Physiotherapy in neurology

Animal physiotherapy in neurology

In the rehabilitation of neurological patients the collaboration of veterinarian, physiotherapist and animal owner is essential in order to provide a successful rehabilitation plan. The patient is usually partly or completely paralyzed and the functional ability is decreased severely in neurological patients. This requires significant commitment and patience from the owner, but even more from the veterinary staff and the physiotherapist who have to guide and encourage the owner through this difficult period. The physiotherapist needs to be informed about the underlying problem and cause of the paralysis. Close cooperation with the treating veterinarian is obligatory to get the sufficient clinical status evaluation, realistic prognosis, step-by-step aims of therapy and careful evaluation of the rehabilitation program. Prevention and detection of complications early enough in the course of recovery is probably the most important reason for tight collaboration between veterinary neurologist and veterinary physiotherapist.

Physiotherapy can make miracles in the severely paralysed patients if the right therapies are chosen in the right periods of recovery of the patient. The most important is not to give up too early as sometimes time is needed for recovery to occur in nervous system and in order to see the positive results. Physiotherapy is considered to be a self-evident part of treatment plan of every paralyzed patient in Aisti independently if the surgery was performed or not. We have the possibility to take paralyzed patients for physiotherapy procedures during the day (physiotherapy day care). The dog is brought in morning and picked up in the afternoon/evening after the physiotherapy treatments. This is a greatly appreciated in severely paralysed patients when intensive physiotherapy is needed and the owners have to work long days.

It is important that the owners will receive adequate instructions about the rehabilitation at home. The other important thing is also not to leave the owner alone with the other challenges of the homecare conditions such as management of the bladder function and prevention of skin problems.

Intervertebral disc disease

Physiotherapy for intervertebral disc disease patient starts immediately after the surgical treatment of the patient. The most important factors taken in consideration are the neurological status of the patient pre- and postoperatively. The postoperative rehabilitation includes basic things like frequent turning of the patient, making sure the bedding is dry and soft and management of patients bladder and intestine function. Physiotherapy procedures such as assisted standing and walking exercises can be started on the first day postoperatively. Passive range of motion for the joints in the affected limbs and careful massage is good to start as soon as possible depending on the clinical status of the dog.

Hydrotherapy is usually started the second day postoperatively. For this reason the special enhanced skin suture of the surgical wound is performed in Aisti. Swimming is the most effective as spontaneous movements in the limbs occur usually first in water and then on dry land. The surgery wound is additionally protected from the water with a greasy ointment.

When the dog is ambulatory, weight shifting and balance exercises are included in the rehabilitation to improve balance, coordination and body control. Coordination is also good to practise with different walking exercises and endurance can effectively be improved with swimming or by walking on an underwater treadmill. Physiotherapy continues at least until the dog is able to move independently.

Conservatively treated discs are more difficult to approach with physiotherapy, because of the strict rest program which is usually indicated in these animals. Nevertheless, physiotherapy is important also in these cases. Please, ask for more information from your neurologist and physiotherapist in these cases as the therapy has to be tailored specifically for every patient.

Degenerative myelopathy

Degenerative myelopathy is a progressive degenerative disease of the spinal cord, common amongst German shepherds, Collies and Hovawarts. Symptoms are progressive loss of coordination in the rear, weakness of the both hind limbs and frequent crossing over of the hind limbs. Degenerative myelopathy is not associated with any pain in the back what makes this condition ideal for active rehabilitation immediately after the diagnosis is made. The spine in these patients is usually totally healthy and the problems are caused by degeneration of the nerve fibres inside the spinal cord. Just active and intensive physiotherapy have been proved to be successful in management of degenerative myelopathy patients. It is usually erroneously concluded that if the dog is walking not normally it should be rested and therefore patients with degenerative myelopathy are treated with rest. This usually causes muscle atrophy and muscle imbalance. The opposite is the aim of the therapy: good, strong and functional muscles in the rear.

Physiotherapy can significantly slow down the progression of the disease and maintain functional ability, muscle mass and endurance. The aims in physiotherapy are maintaining the functional ability and increase quality of life. Methods commonly used are swimming, exercise on underwater treadmill, assisted exercise, balance and coordination exercises. As the disease progresses, assisting devices such as slings can be necessary to use. It is important in degenerative myelopathy patients not to expect the dog to perform something it is no longer able to.

Fibrocartilaginous embolism

Fibrocartilaginous embolism is caused by interruption of blood supply to the spinal cord. It is usually characterised by acute onset paralysis of hind or all four limbs. Paralysis frequently comes spontaneously during physical activity.

Physiotherapy for dogs with fibrocartilaginous embolism is similar to the rehabilitation for intervertebral disc disease. The degree of paralysis and the prognosis stated by veterinarian gives the guidelines to physiotherapy. Physiotherapy is the only treatment method available for these patients and should be started immediately after the diagnosis is confirmed.

Hydrotherapy in all its forms is of great benefit for neurologically impaired patients. Passive range of motion is performed to decrease muscle tension, increase and maintain joint movement. Electrotherapy is used to maintain and increase muscle mass and to restore neuromuscular function.

Weight shifting exercises in a patient with fibrocartilaginous embolism.

Periferal nerve injuries

Periferal nerve injuries, plexus brachialis injuries, sciatic nerve injuries and blood supply problems (causing ischemic neuromyopathy) to mention a few, will benefit from physiotherapy. The prognosis for recovery, the aims and duration of physiotherapy depends on the grade of the injury. The treatments used are passive range of motion, electrotherapy and active exercises to maintain joint motion, prevent muscle atrophy and improve neuromuscular function. The rehabilitation is usually very long lasting and the owner plays a great part in the rehabilitation at home. Different functional supports are well developed and used in human physiotherapy and the interest for using them in animals is growing.

An extensor bandage will help the paw into a physiological position. 

Lumbosacral stenosis, cauda equina syndrome

Lumbosacral stenosis is a chronic neurological disorder. From the pathophysiological point of view it can be considered a peripheral nerve trauma as the weakness is caused by damage to the spinal nerves inside the spinal canal at the lumbosacral junction. This usually results in muscle atrophy which can be moderate or severe. The physiotherapy aim in these cases frequently is aimed to prevent muscle atrophy and to increase the muscle mass after surgery.

The physiotherapy can be started usually 7-10 days postoperatively. In conservatively treated patients the rehabilitation is more careful. Specially introduction of active training should be considered critically. Pain relief is an important aim of physiotherapy in these patients and is achieved with the use of electrotherapy, thermal treatments and manual therapy. The use of active exercises depends on the status of the dog and on the stage of recovery. Active exercises may consider assisted standing, walking, hydrotherapy and later on during the recovery strengthening and endurance exercises. Guiding the sporting dog safely back to training and competition is a great challenge and an important part of the rehabilitation.

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