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260 Section IV: Postoperative Care and Rehabilitation

Figure 29.3 How to perform passive range of motion with two hands during Figure 29.6 Brushing and scratching the patient along the back and limbs,
extension of the stifle and tarsal joints. These two joints move together and full including paws, stimulates sensory pathways. Some patients may react with
extension or flexion of one joint involves flexion or extension of the other. muscle twitches or withdrawals.

Tapping to Stimulate Reflexes
Tap along the spine and along the affected limb while observing for
muscle reactions and twitches in the belly and limbs (Figure 29.5). This
exercise stimulates reflexes and the musculoskeletal system, which is
especially beneficial in patients with lower motor neuron (LMN) signs.
It should be performed for 2 min on each side, two to three times daily.
Brush/Scratch
Brush/scratch the area of the spine and/or limbs (inside and out-
side), trying to elicit muscle reactions and twitches in the abdomi-
nal and hind limb musculature with more sensory stimulation
(Figure 29.6). This task should be performed for 2 min on each side,
two to three times daily.

Passive/Assisted‐Active Exercises with Patient
in Standing Position
All standing exercises should be performed on a carpet, a rug, or
Figure 29.4 Flexor exercise or stimulation of the withdrawal reflex elicits other surface with good traction. The use of different surfaces (foam,
sensory and motor function. Pinching the webbing between the toes is a carpet, grass, gravel, etc.) will also stimulate proprioception. Pinching
noxious stimulus and therefore elicits flexion of the limb.
or scratching of the tail with gentle fingertips might be helpful in
patients with upper motor neuron (UMN) signs and/or intact nocic-
eption to simulate the mass reflex and/or sensation. It will require
more than one person to perform these exercises in large dogs.
Confirmation by the doctor involved in the case is highly recom-
mended to ensure that all exercises are performed in a safe manner
and that none are likely to increase the risk of deterioration. Neck
leashes should be avoided at all times to prevent further damage.
Lateral Flexion of the Spine
Place the patient in lateral recumbency and encourage a lateral flex-
ion of the spine by offering a treat or a toy at the tail, hip or stifle to
work on range of motions (Figure 29.7). This exercise is especially
important in nonambulatory tetraparetic patients to strengthen the
core muscles and spine. Repeat the lateral flexion 3–10 times on
both sides, one to three times daily.

Standing Exercise
Maintain the standing position by placing the limbs of the patient
Figure 29.5 Tapping along the paraspinal dorsal muscles and limbs stimu- correctly. If still weak, the patient should be supported with a sling
lates reflexes. As a result, muscle twitching will be seen. This exercise is espe- or the therapist’s hands under the belly and/or chest. An inflatable
cially important for patients with LMN lesions. round or peanut‐shaped ball can be used for support. Ensure the