Daily Controlled Physiotherapy Increases Survival Time in Dogs with Suspected Degenerative Myelopathy

Prevalence of SOD1 allele associated with degenerative myelopathy in canine population in Greece

Canine degenerative myelopathy (CDM) is a late-onset fatal disorder associated with a point mutation of the superoxide dismutase 1 (SOD1) gene (c.118G > A). The purpose of this study was to determine the genotype and allele frequencies of this mutation in 108 dogs, mainly in Belgian Malinois and German Shepherd dogs with (CDM-affected group) and without CDM clinical symptoms (control group) in Greece. Genotyping of the c.118G > A mutation was possible by Sanger sequencing and PCR-RFLP. The observed genotype frequencies for the control group were 89.4% for the homozygous (G/G), 9.6% for the heterozygous (A/G), and 0.96% for the homozygous mutant (A/A) allele. The mutant allele was not common in the Belgian Malinois dogs (allele frequency = 0.029), but quite common in the German Shepherd dogs (allele frequency = 0.138). In the CDM affected group, all 4 dogs were homozygous for the mutant allele. These frequencies were close to those expected, indicating no significant departure from Hardy-Weinberg equilibrium. A strong but not statistically significant association between the mutant allele and CDM was observed. A previously identified deletion upstream of the mutation of interest was found at a high frequency (0.361) in the population.

Diagnosis and management of dogs with degenerative myelopathy: A survey of neurologists and rehabilitation professionals

BACKGROUND

Antemortem diagnosis of degenerative myelopathy (DM) in dogs is presumptive and there are no accepted guidelines for the management of this condition.

HYPOTHESIS/OBJECTIVES

Describe current practices of neurology clinicians and physical rehabilitation professionals in the diagnosis and management of DM.

ANIMALS

None.

METHODS

Online surveys examining diagnosis and management of DM were constructed and distributed via neurology and rehabilitation listservs.

RESULTS

One hundred ninety neurology and 79 rehabilitation professionals from 20 countries participated. Most neurology (142/189) and rehabilitation (23/39) respondents required genetic testing for the superoxide dismutase 1 (SOD1) mutation and 82/189 neurologists also required spinal magnetic resonance imaging (MRI) for presumptive DM diagnosis. Most neurology respondents recommended exercise (187/190) and physical rehabilitation (184/190). Over 50% (102/190) of neurology respondents perform rechecks on dogs diagnosed with DM. Rehabilitation respondents reported preservation or improvement of strength (78/79) and coordination (77/79) as therapeutic goals. At-home exercises (75/79), underwater treadmill (64/79), gait training (55/79), and strength building exercises (65/79) were used to maintain strength (58/79), coordination (56/79), muscle mass (56/79), and improve overall wellbeing (54/79). Neurology respondents reported that owners elect euthanasia when dogs become nonambulatory paraparetic whereas rehabilitation respondents report euthanasia when paraplegia and incontinence develop.

CONCLUSION AND CLINICAL IMPORTANCE

The majority of dogs diagnosed with DM have not undergone advanced imaging, the combination of history, neurological findings, and genetic testing is heavily relied upon. Whereas the diagnosis of DM is frequently made by veterinary neurologists, continued care is often performed by rehabilitation professionals or primary veterinarians.

VariantscanR: an R-package as a clinical tool for variant filtering of known phenotype-associated variants in domestic animals

BACKGROUND

Since the introduction of next-generation sequencing (NGS) techniques, whole-exome sequencing (WES) and whole-genome sequencing (WGS) have not only revolutionized research, but also diagnostics. The gradual switch from single gene testing to WES and WGS required a different set of skills, given the amount and type of data generated, while the demand for standardization remained. However, most of the tools currently available are solely applicable for human analysis because they require access to specific databases and/or simply do not support other species. Additionally, a complicating factor in clinical genetics in animals is that genetic diversity is often dangerously low due to the breeding history. Combined, there is a clear need for an easy-to-use, flexible tool that allows standardized data processing and preferably, monitoring of genetic diversity as well. To fill these gaps, we developed the R-package variantscanR that allows an easy and straightforward identification and prioritization of known phenotype-associated variants identified in dogs and other domestic animals.

RESULTS

The R-package variantscanR enables the filtering of variant call format (VCF) files for the presence of known phenotype-associated variants and allows for the estimation of genetic diversity using multi-sample VCF files. Next to this, additional functions are available for the quality control and processing of user-defined input files to make the workflow as easy and straightforward as possible. This user-friendly approach enables the standardisation of complex data analysis in clinical settings.

