Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, UK
Neurological patients are now more commonly seen and treated in veterinary practice; these may be post-surgical patients such as hemi-laminectomy following intervertebral disc decompression, or non-surgical patients such as post-fibrocartilage embolism (FCE) or even medical cases (polyradicular neuritis). Remember that these patients will tire quickly, so aim for several short sessions a day rather than one long session, which will fatigue the patient. The aim is for quality rather than quantity of movement. Early physiotherapy and hydrotherapy intervention can greatly improve patient outcomes in neurological patients, reducing disability and secondary compensatory issues.
In the early phase, provide plenty of support for the patient to facilitate voluntary motor function. If the patient is non-ambulatory for a prolonged period of time, he is at risk of secondary complications (muscle imbalance) and compensatory postures (kyphosis), so the physiotherapy programme should ideally commence on day 2 post-surgery, or day 1 in non-surgical patients unless the patient has contraindications which may prevent this.
In the mid-phase, the patient may be able to participate in active assisted exercises. He is still non-ambulatory in this stage, you will be assisting him to mobilise using slings, and may need to give him maximum support to allow him time for weak voluntary motor function in the affected limbs.
In the late stage, the patient may be ambulatory for short distances, but he will tire quickly and may scuff the affected limbs. It is usual for neurological patients to regain weak voluntary motor function first, followed by strength (so he can support his own weight), and finally he will regain his balance and proprioception.
Keep this in mind when assisting him in his rehabilitation programme, there is little point working on his balance in the early stage, as he will not regain his balance until much later. It is better to focus on maintaining his joint range of motion and muscle length in the early phase, so that when he progresses to the mid-phase he has not developed secondary complications (stiff painful joints, or muscle imbalance) that would prevent him from participating in active assisted exercises.
This lecture will review neurological conditions that would benefit from physiotherapy including treatment techniques, patient assessment, how to use simple outcome measures to evaluate treatment techniques, plus a neurology case study to consolidate learning.