Chapter 8 Therapeutic Exercise 203the nose while tickling the pubic bone area
to encourage hip, stifle, and tarsal extension.
In the beginning, this exercise is usually done
with two people.
Weight shifting for balance
Purpose: Strengthen the stabilizer muscles to
improve posture during ambulation.
Goal: Achieve proper balance while standing
on two to three limbs.
Technique: The therapist lifts each limb just
off the ground using two fingers to minimize
assistance, observing for trunk muscle contrac
tion. Swaying indicates challenge. The foot is
lowered when fatigue is evident. Rotate
through all four feet.
Progression: Lift two feet (diagonal or ipsi
lateral), and repeat as above.
Isometrics
Purpose: Strengthen postural muscles.
Goal: Patient is able to resist loading over the
scapulae or pelvis without collapsing.
Technique: With the patient in a square
stand, the therapist places a palm over the scap
ulae or pelvis, applying gentle downward pres
sure with even distribution left to right. During
pelvis work, the abdomen is tickled so the
patient does not think they are required to sit.
Wobble board
Purpose: Strengthen stabilizer muscles, and
enhance balance and proprioception.
Goal: Patient is able to maintain balance
while therapist applies nonrhythmic perturba
tions to the board.
Technique: See previous discussion in this
chapter.
Patterning
This is the last exercise done in a progression of
exercises before ambulation is attempted in a
patient with ataxia or paresis. The overall goal
is to first work on transition from lateral to ster
nal recumbency, sternal recumbency to a tall sit,
and a tall sit to stand using reps of sit‐to‐stand
to “turn on” the pelvic limb muscles, work on
balance by stimulating the muscles of the trunk
(isometrics and weight shifting as above), pat
terning to remind the body of the progression of
steps, and then assisted ambulation. When the
patterning step is eliminated, the ambulation is
noticeably less coordinated and the progression
is hampered.
Purpose: Helping the patient with neurologi
cal disease, who has initiated the progression
through transitions from lateral recumbency to
stand, to develop an appropriate gait pattern as
well as balance and transitions in dynamic
movement.
Goal: Normal or close to normal ambulation.
Gait patterning is a manner of moving the feet
and the pattern of footsteps at various speeds.
Technique: With the patient standing, the
therapist moves each foot through the full
stride, incorporating the stance and swing
phases. The proper footfall for walk is one pel
vic limb followed by the ipsilateral thoracic
limb, then the other pelvic limb followed by the
ipsilateral thoracic limb. The patient may be
supported with an assistive device, allowing
weight shifting away from and stimulation of
the next limb to move.
Most patients with neurological disease have
increased tone in the adductors, which may
lead to adduction and tripping or stumbling
during ambulation. If this is present, the patient
is asked to stand and the caudomedial aspect of
the foot is stimulated by the therapist to cause
contraction of the abductor muscles. A finger is
placed on the gluteal and biceps femoris mus
cles to confirm contraction during the adductor
stimulation. After 10 repetitions, ambulation is
again attempted and the outcome should be
no or significantly less crossing over. This exer
cise is performed before doing any ambulation
work in patients that do not yet have an appro
priate gait pattern.
Progression: Speed is increased to the appro
priate speed for walking, and assistance is
decreased. One way to stimulate ambulation
and give mild assistance is to support the dog
by holding the base of the tail at up to a 45°
angle to the floor; this does not cause discom
fort or affect the spine. As the dog’s balance
improves, hand placement on the tail can grad
ually move caudally until just the hair on the tip
of the tail is held for minor balance support.
Once the patient can rise and walk indepen
dently the next step is to add weaves (from gen
tle to tight), hills (straight up and down, adding