CONCLUSION

We developed an R-package for the identification of known phenotype-associated variants and calculation of genetic diversity.

Intensive neurorehabilitation and allogeneic stem cells transplantation in canine degenerative myelopathy

Introduction

Degenerative myelopathy (DM) is a neurodegenerative spinal cord disease with upper motor neurons, with progressive and chronic clinical signs, similar to amyotrophic lateral sclerosis (ALS). DM has a complex etiology mainly associated with SOD1 gene mutation and its toxic role, with no specific treatment. Daily intensive rehabilitation showed survival time near 8 months but most animals are euthanized 6-12 months after clinical signs onset.

Methods

This prospective controlled blinded cohort clinical study aims to evaluate the neural regeneration response ability of DM dogs subjected to an intensive neurorehabilitation protocol with mesenchymal stem cells (MSCs) transplantation. In total, 13 non-ambulatory (OFS 6 or 8) dogs with homozygous genotype DM/DM and diagnosed by exclusion were included. All were allocated to the intensive neurorehabilitation with MSCs protocol (INSCP) group (n = 8) or to the ambulatory rehabilitation protocol (ARP) group (n = 5), which differ in regard to training intensity, modalities frequency, and MSCs transplantation. The INSCP group was hospitalized for 1 month (T0 to T1), followed by MSCs transplantation (T1) and a second month (T2), whereas the ARP group was under ambulatory treatment for the same 2 months.

Results

Survival mean time of total population was 375 days, with 438 days for the INSCP group and 274 for the ARP group, with a marked difference on the Kaplan-Meier survival analysis. When comparing the literature's results, there was also a clear difference in the one-sample t-test (p = 0.013) with an increase in time of approximately 70%. OFS classifications between groups at each time point were significantly different (p = 0.008) by the one-way ANOVA and the independent sample t-test.

Discussion

This INSCP showed to be safe, feasible, and a possibility for a long progression of DM dogs with quality of life and functional improvement. This study should be continued.

Rehabilitation Therapy for the Degenerative Myelopathy Patient

Degenerative myelopathy is an inherited, progressive, neurodegenerative disorder affecting the spinal cord of dogs. There is no treatment of the disease. Physical rehabilitation is the only intervention that slows progression and prolongs quality of life. Further studies are needed to develop advanced treatment options and to better characterize the use of complementary therapeutic modalities in palliative care for these patients.

Molecular Surveillance of Canine Degenerative Myelopathy in Breeding Kennels from Romania

Canine degenerative myelopathy (CDM) is a spontaneous neurodegenerative disease. Genetically, CDM is an autosomal recessive disease with incomplete penetrance, most commonly caused by a genetic mutation in exon 2 of gene SOD1 (c.118G > A). This study aimed to determine the mutant allele frequency associated with CDM in various dog breeds from Romania. Dogs (n = 230) from 26 breeds were included in the study. Genotyping using the PCR-RFLP technique was performed on DNA extracted from oral swabs. The results revealed that 204 dogs were homozygous for the wild-type allele (G/G), 16 were heterozygous (A/G), and 10 were homozygous for the mutant allele (A/A). The mutant allele was identified in Wire Fox Terrier, Romanian Mioritic Shepherd, German Shepherd, Rottweiler, Belgian Shepherd, and Czechoslovakian Wolfdog breeds. The mutant allele frequency (A) within the tested population was 0.0783. The results for Belgian Shepherd, German Shepherd, and Romanian Mioritic Shepherd were in Hardy-Weinberg equilibrium, but a departure was observed for Rottweiler. The current study included a first screening of the Romanian Bucovina Shepherd, Romanian Mioritic Shepherd, and Caucasian Shepherd breeds. Genetic testing for the mutation associated with CDM is important in order to avoid the risk of the emergence of dogs homozygous for the SOD1:c118G > A allele.

Overview of the Current Literature on the Most Common Neurological Diseases in Dogs with a Particular Focus on Rehabilitation

Simple Summary

This paper aims to report an overview of the most common neurological diseases (intervertebral disc herniation, degenerative myelopathy, fibrocartilaginous embolism, and polyradiculoneuritis), with a main focus on rehabilitative options and outcomes, reported in recent veterinary literature. Literature seems to be positively oriented on the efficacy of the rehabilitation approach, reporting a careful and prudent choice of the protocol to be applied for the correct recovery of the patient. However, blinded, controlled, prospective studies are still necessary, above all for degenerative myelopathy, fibrocartilaginous embolism, and polyradiculoneuritis.

