#itsmyhometoo
Home Assessment Tool
It has long been understood that physical features in the home can positively or negatively affect people’s ability to function safely and independently.
Occupational Therapists work within the field of human medicine to assess the individual in the context of their own home, and with their own unique challenges. They specialise in finding solutions by either modifying the environment or the task. Pet owners are increasingly looking for ways to assist their pet to achieve a better quality of life into older age. Like humans, living into old age often means living with long term conditions, such as arthritis, that have a profound effect on mobility and comfort.
CAM has recognised that there is a lot that the enlightened owner can do to reduce the cumulative effects of activities that are thought to compound ‘wear and tear’ on joints, (such as slipping on laminate floors), and making the dogs environment easier to negotiate thereby improving their quality of life. The authors have used the well respected human screening tool, the Home Fast (Home Falls and Accidents Screening Tool, (Mackenzie, British Journal of Occupational Therapy, 2000) as a model to create a simple checklist for use by owners, therapists or veterinary nurses to consider what features in the home could be modified, to reduce the impact of arthritis on that individual dog’s function.
The items for inclusion have been selected following a request to CAM’s Facebook followers to contribute from their own experience. A cohort of 29 respondents provided information from which the author extrapolated 17 questions that focused on activities of daily living that are closely aligned with the home environment. CAM intend to trial the tool, and then use a panel of experts to refine it. It is hoped that the final tool will contribute to assisting the multimodal management of canine arthritis.
The checklist
DEALING WITH SLIPPERY FLOORS
Are floor surfaces, to which your dog has access to inside the home, non-slip?
Wood, laminate or tile flooring is now commonplace, particularly in kitchens, where dogs often spend a lot of time. These surfaces are particularly slippery for our dogs. Senior dogs are especially at risk, due to their weaker muscular support, in addition to a higher prevalence of stiff and painful arthritic joints.
A slip or a fall causes inflamed joints and tight muscles to stretch outside of their normal range. This causes small injuries to the muscles, ligaments and tendons, which result in scarring. This will add to your dog’s pain and stiffness.
The good news is simple measures can prevent these repetitive and damaging injuries from occurring.
Thinking of laying new flooring? Our sponsor - Flooring for Paws has a great range of anti-slip products for your home.
GOOD EXAMPLE
BAD EXAMPLE
- Carpets, rugs and mats do not have to be expensive. Rubber backed mats can be purchased new or second hand.
- Alternatively, carpet tiles,off-cuts and runners can be used.
- Secure mats and rugs to the floor with non-slip tape to stop them from moving and minimise slipping.
- If it is not possible to cover all your dog’s routes with mats, you can either restrict where they walk, or place mats in strategic ‘problem’ areas. These are high-traffic places such as doorways and thresholds, where your dog often walks.
- There are a huge variety of dog boots available. Where possible ‘try before you buy’ to get a good fit. These boots are not suitable for prolonged periods of use because dogs will sweat from their paws. You may also need to condition your dog to wearing a boot as it can feel quite strange for them at first.
- Keep your dog’s hair trimmed short between their toes and keep their nails trimmed. Walking on hairy feet is a bit like walking in socks, and can lead to higher chances of slipping. If you are not happy to cut your dog’s paw-hair or nails, most veterinary practices run nurse clinics where a qualified veterinary nurse or dog groomer will be happy to do this for you.
Upstairs downstairs
Can the dog easily go up and down stairs and steps to which they have access both inside and outside the house?
Stairs and steps are one of the most challenging areas for the arthritic dog and their owners. By far the best solution is to avoid them if at all possible, but in many cases this is not possible. Where the dog is small enough, and the owner is fit to do so, carrying the dog up and down stairs is a good solution. Where this is not possible, there are some adaptations that may help.
GOOD EXAMPLE
BAD EXAMPLE
- Ramps. These can be permanent (i.e. fixed concrete or wooden) or portable, and must have a non-slip surface. Portable ramps are usually only suitable for a couple of shallow steps and may be purchased from companies that supply human disability equipment. Your dog may need gentle training to feel confident using a ramp.
- Stair gates are very helpful to prevent dogs going up and down the stairs. There are now lightweight barriers available especially made for dogs, and these do not necessarily require screw fixation to the wall. Do your research to find the correct height and width for your space.
- Stairs with no carpets are a particular hazard. Ensure staircases have a secure non-slip covering. Single steps will benefit from the application of anti-slip tape.
- Harnesses may be used to assist your dog to balance and control their movement on the stairs. They should not be used to lift your dog. Harnesses are ideally Y shaped at the front, padded, well fitting and adjusted for each individual.
- Slings can be used where a dog has significant difficulties controlling their hind limbs. Care should be taken so that you don’t end up just carrying their rear-end. If in any doubt please discuss their use with a veterinary physiotherapist.
