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Chapter 29: Physical Rehabilitation of the Neurological Patient 265

Figure 29.20 Patient is placed in cart during early recovery to prevent
kyphosis. Encouraging the patient to lift the head up (cervical extension)
while in the cart helps to stretch the back after back surgery.

Kyphosis
Kyphosis is commonly seen in patients with back injuries. Both
back pain and gait difficulties play a role in the development of this
Figure 29.19 An elastic band that goes from the harness of the patient to the bad habit. After a few weeks of kyphosis, the sublumbar and sub-
tip of boot is used to correct dragging of the limb due to proprioceptive thoracic muscles of the spine and core muscles shorten. This, in
deficits. combination with weakness of the dorsal muscles, worsens the
kyphosis. Adequate pain control and early prevention of kyphosis is
recommended in all cases with back injuries. Cart walks
(Figure 29.20), swimming or dry/water walking, and postural reha-
Dragging the Limbs bilitation (standing, ball‐work) all help in early prevention. Once
Dragging the limbs should be avoided in patients with potential for kyphosis is present and the patient is healed, a few more exercises
recovery of motor function. Cage confinement, cart walks, sling can be recommended.
walks, splints (especially for brachial avulsion lesions), and postural • Lift the head of the patient during walks, sitting or standing (use
rehabilitation (standing, sit‐to stand, or ball‐work) should be initi- treats for encouragement).
ated from the beginning of recovery. Tail stimulation may help in • Lateral flexion of the spine from side to side (use treats for
some dogs with hind limb paralysis. Dogs with instability should be encouragement).
treated cautiously but keeping in mind the importance of maintain- • Gentle stretch of the back by putting some pressure over the dor-
ing range of motion and muscle/bone/joint mass. Patients with dis- sal aspect of the spine at the thoracolumbar region while the
tal brachial plexus avulsion require strict PROM and splinting to patient is standing. Previous warm packs will help with this
maintain range of motion of the front limb, especially the carpal stretch.
joint, which becomes irreversibly degenerated and ankylosed very • Encourage the patient to lie on the back (a belly scratch might
promptly, possibly culminating in amputation of the limb, even in help) on a padded bed. While the animal is lying down, extension
those cases that achieve relief from deep pain. of front and hind limbs will help to achieve a better stretch of the
back.
Abnormal Sitting Posture
Abnormal sitting posture should be discouraged in those patients Bunny‐hopping
with proprioceptive deficits in the hind limbs. Correction of the Bunny‐hopping is commonly seen in dogs secondary to a lack of
posture through repetitive sit‐to‐stand exercises should improve dissociative movement of the hind limbs (ability of the patient to
this and prevent abnormal position. move one limb independently from the other limb or body) in
patients recovering after back issues. Leash‐walks and low cavalettis
Knuckling Over help the patient to use one a leg at a time. The animal may need
Knuckling over of any of the limbs should always be corrected and some extra stimulation with doggie treats.
prevented. Use of rehabilitation accessories during walking or
standing may help. Elastic bands that pull the tip of the paw through
a wrap around the toes or a therapeutic boot (Figure 29.19), as well Management of the Recumbent Patient
as splints, may be recommended in some cases. Usually, these Management of the recumbent patient can be challenging, espe-
accessories will be removed when the patient is back in the cage and cially when the patient is large and recumbency is prolonged.
special attention should be paid to pressure sores in theses cases. Specific preventive measures should be applied from the start of
Tail stimulation might also help in patients with affected hind hospitalization of the neurological patient with motor dysfunction.
limbs, especially those with UMN signs in the hind limbs. Skin integrity, management of bladder function, assessment of