What is Atlanto-Axial instability?

• ~ Uncommon condition that involves the abnormal movement and instability of the first two vertebrae of the neck.
• ~ Usually due to abnormal shape of or trauma to these vertebrae
• ~ It is usually life-threatening condition as abnormal movement in this region can cause compression of the brain stem, which controls vital functions in the body.
• ~ Commonly seen in small breed dogs

Causes:

• ~ Trauma
• ~ Acquired

Signs and symptoms?

• ~ Vary in severity
• ~ Gradual or sudden onset
• ~ Neck pain
• ~ Reluctance to turn neck
• ~ Ataxia
• ~ Paresis/paralysis
• ~ Paralysis of diaphragm
• ~ Abnormally low head carriage

Treatment options:

Goals of physiotherapy?

1. Decrease pain levels
2. Decrease compensatory muscle pain and tightness
3. Maintain spinal ROM – only active range of motion – NB not to force any movement
4. Address neurological signs
5. Prevent muscle atrophy and increase muscle mass
6. Provide a structured exercise plan
7. Provide advice regarding home modification (no tug of war games), diet changes and weight management

What are Tumours?

• ~ Cancer that affects the brain and/or spinal tissue
• ~ Brain tumours are normally the result of age and time, due to the division of cells
• ~ Boxers and Golden Retrievers are genetically predisposed
• ~ Lifestyle and diet also has an effect on tumours

Signs and Symptoms:

• ~ Depends on the location and severity
• ~ Seizures
• ~ Behavioural changes
• ~ Frequent disorientation
• ~ Uncoordinated/ wobbly gait
• ~ Weakness
• ~ Blindness

Treatment Options:

1. Veterinary treatment
   • ~ Surgery
   • ~ Chemotherapy
   • ~ Radiation
2. Supportive care
3. Physiotherapy

Goals of Physiotherapy:

1. Decrease pain levels
2. Decrease compensatory muscle pain and tightness
3. Maintain ROM
4. Increase and/or maintain function
5. Address neurological signs and loss of function
6. Prevent muscle atrophy and increase muscle mass
7. Provide a structured exercise plan
8. Provide advice regarding home modification, diet changes and weight management

Cx Intervertebral Disc Disease (IVDD):

What is IVDD?

• ~ The intervertebral discs are fibrocartilage disc or cushions found in between the vertebrae of the spinal column.
• ~ It is responsible for protection the spinal column and shock absorption
• ~ Abnormal forces and conditions can cause the intervertebral discs to swell and rupture over time.
• ~ This causes compression and compromise of the spinal cord.
• ~ Cx (neck) IVDD is most commonly seen in non-chondrodystrophic breeds (Labradors and GSD) between the ages of 5-12 years

Types:

1. Type 1 – acute massive, extrusion of degenerate nuclear material into spinal canal (T12-T13)
2. Type 2 – slow, chronic protrusion of degenerate disc material into spinal canal (L1-L2)

Causes:

• ~ Trauma
• ~ Genetics

Signs and symptoms?

• ~ Varying in degree depending on the amount of compression
  1. Ranges from mild loss of coordination to hind limb paralysis and severe pain
• ~ Ataxia and loss of hind limb function
• ~ Loss of hind limb function
• ~ Loss of bladder and bowl control
• ~ Loss of pain perception
• ~ Stands with roach due to pain
• ~ Changes in behaviour and decrease in activity level

Treatment options:

• Depends on the severity of the compression and the clinical signs

Goals of physiotherapy?

1. Strict confinement
2. Prevention of bed sores
3. Decrease pain levels
4. Decrease compensatory muscle pain and tightness
5. Maintain spinal ROM – only active range of motion
6. Address neurological signs
7. Prevent muscle atrophy and increase muscle mass
8. Provide a structured exercise plan
9. Provide advice regarding home modification, diet changes and weight management

What is chiari-like malformation?

