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264 Section IV: Postoperative Care and Rehabilitation

Figure 29.18 Underwater treadmill session.

Underwater Treadmill
The UWTM is an expensive piece of equipment that is frequently
used for the rehabilitation of the neurological patient (Figure 29.18).
Figure 29.16 Temporary carts are used for patients during the recovery The combination of controlled gait plus the benefits of water makes
period. These can provide the patient with exercise, conditioning, and men- this technique very useful for recovery. Different water levels are
tal stimulation.
used for different purposes [10]. For instance, low‐level water will
increase range of motion because the patient will instinctively pick
up the legs when walking, whereas high‐level water is recom-
mended for patients needing more support. Some cases need two
people, a person inside the tank manipulating the hind limbs or
helping with balance, the other outside supervising and helping as
needed. A hoist, slings, flotation devices, or elastic bands are some
of the accessories that can be used in the session, with the goal of
maximum benefit for the patient.

Prevention and Treatment of Bad Habits
Many patients present for their 3–6 week rechecks with fair neuro-
muscular function recovery but still with neurological deficits and
abnormal gait and/or postures secondary to the development of
bad habits. Bad habits in neurological patients can be defined as a
negative patterned behavior or motor activity secondary to a neu-
rological disease associated with loss of neuromuscular function
Figure 29.17 Four‐wheel carts are designed for tetraparetic/tetraplegic that is acquired during the recovery through frequent repetition.
patients. They may need to be pushed while the patient is recovering motor Many patients recovering after back injury may present with severe
function, and additional accessories or maneuvers are recommended for kyphosis and/or scoliosis and bunny‐hopping as a consequence of
maximum benefit of cart‐work (e.g., boots for protection, elastic bands to a new negative pattern that has been learnt during the post‐injury
help movement of the limbs, tail clip for mass reflex stimulation). period. These bad habits may not affect the patient’s ability to
move around and be functional but could influence quality of life a
over walking on the treadmill. Patients with no motor function can few months or years in the future. For example, a bunny‐hopping
obtain PROM of the affected limbs in the water, stimulation of gait is a result of increased tone and lack of dissociation in the hind
withdrawal by touching or gently pinching the toes, or stimulation limbs. These abnormalities may lead to muscles spasms in the hind
of the mass reflex by pinching the tail to initiate involuntary or vol- limbs and back and other possible changes due to secondary com-
untary motor function. Two people might be needed, so that one pensation, so that avoidance of bad habits is paramount for full
person can hold and give support while the other can be working on recovery.
performing the exercises. Standing exercises can be performed on Bad habits should be prevented because once the negative pat-
the entry and exit steps if they are safe and provide good traction. tern becomes routine, it may take a long time to remove or may
Turns and use of flotation devices attached to the limbs are some never be completely eliminated. The following sections list the most
other examples of different exercises that can be performed in common bad habits that develop in the neurological patient, espe-
water. Use of treats or toys is recommended to make the therapy fun cially back‐injured dogs, and some of the recommended exercises
and stimulating for the patient. to prevent or remove them.