Abstract

Intervertebral disc herniation, degenerative myelopathy, fibrocartilaginous embolism and polyradiculoneuritis often affect dogs; and physiotherapy may improve the patient’s quality of life and/or reduce recovery times. The aim of this review was to evaluate the current scientific outcomes on these four neurological diseases and on their physiotherapy approaches. From the analysis of the published articles, it emerged that intervertebral disc herniation can be treated, with different rates of success, through a conservative or a surgical approach followed by physiotherapy. The literature is generally oriented toward the efficacy of the rehabilitation approach in this specific canine disease, often proposing intensive post-surgery physiotherapy for the most severe conditions with the absence of deep pain perception. When degenerative myelopathy, fibrocartilaginous embolism or polyradiculoneuritis occur, the existing literature supports the use of a physiotherapeutic approach: allowing a delay in the onset and worsening of the clinical signs in degenerative myelopathy, physical improvement, and, sometimes, complete remission during fibrocartilaginous embolism or acute idiopathic polyradiculoneuritis. However, papers on rehabilitation in dogs affected by polyradiculoneuritis are currently limited to single clinical cases and further blinded, controlled, prospective studies are still advisable for all four neurological diseases.

Electrical Impedance Myography in Dogs With Degenerative Myelopathy

Canine degenerative myelopathy (DM) leads to disuse and neurogenic muscle atrophy. Currently there is a lack of non-invasive quantitative measures of muscle health in dogs with DM. Muscle pathology has been previously quantified in other disorders using the technique of electrical impedance myography (EIM) but it has not been reported for DM. The objective of this study was to compare EIM between DM-affected and similar aged healthy dogs as well as assess EIM changes over time in DM-affected dogs. Multifrequency EIM was performed on DM affected dogs at baseline and during disease progression and on age-matched healthy dogs. Muscles evaluated in the pelvic limbs included the craniotibialis, gastrocnemius, gracilis, sartorius, and biceps femoris. The 100 kHz phase angle was extracted from the full frequency set for analysis. Phase values were lower in DM dogs as compared to healthy controls. Specifically, phase of the gastrocnemius was lower on the left (θ = 7.69, 13.06; p =0.002) and right (θ= 6.11, 11.72; p = 0.001) in DM vs. control dogs, respectively. The mean phase value of all measured muscles was also lower on the left (θ = 9.24, 11.62; p = 0.012) and right (θ = 9.18, 11.72; p = 0.021). Other individual muscles measured did not reach statistical significance, although values were consistently lower in DM-affected dogs. With disease progression, downward trends in phase values were detected in DM-affected dogs when monitored serially over time. This study demonstrates that EIM 100 kHz phase values are sensitive to muscle pathology in DM and that phase values are decreased in dogs with DM. Measurements from the gastrocnemius muscle show the greatest differences from similar aged healthy dogs suggesting it may be the preferred muscle for future EIM studies.

Physical Rehabilitation for Small Animals

Physical rehabilitation incorporates several elements, including but not limited to therapeutic exercises, manual therapy, and physical modalities. Understanding of the effects, indications, contraindications, and precautions is essential for proper use, while understanding of the diagnosis, assessment of the stage of tissue healing and repair, and accurate clinical assessment of the functional limitations are essential when establishing a physical rehabilitation plan.

The Long-Term Clinical Course of Canine Degenerative Myelopathy and Therapeutic Potential of Curcumin

Canine degenerative myelopathy (DM), recognized as a spontaneous model of amyotrophic lateral sclerosis, is known as a late-onset progressive degenerative disease of the spinal cord. Because of the progressive nature of DM, many dogs are elected to be euthanized, resulting in limited information on the end-stage clinical presentation. We investigated the long-term clinical course from diagnosis to natural death to further deepen our understanding of the entire clinical picture of this disease. Because curcumin was administered in some cases, the therapeutic effect of curcumin on DM was also examined. Forty dogs included in this study were client-owned Pembroke Welsh Corgis with a definitive diagnosis of DM by necropsy and histopathology. Dogs were excluded from this study if they died from another disease or were elected to be euthanized. Information on the long-term clinical symptoms of DM was investigated based on a questionnaire, which was collected from the dog owners. Urinary incontinence and respiratory disorder were observed in most dogs, as was respiratory impairment-correlated death. In contrast, signs consistent with brainstem dysfunction were noticed at the terminal stage in a small portion of dogs. Although further studies with more cases are needed, the results of this study suggest that administration of curcumin is effective in slowing the progression of DM.