Getting through doorways safely
Are all door thresholds easy to step over?
Thresholds can be particularly troublesome particularly with UPVC doors. Depending on where they are there are, there are some solutions to make life easier for your dog.
GOOD EXAMPLE
BAD EXAMPLE
- It is possible to purchase special threshold ramps from companies that provide equipment for people with disabilities. Take careful measurements as not all ramps are suitable for all thresholds.
- High thresholds may be easier to negotiate with a half step. These can be homemade or purchased.
- Non-slip mats or anti-slip tape, either side of the threshold will help the dog to remain more stable. CAM sells anti-slip tape at their online shop.
Moving around the home
Are walkways clear of clutter and free from tight turns?
When dogs move, they lack the same rotary movement people have. It is important to keep ‘corridors’ clear of obstacles, so that your dog doesn’t have to twist and turn, trying to avoid them.
GOOD EXAMPLE
BAD EXAMPLE
- Watch your dog as they travel around the home. Where do they struggle? Where do they turn around?
- Clear a straight pathway for the dog to walk down
- Ensure that points where the dog has to turn have secure, non-slip floor coverings
- Consider blocking off non-essential areas
Are they sleeping comfortably
Can your dog get in and out their padded dog bed easily, without help? Can the dog change their position, or move in their bed, without difficulty?
The ability to rest comfortably is a basic requirement for all of us, and is particularly important for your arthritic dog. Some dogs prefer to curl up in a basket, while others want to stretch out on the floor.
Dog beds should combine a draft free position with a mattress that is both supportive and conforming. The bed should be easy to get into and out of, and your dog should be able to change their position without difficulty. The bed should be big enough for your dog to be able to stretch out comfortably. We advise providing one bed per dog, as this provides them with the choice of their own bed or sharing with other pets in the household.
For those of you with large dogs, check out our sponsor Big Barker for big beds.
GOOD EXAMPLE
BAD EXAMPLE
- Make sure that the dog has enough room to line themselves up to get in and out of the bed.
- Shorter legs need lower beds.
- Memory foam mattresses can be purchased in standard sizes, made-to-measure, or cut to size for you to cover. Do some research.
- Dogs that struggle to step onto the mattress may find it easier if the edge is chamfered.
- If you are using loose blankets put the in a duvet cover or pillowcase to prevent them bunching up and forming an obstacle. Tuck them around the mattress.
- Movement of a bed, mattress or bedding on the floor can be eliminated by using a sheet of Dycem or non-slip underneath. Search on line for this product.
- Avoid hammock-style beds.
- It is really important to ensure there is some non-slip flooring such as a rug around the bed. When your dog gets up after a period of rest, they are at their most vulnerable and stiff (just like humans). Non-slip flooring will ensure they are able to find their footing, stretch and walk off comfortably and safely.
sharing your comfy space
If this is their usual practice, is your dog able to get on and off the sofa with ease?
Many dogs share sofas and armchairs with their owners. Getting on and off these can be a challenge for an arthritic dog. Whilst some dogs may accept alternative beds on the floor, other dogs place particular importance on sitting on the sofa and enjoying the closeness and interaction with their owners.
GOOD EXAMPLE
BAD EXAMPLE
- There are a wide selection of ramps and dog steps available, ranging from custom made, to reasonably priced and easily available. Have a look on Amazon or eBay for examples!
- Make sure any ramp or step has a non-slip surface.
- It may be possible to reduce the height of the seat by removing castors or a seat cushion and replacing it with a lower profile blanket.
- Smaller dogs may be happy to be lifted on and off the sofa.
- Ensure that there is a non-slip floor covering in place where your dog gets on and off the sofa.
- Ensure covers are non-slip to prevent the dog falling off.
sharing your bed
If this is their usual practice, is the dog able to get on and off your bed safely? Is the dog safe from falling off the bed?
It is common for dogs to share beds with their owners and is part of the bond that they have together. It is important for both parties to retain this aspect of their lives wherever possible.
GOOD EXAMPLE
BAD EXAMPLE
- There are a wide selection of ramps and dog steps available, ranging from custom made, to reasonably priced and easily available. Have a look on Amazon or eBay for examples!
- Make sure any ramp or step has a non-slip surface.
- If your dog is at risk of falling out of the bed, position the bed against a wall and, if possible, use a solid footboard or a child’s cot side that can be pushed under the mattress.
- Some people may be happy to move their mattress onto the floor.
- Small dogs may be lifted on and off the bed.
- Ensure that there is a non-slip floor covering in place where your dog gets on and off the bed.
Eating & drinking safely
Can your dog comfortably stand at their bowl to eat or drink?
