Front Matter

Chapter 18 Rehabilitation for Geriatric Patients 467

Retrievers and German Shepherds have a higher
incidence of this disease, which may require
advanced imaging such as CT or MRI for diagno­
sis (Hoskins, 2003). Surgical correction is often
indicated for these patients, but mild cases may
be managed conservatively with pain manage­
ment and rehabilitation including controlled
exercise and hydrotherapy (Worth et al., 2009).

Polyneuropathies

Peripheral neurological conditions secondary
to polyneuropathy are characterized by signs
including weakness, knuckling, muscle atro­
phy, hyporeflexia, change in bark, and stridor­
ous breathing (Hoskins, 2003). Affected patients
should be screened for hypothyroidism, myas­
thenia gravis, and laryngeal paralysis within a
comprehensive work‐up, with possible referral
to a neurologist.

Diffuse lower motor neuron dysfunction

Among the differential diagnoses that should
be considered for dogs that present with
absent limb reflexes and sudden‐onset pelvic
limb weakness that may progress to immobil­
ity, the four most commonly seen are: acute
idiopathic polyradiculoneuritis (coonhound
paralysis), tick paralysis, botulism, and acute
myasthenia gravis (Troxel, 2014). Determining
the underlying cause is key to implementing
appropriate treatment prior to developing and
instituting an appropriate rehabilitation thera­
peutic prescription.

Seizures

Differential diagnoses for seizures in a geriatric
patient include metabolic imbalances (e.g.,
encephalopathy from hepatic disease or hypo­
glycemia from diabetes mellitus), toxic insults,
neoplastic or inflammatory processes in the
brain, and vascular events such as infarction
(Hoskins, 2003). Knowing the underlying cause
of seizures is essential in determining progno­
sis for the patient and how well they may toler­
ate modalities and exercises.

Nutritional evaluation

A nutritional assessment should include evalu­
ation of the patient’s body weight, body condi­
tion score (grade 1–9), and muscle mass in

addition to discussing diet (including supple­

ments and treats). As noted earlier, metabolic

energy requirements decline with age, so geri­

atric patients may require fewer calories in their

diet. If caloric content is restricted, it is impor­

tant to ensure that good‐quality, highly digesti­

ble ingredients are still present in the diet (in

particular proteins and fats). A higher protein

diet may be warranted. It is important to encour­

age maintenance of a lean body condition, and

diet recommendations should be geared toward

achieving optimal body weight.

Quality of life assessment

When evaluating quality of life, the concept of

whether the patient is having more good days

than bad is often used. Assessments of pain,

appetite, mobility, independence, interest and

interaction with other people and pets, general

cleanliness, and hydration status are important.

The HHHHHMM Scale adapted by Villalobos

and Kaplan (2007) can be used to assist clients

struggling with quality of life decisions (Table

18.2). While this scale can be used as a guide­

line, the therapist should assist clients in evalu­

ating these parameters to help improve comfort,

mobility, and happiness, if possible.

Therapeutic options for geriatric

patients

Pain management

Multimodal pain management is a critical com­

ponent of the rehabilitation protocol in achiev­

ing client compliance and patient cooperation.

The Colorado State University College of

Veterinary Medicine and Biomedical Sciences

produced a pain scale (Hellyer et al., 2006) that

the International Veterinary Academy of Pain

Management has adopted as the standard for

acute pain scoring (Table 18.3). Validated chronic

pain scales still need to be developed in dogs. See

Chapter  19 for a discussion of multimodal pain

management options for rehabilitation patients.

Supplements and nutraceuticals

Supplements can augment pain management

and improve the health of the tissues in the