Management of tetraparesis in a Shar-Pei-cross dog

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treating tetraparesis  in a dog
Hendrix supported by his Help Em Up Harness

Subedited by Dr Phil Tucak

In Australia over recent years, awareness of veterinary rehabilitation and animal physiotherapy has been on the rise following an exponential increase in their application and benefits seen overseas. The following case highlights how much of a positive impact we can make on the lives of our patients and their families using the different modalities, therapies and devices available in this emerging field of veterinary science.

Hendrix is an 11-year-old male neutered Shar-Pei-cross who presented to his local vet following acute onset of tetraparesis in October 2020. On presentation Hendrix still had voluntary movement in his limbs. However, over the next 24 hours, he lost this function, and had no proprioceptive reflexes, but his local limb reflexes were slightly increased. When placed in a standing position, Hendrix could not support his weight.  

Cranial nerve reflexes, anal tone, and perineal reflex were all intact. Screening bloodwork found no significant abnormalities. Hendrix was not painful on palpation. Mild dynamic extradural compression at the C4/5 vertebrae was identified on a CT myelogram done at this time, however surgery was not indicated based on these findings. 

Hendrix was returned home with an indwelling urinary catheter for strict cage rest with toilet walks only. He was dispensed gabapentin at 5mg/kg twice a day as well as prednisolone at 1mg/kg for 10 days, then 0.5mg/kg for another 10 days, then every other day. His owners were advised to do a gentle passive range of motion exercises and ensure he was turned from one side to the other every four to six hours.

treating tetraparesis  in a dog
Hendrix using his Walking Wheels quad cart.

About a month after his initial presentation, Hendrix’s owners presented to Veterinary Rehabilitation Services for Hendrix be fitted with a Help ‘Em Up Harness (HEUH). At this time, it was discussed how an individually designed rehabilitation program could help rebuild his function, even with the amount of time that had already elapsed and they elected to proceed.

At his initial assessment one week later, Hendrix’s neurologic examination findings were no different to before, although there was some voluntary movement in his forelimbs above the elbows. He was able to get from lateral into sternal recumbency, but unable to change sides or get into a sit from this position. When assisted into a stand, he was unable to bear his own weight. He had mild-moderate generalised muscle atrophy of his epaxial and limb muscles, and mild pain on palpation of his C5/6 vertebrae and ribs 5-7. There was evidence of concurrent osteoarthritis (OA) on palpation with reduced extension of the right hip (1400 compared to 1600 on the left) and both stifles (1650) and pain on end feel.  

The muscles supporting the forelimbs (biceps brachii, pectorals, subscapularis), hips and stifles (gluteals, iliopsoas, quadriceps, hamstrings and adductors) were also variably sore and painful to stretch having been unused over this timeframe. The functional diagnosis was tetraparesis with voluntary movement, secondary disuse muscle atrophy and pain secondary to mild contracture, with mild OA in hips and stifles.  

As part of his management, the prednisolone was withdrawn, and the gabapentin was continued as previously dispensed. He was started on Carprofen at 2mg/kg bid and 4cyte Epiitalis gel was added to promote joint health. Laser therapy was recommended three times a week to stimulate nerve regeneration by increasing blood flow to affected tissues, as well as pain relief when applied over his sore joints and muscles, followed by massage and stretching.1

Hendrix’s initial home exercise program focused on reducing pain with massage of his sore muscles, followed by passive range of motion (PROM) of his hips, stifles and shoulders, building a predictable toileting routine to minimise ‘accidents’, and neurodevelopmental sequencing (NDS)—the predictable order of movement that enables animals to go from lateral to sternal to sit to stand then walk.  

Hendrix’s owners were advised to spend 10 to 15 minutes two to three times a day for three to five days a week doing these home exercise sessions, on top of regular toilet walks. In between sessions, he was to be confined to a crate to minimise inappropriate use of his limbs and muscles which would promote poor neural function instead of the desired patterns.

treating tetraparesis  in a dog
Graduation day

For the initial NDS, toe pinches were used to induce the withdrawal reflex and active flexion—or active range of motion (AROM), of his hindlimbs followed by luring his head from lateral into sternal recumbency. Hendrix spent 10 seconds in the sternal position and then he was lured to the opposite side so that his body would follow, resulting in a change from the initial lateral to opposite lateral recumbency.

