Elderly Sheepdog With Neurological Problems – Homework Review

Here is the short write-up of my recommendations/reminders for Abby’s functional rehab and the process I believe will improve her neuro-muscular capabilities and strength.

To Abby’s Caretakers:

Some of this will be stuff I’ve mentioned several times over the course of working with Abby, however it bears review, and most of the time, when I re-evaluate a program, often we need to go back closer to a beginning point and press forward methodically in order to achieve expected gains. As always, I am available to do this work and especially if you need assistance because it is hard on your own body or even just to make sure it gets done so that Abby may recover well! 🙂

I can’t emphasize enough how beneficial the vibrational massage is, even if you do it every other day instead of every day for now. For a refresher, please watch the 10 minute video here:

https://rehabdeb.com/pet-massage/

And do it as best possible without cutting corners. You will get the best outcome if you follow the video instructions, and I’d really like it done daily to better encourage healing on several levels. Pertinent questions are also covered in the video, as well as methodology and benefits. Make sure you change out the batteries as soon as they seem dull, because the best benefit from this massage is realized from the vibration, which stimulates circulation, lessens tension, and potentially improves nerve conduction. I recommend, for now, doing the massage at the end of the day, at bedtime or thereabouts.

For the next week, please walk Abby twice daily, super slowly and consistently, without stopping, for 15 minutes. I chose 15 minutes because you said she has already accomplished doing 10 min walks for a week, 3-4 times per day. Before that, she laid a foundation with 3-4 five minute walks daily for a week. There are very many reasons why I use this method, and they all contribute to the gains we are trying to achieve. Super slow walking encourages use of all limbs to the best of their ability. Abby has already been able to walk multiple times daily, super slowly, for five and ten minute sessions, having built up slowly. Using the same exercise protocol for a week allows more time for the body to adjust to the work load, and it should go well, because these are introductory workouts, to build a base.

For the week following the twice daily 15 min walks, please walk her 2×20 minutes in the same manner, and only if the 15 minute walks are completed well for a week. She should be able to complete these walks without dragging a hind limb and without sagging or falling down. That’s because we spent time building the base. Otherwise, she needs to return to 10 minute walks and do them multiple times daily to ensure success. I am not wanting complete fatigue and maxing ability at this point; I am after building successful progress, which I believe her body will adapt to and accomplish.

I really would like her to wear two supportive hard braces during these walks, and I realize you have only one. She hyper-extends both her tarsal joints, and in order to use her hind legs properly and to subsequently use the muscles better/properly, the supportive brace that prevents hyper-extension while she is doing her slow drills would be additionally beneficial. Use the one you have on her R hind, since that leg has the most deficits and is the weakest. She hyper-extends because of nerve weakness and deficits in this case, and that has been a problem since I began giving you instruction for her over a year ago.

After the week of 2×20 min slow, relatively flat walks, please add in cavalettis, obstacles, to improve her proprioception. This may be accomplished in many ways and several locations around your environment. I have photos on my Facebook rehab page that depict several home-based cavaletti designs. Please be sure to read the descriptions below the pictures, because not every type of cavaletti is for every pet 🙂

Abby needs to do the cavalettis every other day and during one of the walk workout times. You should warm her up walking for 5 minutes then do obstacle repeats for 10-15 minutes. I suggest you use about 5 items in a row, spaced about half an Abby-length apart, and between 4-6 inches high for now. If we could get the old cat to do the work, I’m pretty sure we can get Abby to do it! If she is too stubborn for you, I will be glad to take a rehab session and work with you and her on this drill.

After a week of this drill, keep doing it as prescribed, and add in hill repeats every third day as one of her twice-daily workouts. I suggest walking out the front door, around to the back yard, and then up and down the hill on the far side of the house for 10-15 minutes, very slowly. I was able to get her to do this work this past summer when I came for rehab checks.

During the hill phase, it may be more beneficial for Abby to receive laser therapy on the hill work days. This should have the effect of stimulating nerves and cellular process and often improves work ability in the older and neuro-challenged animals. In her condition, I see reason to have twice-weekly laser sessions for at least a month-I’ve had good outcomes from doing this with similar cases.

I think it would be great if you were able to just start where I suggest, as if we were beginning from scratch, and let’s see the progress that comes from scripted protocol and collaborative effort. She won’t improve from this point if she keeps doing the same walks and leads the same life she has been leading for the past many months…the body stagnates, and the same happens for humans as well. Our brains aim toward conservation while our bodies are able to do more. I believe, based on my experience that is also based on years of research, that we will see strength and muscle gains if you start here again. I suggest we review in one month after these exercises have been completed. I will then revise the protocol and change the challenges.

