Front Matter

Chapter 18 Rehabilitation for Geriatric Patients 465

of the nervous system were the leading organ
system cause of death in older dogs, and their
frequency increased with age (Fleming et al.,
2011). Neurological conditions encountered in
geriatric patients include vascular events, ves­
tibular disease, neoplasia, seizures, and degen­
erative issues. Degenerative neurological
conditions commonly seen include chronic
intervertebral disc disease, degenerative mye­
lopathy (see Chapter  17), and degenerative
lumbosacral stenosis. Laryngeal paralysis had
been thought to be idiopathic, but polyneurop­
athy, hypothyroidism, and neoplasia should
also be considered when patients present with
signs of this condition. In addition, studies
have  documented a polyneuropathy ini­
tially  presenting with laryngeal paralysis and
esophageal dysfunction and progressing to pel­
vic limb weakness and loss of muscle mass,
referred to as geriatric‐onset laryngeal paralysis
and polyneuropathy (GOLPP) (Stanley et al.,
2010; Thieman et al., 2010; Stanley, 2012).
Mechanoreceptors innervated by large myeli­
nated nerve fibers provide input necessary for
proprioception. The muscle spindle is a stretch‐
sensitive mechanoreceptor that provides input on
joint position and facilitates coordinated move­
ment. With aging, muscle spindle cells become
less sensitive, joint and tendon mechanoreceptor
volume declines, myelinated nerve fibers decline,
tactile sensitivity decreases at a greater rate in
distal extremities, and nerve conduction velocity
slows in the advanced elderly, presumably
all  contributing to a decline in proprioception
(Shaffer & Harrison, 2007) (Figure 18.6).

Aging patients experience sensory losses,

including decreased vision and hearing, lead­

ing to lack of awareness of their environment.

These sensory deficits require the rehabilita­

tion therapist to carefully create appropriate

physical therapies. Deaf patients will be lim­

ited in their ability to respond to verbal com­

mands or comforting words during treatment.

When doing therapeutic exercise with deaf

patients, the patient’s sense of smell or sight

can be used for motivation. Blind patients

may be tentative in accepting treatment and

will respond better to a soothing touch and

verbal reassurance. These patients will be

unable to effectively perform exercises that

require visual input, such as stepping over

cavaletti poles.

Coordination and proprioception decline in

older patients, leading to ataxia. Combined lack

of proprioception, loss of muscle strength, and

postural instability contribute to falls in elderly

humans. Awareness of joint movement (kines­

thesia) and where the body is in space (joint

position sense) contribute to proprioception,

which, along with sensory factors such as vision

and vestibular input, is important for maintain­

ing balance.

Megaesophagus in an older dog is acquired

esophageal weakness. This is most often idio­

pathic but can also be secondary to a neuropa­

thy, myopathy, or junctionopathy. Most patients

present for regurgitation, and a common com­

plication of the disease is aspiration pneumo­

nia. Treatment of an existing underlying

disease such as myasthenia gravis, hypothy­

roidism, or hypoadrenocorticism can be benefi­

cial in controlling megaesophagus, so a

diagnostic work‐up should be recommended

in patients with regurgitation. Over two‐thirds

of the dogs studied for GOLPP, formerly

known as idiopathic laryngeal paralysis, had

esophageal dysfunction with the laryngeal

paralysis (Stanley, 2012).

Degenerative lumbosacral stenosis

Patients with degenerative lumbosacral stenosis

often present with a combination of orthopedic

and neurological signs such as caudal lumbar

pain, being slow to rise and climb stairs, decreased

tail wag, and sometimes fecal or urinary

incontinence. Large‐breed dogs, such as Labrador

Figure 18.6 Geriatric patient displaying dropped tarsi
and carpal hyperextension from muscle weakness due to
neurogenic muscle atrophy.