Clinical and neurological evaluation following treatment with ultrasound and diathermy in dogs suffering from posterior paresis - DOI

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Clinical and neurological evaluation following treatment with ultrasound and diathermy in dogs suffering from posterior paresis - DOI
Indian J Anim Health (2021), 60(1) : 66-76
                                                                                                    Research Article
DOI:10.36062/ijah.60.1.2021.66-76

     Clinical and neurological evaluation following treatment with ultrasound
               and diathermy in dogs suffering from posterior paresis

                      A. Tikoo1, N. Arora1, G. Kumar1, D. K. Tiwari1*, S. Sharma2,
                                      A. Kumar1 and D. Kaushik1
1
 Department of Veterinary Surgery and Radiology, Lala Lajpat Rai University of Veterinary and
Animal Sciences, Hisar- 125004, Haryana, India; 2Department of Veterinary Clinical Complex, College
of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar- 125004,
Haryana, India

Abstract
          The present study was conducted on twelve clinical cases of dogs irrespective of age, breed and sex suffering from
posterior paresis. Male dogs were more affected (n=7) than females (n=5). Posterior paresis was observed highest in
Mongrel (n=4) followed by Pomeranian and Labrador Retriever (n=3 each) breeds, respectively. Minimum occurrence was
shown by German Shepherd and American Bully (n=1 each). Age-wise maximum hospital occurrence was observed in
dogs of 1- 3 years (n=6), while the minimum was found in less than 1 year and more than 3 years of age (n=3 each). Lateral
and ventro-dorsal radiographs of the spine (lumbo-sacral area) were taken in all the animals to evaluate the involvement
of vertebral bodies, but no orthopaedic abnormality detected responsible for posterior paresis. Numeric pain score was
found to be reduced significantly after treatment in both the groups indicative of improvement in pain and hind limb
weakness in dogs with posterior paresis. Further, shortwave diathermy was found to be more effective as compared to
therapeutic ultrasound in the management of posterior paresis in dogs.

Key words: Dogs, Pain Score, Posterior paresis, Shortwave diathermy, Ultrasound therapy

INTRODUCTION                                                     manifestation will be ischemia of spinal cord
          Posterior paresis is the most common                   causing muscular weakness and ataxia (Lorenz
manifestation of spinal cord diseases which                      et al., 2011) and in severe cases when there is
involves loss of bilateral rear limb motor control               compression of multiple spinal nerves, there will
due to neural or muscular system dysfunction,                    be loss of movement of tail and limbs. There
leading to weight-bearing problems, paresis or                   will be no control over urination, defecation and
limb paralysis, along with urinary and faecal                    absence of sensation over the entire hind portion
incontinence (McGowan et al., 2007). It may                      due to which animal is not able to lift the hind
result as sequelae to the spinal cord injury either              portion and most of the time adopt only sitting
by fall, jump from a height, road traffic accident,              posture (Scott, 1997). The treatment option will
dog bite over the vertebral column, malicious                    depend on the type of stage of posterior paresis.
blow by a stick, crush by a heavy object, fracture               In mild degree of spinal nerve involvement, the
and myoclonus form of canine distemper                           treatment regimen can be rest, analgesic and anti-
(Hoerlein, 1978). The degree of posterior paresis                inflammatory drugs (Mann et al., 2007). In
will depend upon the extent of the compression                   moderate degree of spinal nerve involvement,
of the spinal cord or the degree of involvement                  the medical treatment combined with
of nerves. In mild degree of spinal cord                         physiotherapy can give a good response (Rai,
compression or neuritis, the clinical                            1975) and in severe cases prognosis is usually
manifestation will be pain and mild ataxia                       considered grave. However, physiotherapy in
(Brisson, 2010). In moderate degree of spinal                    conjunction with conventional treatment always
cord compression or neuritis, the clinical                       results in early recovery (McGowan et al., 2007;
*
    Corresponding Author
Clinical and neurological evaluation following treatment with ultrasound and diathermy in dogs suffering from posterior paresis - DOI
Posterior paresis in dogs                                        67