Feeling stable and comfortable will ensure that your dog enjoys their mealtime and maintains optimal hydration. The most anatomically stable position for a dog to stand is one where they are not having to crouch, stretch, or reach upwards or downwards.
GOOD EXAMPLE
BAD EXAMPLE
- Ensure that there is a non-slip pathway between their bed and water bowl.
- Give your dog a mat or carpet to stand on for feeding and drinking.
- Raise bowls. The exact height for eating and drinking at is very dog-dependent. We encourage you to trial different heights, starting at the level of their carpus and slowly increasing the height. Usually somewhere between their elbows and shoulders is most comfortable. Look for when your dog seems at their most neutral eating or drinking position. Make sure the raised bowls are stable - some raised bowl stands are quite flimsy and unstable - potentially making eating and drinking difficult for your dog.
- Place a water bowl on an absorbent material such as a towel to prevent wet and slippery floors becoming a slip hazard.
- Use a shallow bowl to prevent the dog having to over-bend their neck when eating.
- Place Dycem or non-slip tape (available in the CAM online shop) under bowls to prevent them moving around.
- There are a lot of cheap or free options for raising your dog’s bowls. A tower can be built out of bricks and wedged into a corner, a stack of books can serve as a stand for the bowls, and some people have even made their own stands out of wood.
Dog flaps to outside spaces
If your dog uses a dog flap (doggy door), can they enter and exit without difficulty?
These are useful for some people, particularly if they are at work during the day. However, dog flaps can be particularly difficult for an arthritic dog to negotiate, especially if they are too small or too low down. They may represent a risk to dogs that are left unattended, and should not be used if the dog has very poor mobility. Alternative arrangements may need to made in these cases.
GOOD EXAMPLE
BAD EXAMPLE
- Find an alternative with a larger door and lower step.
- Non-slip mats on either side of the dog flap.
- Ensure there is no drop on either side of dog flap for your dog to negotiate. A non-slip exterior ramp would help make exit and entrance of house easier.
Moving around your outside space
Are external pathways clear, in good repair and non-slip?
Just as indoor passageways need to be clear of hazards and have a non-slip surface, the same applies to outside surfaces. Dogs are creatures of habit and tend to use the same routes to get to their toileting and recreational areas. Hazards include loose paving stones, slippery, wet or muddy paths, steep slopes, and poorly lit areas.
GOOD EXAMPLE
BAD EXAMPLE
- Repair cracked or loose paving stones along pathways used by your dog.
- Cover any areas that can’t be repaired or are slippery with matting or synthetic grass.
- Consider replacing or covering loose chipped stone pathways which may be painful to walk on.
- Consider using ramps on steps and steep slopes, but ensure that the ramp surface has good grip.
- Where possible, make sure there is effective outdoor lighting.
Playing outside
Does the dog have easy, ‘non-hazardous’ access to an area of well-maintained grass for play?
When taking into account your dog’s walking comfort, we need to think about the surfaces they have access to. A grass surface has greater shock-absorbing properties than hard concrete and is therefore more gentle on sore joints. Short grass is easier for dogs to walk on than long grass and is also less slippery (as long as it isn’t muddy).
GOOD EXAMPLE
BAD EXAMPLE
- Limit access to areas of the garden which may have hazards such as slippery or muddy surfaces, uneven ground, dense vegetation such as brambles, or hazardous objects.
- If you do not have a suitable grassy area at home, try and find a local area where your dog can enjoy some safe walking, exploring, and sniffing.
- Remember that dogs with arthritis will benefit more from regular short, slow walks where they are allowed to go at their own pace and enjoy the scents, rather than longer, faster walks. Be guided by your dog and give them what they want!
- Create some safe, sensory areas in your garden suitable for your dog to explore.
Toileting & arthritis
Can your dog assume a stable posture to urinate and defecate in their chosen toilet zone?
Dogs are creatures of habit and tend to use the same areas for toileting. Most dogs will become very distressed if they are not able to get outside quickly enough to toilet. Signs that your dog may be struggling include: finding ‘accidents‘ in the house that have never happened before, changes to your dog’s posture whilst toileting, or starting to walk as they pass a stool.
GOOD EXAMPLE
BAD EXAMPLE
- Ensure that there is a clear, non slippery ‘path’ for your dog to get from inside to outside.
- Encourage your dog to go out a bit more regularly. Not only will this give your dog a frequent opportunity to relieve themselves, it will help prevent stiffness from lack of movement.
- Provide adequate traction, particularly on your dog’s hind limbs to help with stability. Keeping fur between paw pads short and nails trimmed will help. You can use boots, rubber paw covers or surfaces applied to their pads to increase grip. However, if you do use paw coverings, closely monitor your dog’s walking. If their gait deteriorates or you notice increased clumsiness, we advise you to remove them immediately.
