Researched at http://www.ivis.org. See citations for full text available at IVIS. Neurological Canine Rehabilitation. L.L. McCauley, NAVC Proceedings 2006, North American Veterinary Conference, Internet Publisher: International Veterinary Information Service, Ithaca NY (www.ivis.org), Last acessed: 2/27/0. "Monitoring muscle atrophy can be diagnostic. In cases of spinal cord injuries, if muscle atrophy is severe within two to three weeks, prognosis is more guarded then if the atrophy is slower. This is due to decreased nerve input to the muscle versus disuse atrophy. To prevent or restore muscle mass, active motion is required. Neuromuscular stimulation may be used on the Quadriceps, Gastrocnemius, Cranial Tibial, and Triceps muscles as well as the Hamstring group, Paraspinal group, Forelimb flexor group, and Forelimb extensor muscle groups. Reflexive motion is also beneficial. Tickling the toes or gently pulling or pushing the limb can trigger a reflex that is active motion. Make sure your clients understand that passive range of motion (PROM), although important for circulation and joint health, also prevents muscle loss. Joint care is also necessary. Degenerative joint disease (DJD) can form relatively quickly in immobilized joints. This may be due to the fact that there is low blood circulation in the cartilage itself. Cartilage nutrition is usually supplemented by the capillary rich synovial capsule, which allows nutrients and waste products to be transported to and from the chondrocytes through movement of the synovial fluid. PROM and joint mobilization can decrease the rate of DJD by circulating this synovial fluid. The other benefits include preventing loss of range of motion, stimulating the golgi tendon organs (a mechanoreceptor) and increasing blood and lymph circulation in the muscles. This should be done a minimum of three times daily until active motion is frequent or ambulation exercises have begun, in which case it can be done on a daily basis for stretching purposes. Nerves are like muscles in that if you "don't use them, you lose them". Not that the nerve fibers themselves disappear, but several studies have shown that the number of mitochondria inside the nucleus are increased in athletes and decreased in inactive people. Remember the mitochondria are the "power house" of the cell and if diminished may decrease the nerves ability to transmit messages correctly or quickly." ---- --- Textbook of Small Animal Orthopaedics, Newton C.D. and Nunamaker D.M. (Eds.) Ithaca: International Veterinary Information Service, 1985; Internet Publisher: International Veterinary Information Service, Ithaca NY (www.ivis.org), Last acessed: 2/27/07 "Postoperative Management/Physical Therapy for the Recumbent Animal The goal of postoperative therapy is overall patient comfort and speedy recovery. The major postoperative considerations are diet, exercise, fecal and urinary elimination, and surgical wound management. Most of these concerns are also valid for the medically managed IVD patient. (2,28,54) The recumbent animal or the animal experiencing pain should be handled carefully and affectionately while in the hospital. All personnel should show interest and compassion for the patient. Frequently one member of the hospital staff can establish a good rapport with the patient, promoting a good attitude in the animal that encourages the desire to recover. (28,37,54) It is important that the animal remain clean. Dermatitis, orchitis, and decubital ulcers develop rapidly if the patient is allowed to sit in feces or urine. The cage should be padded with clean synthetic fleece blankets or foam rubber pads. (28,54) The occurrence of corticosteroid-induced enteropathies has been reported as a serious postoperative complication. This syndrome is encountered most frequently in the thoracolumbar surgical patient receiving corticosteroid therapy for more than 3 days. Severe diarrhea, melena, gastric perforations, and colonic perforations have all been described to be associated with this syndrome.(62) Oral antacid or type 2 histamine antagonists have been advocated as prophylactic agents. (28,62) As a guideline for postoperative corticosteroid therapy, 0.4 mg dexamethazone is administered bid on the first preoperative day and 0.2 mg bid on the second postoperative day. Corticosteroid therapy is discontinued as of the third postoperative day. Aggressive therapy is necessary when urinary incontinence is present. Total evacuation of. the bladder either by catheterization or manual expression is performed as often as necessary, usually two to three times daily. The development of urinary tract infections and a delay in the return of urinary function are enhanced by allowing the bladder to become greatly distended. Prophylactic or therapeutic antibiotic therapy is indicated in the incontinent patient. (2,28,43,54) Serial urinalyses are performed to monitor the patient's progress. Once the patient regains full control of urinary function, hospitalization is usually not required. Additional physical therapy can be performed at home. Physical therapy is begun on the third postoperative day. (54) The objective of physical therapy in the recumbent animal is to promote return of function by strengthening the limb muscles and encouraging their use. Supervised exercises on grass or non-stick indoor surfaces are conducted twice daily and may include standing with support, massage of the limbs, extension and fixation of the limbs, and walking while supported by a towel under the abdomen. (28) The use of ultrasound, heat massage, and ambulation carts has also been described. (36) Swimming and whirlpooling are excellent methods of physical therapy. The warm water encourages circulation to the limbs and contributes to removal of any feces or urine present on the skin. (28) These exercises encourage walking movements of the limbs without the added weight required to support the body. (36) Strict supervision of the animal is necessary during hydrotherapy. (28,36) Hydrotherapy sessions are strenuous for the patient and should not extend past the animal's capabilities (usually 10-20 minutes twice daily).(36) Iodinated whirlpool concentrates can be added to the water to promote overall skin care and to combat any contamination of the tub by the patient."