Guest guest Posted February 8, 2011 Report Share Posted February 8, 2011 Hi Rick. Ouch! First, if you've not already, get Lexi out of the wheelchair! It certainly is putting quite a bit of stress on her pectoral girdle and cervico-thoracic spine. Can you do some land-based therapy with her? Get her in standing/weight bearing. It will do wonders for her. What are her pelvic limb reflexes like? Is she continent? Tail wagging/working at all? If Lexi must get into a wheelchair again, this chair needs significant modification. The vertical upright from the wheel isn't vertical and the wheel needs to be more cranial-- aligned with her pelvis/greater trochanter. Some might recommend a quad cart for a dog with pectoral limb issues. It's a thought. I'm not going to tell you what company to order a cart through, but, in my opinion, she needs more sufficient support both at her pelvis and with the chest straps. All of the weight of the cart is on her thoracic spine, caudal to her scapulae. The horizontal bar should be positioned more cranially as well. This position creates a long lever arm with a significant torque on her spine. Oy! THIS should be posted for ANYONE considering a cart long term for their pet! We need to be proactive and not discharge these patients from therapy but continue to re-evaluate them and tune THEM (and their wheelchairs) up! Sorry for ranting. I'm at a GLORIOUS pre-conference course on motor control of the trunk. Lexi would be a fantastic therapy candidate! Amie Amie Lamoreaux Hesbach, MSPT, CCRP, CCRT Physical Therapist Massachusetts Veterinary Referral Hospital 20 Cabot Road Woburn, MA 01801 Phone: Fax: E-mail: ahesbach@... Website: www.IVGMassVet.com > Group, > > I am just starting to work with this very interesting patient for a thoracic limb issue, however, Lexi has been in a wheelchair for the past 3 years following an acute onset, undiagnosed SCI. I have no experience in working with wheelchair patients, especially one that has spent the last 3 years in one. Any thoughts or suggestions might be helpful. I have attached a link to a password protected video on Vimeo. A case description is with Video. With all the DJD I would expect her to be more painful than her examination reveals however we will be starting aggressive pain management. > > http://vimeo.com/19712661 > > Rick Wall > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 8, 2011 Report Share Posted February 8, 2011 I visited with our neurologists regarding this case, and they suspected this is actually a nice presentation of DISH disease, or Diffuse Idiopathic Skeletal Hyperostosis. This is a very common disease in boxers. We have also seen this in a German shepherd and a cat. This disease can be an incidental finding without neurologic deficits. The opinion of our neuro department is that the carts probably don't worsen or accelerate the disease, but the limited spinal mobility with the disease is more of an issue. J. Sessum, RVTTexas A & M UniversityCollege of Veterinary MedicineSmall Animal Rehabilitation & Surgery Technician Supervisorhttp://vmth.tamu.edu/rehab.shtmlFacebook: Veterinary Sports Medicine and Rehabilitation >>> Amie Hesbach 2/8/2011 4:58 PM >>>Hi Rick.Ouch!First, if you've not already, get Lexi out of the wheelchair! It certainly is putting quite a bit of stress on her pectoral girdle and cervico-thoracic spine. Can you do some land-based therapy with her? Get her in standing/weight bearing. It will do wonders for her. What are her pelvic limb reflexes like? Is she continent? Tail wagging/working at all?If Lexi must get into a wheelchair again, this chair needs significant modification. The vertical upright from the wheel isn't vertical and the wheel needs to be more cranial-- aligned with her pelvis/greater trochanter. Some might recommend a quad cart for a dog with pectoral limb issues. It's a thought. I'm not going to tell you what company to order a cart through, but, in my opinion, she needs more sufficient support both at her pelvis and with the chest straps. All of the weight of the cart is on her thoracic spine, caudal to her scapulae. The horizontal bar should be positioned more cranially as well. This position creates a long lever arm with a significant torque on her spine.Oy!THIS should be posted for ANYONE considering a cart long term for their pet! We need to be proactive and not discharge these patients from therapy but continue to re-evaluate them and tune THEM (and their wheelchairs) up!Sorry for ranting. I'm at a GLORIOUS pre-conference course on motor control of the trunk. Lexi would be a fantastic therapy candidate!AmieAmie Lamoreaux Hesbach, MSPT, CCRP, CCRTPhysical TherapistMassachusetts Veterinary Referral Hospital20 Cabot RoadWoburn, MA 01801Phone: Fax: E-mail: ahesbach@...Website: www.IVGMassVet.comOn Feb 8, 2011, at 3:28 PM, Rick Wall, DVM wrote:> Group,> > I am just starting to work with this very interesting patient for a thoracic limb issue, however, Lexi has been in a wheelchair for the past 3 years following an acute onset, undiagnosed SCI. I have no experience in working with wheelchair patients, especially one that has spent the last 3 years in one. Any thoughts or suggestions might be helpful. I have attached a link to a password protected video on Vimeo. A case description is with Video. With all the DJD I would expect her to be more painful than her examination reveals however we will be starting aggressive pain management.