Laurie's Blogs.

Hi Laurie

I hope this finds you well.  I am hoping you can offer some advice on an interesting case that I have...I have utilized everything that I have learned from class and your website but now need a bit of advanced advice

Logan is a 5yo MN boxer who experienced a cervical FCE in early November.  He came to me five days later paralyzed in 3 out of 4 limbs (RH had slight motor).  He had deep pain and withdrawal in all 4.  He could barely lift his head and had lost his bark.  He could not support himself sternally.  With his amazing dads we started bi-weekly therapy sessions all day which included laser, stim, PROM, joint compressions, massage, standing in the UWTM, and Assisi loop.  We sent home a homemade quad cart which his dads used to keep him standing in weight bearing for at least 10 minutes twice daily if not more.  They continued Assisi Loop, PROM, massage, and nursing care.  As he improved we began working on transitions and patterning and last week added acupuncture.  Long story short, he has progressed to where today he can stand, turn himself over, pull himself into sternal, sit upright, and walk well on 2 legs.  With much support he can walk on 3 legs...he is tripping over his left front.  He has increased tone in his LF and seems unable to effectively advance at the shoulder.  We are working on PROM into flexion of the LF. Today I used NMES to fatigue his triceps- they are very tight.  In the UWTM he can walk well if we lift his LF. A toes up isn't helpful as he is not advancing from so high up. He has toe grips on all four toes.  

Any suggestions on how to help him from this point?  I am thinking of having Dad put him in the cart weight bearing on all but the LF so he can get stronger on the other 3 legs.  Also focusing on relaxing the LF as I am concerned that the triceps spasm are holding him in extension and interfering with advancing the limb.  He can move the left decently. It’s just slow.  It seems like he can walk on either front leg but not both if that makes any sense.  

Any suggestions are greatly appreciated.  His progress is amazing for less than a month, I just want to give him the best chance possible.

Thanks in advance!

-C

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Hi C!

Great job so far!  

So, I would do lots of weight bearing as you are thinking.  Good for strength.  And weight bearing can help break down / relax spinal cord mediated reflexes & reactions like the extensor tone.  

Maybe sitting and weight shifting side to side for a cookie (to get weightbearing on each individual forelimb) and progress to same in standing.

I might also try the E-stim trick: On alternating setting (or one at a time) and put one electrode under the pad of his foot and the other electrode anywhere else - maybe on his neck.  And work on a stepping reaction IN STANDING by facilitating a flexor withdrawal one side at a time.

In the home-made cart your created, are you able to tie theraband around each forelimb (up high so that it helps to keep or pull the front leg forewords as he is moving and when the forelimbs get left behind?  We start out with theraband all over the place on our neuro dogs in the beginning.

Either in the UWT, or Land TM, or in the quad cart... would it work to have someone do toe pinches at the appropriate time to again stimulate a flexor withdrawal of each forelimb and get a stepping reaction?

At this point I would have two different treatment 'prongs' for in clinic:  

1) Passive:  Laser, manual therapy to the neck  

2) Active:  Anything functional and active assisted... practicing tasks, trying new tasks.  Side lie to sternal.  Assisted sit to stands.  Standing practice.  Weight shifting.  Movements within each position.  (i.e. you don't need to use clinic time to Massage, PROM (other than to assess), joint compressions.... leave those for the home program.)  You need to do the tougher 'thinking on the spot' kind of things that you only figure out with the dog in front of you... but if you think 'functional' movement, that might help to see what you can try to get the dog to do and you support or assist.

I hope this is a bit helpful... it might just be a change of mindset to think, ‘What can we practice today?’  And in the midst of trying stuff you learn what to work on next.  

Good luck!  

Cheers,

Laurie

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Awesome thank you!  I have been doing most of what you suggested...you trained me well!!  I actually asked Dad to secure either his right or his left off the ground alternating while in his cart so each could get functional time.  We will absolutely use the theraband more now that he can stand.  I love the pad to foot & shoulder trick while moving and will add that... I was doing in lying down just to simulate walking while he was down... alternating between feet at a normal pace. 

Very helpful to know I'm on track and just being impatient....

:)

Thanks again!!

-C