Neurological and Paralysis – 9 Posts
“Y” had an FCE (fibrocartilaginous embolism) and has regained almost “normal” function in her left hind leg while her right is dragging and lagging 
This is our first meeting, and Y is doing much better than it sounded like she might be doing when we were exchanging emails! She was not knuckling (bending over her paw and dragging or walking on the top) during our visit when she was made to go very slowly. I began her on a basic endurance and foundation strength-building walking program. Some of our discussion is in the video, and hopefully it begins to answer some questions you may have.
Update: Y’s caretaker emailed this to me shortly after our visit:
“Have been working out with Yiqqiyr as directed. She is doing FABULOUSLY!”
“Friday after I went home from seeing you, we did a walk and two massage sessions. Saturday we walked 3×15 min and did 3 massage sessions. Sunday was the same. Monday I was off work at the office for the holiday, so we were able to keep the same schedule.”
By the way, my videographer has a dog that had similar problems after back surgery years ago, and he has done great! His rehab went well, family followed instructions, including restrictions, and years later he is going strong and able to play rugby with his kray-kray sister dog
There are MANY conditions that can lead to an animal dragging the hind feet, and the number one cause I see is protruding disks. If your pet is not paralyzed, you DO need to see a vet and work on getting a diagnosis. The treatments are different for the different causes of nerve damage. If your pet IS paralyzed, the sooner you get to the vet, the better. In my area complete lack of limb use gets you an appointment with a surgery specialist. Mild to moderate nerve issues may be dealt with using appropriate drugs and restrictions, depending on the diagnosis.
Blessings-
Degenerative Myelopathy and Neuro Conditions
Question from the vet pain assn. board:
Does anyone have any recommendations regarding treatments for a 14 year old Husky with Degenerative Myelopathy? So far, the only thought I have is a cart. Also, my understanding is these animals are not in significant pain – is this true? Thanks for any info.
My Response:
Hi!
I apologize for taking so long to reply. I have a 30-yr. background in human sport science and nutrition, worked two years in a veterinary specialty hospital designing and building the rehab dept., and since 2007 have had a mobile practice wherein I serve a huge number of “mystery-ortho-neuro” cases, many of which are presumed to be D.M.
The protocol I have developed over time, and which has been successful at improving function to varying, but notable, degrees is derived predominately from my long-time experience in sport science program design. A body at rest stays at rest and only changes with dynamic interference…
Pain management discussion aside (and I DO agree that while D.M. may not produce pain in and of itself, it is highly likely that an animal with any neuro condition has self-induced pain by nature of the fact that they are compensating, stressing tissues, and possibly pinching nerves, akin to when our sciatica or sub-scapular, etc…get impinged and cause us pain), I introduce a system of simple, vibration-based, massage with a $4.99 Homedics unit (see the video elsewhere in this blog), Low-Level Laser Therapy (MUCH research exists regarding nerve conduction, regeneration, re-invigoration), and a plan of return to whatever level of function is possible via primarily-animal-induced movement exercises, retraining brain-to-limb neural pathways and encouraging focus on movement and function. Strength and endurance/conditioning drills I concoct depending on each animals status are implemented. I begin with laser twice a week for a month and review exercise protocol that the owner is charged with doing if they are capable and which I do if the owner prefers. I use a front harness designed for riding in the car that has fleece and the best stitching I have found and only costs $30 shipped from Petsmart. This is the Travelin’ Dog harness. I turn it around, and it is “perfect” for hind end support (legs through arm holes, tail through neck hole) while relieving owner back stress, if used properly. It is much better designed for the body than the blue neoprene sling, less pressure on the abdomen than a belly sling, and less problematic than a Bottoms-Up sling. No one pays me to promote these items; I have just found that they are simply the best and cheap, and in my years of experience I deem that they work better than a lot of what is out there. I have pics of neuro dogs wearing these harnesses around this blog.
There are many more things that may be done, however getting the owner started on helping the animal around the home in a manner that hurts neither owner nor animal, and in a manner that is most productive time-wise, is one of the major components of my mobile practice. I tend to not involve owners in activities that, again, would potentially cause more harm than good or waste more time than be productive.