• ~ Due to a mismatch between the brain and the skull (brain is too big for the skull)
• ~ This causes compression and herniation of the brain and the brainstem as well as obstruction to and build-up of cerebrospinal fluid.
• ~ Often seen in young dogs
• ~ Commonly seen in Cavalier King Charles Spaniels
• ~ It is a very painful condition and pain management is very important

Causes:

• Unknown

Signs and symptoms:

• ~ Neck pain
• ~ Ataxia and weakness
• ~ Fascial pain
• ~ Varying degrees of neurological signs

Treatment options:

• Depends on severity

Goals of physiotherapy:

1. Decrease pain levels
2. Decrease compensatory muscle pain and tightness
3. Maintain ROM and function
4. Slow down progression of disease
5. Address hind limb weakness if present
6. Prevent muscle atrophy and increase muscle mass
7. Provide a structured exercise plan
8. Provide advice regarding home modification, diet changes and weight management

What is DM?

• ~ Nerves are surrounded by a fatty layer called myelin.
• ~ DM is a non-inflammatory degeneration of the nerves in the white matter of the spinal cord – demyelination of the nerves
• ~ This prevents the impulses from the brain to reach the hind limbs
• ~ It is a progressive disease that affects the hind limbs first and then progresses to other areas.
• ~ There is no known cure.
• ~ GSD, Corgi’s and Border Collies are most commonly affected.

Causes:

• ~ Unknown
• ~ Hereditary
• ~ Immune mediated

Signs and symptoms:

• Progressive disease that cannot be cured or reversed

Treatment options:

• ~ There is no cure
• ~ Treatment is supportive and depends on the symptoms
• ~ Physiotherapy is indicated to help treat the compensatory problems and minimize the progression of the disease
• ~ In the case of degenerative conditions owner compliance and home exercises are very important to help maintain the patients along with regular physiotherapy sessions

Quality of life questionnaire

With degenerative conditions it is very important that we track the patient’s quality of life as well as functional monitoring.

1. Canine brief pain index
2. Glasgow composite pain scale
3. Helsinki chronic pain index

Goals of physiotherapy:

1. Decrease pain levels
2. Decrease compensatory muscle pain and tightness
3. Maintain ROM and function
4. Slow down progression of disease
5. Address hind limb weakness if present
6. Prevent muscle atrophy and increase muscle mass
7. Provide a structured exercise plan
8. Provide advice regarding home modification, diet changes and weight management

What is discospondylitis?

• ~ Infection of the disc space (space in between the vertebrae of the spinal column)
• ~ Infection usually starts in the blood and travels to the disc spaces
• ~ It affects the intervertebral disc and vertebrae

Signs and symptoms?

• ~ Neurological signs are related to spinal cord compression
• ~ Fever
• ~ Lethargic/ Tired
• ~ Sick
• ~ Extremely sore

Treatment:

• ~ Treatment of the infection – antibiotics
• ~ Supportive care in hospital
• ~ Physiotherapy during recovery

Goals of physiotherapy in the treatment of spondylosis:

1. Decrease pain levels
2. Decrease compensatory muscle pain and tightness
3. Maintain ROM
4. Address neurological signs
5. Prevent muscle atrophy and increase muscle mass
6. Provide a structured exercise plan
7. Provide advice regarding home modification, diet changes and weight management

Diffuse Idiopathic Skeletal Hyperostosis (DISH)

What is DISH?

• ~ Systemic disease that involves the ossification of the soft tissue running along the vertebral column.
• ~ It usually starts in the lower back and progresses to the neck.
• ~ Common in Dobermans

Causes:

• Unknown

Signs and symptoms:

• ~ Decreased activity level
• ~ Difficulty rising/ jumping onto things
• ~ Extreme stiffness in back
• ~ Painful in back
• ~ Sometimes they can even be lame
• ~ It can sometimes cause impingement of the spinal cord or nerves – leading weakness and instability in the hind limbs
• ~ In some cases they can lose bladder and bowl control

Treatment options:

• There is no cure – treatment focus is on treating the symptoms

Goals of physiotherapy in the treatment of DISH:

1. Decrease pain levels
2. Decrease compensatory muscle pain and tightness
3. Maintain spinal ROM
4. Address hind limb weakness if present
5. Prevent muscle atrophy and increase muscle mass
6. Provide a structured exercise plan
7. Provide advice regarding home modification, diet changes and weight management

What is facet joint osteoarthritis?

