REHABILITATION (REHAB) PROGRAM FOR NEURO (NEUROLOGIC) PATIENTS

WEEK 1 – Beginning the day of the injury – emphasis is on anti-inflammatory control, relieving pain AND repatterning walking (teaching dog to walk normally again).

  • Absolutely NO excessive activity, No stairs, No slippery floors, No running, No jumping, No long walks or rough play. Limited activity or even cage rest is absolutely required during early rehabilitation (for as much as 2 – 3 weeks depending on pet’s comfort level).
  • Short leash walks at a very slow gait on a flat surface three times a day for bathroom privileges only for dogs. Cats can be placed in a small room with their litter box three to four times a day for their bathroom privileges.
  • Ensure pet gets all medication.
  • Apply ice packs to painful regions for 5 – 10 minutes – two to three times a day.
  • Massage – massage helps the muscles feel less painful and increases circulation. Massage can be done once or twice a day depending on how painful patient is. The more painful the patient, the more often the massage is required.

Listed below are the usual massage techniques used and in the recommended order.

  • Stroking: – 2 – 3 minutes
    • Use at the beginning and at the end of the massage
    • Stroking is usually applied from the top of each limb and stroke downwards towards the end of the foot.
    • Begin at the top of the head and stroke backwards toward the tail.
    • Place entire hand in contact with the skin
    • Maintain a gentle but firm pressure.
  • Effleurage – 2 – 3 minutes
    • Following initial stroking – increase pressure (medium pressure) but begin at the toes and move upwards toward the body and from tail upwards towards head.
  • Compression 4 – 5 minutes
    • Begin at toes and work towards the body, when limbs are done, begin at head and work down back.
    • Make full contact with the skin and apply even pressure to skin into superficial tissues (muscles).
    • Make a sweeping movement to the top of the area, molding to the contours and maintaining the same depth of pressure throughout the stroke. Remember Do Not cause undue pain or discomfort.
    • Finish the stroke over the lymph nodes or to the nearest body part. Lymph nodes can be found in groin region, armpits, under jaw, at base of spine near hips and between shoulder and neck.
    • Bring the hands towards you as you work, using the heel of your hand.
    • Overlapping strokes are used, continuing until the entire body is covered.
  • Finish massage with gentle stroking – patient should be very relaxed and sleepy.

WEEK 2 – Emphasis is on strengthening muscles and limbs, and repatterning walking.

  • Passive range of motion (PROM) and ice packs to the region of the incision or injury three times a day. A complete range of motion should occur. If the joint is painful, flex only as much as is comfortable for the animal. Each day try to flex the joint slightly further until a complete range of motion can be done. Signs that the patient is in discomfort include tensing the limb, moving, vocalizing, turning the head toward the therapist, or trying to pull away. Do Not cause undue discomfort.
  • Cervical region (neck):
    • While patient is standing and while gently supporting head, slowly flex head downwards until nose touches the center of the chest then move back to a normal position. If nose can not touch chest without pain, go only as far as patient will allow comfortably.
    • While patient is standing and while gently supporting head, slowly extend head upwards until nose is pointing straight up then back to a normal position. If painful go only as far as patient will allow comfortably.
    • While patient is standing and while gently supporting head, slowly flex head downwards toward left leg then back to a normal position. Then flex downwards toward right leg then back to a normal position. Again if painful to patient, go only as far as patient will allow comfortably.
    • While patient is standing and while gently supporting head, slowly extend head upwards while turning head slightly to left until nose is pointing parallel to shoulder then return to normal position. Repeat on right side.
    • Repeat all of the above but this time while patient is sitting.
  • Thoracic and lumbar region (chest and lower back)
    • While patient is standing or lying down gently flex then extend each limb joint. Begin at the toes and work upwards. Try to flex each joint until a full range of motion occurs. Follow with extending the joint until a full range of motion occurs. If painful to patient, go only as far as patient will allow comfortably. When you get to the shoulder or hip, extend the leg out in front of the patient as far as patient will allow then backwards as far as patient will allow, then, move the limb away from the body as far as is comfortable for the patient. Lastly move the limb in a circular pattern. If any movement is painful to patient, move only as far as patient will allow comfortably.
    • Set up two chairs or obstacles that will allow enough space for you and the patient to walk around. Keeping the patient close to you, slowly walk patient in figure eight pattern, keep the pattern very small to force the patient to bend the body gently left then right. Keep the patient close to your body on a short leash. Continue this for 2 – 3 minutes. (If cat, gently encourage cat to move through obstacle course, keeping it close to the obstacle so it gently bends its trunk region).
    • Slowly walk patient in a tight circle. While keeping patient on a leash and close to your body, slowly walk around towards your left then towards your right for 2 – 3 minutes.
    • Pole weaving – weaving between vertical poles helps to promote side bending of the patient’s trunk. The distance between poles should be adjusted so that sufficient side bending results. In general, the distance between poles should be slightly less than the body length of the patient. Set up any obstacle that could be a pole (i.e. chairs or boxes) and walk the patient in and out of the course. There should be at least 5 “poles” for the patient to walk around. Continue for 2 – 3 laps through the poles.
  • Slow leash walks for 10 minutes two or three times daily.
  • Begin sit – to – stand exercises and sit – to – lay down exercises – make pet stand up and sit down, for 3 – 5 minutes two or three times daily. Allow pet to work at it’s own pace.