I also utilise Ruff Wear boots, usually sometime along the way, for dogs, depending on function-ability, to encourage hind limb use and stability in the home on tile and wood floors. I have contacted the company twice to positively discuss their product and have never heard back from them, nonetheless, they have a product that provides great traction and encourages increased mobility.
OH! And on several elderly canine patients I have used epsom salts baths to great benefit. Owners HAVE to ensure they rinse off all the salt residue after the bath, otherwise if the dog licks it, which they usually will, diarrhea will likely ensue.
I am in a hurry to get to a dog event today and have been intending to respond to this mail and to the mail regarding laser therapy for quite some time. Only have time for this right now, and while it is definitely not all-inclusive, I trust it is a help.
Blessings to All, and I much enjoy and forward many of the informative posts to vet and pharmacist friends. I have been through surgeries and injuries and I am also a patient advocate and navigator for humans, especially for cancer, so I have paid much attention to pain management for many years. Thank you, thank you for your progressive and beneficial attitudes and approaches!
Deborah Carroll
(from a note posted to the IVAPM, veterinary pain management forum)
My Dog is Just Old…
Quite frequently I hear this comment from clients and even from people active in the practice of animal health and science. I provide a mobile rehabilitation and conditioning service to encourage better recovery after surgery or otherwise improve quality of life through functional rehabilitation. Roughly 80% of my client base is elderly dogs, usually with orthopedic and/or neuro issues. Following are some short comments on beneficial treatments for aging pets:….Any fitness/rehabilitation/conditioning/bodywork program should be collaborated with your pets regular veterinarian, i.e., they should be in the loop. This may be accomplished by having your veterinarian refer you to me or by my contacting the vet after you have contacted me should you desire to work hands-on with me as a rehabilitation and conditioning specialist. Dachshunds flying off couches is not the same as plyometrics training, and many owners may not know the risks or benefits to either activity! So make sure to include your primary care veterinarian in your plans to have additional therapies practiced on your pets…..
In addition to #1, pain control, and #2, functional (possibly assisted) exercise protocol:
Massage is a common therapy that almost anyone can use beneficially to encourage circulation and subsequently possibly encourage healing. Many owners may take a stab at performing massage, but instruction from me is always best to start. Different massage techniques accomplish different results, and hands-on massage is not even recommended in some cases! Otherwise, I have found great benefit in using the little AAA battery-operated massagers produced by the Homedics company. My favorite ones cost $5.99, have four balled feet, and the spread of the feet is usually just right to straddle the spine of different animals. These little massagers have a great vibration frequency and anecdotal evidence proves that their use is extremely beneficial. I ran across them in a store about 5 yrs. ago, and based on reading years of research regarding vibrations and circulation, etc…I decided to give it a try. At the least, this massager will increase circulation and the animal will hopefully enjoy it. Cat owners are using it too!
I recommend beginning by slowly using the massager from neck to tail without it turned on, travelling the spine one direction, again, slowly. After a couple of passes, turn on the massager and do the same movement as when it was off. I like to divide the body into 5 minute sections, beginning with the department giving the most discomfort, i.e. mid-spine to tail base, then neck to mid-spine, right thigh, right shoulder, left thigh, left shoulder. If your pet has hip problems, start with the thighs then do the spine then the shoulders, etc…The idea is that doing this form of massage on the whole dog could take 30 min. in one sitting, but if you only have time for 10 minutes’ worth, then do the most important parts first. It is all complimentary and helpful; an animal with hip problems is taking more stress on his front end, and one with elbow problems is straining the neck, spine, and other parts of the body in compensation, so hopefully you get the idea.
Passive range of motion (PROM) should usually be performed and instructed to owners by an experienced practitioner. Some owners I have counseled have come away from surgery discharge having been told to perform massage or PROM, yet the owner actually does not know what this means or how to perform it so that the animal is not injured. A referral to a rehab practitioner to judge protocol and beneficial movements would be great for owners in these cases. Joint mobilization should only be performed by an experienced practitioner. PROM is not usually necessary if the pet is moving on their own, and other physical activities will be a better use of owners time. If your dog is moving and flexing & extending his knee after surgery, very likely his joints are staying mobile and you need not bug him by making him endure your “bicycling” his knee. Other drills and exercises will bring about improved use and recovery of the knee, and you subsequently have less opportunity to hurt him (or you) if you are not trying to manipulate him. Animals do not have the same hesitancy to use their offended joints as humans do, and the PROM is largely unnecessary unless the animal has nerve damage and cannot move the limbs, THEN PROM is indicated.