Retrospective Observational Study and Analysis of Two Different Photobiomodulation Therapy Protocols Combined with Rehabilitation Therapy as Therapeutic Interventions for Canine Degenerative Myelopathy

Objective: The objective of this retrospective review was to examine the impact that adding photobiomodulation therapy (PBMt) to rehabilitation therapy had on the pathology of degenerative myelopathy (DM) in canine patients.

Background: Canine DM is a progressive, fatal neurodegenerative disease for which there exists a dearth of effective treatments, limiting clinicians to pursue symptom palliation.

Methods: Clinical records of dogs referred for presumed DM to a specialty rehabilitation facility were screened for patients meeting study criteria. Qualifying patients were divided into two groups: Protocol A (PTCL-A) and Protocol B (PTCL-B) group, based on the PBMt protocol used. Data related to demographics, diagnostics, rehabilitation protocols, and progression of clinical signs were collected. Data were analyzed to determine differences in outcomes between the two treated groups and historical data expectations, as given by a previously published study.

Results: The times between symptom onset and euthanasia of dogs in the PTCL-B group: 38.2 ± 14.67 months (mean ± SD), were significantly longer than those of dogs in the PTCL-A group: 11.09 ± 2.68 months. Similarly, the times between symptom onset and nonambulatory paresis (NAP) or paralysis of dogs in the PTCL-B group: 31.76 ± 12.53 months, were significantly longer than those of dogs in the PTCL-A group: 8.79 ± 1.60 months. Further, Kaplan–Meier survival analysis showed that the times from symptom onset to NAP of dogs in the PTCL-B group were significantly longer than those of dogs in the PTCL-A group (Mantel-Cox Log Rank statistic = 20.434, p < 0.05) or the historical data group (Mantel-Cox Log Rank statistic = 16.334, p < 0.05).

Conclusions: The data reviewed show significantly slower disease progression—longer survival times—for patients in the PTCL-B group than those in the PTCL-A group or published historical data. Further studies are warranted.

Water height modifies forelimb kinematics of horses during water treadmill exercise

Although equine water treadmills (WTs) are increasingly being used for the rehabilitation of equine athletes, the immediate- and short-term effects of this type of exercise on limb movement in the WT and overground are unknown. Therefore, the objective of this study was to evaluate the effects of WT exercise on equine forelimb kinematics on land and under various WT conditions before and after a prolonged period of WT conditioning. External markers were used to collect 2D kinematic data (joint extension, flexion, range of motion (ROM), elevation; stride mechanics) at 120 frames/s. Thirteen mixed breed, English performance horses were filmed under three test conditions: (1) horses walked on sand; (2) horses walked on a WT (water heights: dry, carpus, stifle); (3) horses walked on sand immediately following a WT session. Walking speeds during testing varied between horses, ranging from 1.3-1.5 m/s, but were held constant for each individual horse for all tests on both days. Testing occurred on days 1 and 10, with horses being trained on the WT for days 2 through 8 (28 min/day). Comparisons were made using linear mixed effects models. Carpal ROM and elbow ROM were greater when horses were walked in water, compared to without water (dry treadmill) and overground (P<0.0001 for all). This increased ROM was achieved primarily via an increase in joint flexion. With the addition of water, stride length increased and stride frequency decreased, accompanied by an increased percentage duration of swing phase. No effects of conditioning on gait mechanics were observed overground. Therefore, WT exercise may be meaningful for physical rehabilitation through increased joint flexion and ROM observed.

In vivo detection of microstructural spinal cord lesions in dogs with degenerative myelopathy using diffusion tensor imaging

Background

Degenerative myelopathy (DM) in dogs is a progressive neurodegenerative condition that causes white matter spinal cord lesions. These lesions are undetectable on standard magnetic resonance imaging (MRI), limiting diagnosis and monitoring of the disease. Spinal cord lesions cause disruption to the structural integrity of the axons causing water diffusion to become more random and less anisotropic. These changes are detectable by the technique of diffusion tensor imaging (DTI) which is highly sensitive to diffusion alterations secondary to white matter lesion development.

Objective

Perform spinal DTI on cohorts of dogs with and without DM to identify if lesions caused by DM will cause a detectable alteration in spinal cord diffusivity that correlates with neurological status.

Animals

Thirteen dogs with DM and 13 aged‐matched controls.

Methods

All animals underwent MRI with DTI of the entire spine. Diffusivity parameters fractional anisotropy (FA) and mean diffusivity (MD) were measured at each vertebral level and statistically compared between groups.