At his first recheck three days later, it was possible to add NDS sternal to sit—by luring his head and neck upwards and providing support through his HEUH so he did not drop back into sternal recumbency. Once in a ‘sit’ position, Hendrix’s owners would gently compress his elbow joints in a distal direction to increase proprioceptive feedback to the central nervous system through the muscles, joints and tendons.  

By the following week, Hendrix was able to swap from side to side much better, his muscles were comfortable and therefore the number of target tissues for laser therapy were reduced. Supported standing exercises were added using a therapy peanut, using gentle joint compressions through his pelvis and scapulae to increase proprioceptive feedback to his central nervous system and increase reflexive muscle tone.  

One week later, Hendrix had increased extensor tone in his hind limbs whenever they contacted the ground, so he was fitted to a Walkin Wheels quad cart. His PROM and AROM exercises were then done in the wheelchair to maximise proprioceptive input and build on associated reflexes to stimulate voluntary motor activity.  

Five weeks since his initial presentation to Veterinary Rehabilitation Services, Hendrix was able to ‘walk’ in the quad cart using his hindlimbs to propel himself from the back of the vet hospital to the reception. His owners continued to work on all the other exercises that had been prescribed, and to build stability by luring his head from side to side in a sit or a stand as well. 

Hendrix’s visit frequency reduced to weekly, and three weeks later he could push himself up into a half sit. His comfort and PROM were maintained, so the gabapentin was withdrawn. Four weeks later Hendrix could get into a full sit on his own, and his visits reduced to fortnightly. One month later, he was getting himself into a stand and then off and running without his cart.  

At this stage, he had to be held back to reduce the amount of damage he would sustain by overusing his muscles in his excitement, or by falling over. So it was recommended to limit his yard time to about five minutes for three to four times a day. His exercise program worked on finesse and stability with cavalettis, backing up and sideways walking exercises gradually added, while reducing the carprofen.  

At his final recheck five months from starting rehabilitation, Hendrix had been off carprofen for a month, had a normal gait pattern and PROM in all four limbs, and was above average strength in all limbs. He graduated to a maintenance program wherein gradual increases in trotting times during his walks was added.

Reference:

1Dycus, D.  Laser Therapy in Companion Animals What it is, How it works, & When it benefits patients. Today’s Veterinary Practice May/June 2014.


Dr Yoko Clinch BSc BVMS (Hons) MANZCVS CCRT

President – Veterinary Sports Medicine & Rehabilitation Chapter of the ANZCVS

treating tetraparesis  in a dog

Dr Yoko Clinch became a certified canine rehabilitation therapist (CCRT) by completing the internationally recognised Canine Rehabilitation Institute qualification in 2017, representing over 180 hours of study—including theory, practical experience and examination.   Dr Clinch became a member of the Australian and New Zealand College of Veterinary Scientists (ANZCVS) in Radiology in 2009, and founded the newest chapter in the ANZCVS in Veterinary Sports Medicine and Rehabilitation in 2020. 

She is currently the president and Science Week convenor for this chapter.  

Dr Clinch started Veterinary Rehabilitation Services in Perth in 2018. This service is unique to Western Australia because it is the only animal hospital with both a veterinarian and registered veterinary nurse who are both internationally certified as canine rehabilitation therapists, ensuring the provision of quality comprehensive care.

Dr Clinch is passionate about rehabilitation therapies which are human physiotherapy treatment techniques adapted for use in animals, and how much they can improve pets’ lives in addition to conventional medical therapy. CCRT training enables accurate diagnosis and treatment for bone and joint diseases, and muscle, ligament and tendon injuries. Rehabilitation is also vital in rectifying neurologic dysfunction and vastly improves the rate and quality of recovery from orthopaedic, neoplastic and neurologic surgeries. For before and after videos of some other cases, go online to
www.vetrehabservices.com.au

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