• ~ Facet joints are the joints in between the vertebrae in the spine.
• ~ Due to wear and tear on these joints – cartilage damage occurs and eventually osteoarthritis forms.
• ~ Can sometimes in severe cases cause compression and irritation of nerves

Causes:

• ~ Trauma
• ~ Wear and tear
• ~ Secondary to other pathologies
• ~ More common in sporting or very active dogs

Signs and symptoms:

• ~ Stiffness of the area of the spine that is affected
• ~ Compensatory muscle pain and tightness

Treatment options:

Goals of physiotherapy?

1. Decrease pain levels
2. Decrease compensatory muscle pain and tightness
3. Maintain spinal ROM
4. Address hind limb weakness if present
5. Prevent muscle atrophy and increase muscle mass
6. Provide a structured exercise plan
7. Provide advice regarding home modification, diet changes and weight management

What is an FCE?

• ~ An embolus is a blockage-causing piece of material – it can be a blood clot or a fragment of fibrocartilage originating from the intervertebral discs.
• ~ In the case of an FCE a blood clot becomes lodged in a spinal vessel blocking the blood supply to the spinal cord – like a spinal cord “stroke”
• ~ The cause of this condition is unknown
• ~ It is usually associated with a traumatic event
• ~ Causes a loss of hind limb function – usually temporary
• ~ Boxers and Schnauzers are commonly affected

Signs and symptoms:

• ~ Common history of acute onset with physical activity
• ~ Usually seen with a traumatic event
• ~ Acute onset
• ~ Non-progressive, non-painful neurological deficits
• ~ Loss of limb function – hind limbs are commonly affected, but sometimes all 4 limbs can be affected
• ~ Loss of bladder and bowl control
• ~ No pain post incident

Treatment options:

• ~ Management usually includes physiotherapy, pain management and confinement
• ~ A very aggressive physiotherapy and pain management regime is indicated immediately post incident to encourage a better prognosis and full recovery.

Goals of physiotherapy in treatment of FCE:

1. Decrease pain levels
2. Decrease compensatory muscle pain and tightness
3. Maintain ROM
4. Address neurological signs and loss of function
5. Prevent muscle atrophy and increase muscle mass
6. Provide a structured exercise plan
7. Provide advice regarding home modification, diet changes and weight management

Geriatric Onset Laryngeal Paralysis Polyneuropathy

What causes GOLPP?

• ~ GOLPP is a common clinical condition affecting geriatric, large-breed dogs in which the laryngeal innervation degenerates over time. 
• ~ Laryngeal paralysis is a disease of the nerves (poly-neuropathy) that can sometimes affect other body parts besides the larynx (voice box). 
• ~ What causes Laryngeal Paralysis? Most of the time, we don't know. This is called “idiopathic” Lar Par. Lar Par occurs because the nerves that control the muscles which act on the cartilage of the larynx are diseased.

Signs and symptoms:

• ~ Affected dogs exhibit respiratory stridor, exercise intolerance, dyspnea, throat clearing, and may even collapse.
• ~ Early signs of Lar Par include increased panting (even when the dog is cool and calm) which may sound harsh or just louder than it used to be.
• ~ Another sign could be a change in the sound of their bark (quieter or hoarser).

Treatment options:

1. Veterinary treatment
   • → Mild cases of laryngeal paralysis can often be controlled with medications such as anti-inflammatory drugs, antibiotics, and sedatives. 
   • → Surgery
     • ◊ More severely affected dogsmight benefit from a surgical procedure called arytenoid cartilage lateralization (commonly known as tie back surgery). 
2. Supportive care
3. Physiotherapy

Goals of physiotherapy:

1. Decrease pain levels
2. Decrease compensatory muscle pain and tightness
3. Maintain ROM
4. Increase and/or maintain function
5. Address neurological signs and loss of function
6. Prevent muscle atrophy and increase muscle mass
7. Provide a structured exercise plan
8. Provide advice regarding home modification, diet changes and weight management

What is idiopathic polyradiculoneuritis?

