An Overview of Rehabilitation Strategies for Acute Spinal Injuries
Overview of Rehabilitation Strategies for Acute Spinal Injuries
Acute spinal injuries are a frequent and often devastating occurrence in veterinary medicine, with causes ranging from intervertebral disc herniation to traumatic injuries and fibrocartilaginous embolism. These injuries can result in primary effects, such as neuronal destruction, hemorrhage, and ischemia, as well as secondary effects, including microvascular destruction, cytotoxicity, inflammation, and necrosis. The complex nature of spinal injuries necessitates a multifaceted approach to treatment and rehabilitation, with physiotherapy playing a central role in promoting recovery and improving outcomes for affected animals.
Primary and Secondary Effects of Spinal Injuries
Primary effects of spinal injuries are the direct consequences of trauma to the tissue, leading to immediate damage. Secondary effects, on the other hand, are a cascade of events that occur as a result of the primary injury. These events include microvascular destruction, cytotoxicity, free radical release, inflammation, and necrosis. Understanding these effects is crucial in developing targeted rehabilitation strategies to address the underlying pathophysiology of spinal injuries
Objectives of Physiotherapy in Acute Spinal Injuries
Physiotherapy aims to achieve several key objectives in the management of acute spinal injuries, including:
Reduction of edema, inflammation, and pain
Physiotherapy modalities such as cryotherapy, massage, and transcutaneous electrical nerve stimulation (TENS) can help reduce edema, inflammation, and pain in the affected area.
Prevention or reduction of muscle atrophy and contracture
Through a combination of passive and active exercises, physiotherapy can help maintain muscle tone and prevent muscle atrophy and contractures.
Recovery of nerve function:
Physiotherapy can facilitate neuroplasticity, the brain's ability to reorganize and form new neural connections, to promote recovery of nerve function.
Neuroplasticity and Rehabilitation
Neuroplasticity plays a crucial role in the rehabilitation of acute spinal injuries. It is the brain's ability to reorganize and form new neural connections in response to injury or disease. Specific neurotrophins, such as brain-derived neurotrophic factor (BDNF) and neurotrophin 3 (NT-3), are endogenous promoters of neuroplasticity that stimulate cell survival and facilitate axonal growth. These neurotrophins are inhibited in spinal lesions, highlighting the importance of targeted rehabilitation strategies to promote neuroplasticity and recovery of nerve function.
Intervertebral Disc Herniation: Types and Rehabilitation
Intervertebral disc herniation is a common spinal condition that can lead to pain, ataxia, paralysis, and other neurological deficits. There are two main types of disc herniation: Hansen type 1, which involves extrusion of the nucleus pulposus, and Hansen type 2, which involves protrusion of the annulus fibrosus. Rehabilitation strategies for intervertebral disc herniation vary based on the type of herniation and may include conservative or surgical approaches.
Cervical Disc Herniation
Cervical disc herniation represents about 25% of clinical cases of disc herniation and may present with cervical pain and muscle fasciculations without neurological deficits. The decision between conservative or surgical treatment depends on the severity of neurological deficits. Studies have shown that a conservative approach can be effective in dogs with mild neurological deficits, with the use of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and restricted activity. Surgical decompression is recommended in patients with severe neurological deficits or recurrent episodes of neck pain.
A retrospective study by Levine et al. in 2007 assessed the effectiveness of conservative therapy in dogs with suspected cervical disc herniation. The study found that 54.7% of dogs had complete recovery, 30.9% showed recurrence of clinical signs, and 14.4% had no positive effect from therapy. The administration of NSAIDs appeared to be associated with greater success and a better quality of life, while corticosteroids and the duration of restricted activity did not significantly affect the prognosis.
In cases where surgical decompression is necessary, post-operative physiotherapy plays a crucial role in promoting neurological recovery. A study by Jeong et al. in 2019 evaluated the effect of post-operative physiotherapy on dogs with cervical disc herniation treated surgically. The study found that dogs treated with a post-operative physiotherapy protocol had significantly better neurological recovery compared to dogs that did not receive post-operative physiotherapy.
Thoracolumbar Disc Herniation
Thoracolumbar disc herniation can lead to a variety of symptoms, including pain and neurological deficits ranging from mild proprioceptive ataxia to paraplegia. Rehabilitation strategies for thoracolumbar disc herniation focus on improving proprioception, coordination, and muscle strength. Studies have shown that a multimodal approach to rehabilitation, including manual therapy, passive and active exercises, modalities, and hydrotherapy, can have a synergistic effect on functional recovery.
Surgical decompression is often recommended in dogs with severe neurological deficits or recurrent episodes of pain. A study by Packer et al. in 2016 assessed the prevalence of disc herniation in dachshunds and found that dogs that performed at least one hour of daily physical activity were less prone to herniation than dogs that performed less physical activity.
Rehabilitation Strategies for Dogs with Spinal Cord Injuries
Rehabilitation strategies for dogs with spinal cord injuries vary depending on the severity and location of the injury. In dogs with complete spinal injuries and a lack of deep pain perception, rehabilitation aims to achieve spinal walking or involuntary unassisted gait. Studies have shown that intensive physiotherapy protocols can lead to the development of spinal walking in a significant percentage of patients.
A study by Gallucci et al. in 2015 evaluated the effectiveness of intensive physiotherapy in dogs with complete spinal injuries and a lack of deep pain perception. The study found that 59% of dogs developed an involuntary unassisted gait following intensive physiotherapy. Young age and an early start to physiotherapy were associated with better outcomes.
In conclusion, acute spinal injuries in veterinary medicine present complex challenges that require a comprehensive and multidisciplinary approach. Physiotherapy plays a central role in promoting recovery and improving outcomes for affected animals. Understanding the pathophysiology of spinal injuries, the principles of neuroplasticity, and the effectiveness of various rehabilitation strategies is crucial in developing tailored rehabilitation programs for individual patients. We will continue to watch the research to bring you up to date information.