Rehabilitation for the Neurologic Patient

A study using a canine hydrotherapy treadmill at five different conditions to kinematically assess range of motion of the thoracolumbar spine in dogs

BACKGROUND

Incline treadmill and underwater treadmill (UWTM) exercises are common canine rehabilitation modalities , which are often used in isolation in dogs recovering from spinal surgery. Early use of an incline during UWTM exercise may have the potential to improve rehabilitation outcomes in dogs, but, it is hypothesised that dorsoventral movement of the spine may be excessive meaning it is unsuitable in some circumstances.

OBJECTIVES

The purpose of this study was to identify changes in canine spinal kinematics in dogs when using a dry treadmill at different angles of incline compared to an underwater treadmill using the same inclines.

METHODS

Eight dogs were encouraged to walk on a dry, horizontal, underwater treadmill as well as under the same conditions with both a 10% and 20% incline. This was then repeated at a 10% and 20% incline with the addition of water to hock level. Data were collected using reflective anatomical markers placed at the occipital protuberance, T1, T13, L3, L7 and sacral apex, captured by a high-speed camera facing the lateral aspect of the treadmill. Dorsoventral motion of the spine as well as flexion, extension and range of motion (ROM) of T1, T13, L3 and L7 were recorded.

RESULTS

We found significant differences in dorsoventral spinal ROM at T1, L3 and L7, but no significant differences in T13 ROM. No significant differences were found in flexion and extension of any of the joints assessed when comparing dry conditions to the use of water (P>0.05).

CONCLUSIONS

The lack of significant differences in joint flexion and extension at T1, T13, L3 and L7 indicates the potential safe use of combining underwater treadmill and incline exercise in canine rehabilitation. However, a lack of uniformity in results makes distinguishing any patterns of significance difficult. More research is needed to establish the effects of these exercises in additional planes of motion before a treatment protocol can be established.

Circulating neutrophil activation in dogs with naturally occurring spinal cord injury secondary to intervertebral disk herniation

OBJECTIVE

To investigate the time course of circulating neutrophil priming and activity in dogs with spinal cord injury secondary to intervertebral disk herniation that undergo decompressive surgery.

ANIMALS

9 dogs with spinal cord injury and 9 healthy dogs (controls).

PROCEDURES

For dogs with spinal cord injury, blood samples were collected on the day of hospital admission and 3, 7, 30, and 90 days after injury and decompressive surgery. A single blood sample was collected from the control dogs. Flow cytometry analysis was performed on isolated neutrophils incubated with antibody against CD11b and nonfluorescent dihydrorhodamine 123, which was converted to fluorescent rhodamine 123 to measure oxidative burst activity.

RESULTS

Expression of CD11b was increased in dogs with spinal cord injury 3 days after injury and decompressive surgery, relative to day 7 expression. Neutrophils expressed high oxidative burst activity both 3 and 7 days after injury and decompressive surgery, compared with activity in healthy dogs.

CLINICAL RELEVANCE

For dogs with spinal cord injury, high CD11b expression 3 days after injury and decompressive surgery was consistent with findings for rodents with experimentally induced spinal cord injury. However, the high oxidative burst activity 3 and 7 days after injury and decompressive surgery was not consistent with data from other species, and additional studies on inflammatory events in dogs with naturally occurring spinal cord injury are needed.

Effects of a flotation vest and water flow rate on limb kinematics of Siberian Huskies swimming against a current

OBJECTIVE

To evaluate the effects of a flotation vest (FV) and water flow rate (WFR) on limb kinematics of dogs swimming against a current.

ANIMALS

7 (1 male and 6 female) healthy adult Siberian Huskies.

PROCEDURES

Dogs were habituated to swim with and without an FV beside an investigator in a continuous-flow pool against WFRs up to 2.9 km/h. During each of 4 experimental sessions in a repeated-measures study, markers were wrapped around the right carpus and tarsus, and a video was recorded while each dog swam with or without an FV for about 2 minutes at each of 7 WFRs between 0 and 2.9 km/h when the WFR was incrementally decreased or increased. Motion tracking software was used to measure stroke excursion and frequency.

