Page 148 - Veterinary Laser Therapy in Small Animal Practice

134 Veterinary Laser Therapy in Small Animal Practice

Case no. 14

F., feline, 9 months old, Domestic Shorthair, MNC, 3.1 kg
• Complaint: severe generalized weakness.
• History: F. was found in the street as a kitten in a very poor condition. He had corneal ulcers and wore an
E-collar for a month, while being kept inside a carrier. Since then his weakness had not improved, to the point
he could barely move, had difficulties holding his head and the owners had to hand-feed him and help him
to the sandbox. He lives on the sofa/bed without moving. The referring hospital performed radiographies,
muscle (cranial tibial, quadriceps) and nerve (common peroneal) biopsy, and MRI. He is taking carnitine and
a B-vitamin complex.
• Radiographic findings: generalized low bone density.
• Pathology: moderate primary non-inflammatory myopathy.
• MRI: no significant findings.
• Physical examination:
• Body condition score 3/9.
• Unable to walk. Plantigrade stance, with phalangeal and elbow flexion, and general spasticity.
• Goniometry: the affected joints (the rest of the joints are normal).

Range of motion (degrees)
Joint
Right Left
Knee 180 180
Elbow 90 92
• Limb circumference:
• Forelimbs (20% of arm): right 9 cm; left 9.5 cm.
• Hindlimbs (70% of thigh): right 21 cm; left 20 cm.
• Neurological exam: normal, except for some mild postural proprioceptive deficit in hind legs.
• Pain assessment: 6/10 NRS in elbows, shoulders, stifles, tarsi, thoracolumbar spine. Overload of
supraspinatus, infraspinatus, and paravertebral muscles.
• Diagnosis: degenerative muscular dystrophy.
• Treatment:
• Laser therapy:
• Although the patient could only be seen once a week, LT was part of a broader treatment program.
• Treatment area included the neck, elbows, and thoracolumbar spine.
• Passive ROM and stretching were applied during the treatment.
• Other physical therapies: twice a week for the first month, then once a week during the second month,
then once every 2–3 weeks for 4 months.
• Neuromuscular electrical stimulation (NMES): biphasic pulsed wave; 50 Hz, to stimulate lumbar
muscles and triceps brachialis.
• Transcutaneous electrical stimulation (TENS): electrodes are positioned bilateral to the spine (T13–
L5) for 20 min.
• Ultrasound: pulsing at 50%, 3.3 MHz, 5 cm probe, for 4 min over elbows and 4 min over biceps brachii
during passive ROM and maintained stretching.
• Pulsed magnetic therapy: initially 2–20 Hz over stifle and hip areas to treat pain, then 100 Hz for
muscle stimulation.
• Exercise program:
• Assisted exercises: assisted stance, maintaining neck, elbow, and phalangeal extension. Balance and
weight-shifting exercises while standing.
• Active exercise: walking over soft non-slippery surface.
• Manual intervention: stretching massage of forelimbs and spinal muscles. Passive ROM of all joints.
• Home exercise program: all techniques were initially performed with the owners in the clinic to ensure
proper delivery. Exercises were performed at home 3–4 times a week.

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