Thanks!

Blessings-

Deborah January, 2013

Degenerative Myelopathy and Neurological Conditions

Question from the International Veterinary Academy of Pain Management, 2012:

“Does anyone have any recommendations regarding treatments for a 14 year old Husky with Degenerative Myelopathy? So far, the only thought I have is a cart. Also, my understanding is these animals are not in significant pain – is this true? Thanks for any info.”

From: A Veterinarian in the U.S.A.

RehabDeb Response:

Hi!
I apologize for taking so long to reply. I have a 30-yr. background in human sport science and nutrition, worked two years in a veterinary specialty hospital designing and building the rehab dept., and since 2007 have had a mobile practice wherein I serve a huge number of “mystery-ortho-neuro” cases, many of which are presumed to be D.M. (Degenerative Myelopathy) (or, as of 11/2014, may have been tested using protocol at Missouri).

The functional rehabilitation protocol I have developed over time, and which has been successful at improving function to varying, yet notable, degrees is derived predominately from my experience in sport science program design coupled with principles of neuroscience. A body at rest stays at rest and only changes with dynamic interference…
(original RehabDeb quote :))

I DO agree that while D.M. may not produce pain in and of itself, it is highly likely that an animal with any neuro condition has self-induced pain by nature of the fact that they are compensating, stressing tissues, and possibly pinching nerves, akin to when our sciatica or sub-scapular, etc…get impinged and cause us pain.

Pain management discussion aside, for my own patients I introduce a system of simple, vibration-based, massage with a less-than-ten-dollars Homedics unit (https://rehabdeb.com/pet-massage/), Low-Level Laser Therapy (MUCH research exists regarding nerve conduction, regeneration, re-invigoration), and a plan of return to whatever level of function is possible via primarily-human-induced and animal-activated movement exercises, retraining brain-to-limb neural pathways and encouraging focus on movement and function. I prefer to use dry land and gravity, and I work with clients on methods to help them get this work done. Strength and endurance/conditioning drills I propose, depending on each animals status, are best

I begin with laser twice a week for a month and review exercise protocol that the owner is charged with doing if they are capable and which I do if the owner prefers. I use a front harness designed for riding in the car that has fleece and the best stitching I have found and only costs $30 shipped from Petsmart (no longer available-2014). This is the Travelin’ Dog harness. I turn it around, and it is “perfect” for hind end support (legs through arm holes, tail through neck hole) while relieving owner back stress, if used properly. It is much better designed for the body than the blue neoprene sling or a belly towel, less pressure on the abdomen than a belly sling, and less problematic than a Bottoms-Up sling. No one pays me to promote these items; I have just found that they are simply the best and inexpensive, and in my years of experience I deem that they work better than a lot of what is out there. I have pics around this blog of neuro dogs wearing these harnesses.

There are many more things that may be done, however getting the owner started on helping the animal around the home in a manner that hurts neither owner nor animal, and in a manner that is most productive time-wise, is one of the major components of my mobile practice. I tend to not involve owners in activities that, again, would potentially cause more harm than good or waste more time than be productive. This list includes ROM, balance balls, and balance boards, among other not-as-productive work that should be performed.

I also utilize a brand of boots with excellent traction, usually sometime along the way but not usually right away. Depending on function-ability I will introduce the boots when I believe they will not encumber the pet and will be more help than hindrance. The right boots always seem to encourage hind limb use when there already is function and they give stability in the home on tile and wood floors. I also often have pet owners stop using boots if they have begun using them before the pet is functionally ready.

On several elderly canine patients I have also used Epsom salts baths to great benefit.  Owners HAVE to ensure they rinse off all the salt residue after the bath, otherwise if the dog licks it, which they usually will, diarrhea will likely ensue.

These are some of the basics, and I will be glad to discuss the topic further if you’d contact me.

Blessings-

Deborah Carroll

 

Luxating Patellas – Rehabilitation After Surgery or Instead of Surgery

First and Foremost: 

1) Please pay attention to the discharge instructions your veterinarian/surgeon has given you if your pet just had surgery for luxating patellas or you have received instructions regarding your pets injury. These instructions usually tell you what to do in the first 24-72 hours in order to care for your pet based on the surgery they had. In many cases, my rehabilitation recommendations will likely fully complement your veterinarian’s instructions and may be used in conjunction with your post-surgical care.