Controlled, specific swimming in warm water can be beneficial for the improvement of muscle tone, fitness and strength, especially if an animal is too sore in their joints to walk well for just basic fitness. Swimming for conditioning or therapy should be done in a controlled manner with the use of a dog life jacket and in short, steady bouts while better fitness is achieved. Just because a 15-year-old dog “likes to swim” does not mean he/she should go at it for 15 minutes straight the first or even the fifth time. I carry a full set of life jackets in my mobile practice should an owner possess facilities for swimming at home. In some environments, a regular harness may be used instead of a life jacket. Small dogs with short legs, like Dachshunds, may be swum in many home tubs. ….I find that outside the home environment, elderly animals (and many of other ages as well) are usually not happy to be in a swim tank in a foreign environment. I worked with a water tank/treadmill during the first years of my practice and determined that I would not miss it one bit in mobile practice. Elderly animals are often slightly confused and seem to want to do things in the comfort of their accustomed environment. In addition to incalculable fear levels when trying to use a facility-based water tank for therapy, this fear often induces nervous diarrhea in the water and the fear is potential cause for new injury. Travel to and from a facility can produce unnecessary stresses on both owner and animal. Therefore, I have come up with a variety of exercises and slings to assist elderly animals while they learn to return to better function on land…..
Epsom salt baths have been very beneficial for my elderly patients whose owners have tried them. Your pet may have health conditions making these baths prohibitive, so check with me or your veterinarian. Make sure to rinse off all the residue after the bath, otherwise when your pet licks off the residue, diarrhea will likely ensue…(magnesium).
Many machine modalities may be used in the practice of rehabilitation. I consider low-level laser therapy to be the most complementary and productive machine modality I utilize in my practice. Laser therapy has immense benefits which I will not attempt to cover here. A wonderful website to peruse is Thorlaser.com, and much information regarding laser therapy may be found there.
Ultrasound therapy on arthritic or sore joints and muscles has been proven to be beneficial. I also utilize this therapy in my practice and have had very positive owner feedback with regard to improved function in their animals. Much research information, including evidence-based research, is available on the web regarding these modalities…..People often ask me about using heating pads on their dogs; the use of heat depends on the nature of the injury or disease process. A combination of ice/heat/ice is often more therapeutic or the use of moist heat or brown rice in a sock heated in the microwave are usually preferential heat application options, but moist is good for some things while dry heat is for others. When in doubt, use ice. Instructions for the use of ice and heat may be found on my websites.
Chiropractic interventions are the choice of some and in my opinion should be combined with other therapies, especially massage, and should be administered by vets who have studied chiropractic or by chiropractors who have studied animal chiropractic—especially with regard to spinal issues—and are working in conjunction with the vet.
Acupuncture intervention has been proved to be beneficial as well and especially for pain control. There are several vets in the Austin area who practice acupuncture.
Diet: There are commonly-recommended neutraceuticals for elderly and injured dogs as well as for young dogs that have genetic or early-onset of disease process in their joints. Younger sporting dogs should benefit from these as well. Animals, like people, are not always being fed an optimal diet, so the receipt of quality nutrition from feeding varies, and the supplementation of neutraceuticals is often warranted. It is my preference, based on 30+ years’ experience, well-performed and founded research, and successful nutritional healing protocol, to encourage my patients toward a grain-free diet. The research is out there, and I will not attempt to summarize is here. Among commonly-used and readily-available supplements in this catagory are Glucosamine Hydrochloride with Chondroitin Sulfate (synergistic benefit), MSM (additional synergistic benefit), SAMe (joint, liver, tissue, brain, pain), and Omega 3 fatty acids, preferably in the form of fish oil. Oil-based supplements included in animal food are chemically altered during the production process to the point of diminishing their efficacy and/or they soon become rancid when the bag is opened. Omega 3 fatty acid chains are very fragile and research shows use of the capsule form is best. Additional options are digestive enzymes, probiotics, vitamin C, B vitamins & L-Glutamine, to name a few.