• ~ Is an ascending paralysis due to inflammation of the nerves
• ~ Usually acute onset
• ~ Affects all 4 limbs
• ~ Also known Coonhound paralysis

Causes:

• ~ Unknown
• ~ Possibly due to viral or bacterial infection
• ~ Possibly immune mediated

Signs and symptoms:

• ~ Progressive paralysis and weakness usually over 1-21 days
• ~ Systemically ill/ lethargic/ decreased activity level
• ~ Painful/sore
• ~ Oversensitivity to pain stimuli
• ~ Low muscle tone
• ~ Weakened vocal ability
• ~ Muscle atrophy
• ~ Labored breathing
• ~ Weakened vocal ability

Treatment options:

• ~ Supportive care
• ~ Physiotherapy
  • ~ See flow chart of what physiotherapy may include
• ~ Most patients make a full recovery within 3-4 months

Goals of physiotherapy:

1. Decrease pain levels
2. Decrease compensatory muscle pain and tightness
3. Maintain ROM and function
4. Address hind limb weakness if present
5. Prevent muscle atrophy and increase muscle mass
6. Provide a structured exercise plan
7. Provide advice regarding home modification, diet changes and weight management

TxLx Intervertebral Disc Disease (IVDD)

What is IVDD?

• ~ The intervertebral discs are fibrocartilage disc or cushions found in between the vertebrae of the spinal column.
• ~ It is responsible for protection the spinal column and shock absorption
• ~ Abnormal forces and conditions can cause the intervertebral discs to swell and rupture over time.
• ~ This causes compression and compromise of the spinal cord.
• ~ TxLx IVDD is most commonly seen in chondrodystrophic breeds (Dachshunds, Pekingese) between the ages of 3-6 years

Types:

1. Type 1 – acute massive, extrusion of degenerate nuclear material into spinal canal (T12-T13)
2. Type 2 – slow, chronic protrusion of degenerate disc material into spinal canal (L1-L2)
3. Type 3 – A very acute disc explosion without any disc degeneration. Associated with a traumatic event.

Causes:

• ~ Trauma
• ~ Genetics

Signs and symptoms:

• ~ Varying in degree depending on the amount of compression
  • ~ Ranges from mild loss of coordination to hind limb paralysis and severe pain
• ~ Ataxia and loss of hind limb function
• ~ Loss of hind limb function
• ~ Loss of bladder and bowl control
• ~ Loss of pain perception
• ~ Stands with roach due to pain
• ~ Changes in behaviour and decrease in activity level

Treatment options:

• Depends on the severity of the compression and the clinical signs

 Goals of physiotherapy?

1. Strict confinement
2. Prevention of bed sores
3. Decrease pain levels
4. Decrease compensatory muscle pain and tightness
5. Maintain spinal ROM – only active range of motion
6. Address neurological signs
7. Prevent muscle atrophy and increase muscle mass
8. Provide a structured exercise plan
9. Provide advice regarding home modification, diet changes and weight management

Cauda Equina Syndrome and Lumbosacral Disease

What is cauda equine syndrome and lumbosacral disease?

• ~ These two terms are often used interchangeably
• ~ At the end of the spinal cord the cord tapers of – this region is called the cauda equina.
• ~ The lumbosacral junction is the junction between the last lumbar vertebra and the sacrum.
• ~ Cauda equina syndrome is the compression, inflammation or vascular compromise of nerve roots of cauda equine
• ~ Lumbosacral disease involves degeneration of the lumbosacral junction and/or compression of the associated nerves.
• ~ There are various conditions that can cause this – there include:
  • ~ Spinal cord stenosis (narrowing)
  • ~ Vertebral fractures
  • ~ Discospondylitis (infection of disc spaces)
  • ~ Intervertebral disc disease
• ~ Often affects larger breed dogs

Causes:

• ~ Traumatic or acquired
• ~ Genetic or congenital

Signs and symptoms:

• ~ Exercise induced lameness – exercise has a detrimental effect on inflammatory conditions
• ~ Intermittent lameness as it is a dynamic condition
• ~ Sphincter dysfunction
• ~ Self-inflicted skin lesions of the tail/perineum and extremities
• ~ Back usually maintained in flexion
• ~ Scuffing
• ~ Reluctance to jump
• ~ Exercise intolerance
• ~ Abnormal tail carriage
• ~ Pelvic limb muscle atrophy

Treatment options:

• Depends on the severity

Goals of physiotherapy:

1. Strict confinement
2. Prevention of bed sores
3. Decrease pain levels
4. Decrease compensatory muscle pain and tightness
5. Maintain spinal ROM – only active range of motion
6. Address neurological signs
7. Prevent muscle atrophy and increase muscle mass
8. Provide a structured exercise plan
9. Provide advice regarding home modification, diet changes and weight management

What is micro-thrombosis?

