Re: help treating possible congenital condition [2 Attachments]

[Guest guest]

Hi,

A little behind on email so sorry if I am jumping in late with the same suggestions. As far as rehab management, I think you are correct that the contractures at the carpi need to be addressed. What type of braces are you using? For how long?

It looks like there is quite a bit of trunk weakness and I think supported standing would be great, over peanut roll, (or paper towel roll wrapped with towels or similar type object), to address the trunk weakness as well as the need for weight bearing through the extremities. I couldn't completely see from the videos, but what is neck control like? In supported stand, just make sure the dog is able to retract his neck versus hyperextend his neck (if that is the case extra support will need to be given to prevent this compensatory posture).

I worked with a dog yesterday with trunk weakness and all four limbs involved and I was quite impressed with how well the Eddie's wheels quad cart functioned as a stander as well as assisted with ambulation (we took off the neck support as that was not needed). If this owner is going to do a lot of the therapy at home, something like that might be a nice option and easier for one person to perform successfully versus trying to do standing over the peanut roll alone. But again, just comes down to how the supported standing is able to be performed, what yields the best alignment, and what yields the best opportunity for the dog to activate postural muscles in the position we want. It might start out that you need to give more support at first, and then come up with options for less support as the dog is (hopefully!) getting a stronger trunk.

Jeanine

To: vetrehab <vetrehab >; VetRehab Moderator <vetrehab-owner >; Janet Van Dyke Sent: Thursday, December 8, 2011 6:41 PMSubject: help treating possible congenital condition [2 Attachments]

Hello!

I was recently presented with a challenging case. I have an approx. 3 month old mixed breed male puppy that presented with acute onset of severe weakness and severe muscle atrophy on all 4 limbs, worse on the forelimbs, to the point where the dog cannot walk or stand at all. He has good pain sensation and motor function. CP's are present but weak. The dog's carpal joints also became contracted in flexed position. According to the owner the puppy was fine up till around 2 months of age when the clinical signs started to develop. 1 littermate died at a very young age I believe, and his 2 other live litter mates have also developed similar problems according to this owner (they belong to someone else). The dog does not have vaccines, and there is no budget for blood work or any type of testing other than radiographs of the distal forelimbs and hind limbs. These are normal except for what seems to be

disuse osteopenia. He cannot extend his carpus on his own at all in order to stand on his forelimbs. We're suspecting a congenital condition (muscular dystrophy?), but a proper work up cannot be done . he's currently on several nutritional supplements and we treated with clindamycin in case it was infectious (neospora?). The owner however has the time and commitment to do therapies at home to try to help the puppy.

We started doing rehab on him with basically range of motion exercises on all joints, working on increasing carpal extension, electrical stimulation to atrophied muscles (triceps, carpal extensors mainly), swimming at home. Since the dog cannot extend carpus, we placed braces on the forelimbs to see if this helped maintaining the carpus extended and prevent further contracture. we've been trying this for about 3 weeks. I have seen mild improvement in the hind limb muscle strength, girth, etc. (although we still have a ways to go) tries to give steps with support , but I don't see any improvement in the forelimbs.

Do you have any other suggestions for me as far as rehab things we can do to help this puppy? I'm not sure where to go from here. If he doesn't improve, what options do we have?

I have attached two videos of him.

Thanks!

Alma Alicea-Garcés, DVM, CCRT

San , Puerto Rico