Neurological Rehabilitation

Three key stages of motor learning

• Cognitive phase

• Associative phase

• Autonomous phase

Cognitive phase

Understanding and goal of activity

Associative phase

Mastering the time of the skill

• Longest phase

Autonomous phase

Well-coordinated

Practice techniques

• Motivation

• Specificity

• Contextual relevance

• Contigity

• Reinforcement

• Feedback

• Activation

• Repetition

Motor control steps

• Mobility

• Stability

• Controlled mobility

• Skill

Mobility

Sufficient range of motion and muscle activity

Stability

Co-concentration of muscles for postural control

Controlled mobility

Ability to lift limbs while stabilizing posture

Skill

Coordination and precision of movement

Therapeutic approaches

• Normal movement and sensory feedback

• Sensory stimulation

• Diagonal patterns and stimulation

• Uses reflexes/synergy in recovery stages

• Task-specific, reinforcement-based training

Physiotherapy goals

• Promotes spontaneous recovery

• Manipulate neuroplasticity

• Prevent secondary complications

• Use compensatory strategies when needed

Recover physiology

• Remyelination

  • Regenerate myelin sheath covering the nerve endings

• Collateral circulation

  • Widen or re-wire blocked or narrowed blood vessels

• Atonal regeneration

• Synaptic reorganization

  • Synaptic terminals re-meet

Common active therapeutic exercises

• PROM

• Massage

• Electrical muscle stimulation

• Therapeutic handling and functional positioning during rest

Functional Evaluation tools

• Finnish Neurological function (FINFUN)

  • Scale of 5

• Texas Spinal cord injury score (SCI)

  • Scale of 10

• Olby score

  • Score of 5

Assistive aids

• Orthoses

• Prostheses

• Carts

• Protective boots or bandages

Orthoses

How we help a limb that’s still attached to the body

• For a hind limb: prevents the leg from knocking or hyperextending while also preventing muscle wasting since they are still using it

Considerations for aids

• Painless

• Constant supervision

• Owner training for correct usage

• Consideration of owner erogonomics

• Must be custom made and properly fitted

• Rest breaks are needed

  • Dogs can’t lie down in them

• Risk of secondary trauma

  • Urine scald

• Mental status of dog must be monitored

Practical considerations of aids

• Prevent pressure sores with proper bedding and positioning

• Can adapt for home care if owners are committed

• Urinary incontinence is common

• Must be informed of costs and treatment intensity

Urinary incontinence practical considerations

• UTIs can be considered emergent in paralyzed animals

• Owners often misjudge urination and need to be taught how to express

Nursing considerations for aids

• Controlled environment

• Padded cages and runs

• Diet control and weight management

• Functional exercise

• Requires sling support or other manual assistance

• Rotation to reduce secondary lesions

Controlled environment for dogs with aids

No stairs, slippery surfaces, or dog play

Functional exercises in dogs with aids

Standing, sitting, sit-to-stand, lying, PROM, flexor reflex activation

Intervertebral disc disease (IVDD)

When the intervertebral discs herniate or rupture putting pressure on the vertebrae

• Can be due to degeneration in geriatric animals, trauma, or genetic predisposition

What breeds is IVDD common in

• DACHSHUNDS*******

• French Bulldogs

• Ship Tzus

IVDD diagnostics

Requires advanced imaging like MRI to create a definite diagnosis

When is there a good prognosis in dogs with IVDD

Early surgical intervention, especially in animals with paresis

Most common surgical procedure to treat IVDD

Hemilaminectomy

IVDD recovery

Prolonged rehabilitation and cage rest

Fibrocartilaginous embolism

Spinal cord injury that occurs when a fragment of the intervertebral discs breaks off and blocks the blood supply to the spinal cord

• Common in young to middle-aged dogs

What breeds are fibrocartilaginous embolisms commonly seen in

• Labrador Retrievers

• German Shepherds

• Border Collies

How do dogs with fibrcartilaginous embolisms commonly present

Suddenly with unilateral paralysis and generally is non-painful

Fibrocartilaginous embolism diagnosis

Advanced imaging like MRI

• Spinal tap can also be useful to rule out infection

Fibrocartilaginous embolism treatment

No surgical intervention is needed

• Supportive care, care rest, anti-inflammatories, and intense rehabilitation

Brachial Plexus injury

A condition that occurs when the brachial plexus undergoes a traumatic injury

• hit by car, nerve compression, over-stretching of the front limbs

How does a dog with a brachial plexus injury present

Lack of front limb proprioception and nociception

• Lack of deep pain

• Knuckling carpus

Brachial Plexus injury diagnosis

Electromyograph can assess nerve function and degree of damage

• definitive diagnosis based on clinical signs

Brachial Plexus injury treatment

• Supportive care

• Cage rest

• Anti-inflammatories

• Intense rehabilitation

Degenerative Myelopathy

The degenerative of the white matter within the spinal cord

• Disrupts the communication between the brain and the hind limbs

• Affects adult to geriatric animals and progresses to hind limb paralysis, fecal and urinary incontinence

  • Will start to affect compensatory limbs

DM diagnostics

Obtained through ruling out other neurological conditions like IVDD, tumors, or infections

• Genetic testing for the SOD1 mutation can be performed

DM prognosis

Progressive and irreversible

• Physical therapy, mobility aids, nutritional support

Wobblers Syndrome

Malformation or lack of stability in the cervical vertebrae that leads to narrowing of the spinal canal or disc herniation

Wobblers syndrome clinical signs

• Ataxia

• Hind and front leg weakness

• Proprioception deficits

• Neck Pain

What breeds are commonly affected by Wobblers syndrome

• Doberman Pinschers

• Great Danes

• Mastiffs

• Bernese Mountain Dogs

Wobblers Syndrome diagnostics

• Obtained by MRI or CT scans

• Neurological exam to localize spinal cord issues

Wobblers Syndrome treatment

• Surgical Decompression

• Supportive care

• Strict rest

• Anti-inflammatories

• Physical therapy

True or False: Wobblers Syndrome requires life long treatment

True