Laurie's Blogs.

 

05
Oct 2014

Lower Motor Neuro forelimb...

Hi Laurie,

 

I have a question about one of my cases that I have been working on.  Perhaps I should know the answer but I need some help. Toby is a 11 year old, MN Beagle that I have been seeing since March. He had surgery to remove an intestinal tumor back in Dec 2013 and at this time had pulmonary thromboemboli that was suspected to have gone to his spinal cord. He was unable to use his LF. He has had an MRI, radiographs and u/s to rule out brachial plexus tumor. I have been working with him on the LF lameness and we have come a long way. He had significant atrophy to shoulder and forelimb muscles. CP deficits and had decreased motor. I have been doing estim 1-2 times a week on the triceps and biceps.  We have regained the biceps muscles but the triceps is very weak and still atrophied. I suspect there is permanent damage to the nerves supplying this muscle. I have taught the owner massage, PROM, PNF and strengthening exercises to do at home to save on expense. She does them at least 1-2 times a day. He is now able to go on walks, trails mostly and will use that LF.  He carries it still at times ( mostly in the house)  but I think he is progressed well so far.  I feel as though we are getting to a plateau though. My first question is there anything else we can do? Funds are limited so UWT is out and he despises water. He walks on a helpem up harness and we use that to help support him with exercises. The second is I am worried about his RF and carpal hyperextension as he will still place majority of his weight on this limb when standing and walking around the house.  Should I use a brace to support this and if so which do you recommend?  Should I use a brace on the LF too?  And when- all the time, on his walks, just during his exercise sessions?

I really appreciate your input and time!

 

Thanks so much,

 

A.M. 

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Hi A.,

 

You might be right about reaching a plateau, but I continue to be amazed by later-stage improvements in neuro cases.  That being said, LMNL have less recuperation (as a general rule) than UMNL from my clinical experience.  But you just never know...

 

So, I would agree with your synopsis to use a brace / wrap for the RF carpus.  I'd just go with something light weight however... so maybe just a Therapaw carpoflex without any of the additional support.  This will not only protect the carpus, but because it will cause him to offload the RF to the LF and may help to increase the LF use & strength.  If the LF doesn't collapse when he's weight-bearing... then let it be (without a splint).

 

As for any continued therapy with you:  If you have a laser that might be the best for stimulating additional nerve regeneration (directed at C6 - T2 nerve roots and brachial plexus).  I would also add neck traction to the home program and your in-house therapy.  Both of these would stimulate an increase in circulation at the site of the lesion... Do they have a land treadmill at home?  Sometimes that can be an even better tool for dogs that have some ability to walk on land, but you need to increase use, build muscles, coordination, etc.  I love adding resistance to land treadmill.  You could show them things to do on the land treadmill (if this were an option).

 

I hope this helps get you thinking.  Let me know if you have an additional questions.

 

Cheers,

 

 

Laurie



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