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Chapter 29: Physical Rehabilitation of the Neurological Patient 261

ball is the correct size for the patient so that the animal can touch inflatable round or peanut‐shaped ball can be used for support. The
the ground with all four paws and split the weight uniformly. This ball can be sized to fit under the body so that the animal can still
task stimulates proprioception and encourages posture. Maintain touch the ground with all four paws; alternately, the ball can be larger
the standing position for 10–60 seconds (depending on the patient’s so that weight is shifted to the front or hind limbs when the hind or
strength). Perform four sets of 1 min each, one to three times daily. front limbs are lifted onto the ball (Figure 29.10). This exercise can
also be performed on balance boards to provide an extra challenge
Sit‐to‐Stand Exercise (Figure 29.11). This helps the patient to maintain posture and
Help the patient to sit and hold this position for 10–40 seconds and balance. Perform four sets of 1 min each, one to three times daily.
then help the patient to stand and hold that standing position for
another 10–60 seconds (Figure 29.8). Ensure the patient maintains Walks
the limbs in the correct position at all times to encourage proprio- Walk the patient with a harness or a sling for balance and support as
ceptive input and postural rehabilitation in order to prevent the needed. Use different surfaces for additional proprioceptive input.
development of bad habits (Figure 29.9). This exercise should be Further tail stimulation can be helpful for stimulating the mass
performed 5–20 times, twice daily. reflex and activating the hind limbs. In some cases, especially
patients with UMN signs, stimulation of the mass reflex can initiate
Weight Shifting involuntary movements that can be followed by voluntary motor
With the dog standing, perform gentle weight‐shifting back and movements. Walks on the treadmill can also be beneficial. This pro-
forth, as well as side to side. The patient may be supported by a har- vides a consistent and uniform repetition of the gait, at an elected
ness/sling and the therapist’s hands under the belly and/or chest. An speed on a uniform surface. A walk on the treadmill also increases
range of motion during hip extension. Walks can last from 2 to
10 min with 1–2 min breaks if the patient is tired; perform one to
three times daily.

Paw Placement Stimulation
Gently drag the patient’s paw backwards over a medium to rough
surface that provides sensory/proprioceptive stimulation
(Figure 29.12). If the patient does not place the paw correctly after
the dragging, fingertip pinch the toes to elicit a withdrawal
(Figure 29.13), and then help the animal drop it on the ground and
place it correctly (Figure 29.14). The goal of this exercise is to stim-
ulate sensory output, proprioception, and posture. Repeat 5–20
times each leg, one to three times daily.

Cavalettis
Set a few cavalettis in a row and have the patient walk through the
obstacles, flexing one limb at a time; prevent the patient from
Figure 29.7 Lateral flexion of the spine can be encouraged with treats or bunny‐hopping or skipping the obstacles (Figure 29.15). This exer-
toys. cise helps the patient to be aware of the position of the limbs in

Figure 29.8 Sit‐to‐stand exercises should be
performed with two people, one person in
front of the patient to say “sit” and with treats
if needed for motivation, the other behind the
patient to position the hind limbs correctly
during the exercise.