Results

Dogs with DM had significant decreases in FA within the regions of the spinal cord that had high expected lesion load. Decreases in FA were most significant in dogs with severe forms of the disease and correlated with neurological grade.

Conclusions and Clinical Importance

Findings suggest that FA has the potential to be a biomarker for spinal cord lesion development in DM and could play an important role in improving diagnosis and monitoring of this condition.

Degenerative Myelopathy in Hovawart Dogs: Molecular Characterization, Pathological Features and Accumulation of Mutant Superoxide Dismutase 1 Protein

Degenerative myelopathy (DM) is an adult-onset, progressive neurological disease affecting several breeds of dog. Homozygosity or compound heterozygosity for the canine superoxide dismutase 1 (SOD1) gene mutations, possibly modulated by the modifier SP110 locus, are associated with a high risk for DM. Although the pathophysiological mechanisms are largely unknown, a role for mutant SOD1 in causing neuronal degeneration has been postulated. Three Hovawart dogs, 9-12 years of age, developed slowly progressive incoordination and weakness of the pelvic limbs leading to non-ambulatory flaccid paraparesis and muscle atrophy. Neuropathological lesions comprised axonal degeneration and loss of ascending and descending spinal pathways, which were most severe in the mid- to caudal thoracic segments. Accumulation of mutant SOD1 protein in neurons and reactive astrocytes was demonstrated by immunolabelling with the 16G9 antibody against the mutant SOD1 protein (p.E40K amino acid substitution). All three dogs were homozygous for the c.118A allele, but none had the SP110 'risk' haplotype, suggesting a weak association of SP110 with the onset of DM in this breed. Our data suggest that the Hovawart breed is predisposed to the SOD1:c.118G>A mutation, which is associated with the development of DM. Prevention of DM could be achieved with the help of strategies based on epidemiological and genetic testing.

A Leaky Noisy-OR Bayesian Network Applied to Genetic Counseling in Dogs

Simple Summary

Genetic disorders represent a serious health problem for companion animals and combating such disorders is a real challenge. Bayes networks facilitate the objective assessment of the risk of such disorders. We apply the methodology to answer two typical questions in genetic counselling, i.e., the risk for an animal of showing clinical signs of a genetic disease when the result at the genetic test is known and the risk of testing positive for the mutant allele when the genetic test is not made. Results showed the network is appropriate to answer objectively and transparently both questions under a variety of alternative scenarios. It can be updated automatically and can be represented visually so interactive discussion are easy between the veterinarian and his/her interlocutor.

Abstract

Genetic disorders are very frequent in dogs but evaluating individualized risks of their occurrence can be uncertain. Bayesian networks are tools to characterize and analyze such events. The paper illustrates their benefits and challenges in answering two typical questions in genetic counselling: (1) What is the probability of a test-positive animal showing clinical signs of the disease? (2) What is the risk of testing positive for the mutant allele when one parent presents clinical signs? Current limited knowledge on the hereditary mode of transmission of degenerative myelopathy and on the effects of sex, diet, exercise regimen and age on the occurrence of clinical signs concurrent with the finding of the deleterious mutation was retrieved from the scientific literature. Uncertainty on this information was converted into prior Beta distributions and leaky-noisy OR models were used to construct the conditional probability tables necessary to answer the questions. Results showed the network is appropriate to answer objectively and transparently both questions under a variety of scenarios. Once users of the network have agreed with its structure and the values of the priors, computations are straightforward. The network can be updated automatically and can be represented visually so interactive discussion are easy between the veterinarian and his/her interlocutor.

Canine Models of Inherited Musculoskeletal and Neurodegenerative Diseases

Mouse models of human disease remain the bread and butter of modern biology and therapeutic discovery. Nonetheless, more often than not mouse models do not reproduce the pathophysiology of the human conditions they are designed to mimic. Naturally occurring large animal models have predominantly been found in companion animals or livestock because of their emotional or economic value to modern society and, unlike mice, often recapitulate the human disease state. In particular, numerous models have been discovered in dogs and have a fundamental role in bridging proof of concept studies in mice to human clinical trials. The present article is a review that highlights current canine models of human diseases, including Alzheimer's disease, degenerative myelopathy, neuronal ceroid lipofuscinosis, globoid cell leukodystrophy, Duchenne muscular dystrophy, mucopolysaccharidosis, and fucosidosis. The goal of the review is to discuss canine and human neurodegenerative pathophysiologic similarities, introduce the animal models, and shed light on the ability of canine models to facilitate current and future treatment trials.