WEEK 3 – Emphasis is on strengthening muscles and continued repatterning of walking ability.

  • Sit – to – Stand exercises and sit – to – lay down exercises continue two to three times daily for 5 – 10 minutes.
  • Increase activities listed in Week 2 to 5 – 10 minutes.
  • Leash walks 10 – 15 minutes.
  • Decline walking (walking down a gentle slope) once daily, if possible.
  • Stairs – 3 stairs up and 3 down twice a day.
  • Continue PROM listed in Week 2 for 10 – 15 minutes.
  • ± Ice packs and gentle massage at end of each exercise session.

WEEKS 4 & 5 – Emphasis is on muscle strengthening.

  • Continued muscle strengthening and development with sit-to-stand exercises and short episodes of trotting 5 minutes once to twice daily.
  • Leash walks for 20 – 30 minutes twice daily.
  • Decline walking 10 – 15 minutes twice daily.
  • Incline walking 10 – 15 minutes twice daily.
  • Stairs – 6 up and 6 down twice daily, if possible.
  • Continue PROM listed in Week 2 for 10 – 15 minutes.
  • ± Ice packs and gentle massage at end of each exercise session.

WEEKS 6 – 12 – Emphasis is on muscle-specific therapeutic exercises.

  • Continued muscle strengthening and development with sit-to-stand exercises and short episodes of trotting. Lengthen period of trotting to 15 – 20 minutes if possible.
  • Leash walks for 40 – 60 minutes twice daily.
  • Figure eight walking for 10 minutes during leash walks.
  • Decline walking 20 minutes twice daily.
  • Incline walking 20 minutes twice daily.
  • Stairs – 8 up and 8 down twice daily.
  • Swimming once daily for 10 – 30 minutes. (seasonal)
  • Continue PROM listed in Week 2 for 10 – 15 minutes.
  • ± Ice packs and gentle massage at end of each exercise session.

WEEK 12 – FINAL REASSESSMENT – please make an appointment for repeat back radiographs (x-rays) at this time and recheck appointment.

  • Exercises must be done only as the patient can manage it. Some exercises may be impossible for the pet.
  • Important things to remember about pets and their backs:
  1. Back injuries are serious and can recur without warning.
  2.  It is important that pets that have back injuries are Not allowed to jump up or down off any surfaces. They should be lifted up or down or given ramps to walk up or down. This may be a lifelong requirement.
  3. During the first week after injury, it is important that pets are Not allowed to walk up or down stairs, No slippery floors, No running or jumping, and No rough play. Their activity should be restricted as much as possible for the first week while we are trying to decrease the pain and inflammation using medication. Cage rest is the standard of care for these pets along with antiflammatory medications.
  4.  Many times we place pets on steroids (Dexamethazone, Prednisone or Prednisolone) as part of their anti-inflammatory treatment. The expected side effects are excessive drinking, urinating more than Normal and excessive hunger. All steroids should be given with food to avoid stomach upset.
  5. Male patients are more susceptible to difficulty urinating or slow urination when they are on methocarbamol (muscle relaxer). Please let us kNow if you feel this is occurring so we can decrease his daily dose.