–For example, my instructions and this website both discuss additional information about pain. I have found in my practice that this information is extremely helpful for clients (and their pet patient!).

–As an additional example, my instructions about how to walk your pet, post-injury or post-surgery, will also help you deal with your pets potty and feeding needs, and they don’t contradict knowledgeable post-op protocol.

2) Please pay special attention to the part about no running, jumping, or playing.

3) After paying special attention to those things, please carry on by following those instructions. 😉

And, if your veterinarian or their staff did not say so, please note your pet should not be doing any flying over or onto or off of couches or beds, no galloping stairs, no jumping into or out of cars and trucks, no twisting very fast in tight circles chasing their tail or air fairies, no hilarious sliding on ice, and NO freedom in and out of doggie doors.

I hope this short list leads you toward further thinking about dozens of other activities you shouldn’t allow your pet to do while they are recovering, so that you may discover and eliminate potentially damaging activities I haven’t mentioned that are a part of your and your pets lifestyle.

But, Wait! There’s More…

And, I’ve found I need to add, there shouldn’t be a pet partner/guardian, or their friend(s) jumping out from behind things to scare the dog into running crazy funny around the house (because, likely damaging to the injury) like you, or your friends, sometimes like to do (because, hilarious).

“No running” really means no running to the door when the doorbell rings, no running away from Halloween costumes, no running from one end of the house to the kitchen every time the fridge or a plastic bag is opened, no running to you when you yell to ask the dog if it wants to go outside, and no running inside after the ball, which is very similar to no running outside after the ball.  No, no swimming until at least 8 weeks after surgery or after injury recovery, and only if your pet isn’t lame/limping.

Next Steps:

For further instructions, including the next steps in my rehabilitation protocol, please see the additional links on

this page about steps to follow after surgery,

or on

this page for steps to follow after injury diagnosis, without surgery or before surgery.

Also, please look at and purchase my related books (on Amazon.com if you want the expanded 4-week program.

What’s in the Books?

The booklets contain the first four weeks of information about “workouts” or active rehab you may do with your pet. These instructions are the same for non-surgical and post-surgical treatment of luxating patellas, as they are for my rehab homework for torn knee ligaments. In the future, I intend to publish the booklet that deals with more specifics of luxating patellas.

The main difference between the post-surgical booklet and the “instead of surgery” booklet is that the post-surgical booklet covers additional information about infections after surgery and about dealing with the surgical incisions.

Guidelines for Home Rehabilitation of Your Dog: Instead of Surgery for Torn Knee Ligament: The First Four Weeks, Basic Edition

Guidelines for Home Rehabilitation of Your Dog: After Surgery for Torn Knee Ligament: The First Four Weeks, Basic Edition

Does My Pet HAVE to Have Surgery?

I have worked on rehabilitation for many cases of luxating patellas that did not require surgery in order to improve the pets function and/or quality of life.

Your veterinarian and I are able to approach your pets recovery in most cases to devise a plan that immediately reduces pain with pharmaceutical pain control (medications), if necessary, and gradually reduce pain with my rehabilitation protocol.

Pain can be quite detrimental to quality of life.

After, and while, reducing pain, I recommend that you follow the instructions in my booklet in order to begin work on improving your pets function.

There are many adjunctive, additional body work therapies that are also helpful for your pets recovery at this time. I speak further about some of them in the booklets I linked above. Please follow this link for my easy & productive massage technique for some info on massage so you may get started with adjunctive therapy on your pet.

The three approaches I just mentioned apply to both non-surgical cases and surgical cases.

Why Do These Exercises and Recommendations Work or Help?

In some cases the patella stops luxating (flipping out of the groove on the bones around the knee joint) when you do the right types of exercises with your pet. These exercises should create stronger and larger, hypertrophied, thigh muscles.

In some cases the increased exercise and specific exercise protocol for individual animals does not completely eliminate all luxation, however in those rehab cases, the kneecaps/patellas usually luxate less, and this work usually reduces or eliminates altogether the initial pain of the kneecap flipping back and forth.

I designed additional rehabilitation protocol toward improvement beyond the first four weeks. I do not yet have these in booklet form, however I’ve been using them for 20 years in my practice. Stay tuned for future booklets and related posts, and in the meantime, you should experience good success with the initial program I have outlined for you on this website.