Bed: Bedding DOES make a difference. If your old dog/cat is still trying to jump onto your bed, I recommend you either stop them and provide an eggcrate bed nearby or get them started using stairs or a ramp up to the bed (and into the car, too…). Infrared bedding is nice (expensive), and solid research proves benefits. I have a Great Dane, and she has the chaise end of a couch, a Papasan Chair cushion, and two egg crate foam beds (in different rooms).
Elevate Food and Water: this reduces strain on elbows and neck. I put my Great Dane’s kibble in a Rubbermaid container that stands about 18″ high. Many varieties of elevated stands are available from stores and many homemade ideas about on the net. Definitely makes a beneficial difference.
There are definitely more ideas to be shared, and you are welcome to make note of some in the comments section. Pain control and exercise are key to keep your pet moving and healthy. I have a 10.5 year old Great Dane, Grace, as of this writing (Aug. 4, 2011), and she has had many severe orthopedic and some neurological issues, as well as several systemic internal issues. She appears as though she is 3 years old to most people. She does okay…:)
Homework Exercise Review for Elderly Sheepdog with Hind-End Neurological Problems
Here is the short write-up of my recommendations/reminders for Abby’s functional rehab and the process I believe will improve her neuro-muscular capabilities and strength.
Some of this will be stuff I’ve mentioned several times over the course of working with Abby, however it bears review, and most of the time, when I reevaluate a program, often we need to go back closer to a beginning point and press forward methodically in order to achieve expected gains.
I can’t emphasise enough how beneficial the vibrational massage is, even if you do it every other day instead of every day for now. For a refresher, please watch the 10 minute video here:
http://rehabilitationandconditioningforanimals.wordpress.com/category/videos/
And do it as best possible without cutting corners. Pertinent questions are also covered in the video, as well as methodology and benefits. Make sure you change out the batteries as soon as they seem dull, because the best benefit from this massage is realised from the vibration, which stimulates circulation, lessens tension, and potentially improves nerve conduction. I recommend, for now, doing the massage at the end of the day, at bedtime or thereabouts.
For the next week, please walk Abby twice daily, super slowly and consistently, without stopping, for 15 minutes. There are very many reasons why I use this method, and they all contribute to the gains we are trying to achieve. Super slow walking encourages use of all limbs to the best of their ability. Abby has already been able to walk multiple times daily, super slowly, for five and ten minute sessions, having built up slowly. Using the same exercise protocol for a week allows more time for the body to adjust to the work load, and it should go well, because these are introductory workouts, to build a base.
For the following week, please walk her 2×20 minutes in the same manner, if the 15 minute walks are completed well. She should be able to complete these walks without dragging a hind limb and without sagging or falling down. Otherwise, she needs to return to 10 minute walks and do them multiple times daily to ensure success. I am not after complete fatigue and maxing ability at this point; I am after building successful progress, which I believe her body will adapt and accomplish.
I really would like her to wear two supportive hard braces during these walks, and I realise you have only one. She hyper-extends her tarsal joints, and in order to use her hind legs properly and to subsequently use the muscles better/properly, the supportive brace that prevents hyper-extension while she is doing her slow drills would be additionally beneficial. (Orthovet Splint) Use the one you have on her R hind, since that leg has the most deficits and is the weakest. She hyper-extends because of nerve weakness and defecits.
After the week of 2×20 min slow, relatively flat walks, please add in cavalettis, obstacles, to improve her proprioception. This may be accomplished in many ways and several locations around your environment. I have photos on my rehab FB site that depict a trained sporting dog doing cavalettis using an extension ladder. I have a video on this site of a cat with neuro problems using a lineup of remote controls across a bar top. I have a pic on my FB site of another older dog using obstacles in the back yard. When time allows, I will attach some of those pictures to this post.
Abby needs to do the cavalettis every other day and during one of the walk workout times. You should warm her up walking for 5 minutes then do obstacle repeats for 10-15 minutes. I suggest you use about 5 items in a row, spaced about half an Abby-length apart, and between 4-6 inches high for now. If we could get the old cat to do the work, I’m pretty sure we can get Abby to do it! If she is too stubborn for you, I will be glad to take a rehab session and work with you and her on this drill.