Zama et al., 2013). Conservative drug therapy         muscles of the affected side and applying
includes the administration of NSAIDs,                ultrasound jelly to ensure perfect contact
corticosteroids and nervine tonics. NSAIDs are        between the transducer head and skin.
commonly used for painful conditions and              Sonication was performed at a frequency of
injuries in animals. Prostaglandins are implicated    1MHz, an intensity of 0.5 watt/cm 2 (SATA),
in the production of inflammatory pain and            daily 10 minutes for 7 days in a pulsed mode
sensitizing nociceptors to the action of other        (1:4) as per the standard technique suggested
mediators (Cashman and McAnuthy, 1995).               by Ansari et al. (2012). The transducer was
Nervine tonics are necessary for normal fatty acid    moved slowly in a proximal-distal linear way
production which plays a major role in improving      on the skin surface (Fig. 1).
neuronal membrane synthesis and integrity
(Read and Harrington, 1981). Therefore, the           Shortwave diathermy
present study was undertaken to evaluate the                   Shortwave diathermy was given in
clinical and neurological parameters following        group II animals using two pads at the hind
treatment with ultrasound and diathermy in dogs       quarter region (lumbo-sacral or hip region)
suffering from posterior paresis.                     depending upon the site of lesion or trauma, each
                                                      on either side of the vertebral column, 200 mA
MATERIALS AND METHODS                                 intensity and 10 volts alternating current
        The present study was conducted from          depending upon the degree of trauma and the size
January to December 2020 on twelve clinical           of the patient (Fig. 2) as per the standard technique
cases of dogs irrespective of age, breed and sex      suggested by Ansari et al. (2012). Treatment was
referred to the department suffering from             given daily for 10 minutes for 7 days.
posterior paresis. Detailed history and gross
examination were conducted on the day of              Supportive therapy
presentation in all the animals for posture and               In addition to physiotherapy
gait. These animals were randomly divided into        techniques, animals of both groups were treated
two groups comprising six animals in each             with supportive medicinal therapy including
group. Rectal temperature (oF), heart rate (beats/    analgesic and anti-inflammatory drug,
min), pulse rate (beats/min) and respiratory rate     meloxicam @ 0.2 mg/kg body weight; nervine
(breaths/min) were recorded in all the animals        tonic containing methylcobalamin (Vit. B 12 )
on the day of presentation, 3 rd and 7th day of       500 mcg, nicotinamide (Vit. B 3) 45 mg and
treatment. Neurological examination without           pyridoxine (Vit. B6) 1.5 mg per 15 mL @ 5-10
giving any sedation or anesthesia was carried         mL twice daily, cholecalciferol 60,000 I.U. @
out in a quiet place on the day of presentation,      1 sachet per 20 kg body weight, per orally; daily
3 rd and 7 th day, and parameters such as             for 5 days.
conscious proprioception, patellar reflex,
panniculus/cutaneous trunci reflex, perineal/         Pain score assessment
anal reflex, superficial (cutaneous) nociception             The pain assessment was made by
reflex, deep nociception reflex and urinary           adopting a multifactorial numerical rating scale
bladder incontinence were evaluated as per Bali       (NRS). Seven behaviours included in the scale
(2000). On the day of presentation, lateral (L)       were posture, vocalization, appetite and thirst,
and ventro-dorsal (VD) radiographs of the             personality or attitude, response to palpation,
spine (lumbo-sacral area) were taken in all the       facial expression and mental status. All
animals for radiological interpretation.              behavioral parameters except appetite and thirst
                                                      were graded in a multifactorial score from 0 to
Ultrasound therapy                                    3 (0= no pain, 1= mild pain, 2= moderate pain,
       In Group-I animals, ultrasound therapy         3= severe pain). Appetite and thirst were graded
was applied after clipping hairs over the thigh       from 0-2 (0= normal; 1= partial; 2= complete)
Clinical and neurological evaluation following treatment with ultrasound and diathermy in dogs suffering from posterior paresis - DOI
Clinical and neurological evaluation following treatment with ultrasound and diathermy in dogs suffering from posterior paresis - DOI
68                           Indian Journal of Animal Health, June, 2021

only. The schedule protocol for pain scoring          reported were highest in Mongrel (n= 4, 33.33%)
was 0, 3rd and 7th day.                               followed by Pomeranian and Labrador Retriever
                                                      (n= 3, 25% each) breeds of dog. Minimum breed-
Statistical analysis                                  wise occurrence was observed in German
         The data obtained were analyzed using        Shepherd and American Bully (n= 1, 8.33%
two-way Analysis of Variance (ANOVA)                  each). Breed-wise distribution is shown in Fig.
followed by Duncan Multiple Range Test                5. The majority of the cases (n= 5, 41.66%) were
(DMRT) using SPSS 16.0 version. The level of          brought to the department between 1-5 days of
statistical significance for all comparisons was      the initiation of illness followed by 15-30 days
established at P
Clinical and neurological evaluation following treatment with ultrasound and diathermy in dogs suffering from posterior paresis - DOI
Posterior paresis in dogs                                      69

                                    Breed
                                                          A      Mongrel

                   D   E
                                                          B      Pomeranian
                                        A
               C                                          C      Labrador Retriever
                                B
                                                          D      German Shepherd

                                                          E      American Bully

     Fig. 5. Breed-wise occurrence of posterior paresis in dogs

                           Duration of illness

                                                          A      1-5 days
                       E
               D                                          B      5-10 days
                                       A
                                                          C      10-15 days
               C
                           B
                                                          D      15-20 days