Factors Contributing to the Decision to Euthanize: Diagnosis, Clinical Signs, and Triggers

This article reviews factors contributing to the decision to euthanize a patient by exploring the diagnosis, clinical signs, and triggers behind the choice. By investigating these triggers, the article helps guide practitioners to proactively manage areas of concern that lead to the decision of euthanasia. Included in this article is a benchmark comprehensive survey for pet families that standardizes documentation of family decision making surrounding end of life and euthanasia. Increased knowledge about diagnosis, clinical signs, and triggers may improve the technical and communication skills of professionals about specific conditions that are encountered at the end of life.

A comparative multi-site and whole-body assessment of fascia in the horse and dog: a detailed histological investigation

Fascia in the veterinary sciences is drawing attention, such that physiotherapists and animal practitioners are now applying techniques based on the concept of fascia studies in humans. A comprehensive study of fascia is therefore needed in animals to understand the arrangement of the fascial layers in an unguligrade horse and a digitigrade dog. This study has examined the difference between the horse and the dog fascia at specific regions, in terms of histology, and has compared it with the human model. Histological examinations show that in general the fascia tissue of the horse exhibits a tight and dense composition, while in the dog it is looser and has non-dense structure. Indeed, equine fascia appears to be different from both canine fascia and the human fascia model, whilst canine fascia is very comparable to the human model. Although regional variations were observed, the superficial fascia (fascia superficialis) in the horse was found to be trilaminar in the trunk, yet multilayered in the dog. Moreover, crimping of collagen fibers was more visible in the horse than the dog. Blood vessels and nerves were present in the loose areolar tissue of the superficial and the profound compartment of hypodermis. The deep fascia (fascia profunda) in the horse was thick and tightly attached to the underlying muscle, while in the dog the deep fascia was thin and loosely attached to underlying structures. Superficial and deep fascia fused in the extremities. In conclusion, gross dissection and histology have revealed species variations that are related to the absence or presence of the superficial adipose tissue, the retinacula cutis superficialis, the localization and amount of elastic fibers, as well as the ability to slide and glide between the different layers. Further research is now needed to understand in more detail whether these differences have an influence on the biomechanics, movements and proprioception of these animals.

Investigation into clients' perception of postoperative physiotherapy for dogs undergoing cranial cruciate ligament disease surgery

AIM

To evaluate clients' understanding, perception and experience of postoperative physiotherapy after undergoing an osteotomy technique for cranial cruciate ligament disease (CCLD).

METHOD

A retrospective questionnaire was sent to 202 owners of dogs that underwent CCLD surgery at the Queen Mother Hospital for Animals between 1 January 2015 and 31 December 2017, with 63 responses obtained.

RESULTS

Significant differences were found in choice of physiotherapy between clients recommended or not by their vets (p<0.01), and between those offered additional information and those who were not (p<0.01). Of those who chose physiotherapy, 85% had a satisfactory experience. No difference was found in choice of physiotherapy between clients aware of its availability and those who were not (p=0.069). No association was found between cost of the service and clients' perception of cost-worthiness (p=0.169) or between cost-worthiness and recovery outcome (p=0.420). A correlation was found between clients' perception of cost-worthiness and satisfaction level (p=0.03). Clients' knowledge was related to the choice of physiotherapy (p=0.01), but not to other investigated factors. A significant relationship was found between clients' age and choice of physiotherapy (p=0.01), with younger clients choosing physiotherapy more often.

CONCLUSION

Veterinarians recommending physiotherapy and providing accurate information affect clients' decision to choose, and perception of, physiotherapy, in addition to clients' own knowledge.

Where Have We Been, Where Are We Going: Continuity from 2011

This article provides a brief review of important foundational concepts and an overview of major milestones in the history of animal hospice and palliative care. This article also presents a view of future goals and challenges that lie ahead of the veterinary profession as the field of animal hospice and palliative care evolves. Some examples of topics reviewed and explored in the article include current "state of-the-art" of animal hospice, future research goals, improved veterinary college curricula, collaboration among medical disciplines, and support of the veterinary staff.

Development of the Finnish neurological function testing battery for dogs and its intra- and inter-rater reliability

Background

The Finnish neurological function testing battery for dogs (FINFUN) was developed to meet the increasing demand for objective outcome measures in veterinary physiotherapy. The testing battery should provide consistent, reproducible results and have established face and content validity. Internal consistency and intra- and inter-rater reliability of the FINFUN were also investigated.

