Laurie's Blogs.

Have you ever second guessed your judgment when it comes to a neurologic dog and when and how to progress exercises?  You’re not alone.  I get this question a lot.  Let’s break it down into the pieces that will matter and factor into the equation.

The first rule of thumb.

Work on stability and mobility in lying first.  Guage the capabilities of the dog.  Strengthen his / her abilities for what we would call ‘bed mobility’ in a human – essentially the ability to move in and out of various recumbent positions.  From there work on the next stage of body awareness and control – that of sitting.  Work on getting from side lying to sternal, to the other side, and then up to sitting, and back down again.  These are often neglected skills, but they are incredibly important for early functioning and to prevent pressure sores in the early days as well.

The second rule of thumb.

Work on a stable surface before progressing to an unstable surface.  A modicum of success should be attained with balance (and later with movement) on a flat, non-slip surface before progressing to an unstable or wobbly surface.

The third rule of thumb.

Start with an easy unstable surface before you reach for the more technically challenging inflatable surfaces.  For example a piece of memory foam, a pillow, or a mattress can work as a level one unstable surface.  From there many options exist to increase the instability challenge (i.e. a mini trampoline, a Bosu ball, a Fit Paws bone, and inflatable disc, and so on.)

With those rules in place, you now factor in the specifics about the patient that will help you to decide what exercises you can safely try.

Where is the lesion?

Cervical Spine?  Thoraco-Lumbar?  Lumbo-Sacral? 

A cervical lesion has the potential to result in quadrupedal ataxia +/- front end weakness or buckling.  These guys require extra hands one when challenging them with unstable exercises.  A two piece harness (such as the Help-Em Up harness) can be invaluable in these cases.  Practice lots with these dogs when ‘in clinic’ before prescribing any unstable surface exercises at home.  The risk with these dogs is the ‘face plant’ if you challenge them with too difficult of an unstable surface too soon.  (Refer to the 1, 2, & 3 Rules of Thumb for guidance on getting started.)

A thoraco lumbar region lesion with have rear end weakness or ataxia.  These are easier to manage than the cervical spine lesion, but the rules of progression are the same.  The caveat is that with these guys you can get them walking on a land treadmill or underwater treadmill and help the rear legs move.  Those are stable surfaces – even though movement is involved.  They won’t have great core stability in order to successfully balance or move on unstable surfaces.  So here I would progress from ‘bed mobility’, to balancing on a stable surface, progressing to walking practice, and then unstable surface training – first balance, and then movement.

Lumbo-sacral lesions, if bad enough, cause lower motor neuron signs.  This means it’s not just a weakness with some intact reflexes to work with, but rather a lack of reflex, and an all-out power-outage in worst scenarios.  So the rear ends need help to support and function.  I spend a lot of time working on the root of the lesion with these cases (i.e. therapies targeted at the L-S junction) and as the nerves regain function, so too do the legs… and then the rules above apply.

Post-Operative or Non-operative?

Ventral slot?  Dorsal Laminectomy? Hemilaminectomy?  Pediculectomy?  Instrumentation (i.e. fusion)?  A ventral slot isn’t as scary as it sounds, however what is more important there is that it’s a cervical issue – and the cervical concerns apply.  A Dorsal laminectory and a hemilaminectomy impact (i.e. remove) facet joints.  So, there is the potential for exaggerated extension motions (or mobilizations) to cause pressure on the spinal cord from the adjacent vertebral arches.  Active extension is okay.  Forced extension is not.  We don’t want a big ‘crash and burn’ with these dogs – common sense prevails when it comes to exercise here.  With all of the laminectomies (dorsal, hemi, pediculectomy), one must realize that often times, the disc material has not been cleaned out.  So, the pressure from the disc is relieved, but the bulging disc is still there.  So, spend some time working on the root of the lesion (i.e. therapies to increase blood flow and healing at the site of the lesion) as well as working on functional tasks.  Lastly, the presence of instrumentation (i.e. plates, screws, or wires) simply means that care and cautions needs to be taken in the timeframe that the bone would need to solidify around the hardware and/or the time for a vertebral segment to fuse if that is the case.  This is more of a precaution to manual therapies, or vigorous exercise.  However, a well thought out rehab program wouldn’t cause much issues (again follow the rules of thumb).

Time since incident or surgery?

Any injury or surgery will go through the typical phases of healing.  Acute, Subacute, Chronic.  Respect the acute stage by keeping things simple for a couple of weeks, then in the subacute phase, start attempting some functional tasks or balancing, progress through this stage for another 4 – 6 weeks, and then land at the chronic stage.  In the chronic stage, you pay attention to what the dog is already doing, already capable of, and work to strengthen those skills, and develop more advanced balance and coordination. (i.e. increase the challenge of the unstable surfaces, but also perturbations during walking or turning.)

Functional capabilities at present & what is the dog already doing?

Is the dog already going for walks on unstable ground? (i.e. out in a pasture)  If yes, then you had better get on with working on stability on unstable surfaces.  Challenge the balancing and movement activities so that the dog is better equipped to deal with the ‘real life’ rodent hole, or hummock, or squirrel that darts past!

Size of the Dog and Ease of Workability?

The little guys are easier to prop up and help them balance or move.  The big dogs are a handful – or rather, all hands on deck-full!  The big dog might progress slower, so it’s best to just be prepared for that!

I’m sure I’ve missed out on some nuances and a number of tidbits, tricks, and tips… but this was off the top of my head, and I hope it helps!

Until next time,

Cheers!  Laurie