A Physiotherapy Program for Bears at Animals Asia’s Vietnam Bear Rescue Centre
Bear bile has been used in traditional Asian medicine for thousands of years. The practice of farming bears for their bile is prevalent in numerous countries across Asia, including Vietnam.1, 2 Most commonly, Asiatic black bears, Ursus thibetanus (hereafter referred to as bears), are kept captive on bear farms where bile is extracted from their gall bladder. Most of the bears residing at Animals Asia’s Vietnam Bear Rescue Centre (VBRC) have been rescued from bear bile farms where they have spent a significant portion of their lives housed in small cages, receiving inadequate or inappropriate nutrition. Animals Asia Foundation3 has found that most of the bears from bile farms suffer a multitude of severe health conditions, including dental disease, gall bladder and liver disease, high blood pressure, and a variety of musculoskeletal diseases. Years confined to cages too small for their size can lead to stunted growth and deformities, and the development of musculoskeletal diseases such as osteoarthritis and spinal disease.
Bears captured at a young age or as cubs can develop growth abnormalities, and adult bears are prone to developing postural abnormalities, which predisposes them to various musculoskeletal diseases. As the population of bears at VBRC begins to age, the number of bears affected is expected to increase, as many of these disease processes are progressive and irreversible. Whilst medical management to relieve the associated pain of musculoskeletal disease is a cornerstone of the treatment plan at VBRC, we wanted to take a holistic, cooperative care approach to support these bears to move well. The various modalities of physiotherapy increase muscular strength and joint range of motion (ROM) to protect the diseased joint.4 Whilst veterinary physiotherapy has gathered recognition in companion animals,5 less is known of its application with captive wildlife. Many of the current modalities used in non-human and human physiotherapy involve manual therapies such as hands-on massage and joint manipulation6, which are not possible when working with captive bears. Therefore, a more innovative approach was required.
The restrictive living conditions of bears on bear bile farms leave them with little to no opportunity to move freely or exhibit natural behaviours. As stated by Balcombe7 “when we keep animals in impoverished conditions we deny them the opportunity to express natural behaviour.” Along with other mammals, bears have long been accepted as sentient beings,8displaying great awareness of themselves whilst also exhibiting complex interactions with their environment. There is still very little known for sure of the entire behavioural repertoire of bears in the wild; they are known to be omnivores that forage over vast areas. While foraging behaviour and seasonal variations appear to be instinctive, food preference is learned through trial and error.9 In resident bears at VBRC suffering from a musculoskeletal disease, we see that this lack of mobility significantly impedes their ability to move freely to engage in these innate behaviours.
The Vietnam Bear Rescue Centre
There are currently 188 resident bears at VBRC, of which 19% are being treated for some form of musculoskeletal disease. There are 11 adult bear houses in total, each of which comprises inside housing areas (or dens) with access to a large enclosure (figure 1). Each enclosure is fitted with numerous structures to allow the bears to climb and forage freely. Dens are also fitted with baskets, with some having special low hammocks and baskets for mobility-compromised bears, or high hammocks and platforms for young, agile bears. Due to muscular weakness, deformities and poor movement and disease, many of the bears are physically unable to utilise what is available to them.
At VBRC the majority of the bears are housed in large, mixed-sex social groups, in order to capitalise on the space available and allow for the rescue of up to 200 bears. In order to house groups like this, we need to ensure resources are abundant. The bears are fed three times per day, around 8AM, 2PM and 5PM. At each feed they receive a variety of fruit and vegetables, as well as dog kibble as their main protein source. They are given enrichment twice per day, and browse twice per day.
Whilst food, browse, and enrichment are placed at various levels of the enclosure, for bears with mobility issues it is often a struggle to get to all of these places. A life where they have a choice and the ability to climb and stand in order to fully engage in all behaviours as much as possible is the ultimate goal and cornerstone of the rehabilitation process.
