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Pointing light at musculoskeletal and neurological conditions: clinical applications 139

• Exercise program:
• Assisted exercises: standing and weight-shifting using different surfaces, bicycling movement.
• Hydrotherapy: started after the first month, with underwater treadmill and swimming pool twice a
week, then once a week, once every 2 weeks, and later just once a month.
• Manual intervention: gentle massage of hindlimb and forelimb musculature. Passive ROM of all joints
of the pelvic limbs with bicycling movements.
• Home exercise program: all techniques were initially performed with the owners in the clinic to ensure
proper delivery.
• Passive exercises: gentle massage of hindlimb muscles two to three times/day, plus footpad
friction massage and phalangeal stimulation. Passive ROM of all joints of pelvic limbs with bicycling
movements.
• Active exercises: assisted standing and weight-shifting on stable surfaces, then on a moderately
unstable surface and on a bi-directional balance board. Slow supported leash walking was added after
the first week, initially for 3–4 min, three times a day, then gradually increasing duration.
• Other exercises were later performed as well, such as turning exercises during walking and sit-to-
stand exercises; the schedule was adapted to the progress of the patient each week.
• NMES: biphasic, symmetric, and rectangular pulsed wave; 40 Hz, to stimulate hindlimb muscles
(hamstrings and femoral quadriceps).
• TENS: local treatment for 20 min, 5 Hz. The electrodes were positioned bilateral to the spine
(T10–L2).
• Owner education: exercise restriction, soft bedding to prevent ulcers. Bladder expression. Brief (later
increased) assisted walking with a supporting harness and sling.
• Outcome:
• On day 12, she was able to stand up by herself and had pain perception down to L5.
• On day 15, she was able to take a few steps and recovered some urinary and fecal continence.
• After 6 weeks, she recovered deep pain in the right hindlimb, and in the left limb after 10 weeks.
• She was gradually able to take longer walks, up to 40 min by the fourth month.
• She recovered continence by the sixth month.

Figure C16.1 Patient, case no. 16. Figure C16.2 Electro-acupuncture session. Figure C16.3 Ground exercises on
different surfaces.

Spot No.
Area P (W) Tx time J/cm 2 Total J/Tx (cm ) W/cm 2 Tx/week Tx
a
2
First week 6 1.5 min 8 400 6 1 4-3-2-1 25
Later 8 3 min 10 1200 5 1.6

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