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Ellie Mae, an eight-year-old female spayed border collie presented to a veterinary emergency centre after it was suspected she was hit by a car. She was found on the road unable to walk with signs of head trauma. On presentation, she was non-ambulatory and tetraparetic, with weak spinal reflexes—including withdrawal reflexes, and voluntary motor function (VMF) in all limbs.
She was transferred to the in-house surgical speciality the following morning, where computed tomography with myelography was performed from the skull to the level of T3. Imaging identified a fracture of the ventral caudal process of C4 and collapse of C5-C6 intervertebral space, with large ventral and right-sided extradural spinal cord compression. Surgery followed immediately, with a ventral slot and spinal stabilisation performed.
Ellie Mae remained hospitalised following surgery. Gabapentin 300mg PO TID, Prazosin 1mg PO BID, and Meloxicam 26kg dose PO SID were prescribed. After 12 days, she was transferred to Veterinary Rehabilitation Services at Roleystone Animal Hospital. At this time, Ellie Mae was still non-ambulatory tetraparetic. She had weak, non-weight bearing VMF in all limbs and was unable to transition from lateral to sternal position.
Her panniculus reflex was intact to L5 bilaterally. Patellar, sciatic and withdrawal reflexes were normal bilaterally. There was moderate pain on palpation of her spine from T1 to T8 and epaxial muscle tone was flaccid. Fascia was very tight and painful over the cranial half of her thorax. Cervical spine epaxial muscles were watery and slightly painful to touch. There was evidence of osteoarthritis with mild effusion of the hocks, stifles and carpi, mild pain as end-feel for right hock, stifle and both hips, as well as moderate pain and reduced flexion and extension in the shoulders.
There was mild pain on left semimembranosus stretching, moderate pain on grade 1 palpation of the right iliopsoas, and mild pain on palpation of the right quadriceps muscles. It was not possible to assess the flexibility of the right forelimb muscles because these muscles were very painful to touch, whereas those of the left forelimb were assessed and comfortable.
Ellie Mae was fitted to a Help ‘Em Up Harness (HEUH) to aid lifting and 4cyte Epiitalis Forte gel was prescribed to promote joint health. Laser therapy was recommended, initially three times per week, to stimulate nerve regeneration by increasing blood flow to affected tissues, as well as to provide analgesia for joint and muscle pain1, followed by soft tissue mobilisation (massage).
The initial home exercise program focused on reducing pain with gentle massage of her painful muscles, followed by a passive range of motion (PROM) exercises for her hips and shoulders. Skin rolling was recommended to release tight fascia, building a predictable toileting routine to minimise accidents. Neurodevelopmental sequencing (NDS)—the predictable order of movement that enables the body to go from lateral to sternal, to sit, to stand then walk—was also implemented.
For initial NDS, toe pinching of all four limbs was used to induce withdrawal reflexes and active range of motion (AROM), followed by lured transitions from lateral into sternal recumbency. When transitioning from left (but not right) lateral-to-sternal recumbency, she required assistance lifting her head for the first half of the movement, but then was able to complete the transition and maintain sternal recumbency. Ellie Mae was allowed to rest in sternal recumbency for 10 seconds before being lured to the opposite side, resulting in a change to right lateral recumbency.
Her owners were advised to spend 10 to 15 minutes 3-4 times a day, for 3-5 days a week doing these home exercises sessions, on top of regular 2-3-minute toilet walks.
Ellie Mae was re-admitted for day hospitalisation three times per week to allow multiple short rehabilitation sessions to be performed on each of these days. By the second visit, she was able to ‘give paw’ in lateral recumbency with her left fore (the stronger side), and was also keen to play rolling a ball back and forth using her head and neck, which activated muscles to keep her in a sustained sternal position.
One week later, it was possible to add NDS sternal to sit by luring her head and neck upwards, tapping her chest to provide sensory feedback, and supporting her cranial body weight with the HEUH. She was able to shuffle her left forelimb upwards into position, but the right fore required placement to prevent knuckling. Once in a sit position, gentle compression was applied at the elbow joints in a distal direction to increase proprioceptive feedback to the central nervous system through the muscles, joints and tendons. She struggled with a ‘drop’ from sit position as she was unable to flex her left elbow, and her right fore would knuckle.
Therefore during this week, ‘paw’ in sit was added to the left forelimb to encourage elbow flexion and weight bearing on the right fore. NDS-assisted sit-to-stand was also added with Ellie Mae being able to weight bear on all limbs, though the right forelimb would collapse intermittently at the carpus.
Two weeks from the initial assessment she started to gain movement in the right forelimb, and was able to shuffle it upwards into a sit, give paw in lateral, and knuckling of the limb during assisted walking was reduced. She was encouraged to dig for a ball covered by a blanket while in left lateral to increase right forelimb use.
By five weeks, Ellie Mae was able to sit unassisted, give paw bilaterally in a sit, and she took a few steps unassisted on the lawn. Her exercise program was adjusted to add stability and proprioceptive exercises such as side bends, figure eights, standing on a mattress and walking over cavaletti poles.
As her strength and ability improved over the following month, her visits were reduced to twice a week rather than day stays. Post-operative radiographs were performed by her surgical team which showed complete fracture healing. Her therapeutic program continued to challenge her by adding height and unstable surfaces to her exercises. By the end of the month, Ellie Mae was trotting unassisted and needed her outdoor time to be restricted to avoid injuring herself from overuse.
Three months from her initial visit, her meloxicam dose was reduced by half. Her comfort and ROM was maintained at this dose, so two weeks later her gabapentin dose was reduced to once daily for one week then stopped.
At her final recheck, five months after starting rehabilitation, Ellie Mae had been off all medication for two months, was comfortable, had normal ROM in her hips and shoulders, was above average in strength and back to all activities of daily living including ball chasing off leash.
Reference:
1. Dycus, D. Laser Therapy in Companion Animals – What it is, How it works & When it benefits patients. Today’s Veterinary Practice May/June 2014.
Kara Airey
Registered veterinary nurse (Cert IV RVN, HCert Bus., CCRVN, Fear Free certified)
Veterinary Rehabilitation Services
Kara Airey graduated as a registered veterinary nurse in 2007, and spent 15 years of her career as a specialist surgical veterinary nurse both in Perth and in Dublin, Ireland. In these roles, Kara’s passion for caring for patients during their post-operative recovery led her to veterinary rehabilitation.
Kara returned to Perth in 2022 where she began working at Veterinary Rehabilitation Services and in 2024, she became the second certified canine rehabilitation veterinary nurse in Australia.
Kara’s special interests are post-surgical and neurological rehabilitation. She is a self-proclaimed ‘cat lady’ with two cats who travelled to Ireland and back with her. They fit well into her lifestyle as they make great study supervisors.