Results

The FINFUN comprised 11 tasks: lying, standing up from lying, sitting, standing up from sitting, standing, proprioceptive positioning, starting to walk, walking, trotting, walking turns and walking stairs. A score from 0 to 4, (0: unable to perform task, 4: performing task with normal motor function) was given for each task, the maximum score being 44. Twenty-six dogs were filmed when performing the FINFUN. Seven observers scored the performances from the video recordings. The FINFUN was considered to have appropriate face and content validity based on a pilot study, clinical experience and critical reflection of the development process. Its internal consistency was excellent, with no Cronbach’s alpha values below 0.922. The intra-rater reliability for total score of experienced observers was almost perfect: 0.999 (observer 1) and 0.994 (observer 2). The inter-rater reliability for both experienced and novice observers’ total scores was also almost perfect (0.919–0.993). Analysis of each individual task showed substantial intra-rater and inter-rater agreement for the tasks “lying” and “sitting”.

Conclusions

The FINFUN is an objective, valid and reliable tool with standardized scoring criteria for evaluation of motor function in dogs recovering from spinal cord injury.

Electronic supplementary material

The online version of this article (10.1186/s13028-018-0408-2) contains supplementary material, which is available to authorized users.

Veterinary Neurologic Rehabilitation: The Rationale for a Comprehensive Approach

The increase in client willingness to pursue surgical procedures, the heightened perceived value of veterinary patients, and the desire to provide comprehensive medical care have driven the recent demand of using an integrative treatment approach in veterinary rehabilitation. Physical therapy following neurologic injury has been the standard of care in human medicine for decades, whereas similar rehabilitation techniques have only recently been adapted and utilized in veterinary medicine. Spinal cord injury is the most common neurologic disease currently addressed by veterinary rehabilitation specialists and will be the primary focus of this review; however, research in other neurologic conditions will also be discussed. Of particular interest, to clients and veterinarians are techniques and modalities used to promote functional recovery after neurologic injury, which can mean the difference between life and death for many veterinary patients. The trend in human neurologic rehabilitation, often regardless of etiology, is a multimodal approach to therapy. Evidence supports faster and improved recoveries in people after neurologic injury using a combination of rehabilitation techniques. Although the primary neurological disorders researched tend to be spinal cord injury, peripheral neuropathies, allodynia, multiple sclerosis, and strokes-many correlations can be made to common veterinary neurological disorders. Such comprehensive protocols entail gait training activities in combination with neuromuscular electrical stimulation and directed exercises. Additionally, pain-relieving and functional benefits are bolstered when acupuncture is used in addition to rehabilitation. Studies, both laboratory and clinical, support the use of acupuncture in the management of neurologic conditions in small animals, specifically in cases of intervertebral disc disease, other myelopathies, and neuropathic pain conditions. Acupuncture's ability to promote analgesia, stimulate trophic factors, and decrease inflammation, including neuroinflammation, make it an alluring adjunct therapy after neurologic injury. Although there is limited research in veterinary medicine on physical techniques that expedite recovery after neurologic injury, there are sparse publications on clinical veterinary research suggesting the benefits of acupuncture, rehabilitation, and LASER in dogs with intervertebral disk disease. Accordingly, due to the relative lack of evidence-based studies in veterinary neurologic rehabilitation, much of the data available is human or laboratory-animal based, however, evidence supports the utilization of an early, comprehensive treatment protocol for optimal neurologic recovery. The rationale for why an integrative approach is critical will be detailed in this review; in addition, literature on specific physical rehabilitation techniques that have evidence of improved recoveries after neurologic injury, will be addressed.

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.

Rehabilitation and physical therapy for the neurologic veterinary patient

A comprehensive physiotherapy plan for neurology patients manages pain, prevents secondary complications, and supports the health and function of musculoskeletal tissues during recovery. Neurologically impaired patients range in ability from complete immobility (tetraplegia/paraplegia), partial mobility (tetraparesis/paraparesis), mild ataxia, to pain only. Important considerations for the design of a physiotherapy program include access to the patient, level of staff support, and safety of staff, patient, and client during treatments. A thorough overview of the treatment plan and expected outcome should be discussed with the client at the onset of therapy and should be reviewed frequently, particularly as the patient's status changes.

A retrospective study of the prevalence of the canine degenerative myelopathy associated superoxide dismutase 1 mutation (SOD1:c.118G > A) in a referral population of German Shepherd dogs from the UK

BACKGROUND

Canine degenerative myelopathy (CDM) is an adult onset, progressive neurodegenerative disease of the spinal cord. The disease was originally described in the German Shepherd dog (GSD), but it is now known to occur in many other dog breeds. A previous study has identified a mutation in the superoxide dismutase 1 gene (SOD1:c.118G > A) that is associated with susceptibility to CDM. In the present study, restriction fragment length polymorphism (RFLP) analysis was used to genotype GSD for SOD1:c.118G > A in order to estimate the prevalence of the mutation in a referral population of GSD in the UK.

