Meet Martha, a 4 year old Miniature Schnauzer who suffered from a fibrocartilagenous embolism (FCE) back in April 2020.
A FCE is a sudden onset spinal cord injury that happens when blood flow to the spinal cord is blocked. It is believed that the embolising (blocking) material is fibrocartilage from the inner part of an intervertebral disc. These discs stabilise and support the spine while allowing movement and distributing loads between the vertebrae (spinal bones). Symptoms of a FCE are related to dysfunction of the spinal cord due to localised loss of oxygen for a short period. They come on very suddenly and are non-progressive (they don't get worse). Symptoms can vary from paresis (weakness) to paralysis (loss of function). One limb may be affected, or one side of the body, or both hind limbs. Dogs may be incontinent. Supportive therapy including physiotherapy is essential for recovery.
When Martha suffered her FCE she lost the use of both hind limbs and was incontinent. Once she had seen the referral vet and had a diagnosis her owner got in touch with us to start therapy.
Martha started her therapy in April while the UK was in lockdown, therefore her therapy began via twice weekly video consultations. We used these video consultations to assess, give advice, and to discuss and demonstrate home therapies. We then provided a home exercise plan which was adjusted after each consultation. At the start Martha's home plan involved lots of sensory exercises to stimulate her neuromuscular system, plus gentle active assisted exercises using a harness and sling to start her on the road to walking again.
At the start of July Martha was finally able to come into the clinic to start her weekly therapy sessions in "person". By this point she was able to walk, although her right hind limb was very weak with not much muscle, and her left hind limb and forelimbs were very stiff with tight muscles due to how she was moving. She would often scuff or knuckle over on her weaker right hind limb due to having less awareness of this limb.
Once she started in clinic we had several physiotherapy appointments where we used pulsed electromagnetic field therapy, photobiomodulation (LASER) therapy, massage and passive stretches to work on relaxing Martha's tight muscles, ease her stiff joints and improve her movement. At each session we adjusted her home plan to make it more challenging and to address what we had found during our assessment.
We included progressively more challenging active exercises into Martha's program.
By the end of July Martha was starting to get stronger on her right hind limb and walking more normally. She also had more control over her toileting. Therefore we added the hydrotherapy treadmill into her treatment plan, starting with several reps of 20 seconds of walking very slowly through the water with us assisting her hind limbs in the correct motion.
Since then Martha has come on in leaps and bounds, and we have altered her therapy to become more challenging as she has progressed. While her right hind remains weaker than the left, she is using herself more evenly and is gradually building back up muscle. She doesn't suffer from as much muscle tightness or stiffness because she is moving more normally, and she has much more stamina. In fact, she is raring to go on walks.
We are continuing to see Martha, now on a fortnightly basis, to further build up her muscle mass and strength.
You can see Martha's progress on the following YouTube video:
Well done Martha! You're a little star.