After a week of this drill, keep doing it as prescribed, and add in hill repeats every third day as one of her twice-daily workouts. I suggest walking out the front door, around to the back yard, and then up and down the hill on the far side of the house for 10-15 minutes, very slowly. I was able to get her to do this work this past summer when I came for rehab checks.
During the hill phase, it may be more beneficial for Abby to receive laser therapy on the hill work days. This should have the effect of stimulating nerves and cellular process and often improves work ability in the older and neuro-challenged animals. In her condition, I see reason to have twice-weekly laser sessions for at least a month.
I think it would be great if you were able to just start where I suggest, as if we were beginning from scratch, and let’s see the progress that comes from scripted protocol and collaborative effort. She won’t improve from this point if she keeps doing the same walks and leads the same life she has been leading…the body stagnates, and the same happens for humans as well. Our brains aim toward conservation while our bodies are able to do more. I believe, based on my experience that is also based on years of research, that we will see strength and muscle gains if you start here again. I suggest we review in one month after these exercises have been completed. I will then revise the protocol and change the challenges.
Thanks!
Blessings-
Deborah
Fighting Foot Drop
From Advance Journal for Human Physical Therapy
My (RehabDeb) Comment:
“Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.”
Employing these techniques in animal-other-than-human rehab is what I do and is highly successful here, as well–proprioceptive training that can also build nerve strength . For dogs and cats, I utilize Orthovet footbed splints and Thera-Paws Dorsi-Flex Assist boots on a case-by-case basis.
The Foot Drop Fight
Early treatment and compliance with a home exercise program are essential.
By Rebecca Mayer Knutsen
Posted on: December 20, 2012
Foot drop, a general term for difficulty lifting the front part of the foot, can be a temporary or permanent condition. The condition signals an underlying neurological, muscular or anatomical problem.
A patient with foot drop due to weakness or paralysis may exhibit behavior such as scuffing her toes along the ground. Or she may develop a high-stepping gait so her foot does not catch on the floor as she walks.
Beyond the obvious frustrations and limitations that accompany this condition, these patients are at greater risk for falls. According to physical therapists, early treatment and patient commitment to a prescribed home exercise program is often the best approach for patients with this gait abnormality.
Gaining Control
The source of foot drop is most commonly a central neurological impairment such as stroke, multiple sclerosis or traumatic brain injury or a peripheral injury such as nerve damage stemming from knee replacement surgery.
“Controlling foot drop through strengthening, orthotics or a functional electrical stimulation foot drop system may address the instability of the ankle, limit the possibility of catching the toe during gait and increase safety and stability to decrease the potential of falls,” said Gregory A. Thomas, PT, physical therapy supervisor, Rehabilitation Center at Eastern Idaho Regional Medical Center in Idaho Falls, ID.
Therapists must conduct a thorough PT evaluation that includes a complete patient history and an assessment of range of motion, strength, sensation, spasticity, reflexes and mobility. Treatment varies depending upon the cause and presentation of the foot drop. Treatment options range from therapeutic exercises including ROM, stretching and/or strengthening to electrical stimulation and gait training.
“The first thing I do with a patient is determine if the dysfunction is central or peripheral,” explained Douglas O. Brown, PT, CSCS, manager of Raub Rehabilitation, Sailfish Point Rehabilitation and Riverside Physical Therapy, all part of Martin Health System in Stuart, FL. “Is it a brain injury such as stroke or MS?” Brown asked. “Or is it a pinched nerve in back or leg or damage from a hip surgery?”
Once the origin of the foot drop has been determined, Brown must determine if the patient is flaccid with no movement whatsoever. “If so, then the outcome /prognosis will not be as good as someone who exhibits some movement,” he shared.
According to Thomas, PT exercises for this patient population include range of motion exercises for knees and ankles and strengthening leg muscles with resistance exercises. And, stretching exercises are particularly important to prevent the development of stiffness in the heel.
“There are no exercises that are off limits to these patients as long as the ankle is stable during the exercise,” Thomas explained. “The exercises can be closed chained or open depending on the level of stability.”
