Tuesday, March 17, 2009

A work in progress- Jinx's rehab

As Jinx progresses with her rehab, I wonder how many people whose dogs have suffered similar injuries, are willing and able to commit the amount of time this has taken? I did pose this question to the therapist during a visit and she said some owners will look at her and say "you want me to do WHAT?" It would be impossible to do with an untrained dog, in my opinion.

When Jinx initially came home following surgery, she was in the hobble system within several days. I was told that some dogs do not tolerate them, and will tear them off. In addition to becoming very expensive, this would make their recovery more difficult. She had to remain still. That meant being in the crate or on her bed. No bedroom access which would tempt her to leap onto the bed, although for the first few weeks I don't think she felt well enough to attempt that. I was able to send her to her dog bed, where she would remain for hours, or all day, until released. She was perfectly content to lay there and watch the world go by around her. I could tell the change in her attitude at week 3, where she began to move around more. I think she had the good sense to know her body needed to be still and heal. But what if your dog was not crate trained, or resisted being crated? What if you could not tell your dog to lay down and remain in one place? You would have weeks of struggling; again, counterproductive to recovery.

At 12-15 weeks post op, these are the home exercises we are given to do, with 2-3 sessions per day:
  1. Passive Range of Motion of elbow joint: flex elbow to point of stopping, hold for 10 seconds, relax and repeat. Affected limb only.
  2. All 4's rocking: Dog standing on all 4's OUT OF HOBBLES. With hands on dogs' shoulders, gently push dog to the side, and then let them go back to center, only pushing 1/2 to 2 cm off center. Continue random pushes as you have been doing.
  3. Down to stand: 3 sets of 10 reps. Because Jinx learned her "positions" as a competition exercise, and the front feet must remain in place while the back feet change positions, we did have to modify the exercise. Initially the therapist wanted us to do a sit to a down and back up, but Jinx kicks her feet back to sit, and does not slide forward to down, and can do it very easily on 3 legs, so that didn't work.
  4. Lateral raises (torso/core strengthening) Increase to 2 sets of 10
  5. Treat to Opposite Shoulder: with dog standing, increase to 3 sets of 10. This is the exercise that we started out doing both laying down and standing, where Jinx had to flex her head to reach a treat at the shoulder. From the prone position, she had to keep her shoulder flat on the ground, so I need a command that would accomplish that. Viola! "LAY" became her command for the flat-on-your-side with head down, "dead dog" position. From there I can flex her. She loves to throw herself to the ground and roll her eyes at me as her head is flat on the ground, which is so hilarious.
  6. 3 Leg standing (rear only) OUT OF HOBBLES Lift rear leg while patient is in standing position. Support lifted leg at stifle with hip and stifle flexted. Hold as tolerated by patient and repeat 3 times on each side, continue with 3 reps of 20 seconds on each rear leg. Be sure she is standing square! Being square is something we have to work on, as Jinx has become very adept at standing in the tripod position. From the rear, her hind legs are spread wide and the weight bearing leg is in the middle, so you can't even see it when you stand behind her. The front leg is in line with her tail. Now, in all of these, with the physical adaptations she has made, I worry about the stress is is putting on other joints. Like the guy who has surgery on one knee and the other one blows out because it has taken all the pressure. So, to combat her tripod position, I am teaching her "stand". She already has a word for that as a competitive position, so this is a new word. It means to put all four feet on the ground. I physically place her hind legs underneath her, which forces her to put the bad leg down for balance. I still have to remind her "stand" to put that leg down, but once she does that, I mark and reward it. It is primarily a process of relearning how to balance using four legs.
  7. 3 leg standing, front only: OUT OF HOBBLES. same as above, but life left forelimb.
  8. Leash walks: OUT OF HOBBLES slow walks, on short leash. Walking in 8 foot diameter circle with right leg to the inside of the circle. Another exercise that was suggested was to find a gentle hillside or roadside back and walk her at a horizontal angle, not climbing up and down. Since our weather has been so awful and muddy yet, we have not tried this. Some days we go to the AKC club building for our walks. We are finally seeing bare ground here, but before that I was afraid Jinx would slip on ice and reinjure herself. I sometimes will walk with her on my right side with a "walk" command which tells her to keep all four feet on the floor as she moves; in the heel position, with her trying to keep in proper position and attention she tends to hop, keeping the right foot off the ground and it is easier to take it out of context.
  9. Sit to beg: hold the beg for 15 seconds. I keep saying that if Jinx doesn't return to work, she may have a bright career as a circus doggie! She has learned her "sit pretty" command and throws herself into it with the same enthusiasm with which she applies the "lay". Like, look how fast I can do this, can i have a treat now, please? We are working on duration. We are also shaping the "wave" which will be done using the injured limb. Right now it is the "paw" ( I really need to think about the physical gesture and word I intend to use long term) where she gives me her foot. Initially it was a struggle for her to even move that leg and foot to my hand, but now she is doing it much more easily, so that movement will be helpful in rebuilding the muscle mass of her shoulder. Eventually it will become a "wave". A friend told me that she teaches it by placing her dogs on the bed and then tempting them with a treat, and they reach for it with their paw. Good idea, but I have to lift Jinx up on the bed and can't risk having her jump OFF of it, so I think I will put that idea aside.
  10. Side stepping: both directions, starting with 2-3 steps and increase as tolerated. When Jinx moves left it will be more difficult for her.
  11. Stepping through ladder rungs or over poles laid on ground: slow walking exercise. Jinx is doing well with this, and raising her feet nicely. She practiced a cavaletti when preparing for her ladder climbing training for USAR and when the ladder is raised off the ground she will walk on the rungs, so I was worried she might attempt it. Held just off the ground, she steps carefully in between the rungs and it has not become and issue.
  12. This excercise is not one that came from the physical therapist, but from my friend, Sam. Jinx now eats her meals from the floor. I make a trail of kibble through the house and she follows it, walking step by step, and using her paw. Holding her head down like that makes it impossible to hop, so she uses the leg. Great idea, eh? Plus, I figure it will help her in her tracking!! Granted, it is pure sight tracking in the house, but she is motivated to follow the food.

So there you have my Jinx rehabilitation exercises. Crazy, isn't it? I know that there are people out there who just expect surgery to fix things and be done with it, but I tell you what, I am the one doing all the hard work here!! Yes, the surgeon had the skill to make the repair but he worked on her for an hour. I have a commitment that will extend for months yet, to seeing that the money spent on surgery was not a waste, and that she can recover fully. At our last visit, the surgeon seemed to have some reservation over whether there was nerve damage, which would be permanent, or not. Since then I have noticed Jinx using that leg more and more, and I am probably more optimistic than I have been previously during her recovery.