Approaches to the physical rehabilitation of dogs and cats with chronic neurologic and musculoskeletal disorders (Proceedings)
Chronic disorders of the musculoskeletal and neurologic systems are often classified as injuries in which the onset of clinical signs began greater than 2 weeks ago, have recurred more than once, or cannot be corrected surgically due to concurrent illness in the patient. These injures can sometimes be addressed with a rehabilitation protocol, but not all cases will respond favorably to rehabilitation and may require surgery at a later date.
Measuring the severity of the disease process prior to onset of treatment and then measuring the progress that is made is key to tailoring the rehabilitation plan to the patient and keeping the owner motivated throughout the often prolonged process of recovery. Visual analog scales for lameness and pain in the patient can be useful but objective measurements are more accurate such as muscle size, range of joint motion with a goniometer, and even force plate analysis of weightbearing on the affected limb. Whatever the method, analysis of progress made is essential to all rehab programs, especially in treated, chronically affected animals where improvements may be slow and gradual.
Rehabilitation of Chronic Neurological DisordersChronic fibrocartilaginous embolism (FCE) or infarction of the spinal cord has an acute onset but if the gray matter of the cord has been severely affected can result in a slow recovery and chronic neurologic deficits similar to chronic intervertebral disk disease (IVDD). Diagnosis is difficult to make in FCE but an MRI and myelogram will show focal regional spinal cord edema with no other abnormalities. Most patients that improve have had improved neurological status within the first few weeks, although some may take months to make significant improvement. Rehabilitation can help these patients and patients with IVDD improve, however, the absence of deep pain is a poor prognostic indicator in both diseases.
Rehabilitation of FCE and chronic IVDD (following surgical intervention) involves electrical stimulation of the major muscle groups affected and possibly laser therapy of the affected spinal regions. Electrical stimulation of muscles can provide nervous stimulation and muscle contraction. Electrical stimulation and laser therapy can stimulate afferent spinal tracts to speed recovery. If animals are recumbent, repositioning every 4 to 6 hours is required as well as passive range of motion (PROM) exercises. All four limbs should undergo PROM exercises to prevent contraction of muscles and tendons, and reduce edema of the limbs. A cart with a sling or a therapy ball can be used to assist the patient in a standing position with all four paws on the ground to stimulate general proprioception. Passive range of motion (PROM) exercises stimulate sensory nerves as well as muscle contraction along with deep muscle massage. Deep massage of the paralyzed limbs is very effective and should be performed at least twice daily. Manual contact of joint surfaces (through partial weightbearing such as bouncing the patient a balance ball) also stimulates general proprioception and postural reactions with contraction of muscle groups. Stimulation of proprioception also should be performed frequently, at least once a day. Hydrotherapy with a jet pool or an underwater treadmill can also stimulate sensory nerves and act to stimulate motor neuron memories.1 Always protect the patient from water inhalation by using floatation devices and having a person support the patient while in the water. While in the water the technician can also move the limbs through a normal range of motion to stimulate motor neuron memories and proprioception.
Degenerative myelopathy in dogs is a progressive disease with demyelination and axonal degeneration of the spinal cord and brain. While the cause remains unknown, the German Shepherd is over-represented for this disease. Recently, the effect of intensive rehabilitation was examined in dogs with degenerative myelopathy. Dogs undergoing intensive treatment survived an average of 255 days while dogs that did not receive any rehab survived an average of 55 days. Dogs that received a moderate regimen of physical therapy survived 150 days. The treatments included 5 to 10 minute leash walks 5 times a day, sit to stand exercises, shifting weight exercises, muscle massage 3 times a day, and hydrotherapy such as an underwater treadmill with floatation device support at least once a week.2