Flo was initially referred to the SMART Clinic at the end of April 2024 with a diagnosis of Idiopathic Polyradiculoneuritis, a disease with an unknown cause affecting the nerves in the body that can lead to paralysis. At her initial appointment, Flo wasn’t able to stand, walk or hold her head up unassisted.
Flo visited the clinic twice weekly as an inpatient, for acupuncture, soft tissue massage and gait training on the underwater treadmill, and for postural training and activation of musculature through exercises, which Flo’s owner continued at home. Weeks 1-2 focused on assisted standing both at home and in the underwater treadmill (UWTM) to help re-engage Flo’s legs. By the end of the two weeks, she was able to hold up her head and neck, and was starting to use her hind legs although very uncoordinated. During week 3-4, a Neuromuscular Electro Stimulation (NMES) machine was introduced for Flo’s owner to use daily at home to help restore some of the muscle loss over her shoulders – her front legs were still paralysed at this stage. At weeks 5-6, we were able to introduce some assisted walking using a Help ‘Em Up harness to support Flo’s weight. She was attempting to push off with her hind legs and was showing small efforts to start using her forelimbs although she would fatigue very quickly.
Flo’s progress plateaued and required an alternative solution to engage the forelimbs. We contacted Pumpkin and Friends charity, who kindly supplied some front wheels in addition to a set of rear wheels loaned by the clinic and by weeks 7-8, Flo was able to gallop towards her mum when she came to collect her from the clinic! This was a turning point in her progress and over the next few weeks, the home exercises focused on walking in the wheels more regularly until she became frustrated and wanted to do more. We added unassisted standing to Flo’s home exercises and a few days later she walked 5 -10 steps with only a sling under her chest for support. At the start of week 11, Flo shocked us by walking into the clinic completely assisted – a very happy and emotional day for us all! Over the course of the week, Flo started initiating standing by herself and taking short walks unassisted. She did a short unassisted treadmill session with several short unassisted walks during the day. Flo’s exercises were advanced to unassisted standing, proprioceptive track walking and short controlled walks. Further sessions were be focused on coordination, muscle building and treating possible compensatory issues.
Flo’s case study is a great showcase of how appropriate rehabilitation and physiotherapy can be used to aid recovery in Polyradiculoneuritis cases, and the importance of constantly monitoring and evaluating these patients, applying multimodal treatment and techniques, and continually communicating with the team, owners and first line Vets to work towards the most successful outcomes.
