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Chapter 29: Physical Rehabilitation of the Neurological Patient 259

Figure 29.1 Therapeutic ultrasound applied to young shepherd dog with
severe quadriceps contracture, severely decreased range of motion, and sci-
atic damage due to femur fracture.

Goals
Increases lymph flow, increases blood flow, relaxation, relieves
muscle spasm, increases range of motion, breaks down fibrous tis-
sue, relief of trigger points.
Figure 29.2 How to perform passive range of motion on a canine patient.
Applications A therapist performs flexion of the stifle and tarsal joints with both hands,
Muscle spasms and contractures, nervous patients, subcutaneous one to hold and give support to the limb, the other to perform flexion of the
fluid accumulation in patients with diminished mobility, decreased joint.
range of motion and ankylosis.
in the shortest time possible. Many of these exercises are demon-
strated in Video 29.1.
Therapeutic Exercises
Therapeutic exercises include all types of passive, assisted‐active, or Passive Exercises with Patient in Lateral
active exercises that maintain or improve the patient’s range of Recumbency
motion, muscle mass, and joint and bone health, as well as stimulate Passive Range of Motion with Stretching
neurological function, without the use of physical therapies. Passive Move the front and/or hind limbs through a full range of motion by
exercises involve an applied force, whereas assisted‐active or active gently flexing and extending every joint of the limb independently
exercises result from voluntary contraction and relaxation of the (move nails, toes, carpus/hock, elbow/stifle, shoulder/hip). Hold
muscles, with or without some support by the therapist. These exer- flexion and extension of each joint for 3–5 seconds. Repeat three to
cises should not cause pain in the patient, although they might be five times per joint, two to three times daily.
challenging and cause discomfort for those with decreased range of
motion or increased tone. Some animals will need some incentive Bicycle Movement
(treats) and sedation might be needed for the most aggressive indi- Move the front and/or hind limbs through a full range of motion by
viduals. Specific rehabilitation equipment and accessories may be gently flexing and extending the whole limb with a forward bicycle
needed for some of the exercises as well as creativity and motivation movement. This movement should be performed as wide as possi-
to encourage the neurological patient to perform the exercises and ble. Perform 15–20 repetitions, two to three times daily.
accomplish specific goals. A specific rehabilitation plan is designed Both passive range of motion (PROM) with stretching and bicy-
for each patient and will include exercises performed either on the cle movement should be performed using two hands; one hand
ground (dry rehabilitation) or on the underwater treadmill holds the limb and gives support, the other performs the movement
(UWTM) or in the pool (water rehabilitation), depending on the safely (Figures 29.2 and 29.3). These two exercises will maintain or
patient and type and location of the injury. improve range of motion in patients with decreased/absent motor
Each of the exercises should be designed according to the neuro- function and/or increased tone.
logical dysfunction and the patient’s needs, paying attention to
other possible concurrent conditions (e.g., an overweight patient Flexor Exercise
would also need a low‐calorie diet). Further, the rehabilitation tasks Gently pinch the webbing between the toes of the affected limb
should follow the five principles of neuroplasticity. Repetition of a until the patient pulls the foot towards the body (Figure 29.4). Try
specific exercise with the adequate intensity and motivation, mini- to encourage the patient to withdraw and achieve full flexion of the
mizing compensation, allows the patient to develop positive neuro- limb before releasing the toe. This exercise stimulates sensory and
plasticity to relearn the lost skill, so as not to end up a “functional motor pathways and at the same time activates the musculoskeletal
pet” that can only move around at home but to aid optimal recovery system. Perform 10–15 repetitions, two to three times daily.