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268 Section IV: Postoperative Care and Rehabilitation

moved around. Most of these patients should be able to move
better over grass or gravel.
• Owners of patients predisposed to back injuries (i.e., chondrodys-
trophic dogs) are advised to make permanent changes at home.
◦ Ramps instead of steps.
◦ Discourage the dog from jumping off furniture or from a car.
This does not seem to be a problem for those owners with pets
used to being on a couch or bed.
◦ Confinement when pets are not supervised. This can be a large
cage where the patient can turn around or a small room with
good footing and without furniture.

Video clips to accompany this book can be found on
the companion website at:
www.wiley.com/go/shores/neurosurgery

References
1 Hallet M. Neuroplasticity and rehabilitation. J Rehabil Res Dev 2005; 42(4):
xvii–xxi.
2 Liepert J, Tegenthoff M, Malin JP. Changes of cortical motor area size during
immobilization. Electroencephalogr Clin Neurophysiol 1995;97:382–386.
3 Nudo RJ. Functional and structural plasticity in motor cortex: implications for
stroke recovery. Phys Med Rehabil Clin North Am 2003;14(1 Suppl):S57–S76.
4 Frost SB, Barbay S, Friel KM, Plautz EJ, Nudo RJ. Reorganization of remote cortical
regions after ischemic brain injury: a potential substrate for stroke recovery.
J Neurophysiol 2003;89:3205–3214.
Figure 29.25 Patient with permanent paralysis of the hind limbs wearing a 5 Ziemann U, Ishii K, Borgheresi A et al. Dissociation of the pathways mediating
protective bag to prevent skin abrasion and diaper tearing. This accessory is ipsilateral and contralateral motor‐evoked potentials in human hand and arm mus-
ideal for incontinent patients that will stay at home for long hours. The patient cles. J Physiol 1999;518:895–906.
in the picture usually wears a diaper but, when the owner stays at work for 6 Johansen‐Berg H, Rushworth MF, Bogdanovic MD, Kischka U, Wimalaratna S,
long periods, the dog wears this protective bag to prevent leakage at home. Matthews PM. The role of ipsilateral premotor cortex in hand movement after
stroke. Proc Natl Acad Sci USA 2002;99:14518–14523.
7 Byl NN, Merzenich MM. Principles of neuroplasticity: implications for neuroreha-
capabilities of the owner: large dogs in homes where the owners have bilitation and learning. In: Gonzalez ES, Myers S, Edelstein J, Lieberman JS,
minimal ability to help their pet might be a challenging situation. Downey JA (eds) Downey and Darling’s Physiological Basis of Rehabilitation
Some examples of patients in need of home environment changes Medicine. Boston, MA: Butterworth‐Heinemann, 2001.
are listed below: 8 Fisher BE. Principles of neuroplasticity: strategies for improving functions in patients
with a neurologic injury. Presented at the 34th Anual Neurohabilitation Conference
• Patients with balance disorders (i.e., cerebellar, vestibular ataxia) of Traumatic Brain Injury, Stroke and Neurologic disorders, Boston, MA, 2013.
require a padded cage/room to prevent further damage when fall- 9 Millis D, Levine D, Taylor R. Canine Rehabilitation and Physical Therapy.
ing over. The patient needs to be kept away from stairs or large Philadelphia, PA: WB Saunders, 2004.
windows and may need to be carried. 10 Millis DL, Levine D. Canine Rehabilitation and Physical Therapy, 2nd edn.
Philadelphia, PA: Elsevier Saunders, 2014.
• Patients with balance disorders and postural reactions struggle 11 Riegel RJ. Laser Therapy in the Companion Animal Practice: Mechanisms and
walking on hard floors and this will necessitate rugs/carpets to be Protocols for Class IV Laser Therapy. Newark, DE: LiteCure LLC, 2008.