Veterinarians at the Canine Rehabilitation Institute find that early rehab for pain management, along with at-home exercises, are key to postoperative success.
Dogs with intervertebral disc disease are likely to improve after surgery. This assertion is supported both by research and through my personal experience over years in practice as a veterinary neurologist. Dogs unable to walk often go home walking—or nearly walking—once the compression on the spinal cord is removed. Surgical decompression of the spine is a tremendous source of satisfaction for most neurologists, validating our four to five years of post-veterinary school training.
Early rehabilitation (flexing and stretching of muscles and massage) can significantly improve the quality of recovery for both postsurgical patients and their owners. It can help in pain management, relaxation, core stability and in building and maintaining muscle mass. Rehabilitation is as appropriate for dogs walking within 24 hours after surgery as it is for those that take longer.
I recommend starting a rehabilitation program with a focus on pain management immediately for postoperative neurosurgery patients. This aids in healing and also encourages relaxation—an important part of recovery. This early rehabilitation is most often done in the hospital and can include a number of manual therapies and modalities typically incorporating the following:
1. Gentle massage of the limbs and axial muscles not directly involved with the surgery.
2. Cryotherapy several times a day at the site of the incision.
3. Passive range of motion and gentle joint compressions to help pain management and maintain strength and muscle mass.
4. Therapeutic laser administration at the surgical site to promote healing.
5. Neuromuscular electrical stimulation for pain management around the incision and to help stimulate the nerves and muscles that can be affected in lower motor neuron diseases or when there is significant atrophy from disuse.
Patients are usually ready to return home 48 hours after surgery. I discuss a home exercise plan with the owner and arrange a follow-up visit within one week at the time of discharge. At that point the patient's home exercise plan may be gradually increased.
The majority of the patient's time during the first four weeks at home is spent in a crate. Time out of the crate is dedicated to work on standing, balancing, core work and other controlled exercises consistent with the patient's ability. The home exercise plan could include any of the following: cryotherapy, massage, passive range of motion and stretching, and sit-to-stand exercises.
The owner is encouraged to bring the patient back to the hospital several times a week for several weeks to do additional work. These visits are reassuring to the owner and allow us to work together as a team to encourage and monitor progress. In-hospital therapy varies by patient, but anytime from 48 hours to four weeks after surgery it could include:
1. Underwater treadmill or dry treadmill to enhance the patient's function and overall fitness and to improve gait, range of motion and movement patterning.
2. Physioballs to improve strength and core stability.
3. Cavaletti poles for gait patterning, proprioceptive input and coordination.
4. Massage for relaxation and pain relief (hopefully not needed at this point), increased circulation and proprioceptive awareness
5. Therapeutic laser administration for pain management and incisional healing.
6. Joint compressions for pain management and proprioceptive input.
7. Re-education techniques for neuromuscular facilitation and patterning.
8. Neuromuscular electrical stimulation for muscle strengthening and prevention of disuse atrophy and to improve sensory awareness and decrease spasticity.
As the patient improves and there is a lower risk of complications or setbacks, more vigorous work to build muscle mass and improve core stability can begin. At-home exercises during this time could include an increase in the number of controlled walks, swimming and walking on different surfaces and up hills. In-hospital exercises involve the underwater treadmill and the stability ball. Other core-strengthening exercises that may be added now are stretching, walking exercises using obstacles, and two- and three-leg-standing on different surfaces.
All in all, rehabilitation for the postoperative neurosurgery dog should be a positive experience for everyone involved. The patient, the owner and the rehabilitation veterinarians and technicians should all benefit from the good outcomes that are typically achieved with appropriated postoperative rehabilitation. Ideally, patients will leave the hospital stronger and less likely to have setbacks, and owners will complete the rehabilitation program equipped with a better education about how to keep their dogs in the best physical shape possible.
Dr. Stephanie Kube is a faculty member with the Canine Rehabilitation Institute in Wellington, Fla., and works at VCA South Shore Animal in hospital in South Weymouth, Mass. She is the head of neurology, neurosurgery, rehabilitation and pain management services.