RESULTS

Stroke excursion varied more than frequency among all dogs and in response to changes in experimental conditions. The male dog and 1 female dog were unable to complete the study. For the remaining 5 dogs across all experimental conditions, mean tarsus excursion was 30% that of the carpus. Mean total excursion (sum of the excursion-frequency products for the carpus and tarsus) decreased when an FV was worn and increased with WFR by 69% and 19% when WFR was incrementally increased and decreased, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

In dogs, range of motion during swimming was greater for the carpus than tarsus, when an FV was not worn, and increased more with WFR when WFR was incrementally increased. Those factors should be considered during swimming-based rehabilitation.

Structural characteristics and predicted functional capacities of epaxial muscles in chondrodystrophic and non-chondrodystrophic dogs with and without suspected intervertebral disc herniation- a preliminary study

Epaxial muscle atrophy is related to spinal diseases in dogs. However, the influence of intervertebral disc herniation (IVDH) on the functional capacity of epaxial muscles has not been investigated. We aimed to estimate force and power-generating capacity of epaxial muscles in chondrodystrophic Dachshunds and non-chondrodystrophic Border terriers bred for similar purposes. Further we aimed to compare these features in Dachshunds with and without IVDH. Cadavers of Dachshunds (n = 16) and Border terriers (n = 7) were investigated with MRI. In the absence of clinical information, MRI findings were used to categorize the Dachshunds into affected (n = 8) and non-affected (n = 8). Epaxial muscle mass, muscle belly length, fascicle length, architectural index and physiological cross-sectional area (PCSA) were obtained through dissections, pain and exercise history through questionnaires. Difference between groups and effect of covariates were assessed with ANCOVA models. Dachshunds had greater muscle mass in M. splenius, M. longissimus capitis and M. iliocostalis thoracis (all P < .05). Dachshunds had higher PCSA in M. semispinalis complexus (P = .004) and M. iliocostalis lumborum (P = .016) than Border terriers, which had longer muscle fascicles in these muscles (P = .004 and P = .002, respectively). Affected Dachshunds had longer muscle fascicles than non-affected Dachshunds in M. longissimus thoracis et lumborum (P = .004) and M. longissimus cervicis (P = .011). Body weight had a significant impact on all muscle variables, but pain and exercise had none. Dachshund epaxial muscles have greater potential for force production than those of the Border terrier. This may imply that Dachshunds, due to predisposition to IVDH, require more spinal stability provided by the epaxial muscles.

Modalidades fisioterapêuticas na reabilitação de cães com doença do disco intervertebral toracolombar submetidos à cirurgia descompressiva: 30 casos (2008-2016)

RESUMO Este estudo retrospectivo teve como objetivo demonstrar as modalidades fisioterapêuticas empregadas no tratamento de cães com doença do disco intervertebral (DDIV) toracolombar após descompressão cirúrgica da medula espinhal, bem como relatar os fatores que determinaram as alterações das modalidades. Foram incluídos 30 cães que apresentavam sinais neurológicos desde paraparesia ambulatória a paraplegia com dor profunda na primeira sessão de fisioterapia. As modalidades utilizadas nos protocolos de todos os pacientes foram a crioterapia, massagem, alongamento passivo, movimentação passiva articular, estímulo do reflexo flexor e estimulação elétrica neuromuscular. A inclusão ou exclusão de exercícios terapêuticos, como a tipoia corporal, a plataforma proprioceptiva circular, a natação, a hidroesteira, os obstáculos e a caminhada em colchão, foi de acordo com a evolução clínica e a adaptação de cada paciente. Oitenta por cento (80%) dos cães alteraram o grau de disfunção neurológica antes de iniciar a fisioterapia e 93% retornaram à habilidade de caminhar (paraparesia ambulatória) ao final da fisioterapia. O número de sessões e o tempo de recuperação foram maiores quanto pior foi o grau de lesão do paciente.

Preliminary evaluation of the effects of photobiomodulation therapy and physical rehabilitation on early postoperative recovery of dogs undergoing hemilaminectomy for treatment of thoracolumbar intervertebral disk disease