- Support harnesses and slings can be useful to help stabilise your dog whilst walking and toileting. If you do make use of these aids, make sure you receive training in their correct use and positioning from a veterinary physiotherapist to avoid causing discomfort or pain.
Safe socialising
Does your dog display their usual level of confidence and stability when interacting with other dogs within or outside of the home?
Socialising with other dogs, either in the same household, or ‘out and about’, will be more concerning for a dog with pain or unstable joints. It is particularly important for arthritic dogs to avoid any potential injury from “boisterous” play. Dog-on-dog interactions should be closely controlled and monitored to ensure that play is gentle and within the ‘comfort zone’ of the affected dog.
GOOD EXAMPLE
BAD EXAMPLE
- Limit play to trusted companions. Do not put the dog in a position where he will be forced to defend himself from multiple dogs wanting to play.
- Change activities. If your dog has always played ‘high drive’ adrenaline-fueled games, try and reduce these, introduce calmer activities which they will enjoy just as much. Look out for ideas on canine enrichment from the CAM website and join some canine enrichment Facebook groups.
- Teach other dogs in the household to be calm around your arthritic dog.
- Ensure that your dog can always get away from others if they wish.
travel safely
Can your dog get in and out of the car without additional help and with ease? Once in the car, does your dog settle down comfortably?
Travelling in a car provides two major areas of challenge for the dog with arthritis, and yet most dogs will need to travel in a car if only for regular appointments with their vet.
- Getting in and out of the car - Jumping can cause excessive pressure on already painful joints.
- Travelling comfortably - your dog may be destabilised by the movement of the car and require some adaptations to make travel a manageable activity.
GOOD EXAMPLE
BAD EXAMPLE
If you have a small dog, and it is safe for you to do so, lift them in and out of the car. Do not allow them to jump.
Larger dogs can be trained to use a portable ramp or dog steps to get in and out.
Your model of car will affect the ability of your dog to get in and out. Look for cars with no lip into the boot and a lower chassis.
Electronic boot lifts are available but expensive and not suitable for every model of car.
Pad out the boot or seat with cushioning underneath and at the side of the dog.
Consider rear seat hammocks or harnesses to prevent falls into the footwell.
Ensure a comfortable temperature in the vehicle for travelling.
Take regular breaks on long journeys to allow your dog out of the car for a stretch and to go to the toilet.
Drive carefully, particularly if it is windy or if you are travelling down winding country lanes. The slower and more gently you drive, the better your dog will cope with the journey.
The home assessment checklist booklet
If you would like access to the PDF version of the Home Assessment Checklist it is available to download in our Member Zone.
joint protection
Joint protection is widely used in human medicine for the management of inflammatory joint disease. There are several components to a joint protection programme including use of proper joint mechanics and joint alignment, altering working methods, using assistive devices, modifying activities, pacing and modifying environments (Hammond, 2013).
Research has demonstrated that significant improvements in pain, disease status and functional ability are found in people who have attended a joint protection programme, and there is evidence that it can slow the progression of the effects of rheumatoid arthritis over and above the effects of drug therapy (Hammond and Freeman, 2001) Using techniques and equipment that spare joints from further trauma, joint protection seeks to reduce loading on articular cartilage and subchondral bone, strengthen muscle support and improve the shock absorbing capabilities of joints (Cordery and Rocchi, 1998). Other benefits include reducing pain during activities, helping to reduce deforming forces on joints, reducing fatigue and maintaining function (Hammond, 2013).
The application of joint protection principles has not been researched in dogs with arthritis, however common sense would dictate that attempting to reduce repetitive, concussive or twisting forces on inflamed tissues may positively impact pain and disease progression in dogs with similar pathology. It is our hope that some of these practical suggestions will help to protect the joints of the dogs that we share our lives with.
REFERENCES
Cordery J, Rocchi M (1998) Joint Protection and Fatigue Management. In: Melvin J, Jensen G. (eds.) Rheumatologic Rehabilitation Volume 1: Assessment and Management. American Occupational Therapy Association, Bethesda, MD.
A. Hammond, K. Freeman (2001); One-year outcomes of a randomised controlled trial of an educational–behavioural joint protection programme for people with rheumatoid arthritis. Rheumatology, Volume 40, Issue 9, 1 September 2001, Pages 1044–1051, https://doi.org/10.1093/rheumatology/40.9.1044
Hammond A (2013) Chapter 8: Joint Protection. In L Goodacre and M MacArthur (Eds): Rheumatology Practice in Occupational Therapy: Lifestyle Management. Edition 1. (pages 111-132). Wiley-Blackwell, Chichester. ISBN: 9780470655160