Extensor rigidity / high tone complications

[lehughes]

Post by drkcarlson » Thu May 25, 2017 9:16 pm

HI Laurie,

I am also working with a patient with extensor rigidity/ high tone complications and could use advice

Hank is a 5 yo Doberman (36kg) who had a T13- L3 continuous right sided hemilaminectomy 6 weeks ago. He also had evidence of chronic disk material on the left (L3-L5) but was not felt to be responsible for his acute onset of neurologic signs.

Hank was referred to me at 6 weeks post op (really wish I had been able to see him much sooner ). He is able to ambulate and is relatively comfortable but due to excessive high tone/ extensor rigidity of the hindlimbs he is unable to get himself into a standing position. The owners ceased doing ROM in him as it became difficult (due to high tone).

These owners liver about 1 1/2-2 hours away and will not be able to come in for regular rehab sessions. Today after initial evaluation I demonstrated and practiced with them the toe flexion and hip rocking techniques to attempt to break extensor tone and perform PROM. We also started low cavalettis and the owners are attempting assisted/ modified stand to sit (owner sits on chair and Hank backs up and sits on her lap but does not require full flexion).

I am looking for further ideas for Hank and my other patients in the future. Exercises or techniques I can perform in hospital for high tone / extensor rigidity. Also exercises and techniques owners can work on at home. Any insight ( or direction to resources) would be greatly appreciated. This is a common issue with our large breed IVDD patients post sx and our FCE patients.

- Kendra Carlson, DVM, CCRT

[lehughes]

Hi Kendra,

I reposted this for you under it's own heading / title.

So it sounds like you are on the right tract with this dog. My neuro lectures are posted - Video Training 23 - 26. (And my Neuro assessment lecture is in Video Presentations).
You'll find lots of into in the 4 Neuro Rehab Training Videos.

The thing with extensor rigidity / high tone is that it's a slow thing to change. It's a reflex thing, and for improvement the body needs to rebuild the 'interrupted pathway' at the lesion site in order for the brain to have descending inhibitory control over the spinal reflexes.

So IN-CLINIC, I'd always do a little laser on the spine - trying to help with healing, and then figure out what the next set of home exercises should be. (I.e. your therapy will be to try multiple things to take advantage of any functional returns, and then send the owners off with a new / modified home program.

Some ideas: Work on turning, and lateral recumbency to getting up to standing and back down again, backing up, weaves. FUNCTIONAL tasks. "Exercises" don't need to specific or hard... just functional. And therefore YOU need to watch and learn how you can 'cue' the dog's body to do the task correctly and as precisely as able.

To break spasms / extensor tone: try using ice or a massager / vibrator on a flexor muscle group, slowly weight bear through the limb, manually touch the antagonist muscles (rub them, or squeeze the) to help them to activate, try diagonal strokes across the back (as a method to relax), or try shaking the limb a little. And then you continue on with the practicing of the functional task.

Hopefully this is a wee bit helpful!

Cheers,

Laurie