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20
Oct 2013

IVDD Neuro Dog Progressions

Good morning Laurie!  

 

I have another IVDD question.  I have a 4 y.o SF Bichon that had a hemilaminectomy @ left T11-T12 and bilateral @ T12-T13 9/9/13.  She came to me the first time on 9/23/13-walking, trotting actually, wagging her tail, minimally painful, left hind a bit weaker than right.  The owner's are very dedicated and bring her in 3x/week for UWTM/PT/laser and she has progressed remarkably well.  In fact, it's hard to tell that there is anything wrong with her at this point.  Her left leg is almost as strong as her right (she also has a grade II left MPL) and the biggest challenge with her is keeping her from jumping up, jumping up and down from furniture.  She is used to chasing toys in her house and playing tug (but she's not now).  

 

So, my question is, how do you know when it's okay to progress exercises?  When is it okay to say go ahead and let her go up the two steps in their yard?  Chase after a toy (no elevation changes), play tug?  I assume to be conservative I would recommend never jumping on/off furniture again?

 

We are doing weaves, sit-stands on the mattress, wobble board, 3 legged stands, snoopies, parallel walking, backwards walking, walk across the mattress, assisted balance on red pnut, UWTM 11 mins.  We also do traction, laser, cookie stretches, iliopsoas, hamstring stretches, skin rolls. 

 

Today I had her front feet on the balance disc and just did gentle sways.  My inclination is that it would be no problem to gradually add in additional elevated FL exercises, but don't want to overdo it and cause a setback.  

 

I'm not really finding guidance on how you know it's okay to progress exercises in these cases and appreciate your help.  

Thanks!

S.M.

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Hi S,

 

Great job with this case.  She is looking great!

 

As for exercise progressions - I tend to look at it from a very practical standpoint.

  1. Is there still pain or inflammation that is limiting the dog?  If yes, then you stick with easy exercises only.
  2. Are the exercises I am doing now challenging to the patient?  Yes - then continue with them, or No - then progress.
  3. Can I progress the current exercises simply by adding an element of instability (i.e use of a physioball or peanut ball or donut, or wobble board, or air mattress, etc)?
  4. What is the next thing my patient needs?  Balance / Coordination (in stance or perhaps while moving) or Strengthening?  or both?  Do you use a land treadmill or UWT, but add manual displacement forces to increase the co-ordination-balance component while moving?  Do you add an incline for strengthening?
  5. What kind of movement am I afraid could damage my patient?  (IVDD = jumping down or going down stairs, rough play, sudden changes of direction at high velocity, or another dog jumping on her back for example.  Going UP stairs requires strength and is not dangerous per se, and adding an extension component to an exercise - FL elevated is merely a progress - and not dangerous...if done too soon, it could be painful... but is not deleterious.  So try it... if okay, you can add it, if it causes pain, then you don't.)
  6. If my patient is ready to progress, what pieces or components of a more advanced exercise or ADL (activities of daily living) could I try?  So perhaps you try tug of war during one session and watch how she tugs... is it a steady pull, or a terrier-type of vigorous shake mixed in with the pull?  If it is a steady pull, then you could allow 1 - 2 minutes of pull so long as the owner does not see any deterioration.  (Note that the disc will require force and velocity to extrude... it is not a ticking time bomb... you can tweek it and not have anything more adverse than pain.  If you get pain, you discontinue.)  If the dog is one that likes to chase / fetch, then this could be tried in a very small area or by throwing a toy / ball directly AT the patient.  If stairs are to be navigated, then trying 2-steps at at time (as in the backyard for this case) is perfect.
  7. Forever restrictions... with this, you have to figure out what will be practical as well as safe.  I agree that jumping off a couch is not ideal - so start to provide the owners with ways to re-train their dog to a) stay on the floor, b) ask to be let down, c) use a set of stairs or cushions at one end, d) when not supervised and the dog is loose - take the cushions off the couch and/or shut the door to the bedroom.  (P.S. regarding training... perhaps the owners use treats or a clicker to reinforce that there is a reward involved when the owner helps the dog off / down.)

By the sounds of it and the look of it (I did watch your video) you are ready to progress... just try a couple of progressions at a time and monitor. 

 

I hope this helps... and calms your fears a bit too!

 

Cheers,

 

Laurie



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