A Controlled Clinical Study of Intensive Neurorehabilitation in Post-Surgical Dogs with Severe Acute Intervertebral Disc Extrusion

Abstract

This retrospective controlled clinical study aimed to verify if intensive neurorehabilitation (INR) could improve ambulation faster than spontaneous recovery or conventional physiotherapy and provide a possible therapeutic approach in post-surgical paraplegic deep pain perception-positive (DPP+) (with absent/decreased flexor reflex) and DPP-negative (DDP−) dogs, with acute intervertebral disc extrusion. A large cohort of T10-L3 Spinal Cord Injury (SCI) dogs (n = 367) were divided into a study group (SG) (n = 262) and a control group (CG) (n = 105). The SG was based on prospective clinical cases, and the CG was created by retrospective medical records. All SG dogs performed an INR protocol by the hospitalization regime based on locomotor training, electrical stimulation, and, for DPP−, a combination with pharmacological management. All were monitored throughout the process, and measuring the outcome for DPP+ was performed by OFS and, for the DPP−, by the new Functional Neurorehabilitation Scale (FNRS-DPP−). In the SG, DPP+ dogs had an ambulation rate of 99.4% (n = 167) and, in DPP−, of 58.5% (n = 55). Moreover, in DPP+, there was a strong statistically significant difference between groups regarding ambulation (p < 0.001). The same significant difference was verified in the DPP– dogs (p = 0.007). Furthermore, a tendency toward a significant statistical difference (p = 0.058) regarding DPP recovery was demonstrated between groups. Of the 59 dogs that did not recover DPP, 22 dogs achieved spinal reflex locomotion (SRL), 37.2% within a maximum of 3 months. The progressive myelomalacia cases were 14.9% (14/94). Therefore, although it is difficult to assess the contribution of INR for recovery, the results suggested that ambulation success may be improved, mainly regarding time.

Pilot Study on Feasibility of Sensory-Enhanced Rehabilitation in Canine Spinal Cord Injury

“…Incorporating two different, readily accessible surfaces, a piece of artificial grass or a child's floor piano, we provided a simple means to enhance sensory feedback as part of a basic post-operative rehabilitation protocol consisting of PROM, assisted weight shifting and assisted walking. There is very limited detail from prior studies in veterinary patients regarding how exercises with a sensory component are incorporated ( 8 , 10 – 12 , 16 , 19 ). Importantly, sensory stimulation exercises in the post operative veterinary neurologic patient typically center on the owner or rehabilitation professional stimulating the patient's feet, with activities like toe pinching, tickling or rubbing having been described ( 6 , 8 , 10 , 11 ).…”

“…Sensory stimulation as a component of rehabilitation protocols in dogs is occasionally mentioned with descriptions of toe pinching, hair brushing, and utilizing different flooring surfaces ( 7 , 10 – 12 , 16 , 19 ). However, details are limited regarding how they are incorporated and evidence to support such sensory-stimulating exercises is lacking in veterinary patients.…”

Influence of Spinal Shock on the Neurorehabilitation of ANNPE Dogs

“…The electrical stimulation (BTL ® 4000 Smart, Famões, Portugal) programs included functional electrical stimulation (FES), a neuromodulation modality based on the application of superficial electrodes after trichotomy, according to the segmental technique [ 44 , 45 , 46 ]. All of the patients who showed an evident decrease in muscle tone were subjected to the co-contraction protocol, which consisted of the simultaneous contraction of both the quadriceps femoris group and the hamstring muscles group ( Figure 2 A).…”

“…If the patients showed good muscle tone in the quadriceps femoris muscle tone associated with patellar hyperreflexia, then the electrodes were only placed following the sciatic nerve trajectory, stimulating the contraction of the hamstring muscles ( Figure 2 B). The current parameters were as follows: 40–60 Hz; 10–48 mA; 150 μs duty cycle 1:4; and trapezoid current [ 44 , 45 ]. Electrical stimulation was carried out for 10 min and was conducted first three times/day at first before decreasing to once a day ( Table 3 ).…”

“…Data collection also included categorical ordinal variables, such as OFS evaluation at admission, time points, and follow-ups, and ambulatory status with OFS scores ≥ 11. Ambulation was defined as the patient’s ability to stand up, maintain postural standing, take at least ten steps without assistance or weight support on any walking surface, and obtain voluntary or automatic micturition and defecation [ 44 ].…”