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Chapter 29: Physical Rehabilitation of the Neurological Patient 267

Figure 29.24 Critical tetraparetic patient placed on four‐wheel cart for short
outside walk for environmental enrichment, mental motivation, and pos-
ture rehabilitation. Note how the patient carries his urinary bag attached to
his cart.

muscle and combination with other drugs to relax the sphincters
might be indicated, especially in male dogs with a strong urethral
Figure 29.23 Severely worn down nails and skin abrasion wounds on the muscle.
top of the toes in patient with absent nociception with severe sciatic lesion.
Patient presented no proprioception and dragged the paw repetitively. Permanent Disabilities
Currently, there are clients willing to take care of a pet with perma-
nent neurological disabilities and it is our job to inform these own-
and shave the region until healthy skin is apparent, then apply ers about their pet’s possible special care, cost, or complications to
ointment if needed (topical antibiotic, diaper rash ointment for expect at home in a long‐term setting. Monoplegia/paraplegia and
fecal irritation). Consider male or female doggie diapers for incontinence are some of the most common conditions in the neu-
some cases. rological patient. For owners that still want to keep their pet, these
conditions can be overwhelming and our support and empathy is
Bladder Management essential in order to ease adaptation to the new circumstances.
Patients with neurological problems often have urinary and/or fecal Quality of life is a subjective concept and full understanding of a
incontinence and/or retention. Incontinence is the involuntary particular situation might not be possible. Some owners have a spe-
leakage of urine or feces, whereas retention is the involuntary hold- cial bond with their pet and might not be ready to let them go, so it
ing of urine or feces within the bladder or rectum, respectively. is our responsibility to ensure they receive sound advice to guaran-
Patients with UMN lesions present with increased tone of sphinc- tee the best quality of life for the patient in a home environment.
ters and bladder wall, while patients with LMN lesions or spinal Hospice care may be necessary for the most severely affected
shock exhibit decreased tone of both. In patients with UMN lesions, patients, but many may be able to enjoy a fair quality of life with
bladders that are not released adequately may show overflow incon- minimal extra care by the owner.
tinence, i.e., leakage of urine after the bladder becomes full and Multiple cart designs, harnesses, and other accessories are avail-
over‐extended. This is commonly confused with voluntary urina- able to support the patient with permanent paralysis of the hind
tion in those cases where the dog is found in the cage with a wet limbs, front limbs, or even all four limbs (Figure 29.25). Carts can
bed. Palpation/ultrasound of the bladder is essential for assessment be designed with two or four wheels according to the type and loca-
of bladder function in these cases. Patients unable to empty the tion of the lesion, size/weight, body condition, and any other health
bladder efficiently are predisposed to urinary tract infections, and issues. Sturdy and durable carts are recommended for permanent
urinary analysis and/or cultures may be indicated in those with dif- disabilities. Some patients, especially toy or large breeds, might
ficult bladder management. need custom carts that fit them correctly and provide comfort while
Urinary catheterization and/or medical management is fre- moving around. Skin, toes, and nails should be checked frequently
quently recommended in the early recovery stage of the patient for any abrasions or sores from dragging, cart rubbing or pressure
with back problems to prevent complications (Figure 29.24). sores.
Parasympathomimetics (e.g., bethanechol) are used to increase det-
rusor muscle contractility in combination with muscle relaxants Adaptation of Environment
(e.g., diazepam) and α‐adrenergic blockers (e.g., prazosin, phe- Recovery of a neurological patient may take weeks to months and
noxybenzamine) in order to decrease the external or internal ure- never be complete. Owners need to be adequately educated so they
thral resistance in those with severe UMN lesions. In cases with can make changes at home promptly to prevent further damage and
LMN lesions with decreased tone of the bladder wall, the use of improve the quality of life of the patient. The individual manage-
parasympathomimetics can increase the tone of the detrusor ment of each case is determined by the home environment and the