OBJECTIVE To evaluate the effects of postoperative photobiomodulation therapy and physical rehabilitation on early recovery variables for dogs after hemilaminectomy for treatment of intervertebral disk disease. ANIMALS 32 nonambulatory client-owned dogs. PROCEDURES Dogs received standard postoperative care with photobiomodulation therapy (n = 11), physical rehabilitation with sham photobiomodulation treatment (11), or sham photobiomodulation treatment only (10) after surgery. Neurologic status at admission, diagnostic and surgical variables, duration of postoperative IV analgesic administration, and recovery grades (over 10 days after surgery) were assessed. Time to reach recovery grades B (able to support weight with some help), C (initial limb movements present), and D (ambulatory [≥ 3 steps unassisted]) was compared among groups. Factors associated with ability to ambulate on day 10 or at last follow-up were assessed. RESULTS Time to reach recovery grades B, C, and D and duration of postoperative IV opioid administration did not differ among groups. Neurologic score at admission and surgeon experience were negatively associated with the dogs' ability to ambulate on day 10. The number of disk herniations identified by diagnostic imaging before surgery was negatively associated with ambulatory status at last follow-up. No other significant associations and no adverse treatment-related events were identified. CONCLUSIONS AND CLINICAL RELEVANCE This study found no difference in recovery-related variables among dogs that received photobiomodulation therapy, physical rehabilitation with sham photobiomodulation treatment, or sham photobiomodulation treatment only. Larger studies are needed to better evaluate effects of these postoperative treatments on dogs treated surgically for intervertebral disk disease.

Vertebral Subluxation Repair in a Pet Goat

OBJECTIVES

To describe the perioperative management, including surgery, anesthesia, metabolic derangements, and physiotherapy, in a goat referred for paraparesis secondary to a road traffic accident.

STUDY DESIGN

Case report.

ANIMALS

2-year-old mixed breed dwarf 44 kg female pet goat.

METHODS

Clinical examination showed symptoms of early compensatory stages of shock, paraparesis with hyperextension of the thoracic limbs, pain on palpation of the thoracolumbar spine, increased patellar reflexes of both pelvic limbs without superficial sensitivity, but preserved deep pain sensation. These signs suggested a spinal cord injury with upper motor neuron syndrome and an anatomic localization between the third thoracic and third lumbar vertebrae. Radiographic examination revealed a thoracolumbar vertebral subluxation. Vertebral stabilization was achieved with the application of pins in the vertebral bodies stabilized by an interconnecting bridge of polymethylmethacrylate, a technique commonly adopted in companion animals.

RESULTS

Surgery and recovery from anesthesia were uneventful, but 3 days later ruminal atony and subsequent bloating occurred. This was associated with metabolic derangements (metabolic alkalosis), decreased mentation, and marked tachypnea that responded to medical treatment. From day 3 post-surgery, the goat underwent physiotherapy with manual and active exercises during the rehabilitation period of 21 days duration.

CONCLUSION

The injury in this goat was successfully managed using vertebral stabilization similar to that used in dogs and cats. Extensive postoperative physiotherapeutic support contributed to the complete recovery of the animal.

Goniometry and Limb Girth in Miniature Dachshunds

Purpose. To report the mean and median pelvic limb joint angles and girth measurements in miniature Dachshunds presenting with varying degrees of pelvic limb weakness secondary to thoracolumbar intervertebral disc extrusion. Methods. 15 miniature Dachshunds who presented to WSU-VTH for thoracolumbar disc extrusion. Dachshunds varied in neurologic status from ambulatory paraparetic to paraplegic at the time of measurements. Results. There were no significant differences in joint angles or girth among the three groups (ambulatory paraparetic, nonambulatory paraparetic, or paraplegic) (P > 0.05). When group was disregarded and values for extension, flexion, and girth combined, no differences existed. Conclusions. Goniometry and limb girth measurements can successfully be made in the miniature Dachshund; however, the shape of the Dachshund leg makes obtaining these values challenging. There were no differences in joint angle or girth measurements between dogs with varying neurologic dysfunction at the time of measurement.

Arachidonic acid pathway alterations in cerebrospinal fluid of dogs with naturally occurring spinal cord injury

Background

Canine intervertebral disc πherniation causes a naturally-occurring spinal cord injury (SCI) that bears critical similarities to human SCI with respect to both injury pathomechanisms and treatment. As such, it has tremendous potential to enhance our understanding of injury biology and the preclinical evaluation of novel therapies. Currently, there is limited understanding of the role of arachidonic acid metabolites in canine SCI.

Results

The CSF concentrations of PLA2 and PGE2 were higher in SCI dogs compared to control dogs (p = 0.0370 and 0.0273, respectively), but CSF LCT4 concentration in SCI dogs was significantly lower than that in control dogs (p < 0.0001). Prostaglandin E2 concentration in the CSF was significantly and positively associated with increased severity of SCI at the time of sampling (p = 0.041) and recovery 42 days post-injury (p = 0.006), as measured by ordinal behavioral scores.

