Chapter 5 Introduction to Canine Rehabilitation 101Case Study 5.1 Rehabilitation of T3‐L3 nonsurgical paraparesis through collaborative efforts
of a veterinary neurologist, veterinary acupuncturist, and physical therapist
Signalment: 15 y.o. F/S Golden Retriever.
Presenting complaint: Patient referred by primary
care veterinarian to veterinary neurologist with
chief complaint of weakness in pelvic limbs follow-
ing a fall from a step between house and yard.
Ambulatory with thoracolumbar kyphosis. Clients
elected against diagnostic imaging. Presumptive
diagnosis through physical examination: T3‐L3
lesion. Prednisone (15 mg b.i.d.) prescribed. Clients
instructed in use of Help ‘Em Up Harness™ by
rehabilitation‐certified veterinary technician. Patient
referred to veterinary acupuncturist, where evaluated
3 weeks later. Patient had progressed to nonambula-
tory, paraplegic status. Veterinary acupuncturist
performed acupuncture, prescribed tramadol (50
mg b.i.d.) for neck pain, initiated low‐level laser
therapy (class IIIb) and amoxicillin, 500 mg b.i.d.,
for bilateral greater trochanteric pressure injuries
(grade 3), and suggested clients obtain a wheelchair.
Four weeks following initiation of acupuncture treat-
ment, patient referred to a physical therapist certified
in canine rehabilitation.
Current treatment: Medications (prednisone, trama-
dol, amoxicillin), dry needle and electro‐acupunc-
ture, and low‐level laser therapy to pressure
injuries.
Rehabilitation evaluation: Patient unable to rise from
lateral recumbency to standing without complete
body‐weight support/assistance. Able to lift head
independently. When supported in standing via
harness, standing frame, quad cart or wheelchair,
patient actively steps with thoracic limbs, though with
internal rotation and frequent adduction (scissoring).
No tail wag with sensory stimulation, laser therapy,
or during mobility activities. Withdrawal weak and
delayed (>2 s) in pelvic limbs, though slightly more
responsive medially than laterally and in left vs right.
PROM within functional limits (WFL) with some tight-
ness noted at bilateral teres major, bilateral iliopsoas,
and bilateral pelvic limb interosseus muscles. Girth
not objectively measured, however, atrophy observed
at scapular, triceps, epaxial, cranial, quadriceps, and
hamstring muscles. Greater trochanteric pressure
injury sites grade 3 (defined by the National Pressure
Ulcer Advisory Panel as full‐thickness skin loss
involving damage to, or necrosis of, subcutaneous
tissue that may extend down to, but not through,
underlying fascia, 2–3 cm in diameter, pink to red
without eschar and without drainage noted). Patient
nonpainful with palpation, PROM, and during func-
tional mobility activities.Home environment: The patient lives in a two‐story home
with tile and hardwood floors with area rugs/runners. Four
wooden stairs to enter the home. No other pets and
no children. Client telecommutes from home.History: Patient previously very active (hiking with
the client regularly).Table 5.1 Summary for Case Study 5.1 using disablement model
Diagnosis T3‐L3 nonsurgical paraparesis
Disability Unable to participate in activities (hiking) with clients
Functional
limitationUnable to rise from lying and walk from indoors to outdoors without body‐weight
assistance
Impairment Nonambulatory, requires assistance for all functional mobility/transfers, reduced sensory
awareness, reduced strength, pain
Goals ● Clients will be compliant and competent with home exercises/activities in 2 weeks
● Patient will tolerate standing (in the cart, over a physioroll/peanut, or over the standing
frame) for up to 10 minutes in 4 weeks
● Patient will step with thoracic limbs while in the quad cart for at least 50 feet with
minimal assistance in 4 weeks
● Patient will assist with transitions from lateral to sternal and sternal to sitting in 4 weeks
Rehabilitation
plan, strategy, and
tactics● Home‐based physical therapy sessions, weekly
● Acupuncture sessions, weekly
● Strategy: strengthening, sensory stimulation, neuromuscular facilitation/stimulation,
pain management, promoting increased independence with function
● Tactics: therapeutic exercise, neuromuscular facilitation, manual therapy, laser therapy,
neuromuscular electrical stimulation (NMES), and functional mobility facilitation