RESULTS

This study demonstrated that the RFLP assay, based on use of PCR and subsequent digestion with the Eco571 enzyme, provided a simple genotyping test for the SOD1:c.118G > A mutation. In a young GSD population (i.e. dogs less than 6 years of age, before clinical signs of the disease usually become apparent), 8 of 50 dogs were found to be homozygous and a further 19 were heterozygous for the mutation. In dogs over 8 years of age, 21 of 50 dogs admitted to a tertiary referral hospital with pelvic limb ataxia as a major clinical sign were homozygous for the mutation, compared to none of 50 dogs of similar age, but where no neurological disease was reported on referral.

CONCLUSIONS

This data suggests that genotyping for the SOD1:c.118G > A mutation is clinically applicable and that the mutation has a high degree of penetrance. Genotyping might also be useful for screening the GSD population to avoid mating of two carriers, but since the allele frequency is relatively high in the UK population of GSD, care should be taken to avoid reduction in genetic diversity within the breed.

Breed distribution of SOD1 alleles previously associated with canine degenerative myelopathy

Background

Previous reports associated 2 mutant SOD1 alleles (SOD1:c.118A and SOD1:c.52T) with degenerative myelopathy in 6 canine breeds. The distribution of these alleles in other breeds has not been reported.

Objective

To describe the distribution of SOD1:c.118A and SOD1:c.52T in 222 breeds.

Animals

DNA from 33,747 dogs was genotyped at SOD1:c.118,SOD1:c.52, or both. Spinal cord sections from 249 of these dogs were examined.

Methods

Retrospective analysis of 35,359 previously determined genotypes at SOD1:c.118G>A or SOD1:c.52A>T and prospective survey to update the clinical status of a subset of dogs from which samples were obtained with a relatively low ascertainment bias.

Results

The SOD1:c.118A allele was found in cross‐bred dogs and in 124 different canine breeds whereas the SOD1:c.52T allele was only found in Bernese Mountain Dogs. Most of the dogs with histopathologically confirmed degenerative myelopathy were SOD1:c.118A homozygotes, but 8 dogs with histopathologically confirmed degenerative myelopathy were SOD1:c.118A/G heterozygotes and had no other sequence variants in their SOD1 amino acid coding regions. The updated clinical conditions of dogs from which samples were obtained with a relatively low ascertainment bias suggest that SOD1:c.118A homozygotes are at a much higher risk of developing degenerative myelopathy than are SOD1:c.118A/G heterozygotes.

Conclusions and Clinical Importance

We conclude that the SOD1:c.118A allele is widespread and common among privately owned dogs whereas the SOD1:c.52T allele is rare and appears to be limited to Bernese Mountain Dogs. We also conclude that breeding to avoid the production of SOD1:c.118A homozygotes is a rational strategy.

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.

Evaluation of a proposed therapeutic protocol in 12 dogs with tentative degenerative myelopathy

The objective of this work was to evaluate the long-term efficacy of a proposed therapeutic protocol in 12 dogs with a tentative diagnosis of degenerative myelopathy, followed-up for a 6-month period. Twelve dogs fulfilling the antemortem inclusion criteria (breed, age, adequate vaccination, history of progressive posterior ataxia and/or paraparesis, no radiographic and myelographic abnormalities in the spinal cord and vertebral column) were allocated. All these dogs presented signs of thoracolumbar syndrome (T3-L3), scored as grade I (mild to moderate ataxia and paraparesis) in 10 and grade II (severe ataxia and ambulatory paraparesis) in 2 cases. Treatment included the use of epsilon-aminocaproic acid and N-acetylcysteine, supplemented with vitamins B, C and E. Prednisolone was given for the first two weeks and upon worsening of neurological signs. Daily exercise, performed as walking or swimming, was strongly recommended. Clinicopathological evaluation was normal in all 12 dogs, and survey radiographs and myelograms did not show spinal cord compression. Magnetic resonance imaging (MRI), performed only in 4 dogs, did not disclose compressive disorders or intramedullary lesions. Neurological signs were progressively worsening in all 12 animals, eventually resulting in severe paraparesis (grade III) or paraplegia (grade IV). The applied medications do not appear to be an attractive alternative to conservative management (physiotherapy) or euthanasia in canine degenerative myelopathy, irrespective of its chronicity.