Conclusion

Arachidonic acid metabolism is altered in dogs with SCI, and these data suggest that these AA metabolites reflect injury severity and recovery, paralleling data from other model systems.

The linear-ordered collagen scaffold-BDNF complex significantly promotes functional recovery after completely transected spinal cord injury in canine

Spinal cord injury (SCI) is still a worldwide clinical challenge for which there is no viable therapeutic method. We focused on developing combinatorial methods targeting the complex pathological process of SCI. In this study, we implanted linear-ordered collagen scaffold (LOCS) fibers with collagen binding brain-derived neurotrophic factor (BDNF) by tagging a collagen-binding domain (CBD) (LOCS + CBD-BDNF) in completely transected canine SCI with multisystem rehabilitation to validate its potential therapeutic effect through a long-term (38 weeks) observation. We found that LOCS + CBD-BDNF implants strikingly promoted locomotion and functional sensory recovery, with some dogs standing unassisted and transiently moving. Further histological analysis showed that administration of LOCS + CBD-BDNF reduced lesion volume, decreased collagen deposits, promoted axon regeneration and improved myelination, leading to functional recovery. Collectively, LOCS + CBD-BDNF showed striking therapeutic effect on completely transected canine SCI model and it is the first time to report such breakthrough in the war with SCI. Undoubtedly, it is a potentially promising therapeutic method for SCI paralysis or other movement disorders caused by neurological diseases in the future.

Perspectives on tissue-engineered nerve regeneration for the treatment of spinal cord injury

Over the past few decades, substantial progress has been made to safely improve nerve function in spinal cord injury (SCI) patients through the regeneration of injured nerve tissue. This perspective focuses on an extensive overview of SCI research as well as tissue-engineered nerve regeneration for the treatment of SCI.

Feline physiotherapy and rehabilitation: 1. principles and potential

PRACTICAL RELEVANCE

Physiotherapy is highly valued within human medicine and relatively well established for canine patients. Despite a popular misconception that feline patients will not cooperate with such treatment, physiotherapy is now increasingly being performed with cats. With cat ownership increasing in many countries, and an emergence of specialist physiotherapy practitioners, there is demand for effective postoperative and post-injury rehabilitation for any cat with compromised physical function due to injury, surgery or disease.

CLINICAL CHALLENGES

While physiotherapy and rehabilitation are potentially beneficial for cats, due to their independent nature feline patients certainly present a greater challenge in the pursuit of effective therapy than their canine counterparts.

AUDIENCE

This two-part review article is directed at the primary care veterinary team. The benefits of physiotherapy and the various treatment modalities available to the qualified veterinary physiotherapist, as well as the non-specialist veterinarian and veterinary nurse or technician, are examined in this first part.

EVIDENCE BASE

The benefits of human physiotherapeutic intervention are well documented, and there is good evidence for the effectiveness of most treatment modalities. Animal studies are still in their infancy, although some preliminary studies in dogs have shown good results.

Naturally occurring disk herniation in dogs: an opportunity for pre-clinical spinal cord injury research

Traumatic spinal cord injuries represent a significant source of morbidity in humans. Despite decades of research using experimental models of spinal cord injury to identify candidate therapeutics, there has been only limited progress toward translating beneficial findings to human spinal cord injury. Thoracolumbar intervertebral disk herniation is a naturally occurring disease that affects dogs and results in compressive/contusive spinal cord injury. Here we discuss aspects of this disease that are analogous to human spinal cord injury, including injury mechanisms, pathology, and metrics for determining outcomes. We address both the strengths and weaknesses of conducting pre-clinical research in these dogs, and include a review of studies that have utilized these animals to assess efficacy of candidate therapeutics. Finally, we consider a two-species approach to pre-clinical data acquisition, beginning with a reproducible model of spinal cord injury in the rodent as a tool for discovery with validation in pet dogs with intervertebral disk herniation.

Kinematic motion analysis of the joints of the forelimbs and hind limbs of dogs during walking exercise regimens

OBJECTIVE

To assess forelimbs and hind limb joint kinematics in dogs during walking on an inclined slope (uphill), on a declined slope (downhill), or over low obstacles (cavaletti) on a horizontal surface and compare findings with data acquired during unimpeded walking on a horizontal surface.

ANIMALS

8 nonlame dogs (mean +/- SD age, 3.4 +/- 2.0 years; weight, 23.6 +/- 4.6 kg).

