Cart to assist rehab in grade 5/5 hemilam, 10d post op??

[JaneHK]

Hello All

I saw somewhere that some rehabbers recommend using a cart in the early stages of spinal rehab as it helps to position the patient for gaiting.

I have a small dog, mini poodle, grade 5/5 with no deep pain after her 10 day post op hospital stay with very limited physio during her stay. I am getting her onto a peanut TID, which is good for positioning and we have a little increase in HL tone over the past few days. Of course doing ROM, massage and sensory stim.

What are your thoughts/ experience regarding use of a cart this early? Concerns that the HLs will chill out and the leave the FLs to party on? Or great as you can perhaps lower the HL support a little to help positioning and proprioception/ placing of the HLs as the doggy skirts about (if one is also on skates).

No UWTM options (unless it's a cart on a land treadmill)......
thanks in advance.
Jane

[lehughes]

Okay... so I too would like to hear of the others that are using the cart early on for rehab as well.

My experience has been that if you give them wheels early, then don't ever learn to slow down and try to use their legs (IF they have some degree of return to function). That being said, IF you were to use a cart, I think that using it on a land treadmill would be brilliant, b/c you could control the speed. Without that... you are likely to put a hole in the knees of your pants from crawling around after the dog in the w/c. I have done this a handful of times.

I actually prefer hands on stimulation of the muscles, lots of standing practice and proper sit practice, and learning to roll and get from side to side. Then super slow land treadmill with facilitation of the legs and lots of sensory feedback.

Be sure to be lasering and acupuncturing the spine if you have access to those modalities. Or PEMF. Basically things that will increase bloodflow and diminish inflammation.

Now let's see who else pipes up and weighs in on this!

Laurie

[DancingDog]

I have a similar dog right, working with her about 10 weeks now, got into rehab a bit late post op. She has pretty high HL extensor tone, looks great in the UWTM, but on land defers to some bunny hopping, intermittent Hl weight bearing and "steps" using a Help-em-Up, and side scooting. She has a lot of atrophy, and she seems to prefer keeping her hind end in flexion. Even will eat in a handstand at her bowl to avoid remaining on all 4s! The owners do not want to think about a cart right now, and I am ok with that for now as she is making some slow progress. I cannot seem to get any contraction with stim, am doing spine laser, weight bearing/standing exs, UWTM, sitting practice and she is now able to get herself side to side. I sort of feel like I have to go with the dog, and feel she would take off with a cart (she is 4-5 years old) but not sure when to call it and raise the option with owners. Maybe she will have enough functional stuff to get her around inside at home, but longer walks and travels will be best off with a cart? She is my "first" of this diagnosis so not sure how long or the direction to go. Thoughts?

[DancingDog]

correction-my hemilami is 10 weeks post op and I have been working with her now for about 5 weeks! She continues to make slow gains, and I am beginning to think that if we put her in a cart allowing her to weight bear with support, she may continue to progress and "rehab" out of it, or at least have gained more function. Has pretty intense extensor tone,which I thinks is a blessing.

[lehughes]

Dear "Dancing Dog"

Since you've only been working with the dog for 5 weeks, I'd say keep going for a bit longer. To be honest, I'd not be hugely optimistic... but neuro cases can always surprise you.

With your case, I'd agree that putting her in a cart to rehab may create a cart reliance and need for speed. You don't say the level of the hemi-lam. This could make a difference as well.

Unfortunately, there is no crystal ball with neuro cases. And you're right, you have to go with the dog i in front of you. With what you are describing, I too think that you might be able to work with getting some around the house abilities (even if simply spinal walking) and a cart for going out and about.

I find that owners need to have those seeds of thoughts planted slowly and in pieces so that if/when you get to a point of saying, "Yup. She needs a cart." It is not a surprise. For example, you can say, "Some folks might opt for a cart at this stage, but if you're willing to keep going with some therapy, let's revisit it in a month."

Hope this helps...

Laurie

[JaneHK]

Thanks for your comments and great to read others cases.

My doggie is now 8 wks post injury and we have no progress. I can't see any suggestion she will spinal walk - not in water and not with our cart gaiting.
I just read Gallucci et al's paper (2017) in JVIM and am excited to see 59% of dogs without deep pain were able to spinal walk at 75d (median) but I note that they had 2 sessions per day of physiotherapy with UWTM. http://onlinelibrary.wiley.com/doi/10.1 ... .14651/pdf

Despite what seemed to be great bladder management, she has a raging UTI which has limited her access to UWTM.
So I'm going to suggest we embrace my little patient's enthusiasm for the front end and get her in the cart with HLs lifted.

[lehughes]

That sounds like a plan Jane!

And for what it's worth, those UTI's seem to cause some degree of neurologic regression.

Best of luck!

Laurie