My Pet is Grade 1 – 2 – 3 – 4…

For animals with grades 1 and 2 luxation, as diagnosed by your pets veterinarian, my rehabilitation protocol has worked successfully to reduce pain and/or luxation. My client’s veterinarians have seen this in practice and have agreed/concurred.

My recommendations and protocol often greatly help pets with Grade 3 luxations. Depending on the size and lifestyle of the animal, or the severity of lameness, your vet may yet recommend surgery for your pet. I, and a lot of veterinarians, recommend that you start your pet on the first week(s) of my rehab protocol while you await your surgery date. We call this “pre-hab” in the functional rehabilitation world. You will also likely gain more confidence in how and what to do when you bring your pet home from surgery. You will have already had some experience with how the exercises “work”.

Grade 4 luxations are almost always referred by a veterinarian to surgery, in order to possibly improve quality of life and to possibly help the pet if it has persistent pain due to pelvic or other malformations. I have worked with grade 4 luxation pets, and to my knowledge, all were helped with these rehab protocols, despite physical malformations. If you do opt for surgery, the I recommend you follow my post-op rehab protocol and follow your veterinarian’s post-op recovery instructions (gonna be more “no running, jumping, or playing”…always!).

How Long Do I Do Rehabilitation?

You should continue rehabilitation work with your pet for at least six to eight weeks after injury or surgery. I prefer 12. Often owners relax around week four (or three, or two, or at the end of a successful first week), especially if things seem to be going very well.  I recommend you continue all the way up to “week four” exercises, and continue those, until you are released from re-evaluations with your pets veterinarian and your pet is cleared for “regular activity”. In the meantime, I’ll soon be working on a book with a full 12 weeks of protocol for you.

copyright 2007, Deborah Carroll

Reviewed November 16, 2023

How to Use The Homework Guides for Rehab After Dog Knee Injury or Surgery

Intro to the books, found on Amazon here:

 and here…

and elsewhere from a variety of booksellers.

Read the Preface.

Read the Prologue.

Read the whole booklet before beginning the work.

Thank you! Now continue to read this chapter. The above three bullet point sentences were for people who really want bullet points. Both the Preface and the Prologue contain beneficial information, and I think the following contents will answer several questions you might not even know you have!

This homework covers guidelines that may be used after any invasive procedure performed for surgical repair of your pet’s knee after a torn ligament, whether any of the bones were cut or not. Right now it does not matter so much that you know exactly which surgery was performed; the restrictions and care are equally beneficial.

These guidelines are also very beneficial for recovery after surgery for torn meniscus and after surgical intervention for osteochondritis dissecans (OCD) (yes, really, but different from psych OCD) of the stifle (knee) joint. Whichever method of surgery was used, this homework is an excellent place to continue the healing journey!

As I stated earlier, written programs like this were not readily available, if at all, when I first began working officially in small animal veterinary medicine rehab in 2004. I knew from working with athletes and others, as well as from reading related research for several decades, that very slowly progressing, return-to-function programs were needed for our pets, as well.

In light of what I knew, I began using simple post-surgical protocol I developed. The larger discussion, continually, is among varieties of veterinarians who have come to believe in a particular method or methods of surgery to be used to stabilize the knee after ruptured cranial cruciate ligament. Regardless of method used, this intro protocol should be very beneficial toward accustoming the joint to greater amounts of use again, toward improving bone healing, and toward improving bone and muscle strength.

I don’t have the money to fund a large study or the time to ask for it at this point or in recent years. I do, however, have the validation of many veterinarians who have seen the progress of the pets whose caretakers have fastidiously followed my instruction for at least 8 weeks.

Often people see such notable improvement after only 4 weeks that they don’t understand the need to continue to follow through with progressive rehab. In well-established human rehabilitation protocol for ACL surgery, patients are progressed through criteria-based functional activities and evaluations for discharge from rehab are targeted between 4 and 6 months after surgery.*

Is this happening with your pet?

My preference is that people follow at least 12 weeks of rehab protocol for their pets in almost every case. The feedback from situations of which I am aware where this has occurred has been entirely positive.  This homework is an excellent place to continue the healing journey, so take a deep breath and move forward confidently!

Also, as noted, my practice and protocol are based on using the home or a standard vet clinic environment to accomplish functional rehabilitation. I prefer land-based exercise because I find it very practical for most pets and their caretakers after this surgery. You may put your internet researching skills to good use by looking for research data which encourages the use of weight-bearing exercise, where possible, to bring about greatest changes toward healing, including bone strengthening and the strengthening of soft tissue, as well as muscle hypertrophy. The latter is often the reason animals are referred to me; people want to see the muscle rebuilt where it has diminished over time due to injury and subsequent lameness (muscle atrophy).