“We have to focus on restoring normal movement patterns but also on stability,” Brown said. “Can the patient stand on one leg without swaying back and forth? It’s important that we remember the static part because these patients function on different surfaces in real life.”
Archive ImageA
Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.
“If my patient’s goal is to be able to walk the beach in her bare feet, then we need to work on uneven surfaces,” Brown said.
The therapists need to understand a patient’s case 100 percent and treat each one as an individual. These patients need to be assessed on their own merits, according to Brown. “If I have a patient with a traumatic ankle injury from being run over by a car, then I may stay away from certain load bearing exercises,” he shared.
Enter the AFO
If a patient does not have functional use of his muscles, then an ankle foot orthosis (AFO) can be used to keep the ankle at 90 degrees and prevent the foot from dropping toward the ground, thereby creating a more even and normal gait.
The type of AFO used depends on each patient’s specific needs. Some of the types most commonly used include solid ankle, articulated ankle and posterior leaf spring and are most typically made of polypropylene. Articulated ankles allow for some ankle motion, dorsiflexion assist and partial push-off during gait and solid ankle AFOs are rigid and more appropriate if the ankle and/or knee are unstable. Patients typically need to wear a larger shoe size to accommodate these types of AFOs.
“As a physical therapist, I need to realistically fulfill the goal of a patient, which in the case of foot drop, is most typically to stop using an AFO,” Brown explained. “But there are other issues to consider aside from the annoyance of the device. I may need to worry about comorbidities such as diabetes and how the AFO may be causing skin breakdown.”
Brown aims to improve his patients’ optimum function and quality of life while decreasing the fall risk. “Once a patient tells me his goals, I need to determine if they are realistic,” he told ADVANCE.
The goal of physical therapy with these patients is to use the least restrictive device, according to Thomas. “If there is active movement at the ankle and we can strengthen it back to normal, then a temporary brace can be used for support and to increase safety,” he stated. “If the foot drop is more long standing, a custom fitted AFO may be needed.”
In the last 10 years or so, AFOs have improved in quality and function, according to Brown. In fact, he says, some AFOs are made of carbon fiber and elicit a dynamic action instead of keeping the foot rigid while going through the swing phase of gait.
Another option is a foot drop system that applies electrical stimulation in a precise sequence, which then activates the muscles and nerves to lift the foot and bend or extend the knee. This type of device assists with a more natural gait, reeducates muscles, reduces muscle loss, maintains or improves range of motion and increases local blood circulation.
The foot drop device allows a flexible ankle during gait to obtain a more normal walking pattern. A good alternative to bracing, the device’s gait sensor adapts to changes in walking speed and terrain, allowing the patient to walk easily on stairs, grass and carpet.
Brown recently treated a 37-year-old woman with early stages of MS. He put the FES foot drop system on her and it helped her walk normally for the first time in years, bringing tears to her eyes.
“FES can help patients develop great gait patterns and fire muscles,” Brown observed. “FES shows the potential for improvement and the patient can rent the device themselves to wear all day instead of an AFO. The technology is helpful but the device isn’t for everyone. There is a better response with central foot drop as opposed to peripheral lesions.”
The device works well when the peripheral nerve is intact. Patients with a peripheral nerve injury-from diabetes or trauma-who have no palpable muscle contractions may not see improvements. “If the damage is peripheral nerve, then a FES foot drop system will not work in correcting foot drop and a passive AFO system will have to be used,” Thomas shared.
If the patient’s spinal cord has been interrupted in any way, then retraining the muscles would be a very difficult-and maybe even impossible-endeavor.
An AFO remains the appropriate solution for patients with lower-extremity edema, unstable ankle stance or cognitive impairments that interfere with operation of a foot drop system.
Complying at Home
For this condition, patients typically go to therapy for about 45 minutes, two times a week, according to Thomas. “If a patient is going to make gains, however, it’s imperative that there is good compliance with a home exercise program,” he shared. “The patients who have the greatest success are the ones with a solid work ethic outside the clinic.”
Brown’s approach to ensure compliance with a home program begins with the patient’s first evaluation. “I tell them how important the home program is and that participation is crucial,” he shared. “I put them on the spot and I go through the exercises the first day and then send them home with illustrations. I say I will quiz them during the beginning of the next session and will ask them to demonstrate the exercises I assigned.”