How physiotherapy is delivered at VBRC
As previously discussed, a hands-on approach for physiotherapy is not possible when working with captive bears, and a more innovative and imaginative approach was required. In collaboration with Brooke Williams, an Australian veterinary physiotherapist, a program was designed utilising positive reinforcement training and a specialised den set-up.
During the pilot program a baseline observation study was conducted prior to the beginning of a six-week physiotherapy block. This involved recording various behaviours and activities that each bear performed during their time with enclosure access. Observations were made every five minutes for a period of two hours, between 9AM and 11AM, for five consecutive days. Due to time restrictions, the observer often changed from day to day. Therefore, to reduce observer subjectivity, a standardised observation form was used. These observations were then repeated at the end of the six-week block of physiotherapy to assess behavioural changes. Once the results were evaluated, any improvements were noted, and a plan was further developed before the commencement of the next block of physiotherapy.
Following the initial observations, two sessions per week were dedicated to physiotherapy in a dedicated physio den (an explanation of the set up follows below). At each session, there was an observer; again, to ensure consistent and relevant data were collected, a standardised observation form was used. This means all activities performed by the bear, including what they found easy, what was more challenging, and the length of time it took them to forage for all food items, was recorded regardless of the observer. Before entering the physio den, bears underwent a short one-on-one training session using positive reinforcement methods to encourage movement and build strength as required.
The den set-up and training
The physio den set-up is tailored to the specific needs of the individual bear. As such, those bears with hind limb weakness and mobility concerns have puzzle feeders and enrichment items hung from different heights to encourage bipedal standing (Figure 2). These are situated close to a wall or structure for the bear to use as support if they lack the required strength. The set-up can then be adapted, and items lifted higher as the bears build strength. For bears with forelimb weakness and mobility concerns, enrichment items that provide resistance, such as a digging pit of sand or bark and resistance bands of increasing difficulty, are hung from the roof with treats attached to encourage stretching and pulling. Where possible, food from the daily portion is used in these sessions to try and prevent weight gain, which would further increase pressure on already diseased joints.10 As a result of dormancy behaviour at certain times of the year,11 the bears can be unmotivated to eat. Therefore, food items that offer a higher reward, such as honey, condensed milk, and jam are used.
The positive reinforcement training is also tailored to the individual bear’s needs. To date, we have trained three different behaviours in bears participating in this program – “target,” “massage,” and “bar-pull.”
The “target” behaviour teaches the bear to touch their muzzle to a tennis ball on a bamboo pole. It is used to help build strength and aid physio den sessions by providing a muscular warm-up. The bear learns to follow the target from a sitting position into a standing position a predetermined number of times (Figure 3a). This is performed before entering the physio den.
The “massage” behaviour requires the bear to sit still and accept physical touch using various massage balls and tools as part of targeted massage therapy (Figure 3b). This is done with protected contact for the trainer through the bars of the den. Massage therapy is used to help reduce muscle tension. 12
The “bar-pull” behaviour has been trialled on a single bear so far, with the aim of increasing forelimb strength. A metal T-bar is attached to a resistance band and placed through the bars of the den. The bear is then taught to place both front paws on the metal bar and pull.
The results of the initial pilot study
Before implementing physiotherapy more widely in the sanctuary, we embarked on a pilot study to trial and assess the proposed program. Included in this study was a 19-year-old male bear called Arthur, who has been resident at VBRC since 2015. He is currently receiving multiple types of pain relief and, prior to the study, was noted to be very weak in his hind limbs, inactive, and not seen to climb on any structures within the enclosure.
Overall, Arthur spent more of his time lying down before he underwent physiotherapy than after, with the overall amount of time he spent on his legs, both standing and moving, increasing post-physiotherapy. During observations, he spent more of his foraging time in a standing position post-physiotherapy than before physiotherapy when he often sat to eat as he foraged. He also spent a more significant amount of time foraging, with a decrease in overall resting time post-physiotherapy (see figure 4 and figure 5 for visual representation).
