Neurorehabilitation
In companion animals, damage to the central nervous system often results in dysfunction of the spinal cord, peripheral nerves and in some cases the brain. These injuries can cause pain at the site of injury, loss of coordination, spasticity and weakness of one or more limbs. The degree of neurological impairment varies depending on the severity of nerve damage. Thus, clinical signs can range from pain without mobility impairment, to mild or even severe neurological dysfunction in one or more limbs (1). The animal may experience partial or complete immobility and in severe cases complete paralysis with loss of pain sensation of one or more limbs may occur (2).
Physical rehabilitation for a neurologic patient extends beyond simply treating their physical disability. Neurologic rehabilitation often involves helping owners adapt and cope with their pet’s injury; this may include teaching appropriate nursing care in the home, demonstrating bladder and bowel management, and providing guidance on mobility aids to prevent dragging of the weak or paralyzed limbs (2). A comprehensive neurologic rehabilitation program should utilize a multimodal approach including therapeutic modalities, manual therapies and physical exercise to promote neuromodulation of the sensorimotor systems and restore neuromuscular function (3). There are several treatment options such as neuromuscular electrical stimulation, laser therapy and acupuncture which have been shown to improve neuromuscular restoration and pain management (4). Neuromuscular stimulation uses a low voltage electrical current to reactivate sensorimotor nerve conduction, in turn facilitating a passive muscle contraction, enhancing nerve excitability and helping to slow muscle atrophy (3,5). Laser therapy increases localized circulation to reduce pain and inflammation at the site of injury, as well as promote regeneration and restoration of damaged spinal nerves (6,7). Acupuncture is a non-invasive technique that can be applied passively to stimulate nerve signalling and reduce neurogenic pain. Acupuncture is frequently utilized alongside laser therapy and electrical muscle stimulation within the early phase of recovery when treating neurologic injuries (2).
Manual therapies such as passive range of motion and stretching of affected limbs and other areas of compensatory tension can help to significantly reduce pain and stiffness in muscles of the limbs and trunk (2). Manual stimulation of the paws and tail play a crucial role in improving sensory nerve conduction within the central nervous system (3). Early neurologic rehabilitation exercise focuses on improving core and spinal strength and alignment by retraining proper transitions and standing postures, with a goal of being able to rise and hold a stance position without assistance. Once a standing position is achieved, therapeutic exercise is geared towards re-training of normal gait patterns, limb strength and proprioception to enhance overall motor function of the affected limbs (2,3,8). Manual limb patterning is often performed during assisted ambulation on land, or when utilizing buoyancy in an underwater treadmill to instil repetitive, rhythmic gait patterns and modulate neuroplasticity (3,8). As strength and locomotor function improve, physical exercise is progressed as tolerated, in a safe and gradual manner (8).
Assistive devices such as supportive body harnesses, no knuckling boots and wheelchairs can all promote mobility when recovering from a neurologic injury by allowing the animal to move with improved biomechanics and independence (9). Wheelchairs can often be seen as a last resort for a paralyzed or weak animal, when in fact wheelchairs are a great addition to a neurologic rehabilitation program. They ergonomically support the body weight and allow the animal to more easily perform exercise, promoting voluntary movement and strengthening in the core, spine and limbs, which can greatly improve the quality of life and recovery of animals suffering from neurologic injuries (2).
Whether a neurologic injury is being managed surgically or medically, neurorehabilitation offers many benefits including managing pain, restoring neurologic pathways and promoting a return to functional mobility (2-4).
Ask us how we can help your pet’s neurologic recovery!
REFERENCES:
Millis, D. L. & Levine, D. (2014). Canine rehabilitation and physical therapy. (2nd ed.). Elsevier Saunders. 193-194.
Sims C, Waldron R, Marcellin-Little DJ. Rehabilitation and physical therapy for the neurologic veterinary patient. Veterinary Clinics of North America Small Animal Practice. 2015;45(1):123-143. https://doi.org/10.1016/j.cvsm.2014.09.007
Gon alves FIR, Martins APNR, Alves MMF (2016) Functional Neurorehabilitation in Dogs with Cervical Neurologic Lesion. Journal of Veterinary Science Technology 7(2): 301. doi:10.4172/2157-7579.1000301
Jeong IS et al. Canine thoracolumbar intervertebral disc herniation and rehabilitation after surgical decompression: A retrospective study. Journal of Advanced Veterinary and Animal Research. 2019;6(3): 394–402. http://doi.org/10.5455/javar.2019.f359
Zink, C. M., & Van Dyke, J. B. (2013). Canine sports medicine and rehabilitation. John Wiley and Sons Inc., p120
Riegel, R. J., & Godbold, J. C. (2017). Laser therapy in veterinary medicine: Photobiomodulation. John Wiley and Sons Inc. 133
De Oliveira MP, et al. Photobiomodulation therapy (PBMT) in peripheral nerve regeneration: A systematic review. Bioengineering. 2018;5(44): https://doi.org/10.3390/bioengineering5020044
Millis, D. L. & Levine, D. (2014). Canine rehabilitation and physical therapy. (2nd ed.). Elsevier Saunders. 610-619
Millis, D. L. & Levine, D. (2014). Canine rehabilitation and physical therapy. (2nd ed.). Elsevier Saunders. 499-500.