• ~ An embolus is a blockage-causing piece of material – for example a blood clot
• ~ The micro-thrombi becomes lodged in vessel blocking the blood supply to an area
• ~ Causes varying degrees of clinical signs depending on the area that is affected

Signs and symptoms?

• ~ Depends on the location and severity
• ~ Loss of function
• ~ Paralysis and weakness
• ~ Atrophy
• ~ Seizures
• ~ Behavioural changes
• ~ Frequent disorientation
• ~ Uncoordinated/ wobbly gait
• ~ Weakness

Treatment options:

• Management usually includes physiotherapy, pain management, confinement and management of complications.

Goals of physiotherapy?

1. Decrease pain levels
2. Maintain and increase function
3. Decrease compensatory muscle pain and tightness
4. Maintain ROM
5. Address neurological signs and loss of function
6. Prevent muscle atrophy and increase muscle mass
7. Provide a structured exercise plan
8. Provide advice regarding home modification, diet changes and weight management

What is Peripheral Neuropathy?

• ~ Peripheral nerves connects the central nervous system (brain and spinal cord) to the muscles of the limbs.
• ~ The brachial plexus gives origin to the peripheral nerves that supply the front limbs
• ~ The lumbosacral plexus gives origin to the peripheral nerves that supply the hind limbs
• ~ Damage to the nerves are often caused by trauma
  • ~ Compression injury
  • ~ Laceration
  • ~ Traction injury
• ~ Damage often varies in degree, leading to varying degree of clinical signs and can lead to temporary or permanent loss of function.

Signs and symptoms:

• ~ Depends on the degree of damage and which nerve is affected
• ~ Loss of function
• ~ Pins and needles – often leading to self-mutilation
• ~ Atrophy of affected muscles
• ~ Common peripheral nerve injuries

Treatment options:

• ~ Veterinary care
  • ~ Treat adjacent injuries
  • ~ Pain management
  • ~ Prevent self-mutilation
• ~ Physiotherapy – to support nerve regeneration and prevent loss of function
  • ~ See flow chart of what physiotherapy may include

Goals of physiotherapy?

1. Decrease pain levels
2. Increase nerve regeneration
3. Decrease compensatory muscle pain and tightness
4. Maintain ROM and function
5. Address hind limb weakness if present
6. Prevent muscle atrophy and increase muscle mass
7. Provide a structured exercise plan
8. Provide advice regarding home modification, diet changes and weight management

What is spinal arachnoid diverticulum?

• ~ A spinal subarachnoid cyst is not actually a cyst; instead it is a fluid-filled dilation within the subarachnoid space.
• ~ Arachnoid cysts are non-neoplastic, intracranial cerebrospinal fluid (CSF)-filled spaces lined with arachnoid membranes.
• ~ While not usually life-threatening, most arachnoid cysts are benign (noncancerous) and can be treated or managed.

Signs and symptoms:

• ~ Large arachnoid cystsare often symptomatic because they compress surrounding structures; therefore, they must be treated surgically.
• ~ When these cystspress against brain tissue, they can cause serious complications such as blocking of the critical flow of CSF.
• ~ The most common symptoms associated with arachnoid cystsare usually nonspecific and include headaches, nausea, vomiting, dizziness and the accumulation of excessive cerebrospinal fluid in the brain (hydrocephalus), resulting in increased intracranial pressure

Treatment options:

• ~ Veterinary treatment
  • ~ Surgery
    • ~ Surgically treated dogsunderwent either a durotomy, a durectomy, or a marsupialization to drain the accumulated fluid from the subarachnoid All surgical procedures were performed under general anesthesia and dogs received perioperative pain management.
  • ~ Supportive care
  • ~ Physiotherapy

Goals of physiotherapy?