> > http://vimeo.com/19712661> > Rick Wall> > ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2011 Report Share Posted February 9, 2011 , Your input is invaluable! You have access to experts that many of us can only dream of! Thank you so much for your response and efforts to answer questions that we seek. This is the cooperation between disciplines that we all desire! I am very fortunate to be so close to Texas A & M, both from a geographical and ideological perspective! Rick Wall Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2011 Report Share Posted February 9, 2011 I agree with Amie. Lexi needs a refit. Additional considerations for fit: I am concerned by the slope from cranial to caudal trunk (i.e the back is not level) and I am concerned by the saddle/support for the caudal aspect of the body. Even with a more level spine the support for the abdomen and pelvis could be improved for comfort; with the current sloped position any discomfort in the saddle fit is exacerbated by the increase weight carried by the saddle and abdominal straps. Straps are likely (though I can't see them) narrow and this concentrates pressure over relatively small areas (pinchy and digs in... think about repelling in a climbing harness..you don't want to hang there all day!) This looks like a DISH case to me too albeit incomplete. I have seen this in 2 Boxers so far. I agree that neurologically they have been fine and the spine itself does not seem to be painful on palpation; However, I found a lot of myofascial pathology suspected to be associated with the decreased spinal mobility. The lesion at what appears to be T5-6 is suspicious and not related to DISH. It's hard to read clearly on the video, but the dorsal spinous process of T5 appears odd in addition to the bodies of the vertebrae. What does the VD or DV look like? Although the history is protracted and that seems to speak against it, I would still ruleout an aggressive lesion. On the other hand any chance it's a hemivertebrae? Still looking for reasons for pathology and recent changes to the thoracic limb. What does her cervical spine look like clinically and radiographically? (do you have cervical films) Is there any evidence of root signature? What are the reflexes and CP's like on the thoracic limbs. Lastly a big AMEN to Amie's comment about followup and continued reassessment whenever any any medical device is prescribed. Patrice M. Mich DVM, MS, DABVP, DACVA OrthoPets Medical director and owner Specialist in pain medicine and mobility Denver, CO > > > Group, > > > > I am just starting to work with this very interesting patient for a thoracic limb issue, however, Lexi has been in a wheelchair for the past 3 years following an acute onset, undiagnosed SCI. I have no experience in working with wheelchair patients, especially one that has spent the last 3 years in one. Any thoughts or suggestions might be helpful. I have attached a link to a password protected video on Vimeo. A case description is with Video. With all the DJD I would expect her to be more painful than her examination reveals however we will be starting aggressive pain management. > > > > http://vimeo.com/19712661 > > > > Rick Wall > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2011 Report Share Posted February 9, 2011 Amie, thank you so very much for your comments. I don't know who fitted her originally and I just don't have any experience with carts and wheel chairs. Regarding getting her out however, severe OA of hips with limited ROM and both stifle, past CCLD, one had surgery. The ROM of the stifles is less than 20 degrees w/ hard, bone end feel both ways, they are maintained is the same position out of the cart as when in cart. Amazingly enough she has very little pain. We are focusing our efforts on her thoracic limbs and now will discuss refitting cart. Rick Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2011 Report Share Posted August 25, 2011 It looks like the hip extension is so that the dog can go to a lay down position- but that would torque the spine.... Quote Link to comment Share on other sites More sharing options...
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