Some people will want to utilize a clinic and a water treadmill in addition to the instructions in this booklet, possibly because the clinic option is available and their veterinarian has recommended it. Most people do not have the option of a rehabilitation facility for their pet, and that’s okay, because it’s not necessary to have that in order for your pet to recover…so don’t fret!

Regardless, I find that people are really in need of instructions that outline steps they may take to assist the healing and improved return to function of their pet in the home environment. Caretakers usually just don’t know what to do that is proactive and practical at home after pet surgery (or injury!).

I also emphasize over and over that pain control is important to my rehab protocol. If you are not going to use enough pain control to help your pet bear weight on the injured leg, then you should consider using the water treadmill..

It is extremely important for pet caretakers to learn how to control and care for their companions at home after this surgery whether or not they also entrust this aftercare to a clinic for a few hours a week as well. Do collaborate with your vet clinic, yet also learn how to do your part, hopefully aided by the ideas in this booklet.

*You may find out more about the topic of clinic-based human rehabilitation from books like Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician, Hospital for Special Surgery, Department of Rehabilitation, Copyright 2006, Elsevier, Inc.

Cavaletti (Obstacle) Photos

Some Examples of Cavaletti Equipment my Clients Have Used in their Home Environments –

Since my practice is mobile, I look around the client’s home or workout environment to find cavaletti equipment or tools to get the (obstacle) work done. These drills are for proprioceptive benefit as well as range of motion and isometric strength building.

Cavalettis should technically and scientifically be done only after establishing a base with this program.

First…

I look around the home environment to help people with ideas that are inexpensive and easy to set up the right size and spacing of cavalettis for their pet. Finding options for the right kind of obstacles in the home environment makes it easier for the people and the pets to be compliant with the work. Less time demand and easier access makes for greater compliance. Even if people have to buy stuff to use for these drills, sometimes pool noodles or something from the home supply store, these tools are inexpensive.

Cavalettis Original Design 2-27-14I lined up these bricks along a house to make range of motion and isometric drills for a mid-sized herding dog with non-surgical rehab of torn cruciate ligament.

Cavalettis 3 Cavalettis 4

Later, her person caretaker raised the bar by raising the bar and building a more elaborate brick-scapade across the back yard!

Second –

10-11-14 Cavalettis

This was the cavaletti path for a large Pit/Lab X doing non-surgical rehab for torn cruciate ligament and torn meniscus. She also had a tarsal (ankle) injury that I discovered at the same time!

This client was unable to work her large, happy, strong dog outside with much success. She had great success doing all the advanced drills inside the home.

She also didn’t have the right size and type of items for the drills lying around the home, so she spent a little bit of money on wood. After doing the introductory drills at this height, the client then placed flat 2×4 blocks under the ends of the boards to raise them.

After several successful sessions at an introductory level, pets need to continue the drill at increasingly higher bar levels. For videos of cavaletti instructions, click here!

This client bought wood, nails, and pvc –

Cavalettis 2-27-14

This was level 2 cavaletti height for a Goldendoodle doing non-surgical rehab for torn meniscus and torn cruciate ligament. She also had hip pain issues that after muscle atrophy from the knee injury. This resolved after she started my program for muscle-building and received the proper pain medications from her veterinarian.

The next level for her was to put 2 x 4 blocks under the pvc. You already see that in the picture.

Cavs 2 7-11-14Cavs 7-11-14 These were from the woodpile out front at this mid-sized dogs home. I set them up to help her recover from her neurological event, an FCE (fibrocartilaginous embolism). I directed them to begin this work only after completing my base work of fitness and muscle strength.

BJ Cavs 1 8-8-14

BJ Cavs 8-8-14

Yes, these ARE speaker stands inserted into milk crates. Only in Austin, TX (and maybe Nashville…)

Cavalettis

I DO work with many cats. This one is Kacey, and there’s a vid on this site of her doing cavaletti repeats…

Chile R 6-26-13 Cavs Happy

And this guy is getting a start using his own standard cavaletti equipment he usually uses for agility training. Recovery cavaletti drills are much different than agility training work with jumps. There is no jumping in recovery cavaletti drills.  He was working on this drill to help with his disk disease and degenerative myelopathy.

 

(Original Post November 3, 2014. Updated March 27, 2018)

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