Front Matter

466 Canine Sports Medicine and Rehabilitation

Case Study 18.2 Geriatric patient with compromised mobility

Signalment: 12‐y.o. M/N Labrador Retriever; 87 lbs.

History: Referred with presumptive diagnosis of

degenerative myelopathy. Client informed patient

would be non‐ambulatory within 6 months. Eight

months earlier, patient’s gait started to change with

pelvic limbs slightly weak; patient will get on the

couch, but climbs up rather than jumping; patient’s

toenails drag on sidewalk. One week prior to referral,

after swimming for about 20 minutes, patient’s pelvic

limbs splayed out and seemed weak.

Currently receiving fish oil, meloxicam, tramadol,

famotidine, plus monthly heartworm (oral) and flea/

tick (topical) prevention.

Referral radiographs: V/D and lateral views of pelvis/

lumbar spine unremarkable, consistent for breed and

age. Very slight flattening of femoral heads (L > R) and

very slight roughening of the caudal endplate of L6.

Client’s goals: Provide best possible mobility for as

long as possible.

Physical examination: BAR, WNL except BCS 5–6/9.

Rehabilitation examination:

Posture: Slight kyphosis of lumbar spine and tucking

of pelvis, tail held down; stands base wide behind

with slight decreased extension of both tarsi and sti-

fles. Occasionally knuckles on left rear foot, but

immediately self‐corrects. Slightly more wear of left

rear toenails.

Gait: Toes in and abducts/externally rotates both

elbow joints; circumducts both pelvic limbs from

coxofemoral joints; first steps after getting up are very

base wide. Knuckled over less than 10% of his

strides; holds pelvis to right with left pelvic limb

under midline; tail held slightly to right and down;

pelvic limbs occasionally cross over.

Palpation: Pain on palpation L3–S1 and SI joint; slight

heat over L3–L6 and SI joint; mild decreased flexion

both carpi; mild resistance to full flexion of coxofem-

oral joints—firm end‐feel, consistent with tight hip

extensor muscles.

Gulick girthometry: Initial measurements: left and

right mid‐thigh = 35 cm; left mid‐tibia = 21 cm; right

mid‐tibia = 22 cm.

Neurological exam: Patellar and cranial tibial reflexes

bilaterally diminished; proprioception both pelvic

limbs very slightly diminished (approximately 1

second).

Diagnosis: Lumbosacral disease and degenerative

myelopathy.

Assessment and rehabilitation plan:

Primary objectives:

(1) Pain and inflammation management: Therapeutic

massage, acupuncture, veterinary spinal

manipulative therapy, and therapeutic laser.

(2) Moderate weight loss and weight management: Goal

weight 82 lbs. Discuss optimal diet with client.

(3) Improve and maintain mobility and neuromuscu-

lar function: Therapeutic exercises, VSMT, and

underwater treadmill; mobility harness to

assist the patient’s walking and with position­

ing/stability during therapeutic exercises.

(4) Improve and maintain overall strength, including

core muscle strength and flexibility, and endur-

ance: Therapeutic exercises and underwater

treadmill.

(5) Medications and supplements: Continue medica­

tions prescribed by rDVM.

Reassess patient response to treatment in 4 weeks.

Therapeutic exercises:

(1) Corrected, guided sit‐to‐stands

(2) Single leg lifts. Goal: work up to diagonal leg

lifts

(3) Balance disc and balance board—front feet on

with weight shifting and rhythmic stabilization

(4) Thoracic antebrachii on a large inflated pea­

nut; progress to front feet on peanut

(5) Cavalettis—5 cm high

(6) Sitting back extensions

(7) Tummy tickles

(8) Backwards walking and side‐stepping.

Case summary:

Six‐month measurements: Left mid‐thigh = 37 cm;

right mid‐thigh = 36.5 cm; left mid‐tibia = 22 cm;

right mid‐tibia = 22.5 cm.

Patient responded well to therapy, improving in

mobility and activity. After 12 months of therapy,

client pleased with the patient’s improvement,

walking 20–30 minutes without difficulty; weight

maintained at 80–81 lbs.