmetric
other (see "Additional Comments")
Conformation of Thoracic Limbs
normal
camped under
out at the elbows
chest too shallow, crooked at wrist
toeing out, underdeveloped shoulders
overdone shoulders, legs set too far apart
pigeon toes
too narrow, concave chest
down in pastern
other (see "Additional Comments")
Range Of Motion (functional assessment, pain, comments)
Range of Motion (in degrees)
right
flex/ext.
left
flex/ext.
end feel
comments
test position
carpus (32-196)
elbow (36-166)
shoulder (57-165)
tarsus (36-165)
stifle (41-162)
hip (50-162)
Thigh Girth L/R
Upper Arm L/R
Gait Analysis: walk
crossover thoracic limbs
center tracking
shoulder lameness or short stride with hindlimbs
elbow lameness or circumduction of thoracic limb
weight shifted caudally
head bob, head goes down on the sound limb
hindlimbs tucked under
weight shifted cranially
forelimbs placed more caudally
head and neck extend and lower to offset weight from the hind end
hip hike, hip on the lame side has increased vertical motion
painful or stiff in one or more limbs
Inability to walk
Knuckling
Limb incoordination
Lameness
Unsteadiness
Painful walking
Limping while walking
Arching of the back
Lowering of the neck and head
Shift in weight
Weakness
Staggering walk
Swaying on feet
Standing in a wide stance with limbs spread far apart
Inability to extend legs during gait
Crouched gait
Skipping a stride
Shuffling gait
Goose stepping gait
Loss of balance
Stumbling
Paw scuffing
Loss of movement control
Carrying a limb
Limb paralysis
Other (see "Additional Comments")
Gait Analysis: trot
crossover thoracic limbs
center tracking
shoulder lameness or short stride with hindlimbs
elbow lameness or circumduction of thoracic limb
weight shifted caudally
head bob, head goes down on the sound limb
hindlimbs tucked under
weight shifted cranially
forelimbs placed more caudally
head and neck extend and lower to offset weight from the hind end
hip hike, hip on the lame side has increased vertical motion
painful or stiff in one or more limbs
Inability to walk
Knuckling
Limb incoordination
Lameness
Unsteadiness
Painful walking
Limping while walking
Arching of the back
Lowering of the neck and head
Shift in weight
Weakness
Staggering walk
Swaying on feet
Standing in a wide stance with limbs spread far apart
Inability to extend legs during gait
Crouched gait
Skipping a stride
Shuffling gait
Goose stepping gait
Loss of balance
Stumbling
Paw scuffing
Loss of movement control
Carrying a limb
Limb paralysis
Other (see "Additional Comments")
Photographs
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Palpation
Warm-Up
massage
gentle stretch
active range of motion
passive range of motion
treadmill
other (see "Additional Comments")
Cool Down
massage
gentle stretch
active range of motion
passive range of motion
treadmill
other (see "Additional Comments")
Acupoint Therapy
applied with acupoint laser light
applied with microcurrent
applied with acupressure
applied using combination of laser light, microcurrent, and acupressure
LU 1
LU 5
LU 7
LU 9
LU 10
LU 11
LI 1
LI 3
LI 4
LI 10
LI 11
LI 15
LI 20
ST 1
ST 2
ST 4
ST 6
ST 25
ST 35
ST 36
ST 37
ST 40
ST 41
ST 42
ST 45
SP 1
SP 3
SP 4
SP 5
SP 6
SP 9
SP 10
SP 21
HT 1
HT 3
HT 5
HT 7
HT 8
HT 9
SI 1
SI 3
SI 4
SI 5
SI 6
SI 8
SI 9
SI 10
SI 15
SI 19
BL 1
BL 2
BL 10
BL 11
BL 12
BL 13
BL 14
BL 15
BL 16
BL 17
BL 18
BL 19
BL 20
BL 21
BL 22
BL 23
BL 24
BL 25
BL 26
BL 27
BL 28
BL 35
BL 36
BL 39
BL 40
BL 54
BL 60
BL 62
BL 64
BL 66
BL 67
KI 1
KI 3
KI 6
KI 7
KI 10
PE 3
PE 6
PE 7
PE 8
PE 9
TH 1
TH 3
TH 4
TH 5
TH 6
TH 10
TH 14
TH 17
TH 23
GB 1
GB 2
GB 3
GB 14
GB 20
GB 21
GB 24
GB 25
GB 29
GB 30
GB 31
GB 33
GB 34
GB 39
GB 40
GB 41
LV 1
LV 2
LV 3
LV 5
LV 8
LV 13
LV 14
GV 1
GV 3
GV 4
GV 14
GV 16
GV 17
GV 20
GV 21
GV 24
GV 25
CV 1
CV 3
CV 4
CV 5
CV 6
CV 12
CV 14
CV 17
CV 20
CV 22
CV 24
Other (see "Additional Comments")
Massage Strokes and Stretching
Warm-up massage strokes
Cool down massage strokes
Swedish
Deep tissue
Chinese Tuina
Cranial Sacral
Indian Champissage
Trigger Point
Stress Point
Myofacial
Gua-sha
Tellington Touch or other Touch Therapy
Passive Range-of-Motion
Active Range-of-Motion, cookie stretches
Gentle Stretching
Gentle strokes for geriatric, diabetic, syringomyelia, other sensitive conditions
Effleurage only
Lymphatic massage
Other
Underwater Treadmill: speed, level, minutes, incline yes/no
Land Treadmill: speed, minutes, incline yes/no
Floor Exercises
long tunnel
short tunnel
figure 8s
figure 8s with stability disk(s)
reach for a treat
down-sit-stand
down-sit-stand on stability disk or cushion
sit-stand
sit-stand on stability disk or cushion
balancing stand stability disk(s)
balancing stand stability disk(s) with weight shifting
weave poles at a walk
low cavalettis
low cavalettis with stability disks
peanut/donut balance
peanut/donut balance with sit to stand
peanut/donut balance with weight shifting
peanut/donut balance with 3-leg stand
3-leg standing
weight shifting
bouncing/rocking on unstable surface
standing
shake plate
shake plate with sit to stand
shake plate with weight shifting
shake plate with 3-leg stand
plank walking
plank sit to stand
plank down-sit-stand
plank with bow
large circles in both directions
small circles in both direction
trampoline with bouncing
trampoline with sit, stand, shake
trampoline with bow
trampoline with weight shifting
wobble board
wobble board with thoracic limbs only
wobble board with pelvic limbs only
running up and down ramp
walking up and down ramp
fetch
walking up and down stairs
cookie/treat reach
walking with theraband resistance
exercises with bells on pelvic limbs
exercise done with assistance
other (see "Additional Comments")
Cryotherapy
ice pack
ice massage
other (see "Additional Comments")
Thermotherapy
heating pad
infrared mat
other (see "Additional Comments")
Water Therapy
lap swimming
3-leg standing
weight shifting
passive range of motion
active range of motion
bouncing
circles
fetch
exercises done with assistance
exercise done in deep water
other (see "Additional Comments")
Other
Additional Comments
Plan of Care for Next Visit
Next Appointment
Therapist's Name
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