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Rehabilitation of the neurological patient

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Abstract

Devising an appropriate plan for physical rehabilitation is a critical component of treating patients recovering from or with ongoing neurological disease. Animals with severe injuries greatly benefit from rehabilitation at a dedicated centre, where their general management can be achieved more easily and they can benefit from the use of specialist equipment, such as underwater treadmills. This chapter covers patient assessment, treatment plan, supportive care, physical rehabilitation.

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Figures

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25.1 Developing a treatment plan for the neurological patient.
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25.2 Sample physical rehabilitation home treatment plan.
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25.3 Various forms of bedding. A sling bed made of netting to allow fluids to drain away from the animal. This dog is lying on a thick rubber mat with easily removable nappies (diapers) underneath its hind end. A grate with porous bedding material on it for recumbent animals.
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25.4 Dermatological consequences of neurological disease. This dog has severe urine scalding from 2 days of recumbency and inability to urinate, combined with urine overflow and a UTI. This chronically paraplegic dog has been licking the dorsal aspect of its tarsus. A chronic decubital ulcer over the calcaneus.
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25.5 Carts for paraparetic and tetraparetic animals. Note that the paraparetic dog is wearing boots on its hindfeet (arrowed) to protect them from abrasions.
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25.6 Typical pose of a dog with a caudal lumbar lesion, causing it to sit on its ischial tuberosities.
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25.7 Correct hand position for coupage.
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25.8 Hydrotherapy performed with a team approach to ensure that it is both safe and effective.
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25.10 Full ROM in the thoracic and pelvic limbs. Note that the digits have also been extended and flexed.
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25.11 A patient in an IES unit. The metal strips on the sides of the bath are the electrodes (arrowed). The patient is wearing a life jacket for dogs.
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25.12 A dog walking in an underwater treadmill. This dog can now bear weight on its own with the water level coming up to its shoulder, and is completing 15 minutes of exercise.
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25.13 An NMES unit with carbon rubber electrodes attached.
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25.14 A mechanical hoist enables movement of large patients into and out of bathing facilities.
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25.15 Equipment to aid in proprioceptive training. An inflatable ball can be used to encourage control and balance. A Cavelletti drill made from traffic cones and poles. A wooden block with poles leant up at angles allows circular drills that encourage precise foot placement. This patient is standing on a foam pad placed in a shallow layer of water. The surface of the pad is moved using the sticks, forcing the patient to adjust its balance.

Supplements

Caveletti

Cavaletti rails are available commercially or may be homemade using polyvinyl chloride (PVC) rods, which are inserted into holes predrilled at various heights into traffic cones. When using cavaletti rails, the rails should be placed at a height that is feasible, yet challenging, for the patient to clear at a walking pace. The clip shows a dog being walked at a pace that allows the rails to be cleared with mild effort. As the strength and coordination of the patient improves, the rails should be elevated to continuously offer a feasible challenge. (See page 494 in the Manual)

Passive range of motion

PROM is an effective way to preserve joint range of motion in patients that have reduced limb use due to either neurological or orthopaedic conditions. It should be noted that because it is a passive exercise, it does not enhance muscle mass. When performing PROM, the patient should be relaxed and lying comfortably in lateral recumbency. The affected limb(s) should be gently held and each joint isolated and slowly taken through the full comfortable range of motion. This exercise should be repeated 15–20 times and as frequently as every 4 hours, depending on how often the patient moves their joints independently. (See page 490 in the Manual)

Sit to stand

The sit to stand exercise helps strengthen hindlimb extensor muscles as well as encourage full stifle flexion. Treats can be used to encourage the patient to assume a sitting position, where both stifle joints are fully flexed and the animal is sitting squarely. The patient is then coaxed into a standing position and the exercise is repeated. In weak patients, the exercise should be repeated until early signs of fatigue develop. (See page 492 in the Manual)

Underwater treadmill

This patient is recovering from decompressive spinal surgery and hydrotherapy is being used to facilitate ambulation. By having the water level with the shoulder joints, the water is providing buoyancy for the patient’s body. This allows a weak patient to ambulate whilst the water resistance increases muscle strength. The hydrotherapy session should be discontinued once early signs of patient fatigue are observed. (See page 494 in the Manual)

Weaving

Weaving is a useful rehabilitation exercise for improving limb coordination and encouraging the patient to shift their weight on to a limb following surgery for orthopaedic conditions. Traffic cones are effective props for this exercise. The patient is slowly guided past the cones, in a similar manner to a slalom race, where they pass to the right of the first cone, to the left of the second cone, to the right of the third cone, and so on. (See page 494 in the Manual)

Weight shift

This exercise involves isometric muscle strengthening and is appropriate for use on neurological patients who can stand without assistance, yet require strengthening of their appendicular muscles and enhancement of their balance. With the patient standing on a level non-slip surface, each limb is flexed in turn, thus requiring the patient to weight-bear on its contralateral limb. Each pose is held for 5–15 seconds, based on the patient’s ability. The activity may be repeated 3–4 times per day until the patient’s strength and co-ordination permit unassisted walking. (See page 492 in the Manual)

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