It was noted during Arthur’s post-physiotherapy observations that he would stand bipedally at a few different structures during foraging, which was a behaviour that had not been observed prior to physiotherapy. He was also seen to venture farther into the enclosure and was still foraging, even when access back into the dens was available, not entering the dens to rest until later. Compare this to observations prior to physiotherapy, where he would often be waiting at the den slide or close by to enter the den as soon as they were opened.
To summarise, an overall improvement in Arthur’s activity levels and scope of behaviours were observed after a six-week block of physiotherapy. Before physiotherapy, he had not been seen climbing structures or reaching whilst standing on his hind limbs for a significant amount of time. Results show that after the physiotherapy program, he was willing and able to explore, climb, and stand on his hind limbs with some support, indicating that the behaviours trained were being successfully transferred to his choices during enclosure access. This also suggests that his strength improved, as he can now perform a wider variety of activities and behaviours.
Expanding the physiotherapy program
Following the pilot’s success, we have expanded the program to enrol other bears to benefit from physiotherapy. We created a modified, easily prepared approach to make the program scalable. This removed the need for observations pre- and post-physiotherapy, reducing a considerable time expense. We created a guide for carers to follow to ensure the program delivered effective therapy; this ensures each bear engages the appropriate muscle groups and joints during each session. We also developed a range of den designs to specify easy, medium, and hard set-ups for forelimb and hind limb issues. A scalable approach means enrolling more bears in the program while maintaining scope to deliver tailored plans for individuals who need it.
Developing the physiotherapy program has required some problem-solving. Due to the seasonal nature of bear physiology, we have experienced some challenges related to decreased bear activity levels during winter; during winter dormancy, bears are less inclined to participate in the therapy actively. In response, bears known to enter winter dormancy are either not enrolled in the program, or their program is paused during dormancy. Another challenge has been space restrictions in a sanctuary that is reaching 95% capacity. To address this, we are developing a physiotherapy den design that is easily assembled and dismantled to allow quick and easy conversion back into bear living space.
Innovation, co-operation, and communication between our vets and carers have proven crucial in ensuring the success of our pioneering bear physiotherapy program. Developing a scalable program tailored to the individual and using positive reinforcement theory to encourage bears to cooperate in their care has been key to its success. In adopting this holistic approach and blending husbandry, training, and veterinary care, we have seen a marked improvement in the mobility of compromised bears. We hope the success of our program may serve to inspire other rescue facilities to investigate innovative care and perhaps develop their own physiotherapy programs to improve the welfare experienced by the animals in their care.
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Kate has been a practicing veterinary surgeon for 13 years. After 9 years working in Australia Kate moved to Vietnam where she spent two years working as the resident veterinary surgeon at Animals Asia’s award-winning Vietnam Bear Rescue Centre. Recently, Kate has returned to her home in the UK where she is working in companion animal practice whilst completing her Masters degree in Animal Welfare Science, Ethics and Law at the University of Winchester. Kate holds a Bachelors degree in Veterinary Medicine (BVetMed) from the Royal Veterinary College, London and a Postgraduate certificate in International Animal Welfare Science, Ethics and Law from the University of Edinburgh.
Sarah is the Senior Bear Team Manager at Animals Asia’s award-winning Vietnam Bear Rescue Centre. Animals Asia works to end the bear bile trade in Vietnam and China and has rescued more than 600 bears from the industry since it was established. Heading up the sanctuary bear care team, Sarah ensures the care and welfare of over 180 Asiatic black bears and Malayan sun bears. Sarah has innovated bear care at the sanctuary using her more than 12 years of theoretical and practical expertise in animal husbandry and behaviour. A native New Zealander, Sarah holds a BSc, Ecology and Zoology and MSc, Conservation Biology from Massey University. She has a certificate in veterinary nursing and has completed the ‘Living and Learning with Animals: The Science and Technology of Behaviour Change” course hosted by BehaviorWorks.