With this approach, Brown knows whether or not they’ve followed through based on their familiarity with the exercises. “I give additional exercises and instruction during each session,” he said. “And that’s how I make sure that they are compliant. It usually works because patients come prepared because they don’t want to fail.”
When it comes to foot drop-and really any PT-related injury or diagnosis-Brown stresses the importance of seeking care with a physical therapist as soon as possible. “I don’t want to see someone with foot drop after 6 months,” he stated. “Once a patient is medically stable and safe to treat, they need to be sent to PT.”
Brown recalls seeing a patient with foot drop after having a stroke one and a half years earlier. “There was a lot less I could do for her compared with what I could have done right after her stroke,” he said. “It’s crucial to treat these patients as soon as possible with exercise, stretching and weight bearing.”
Rebecca Mayer Knutsen is senior regional editor of ADVANCE and can be reached atrmayer@advanceweb.com.
Simple Massage Video Uploaded to YouTube
Water Treadmill is Not Necessary for Rehabilitation
Compared to the number of dogs in the world, then compared to the number of ruptured cruciate ligaments on aforementioned dogs, then compared to the number of said dogs with ruptured ligaments who are treated by a veterinarian, then compared to the number of those dogs who are taken to surgery for structural remedy, there are relatively very few rehab clinics in the world and fewer still water treadmills.
Dogs of the world do relatively “ok” on all areas of the treatment spectrum and definitely do not need to be “put down” due to ruptured cruciate ligament (torn ACL, CCL). I have encountered clients in my practice who were told unless they had surgery, the dog would have to go. Just wanted to clear up that situation.
That being said, and along with explaining the title of this blog, of foremost importance I will note that I came into veterinary functional rehabilitation with approximately 25 years experience in human sport science and nutrition. I decided to call my practice “functional rehab”, not having seen that designation applied much but having presumably heard the term somewhere. I decided to use it when I began an independent, mobile rehab practice in 2007, two years after starting and running a rehab clinic for a veterinary specialty hospital.
I became aware of the water treadmill via my work at the hospital, and I found that the use of it was/is widely promoted within veterinary medicine and the canine rehab model, which draws heavily from structured, academic-oriented, human physical therapy concepts. I think the overall concept is decent, yet the wtm is one very, very small tool in the vast array of protocol and modalities that exist in order to better the health of your pet.
Unfortunately, I found that what is not taught within this same model is a good basis and understanding of program design, writing training programs, and the development of dynamic activities/protocol designed to encourage healing and increase muscle and bone mass. These are principles I began learning over 30 years ago as an athlete, as a self-coached athlete, and then as a coach and trainer to others, even world-class athletes.
What does this mean to you and your pet (primarily dogs…)?
The chief complaint I hear from people who contact me is that they were referred to this clinic or that one for post-surgical rehab, and after many weeks of walking in the treadmill, moving around on balls, and doing a variety of other things, the dog is not much better or is not to a place where the owner feels comfortable with letting them be loose and rambunctious. They aren’t where the owner thought they would be after surgery. When I was in a clinic setting and working on utilising the wtm we had, I did structure the workouts to be progressively difficult, using a 3x workout adjustment protocol, meaning that if three workouts went well, then I changed the protocol, making the workout more dynamic. This could be done by increasing time or lowering water in the tank. Since I do not believe that much benefit is realised by walking in a wtm more than 20 min., and some data is published to recommend that animals not be worked beyond that time anyway, I find more benefit realised by lowering the water height, thus increasing the force on the joint/leg/muscle/bone.
HOWEVER, I also find that after very many years of reading many, many reports in sport science and regarding functional return to activity, the best benefit is realised via gravity-based, slow, structured exercise protocol, and I began developing that for small animal rehab since I did not find any published when I arrived on the scene.
Your dog will use their leg to some extent and increasingly after surgery if he/she is not in pain. That has been my finding after working with hundreds of cases. With that in mind, a structured workout program is entirely necessary and may vary from any standardized protocol depending on the nature of the dog and the owner.