PROCEDURES

By use of 10 high-speed cameras and 10 reflecting markers located on the left forelimbs and hind limbs, joint kinematics were recorded for each dog during uphill walking, downhill walking, and walking over low obstacles or unimpeded on a horizontal surface. Each exercise was recorded 6 times (10 s/cycle); joint angulations, angle velocities and accelerations, and range of motion for shoulder, elbow, carpal, hip, stifle, and tarsal joints were calculated for comparison.

RESULTS

Compared with unimpeded walking, obstacle exercise significantly increased flexion of the elbow, carpal, stifle, and tarsal joints and extension in the carpal and stifle joints. Only uphill walking caused increased hip joint flexion and decreased stifle joint flexion; downhill walking caused less flexion of the hip joint. During obstacle exercise, forward angle velocities in the elbow and stifle joints and retrograde velocity in the tarsal joint changed significantly, compared with unimpeded walking. Joint angle acceleration of the elbow joint changed significantly during all 3 evaluated exercises.

CONCLUSIONS AND CLINICAL RELEVANCE

These evidence-based data indicated that each evaluated exercise, except for downhill walking, has a specific therapeutic value in physical therapy for dogs.

Association of clinical and magnetic resonance imaging findings with outcome in dogs suspected to have ischemic myelopathy: 50 cases (2000-2006)

OBJECTIVE

To determine whether clinical signs or magnetic resonance imaging findings were associated with outcome in dogs with presumptive ischemic myelopathy.

DESIGN

Retrospective case series.

ANIMALS

50 dogs.

PROCEDURES

Medical records and magnetic resonance images were reviewed. A neurologic score from 1 (normal) to 5 (most severe degree of dysfunction) was assigned on the basis of neurologic signs at the time of initial examination. Follow-up information was obtained from the medical records and by means of a telephone questionnaire completed by owners and referring veterinarians.

RESULTS

Median neurologic score at the time of initial examination was 3 (range, 2 to 5). Median follow-up time was 584 days (range, 4 to 2,090 days). Neurologic score at the time of initial examination and extent of the lesion seen on magnetic resonance images (quantified as the lesion length-to-vertebral length ratio and as the percentage cross-sectional area of the lesion) were significantly associated with outcome. Sensitivity of using a lesion length-to-vertebral length ratio > 2.0 or a percentage cross-sectional area of the lesion > or = 67% to predict an unsuccessful outcome was 100%.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that severity of neurologic signs at the time of initial examination and extent of the lesions seen on magnetic resonance images were associated with outcome in dogs with ischemic myelopathy.

Evaluation of the Success of Medical Management for Presumptive Cervical Intervertebral Disk Herniation in Dogs

OBJECTIVE

To determine the success of medical management of presumptive cervical disk herniation in dogs and variables associated with treatment outcome.

DESIGN

Retrospective case series.

ANIMALS

Dogs (n=88) with presumptive cervical disk herniation.

METHODS

Dogs with presumptive cervical and thoracolumbar disk herniation were identified from medical records at 2 clinics and clients were mailed a questionnaire related to the success of therapy, clinical recurrence of signs, and quality of life (QOL) as interpreted by the owner. Signalment, duration and degree of neurologic dysfunction, and medication administration were determined from medical records.

RESULTS

Ninety-seven percent of dogs (84/87) with complete information were described as ambulatory at initial evaluation. Successful treatment was reported for 48.9% of dogs with 33% having recurrence of clinical signs and 18.1% having therapeutic failure. Bivariable logistic regression showed that non-steroidal anti-inflammatory drug (NSAID) administration was associated with success (P=.035; odds ratio [OR]=2.52). Duration of cage rest and glucocorticoid administration were not significantly associated with success or QOL. Dogs with less-severe neurologic dysfunction were more likely to have a successful outcome (OR=2.56), but this association was not significant (P=.051).

CONCLUSIONS

Medical management can lead to an acceptable outcome in many dogs with presumptive cervical disk herniation. Based on these data, NSAIDs should be considered as part of the therapeutic regimen. Cage rest duration and glucocorticoid administration do not appear to benefit these dogs, but this should be interpreted cautiously because of the retrospective data collection and use of client self-administered questionnaire follow-up.

CLINICAL RELEVANCE

These results provide insight into the success of medical management for presumptive cervical disk herniation in dogs and may allow for refinement of treatment protocols.