Influence of Spinal Shock on the Neurorehabilitation of ANNPE Dogs

Abstract

Acute noncompressive nucleus pulposus extrusion (ANNPE) is related to contusive spinal cord injuries, and dogs usually appear to be exercising vigorously at the time of onset. ANNPE has a characteristic peracute onset of clinical signs during exercise or following trauma, with non-progressive signs during the first 24 h and possibly signs of spinal shock. The main aim was to assess if the presence of spinal shock affects the neurorehabilitation outcomes of ANNPE dogs. This prospective controlled cohort clinical study was conducted at the Arrábida Rehabilitation Center. All of the dogs had T3–L3 injuries and were paraplegic/monoplegic with/without nociception, the study group (n = 14) included dogs with ANNPE spinal shock dogs, and the control group (n = 19) included ANNPE dogs without spinal shock. The study group was also evaluated using a new scale—the Spinal Shock Scale (SSS)—and both groups were under the same intensive neurorehabilitation protocol. Spinal shock was a negative factor for a successful outcome within less time. SSS scores > 4 required additional hospitalization days. The protocol was safe, tolerable, and feasible and accomplished 32% ambulation within 7 days, 29% in 14 days, and 29% in 30 days. The results were better than those obtained in previous studies—94% at 60 days—and 75% of the dogs without nociception recovered ambulation. Long-term follows-ups carried out 4 years later revealed a positive evolution.

Approach to Small Animal Neurorehabilitation by Locomotor Training: An Update

“…In addition, early intensive LT should be associated with multimodal modalities [ 18 , 19 , 20 , 63 , 85 , 88 , 123 ] in all neurological dogs and cats with or without pain perception after surgery or with conservative management, maintaining the stability of the SC. This early and intensive multimodal training can be applied across a diverse range of neural diseases, promoting research for years to come.…”

“…In SCI human patients, this exercise can be performed through manual assistance by therapists or, mostly in cases of severe deficits and cardiorespiratory restrains, continued by robotic exoskeleton assistance or robotic assisted treadmill training (e.g., Lokomat ® ) [ 60 , 61 ]. On the other hand, in the veterinary field, spinalized animals presented good results when performing treadmill training [ 18 , 19 , 20 , 62 , 63 ], also in comparison with walking on different floors [ 64 ]. The alternative to robotic assistance in small animals that require body weight support has been the use of continuous wheelchair training, or in heavier dogs through a passive standing device above the treadmill [ 62 ].…”

“…In translation for small animals, there are few reports of rehabilitation sessions manly with underwater treadmill locomotor training [ 85 , 86 ]. Recently some studies have been published describing locomotor exercises on land and underwater treadmill, in acute and chronic intervertebral disc disease (IVDD) dogs [ 19 , 20 ], SCI contusion cats, cervical IVDD dogs and in acute non-compressive nucleus pulposus extrusion (ANNPE) dogs [ 62 , 63 ].…”

“…If the patient has monoplegia/monoparesis, paraplegia/paraparesis, or tetraplegia/tetraparesis, the adaptation to the treadmill surface is necessary to obtain voluntary or automatic movement. For that, the surrounding environment must be calm and quiet with classical music [ 19 , 20 , 62 , 63 , 88 ], but also with enough energy to promote motivation to start the step cycle, autonomously or with assisted exercises, such as the established bicycle movements, that may require perineal or tail stimulation [ 18 , 64 , 89 ].…”

“…Regarding bicycle movements, and in the case of hypotonic muscles, they should be performed with stretching limbs and vigorous stimulation of cutaneous afferent receptors on the treadmill surface [ 63 ]. However, if the dog or cat demonstrates hyperreflexia and increased muscle tonus, bicycle movements have to be smoother, and it is not advised the stretching of intrafusal fibers group Ia/Ib.…”