1. Decrease pain levels
2. Decrease compensatory muscle pain and tightness
3. Maintain ROM
4. Increase and/or maintain function
5. Address neurological signs and loss of function
6. Prevent muscle atrophy and increase muscle mass
7. Provide a structured exercise plan
8. Provide advice regarding home modification, diet changes and weight management

What is Spondylosis?

1. Degenerative, non-inflammatory condition of the spine that involves the formation of bone in between vertebrae
2. On radiographs is it often seen as body protrusions on the vertebrae, sometimes forming complete bridges between them.
3. In a normal spine, ligaments, tendons and the intervertebral discs provide support for the back and spinal cord.
4. When there is instability or weakness in the spine the body produces bony spurs in attempt to provide stability for weak vertebral joints or any soft tissues attaching to the spine.

Causes:

• ~ Trauma
• ~ Microtrauma
• ~ Wear and tear

Signs and symptoms?

• ~ Decreased activity level
• ~ Difficulty rising/ jumping onto things
• ~ Stiffness in back
• ~ Painful in back
• ~ Sometimes they can even be lame
• ~ It can sometimes cause impingement of the spinal cord or nerves – leading weakness and instability in the hind limbs

Treatment Options:

Goals of physiotherapy in the treatment of spondylosis?

1. Decrease pain levels
2. Decrease compensatory muscle pain and tightness
3. Maintain spinal ROM
4. Address hind limb weakness if present
5. Prevent muscle atrophy and increase muscle mass
6. Provide a structured exercise plan
7. Provide advice regarding home modification, diet changes and weight management

What is vestibular disease?

• ~ A sudden non-progressive loss of balance
• ~ Due to damage of the vestibular apparatus

Causes:

• ~ Middle or inner ear infections,
• ~ Drugs that are toxic to the ear
• ~ Trauma or injury
• ~ Tumours

Signs and symptoms?

• ~ Sudden onset of loss of balance
• ~ Disorientation
• ~ Head tilt
• ~ Nystagmus - Irregular jerking eye movements (up and down and side to side)
• ~ Reluctance to stand or walk
• ~ Tendency to lean or fall in the direction of their head tilt.

Treatment options:

• ~ Treat underlying cause
• ~ Physiotherapy

Goals of physiotherapy in treatment?

1. Decrease compensatory muscle pain and tightness
2. Maintain ROM
3. Increase and/or maintain function
4. Address neurological signs and loss of function
5. Prevent muscle atrophy and increase muscle mass
6. Provide a structured exercise plan
7. Provide advice regarding home modification, diet changes and weight management

Caudal Cervical Vertebral Malformation / Cervical Spondylomeylopathy (Wobbler’s Syndrome)

What is Wobbler’s Syndrome?

• ~ Wobbler’s syndrome is compression of the spinal cord in the neck.
• ~ Usually due to abnormal movement caused by abnormally shaped vertebrae, vertebral column stenosis (narrowing) and/or damage/degeneration of the intervertebral discs.
• ~ Usually seen in large/giant breed dogs around 1 year of age
• ~ Great Danes and Dobermans are commonly affected

Causes:

• ~ Nutritional (excess Ca, protein, energy)
• ~ Fast growth rate
• ~ Vertebral malformation
• ~ IVDD
• ~ Hereditary/Genetics
• ~ Traumatic/Acquired

Signs and symptoms?

• ~ Neck pain/stiffness
• ~ Weakness
• ~ Uncoordinated gait – hind limbs are often affected worse
• ~ Hind limb weakness
• ~ Stiff, short, choppy gait with straight legs
• ~ Atrophy of the neck and shoulder region
• ~ Possible paralysis
• ~ Worn or scuffed nails
• ~ Neurological signs are usually progressive
• ~ Difficulty rising from lying

Treatment options:

• Depends on the severity of the lesion and clinical signs

Goals of physiotherapy?

1. Activity restrictions are very important
2. Decrease pain levels
3. Decrease compensatory muscle pain and tightness
4. Maintain spinal ROM – only active range of motion – NB not to force any movement
5. Address neurological signs
6. Strengthen
7. Gait re-education and proprioception
8. Prevent muscle atrophy and increase muscle mass
9. Provide a structured exercise plan
10. Provide advice regarding home modification (no tug of war games or rope toys), diet changes and weight management