If your dog is not using the leg within 2-3 days after surgery, then my findings are always that they are in pain, and that they are in pain due to 1) not enough post-op analgesic, which I believe should be a combo of at least two analgesics for potentially several weeks while we pursue the best activity and homework for healing (in this area we commonly use an nsaid and Tramadol); 2) infection, the pain of which will only be finally remedied by antibiotics (and subsequently the infection remedied as well); or 3) structural abnormality, i.e. some sort of failure related to the surgery, yet not necessarily the surgeons/your/your dogs *fault*.
The homework protocol I generically recommend is contained elsewhere in this blog. If you are within range of my services, I recommend you contact me for an evaluation appointment and we establish a base for your dog and then you perform the exercises which will bring solid healing while helping to also protect the opposing limb.
Thank you!
Kacey Cat Does Cavaletti Work
http://youtu.be/IqwFemytxzs (CLICK HERE)
Kacey has neurological problems in her hind end. I have been performing laser therapy on her and working on finding exercises that will benefit her quality of life. The owner and I discovered during one visit that she would walk one direction across a particular section of bar top to get to some place her kitty brain holds special…so special that she will repeat this action many times.
I placed 5-6 remotes across the bar top, and Kacey is to make 5-6 passes over all of them, every other day, doing it all at one time.
She has improved much around the home, and we made some other exercises work for her too.
She is working on losing some of her “extra”.
Click on the link above to view the video.
Anecdotal Progress
Exercise is thought to have beneficial effects on Parkinson’s disease. Jay L. Alberts, Ph.D., neuroscientist at the Cleveland Clinic Lerner Research Institute in Cleveland, saw this firsthand in 2003 when he rode a tandem bicycle across Iowa with a Parkinson’s disease patient to raise awareness of the disease. The patient experienced improvements in her symptoms after the ride.
“”The finding was serendipitous,” Dr. Alberts recalled. “I was pedaling faster than her, which forced her to pedal faster. She had improvements in her upper extremity function, so we started to look at the possible mechanism behind this improved function.” As part of this inquiry, Dr. Alberts, researcher Chintan Shah, B.S., and their Cleveland Clinic colleagues, recently used fcMRI to study the effect of exercise on 26 Parkinson’s disease patients.”
The above is a quote from an article regarding research looking at the benefits of exercise for Parkinson’s patients, found on Science Daily dot com, and as I read it this morning, I thought it to be a perfect example of the practice protocol I have developed that has proved beneficial for several orthopedic conditions in lieu or surgery…whatever reasons one might have for not having surgery performed on their pet.
I am one person working alone, however I have over 30 years background and experience in principles of human sport science, exercise physiology, program design, and the like. There are a few others with similar backgrounds working in veterinary rehabilitation. I began using simple principles based on years of experience, and I’ve seen much success, as evidenced by improved quality of life, improved function, and veterinary professional confirmation.
I don’t have money to drive clinical research, and while I have ideas of those whom I could approach to get involved with this research, I am busy in my practice and haven’t wanted to take the time aside to pursue grants or corporations. At some point I intend to write more about the beneficial outcomes and to further discuss cases, however in the meantime, take the first paragraph as affirmation that science is observation of a particular outcome or experience as well as the steps to prove what we imagine/postulate/thought we observed.
It has been proved anecdotally time and again that when the conservative and slowly progressive non-surgical interventions I have outlined in the homework discussions on this site and/or in my books are followed within the parameters I outline, improvement of the condition ensues, barring extenuating circumstances. I do not see the discussion as being whether surgery or no surgery is better; I present the protocol I use as beneficial guidelines instead of not giving a program of recovery to those who choose to wait or altogether forego surgery for some conditions.
In other words, for injuries and conditions that are not “life or death”, the fact is there are very many people who will not choose surgery for their pet (or for themselves, for that matter). The instead-of-surgery protocol I develop and use fills a need to help the pet recover.
Keep moving forward; there is no time constraint on the “one step at a time” methodology…you can always begin, again, now.
Blessings-
Filed under: HOMEWORK SUGGESTIONS FOR FUNCTIONAL REHAB Tagged: ankles, dog muscle building, dog rehab, hind end weakness, hips, hyperextended tarsal joint, neuro-muscular strength, neuro-muscular weakness, neurological, spine, weak legs