                                                          E      20-25 days

Fig. 6. Duration of illness-wise occurrence of posterior paresis in dogs

                               Etiological factors

                   D
                                              A      No trauma
           C
                               A
                                              B      Fall from height

                   B                          C      Automobile accident

                                              D      Hitting with any hard object

Fig. 7. Etiological factor-wise occurrence of posterior paresis in dogs
Clinical and neurological evaluation following treatment with ultrasound and diathermy in dogs suffering from posterior paresis - DOI
70                              Indian Journal of Animal Health, June, 2021

Table 1. Effect of Ultrasound Therapy and Shortwave Diathermy on pain management at different
         time intervals (Mean±SE)
 Pain score                   Day 0                       Day 3                                 Day 7
   Group I                  6.17±0.95aB                 3.00±0.49aAB                         0.83±0.77aA
   Group II                 5.33 ±0.60aC                2.67±0.45aB                          2.00±0.31aA
Values without a common superscript letter A-C are significantly different within groups (P
Clinical and neurological evaluation following treatment with ultrasound and diathermy in dogs suffering from posterior paresis - DOI
Posterior paresis in dogs                                    71

dogs while eight (66.67%) dogs were reluctant         elicited on touching the affected area in four
to take solid food. Normal food intake resumed        (34.00%) cases. No response to touch was
in all animals by the 7th day of treatment except     shown by all the animals after day 7 th post-
in two cases. Mild to strong pain response was        treatment. Licking and scratching of the affected
Table 3. Effect of Shortwave Diathermy on neurological response in group II at different time
         intervals
Neurological   Conscious    Patellar Cutaneous Anal            Superficial    Deep     Urinary
  signs      proprioception reflex    truncii reflex           nociception nociception Reflex
                                       Case no. 1
Day 0              1           -2       +1        -1               Absent        Present     Flaccid
Day 3              1           -1       +1        0                Present       Present     Flaccid
Day 7              2           -1       +1        +1               Present       Present     Flaccid
                                       Case no. 2
Day 0              1           -1       -1        +1               Present       Present      Tonic
Day 3              1           -1       +1        +1               Present       Present      Tonic
Day 7              2           0        +1        +1               Present       Present     Flaccid
                                       Case no. 3
Day 0              1           -2       -1        -1               Absent        Present      Tonic
Day 3              2           -1       -1        0                Present       Present      Tonic
Day 7              2           0         0        +1               Present       Present     Flaccid
                                       Case no. 4
Day 0              0           -1       -1        +1               Present       Present     Flaccid
Day 3              1           0         0        +1               Present       Present     Flaccid
Day 7              1           0        +1        +1               Present       Present     Flaccid
                                       Case no. 5
Day 0              0           -1       +1        -1               Present       Present     Flaccid
Day 3              1           0        +1        0                Present       Present     Flaccid
Day 7              2           0        +1        +1               Present       Present     Flaccid
                                       Case no. 6
Day 0              0           0        +1        -1               Present       Present     Flaccid
Day 3              1           0        +1        0                Present       Present     Flaccid
Day 7              2           0        +1        +1               Present       Present     Flaccid

Table 4. Effect of Ultrasound Therapy and Shortwave Diathermy on physiological parameters
         at different time intervals (Mean±SE)
Parameters                   Group I                                    Group II
               Day 0          Day 3          Day 7         Day 0             Day 3         Day 7
RT (°F)      101.83±0.21aA 102.74±0.32aA 102.93±0.01aA 101.33±0.32aA 102.72±0.11aA      102.98±0.45aA
HR (/min.)   99.17±0.12aA 103.17±0.03aB 104.00±0.44aB 98.83±0.87aA 102.83±0.43aB        103.67±0.23aB
PR (/min.)   97.22±0.02aA 101.17±0.24aB 103.35±0.42aB 98.23±0.47aA 102.22±0.33aB        104.17±0.34aB
RR (/min.)   29.00±0.98aA 28.90±1.32aA 29.33±1.33aA 29.67±0.77aA 29.68±0.43aA 30.17±2.01aA
Values without a common superscript letter A-C are significantly different within groups (P
Clinical and neurological evaluation following treatment with ultrasound and diathermy in dogs suffering from posterior paresis - DOI
72                            Indian Journal of Animal Health, June, 2021

painful area was observed in four (33.33%)             n= 1 in group II) on day 7. Anal reflex was
cases, while eight (66.67%) dogs became                normal in five dogs (n= 3 in group I and n= 2
docile and quiet in attitude. Most of them             group II). Seven dogs (n= 3 in group I and n= 4
showed recovery within one week except four            in group II) exhibited diminished reflex which
dogs which were still in pain.                         returned to normal in all the dogs till day 7.
         The mean±SE values of numeric pain                     The mean±SE values of rectal
score (NRS) at various time intervals have             temperature (oF), heart rate (beats/min.), pulse
been shown in Table 1. Pain score values               rate (pulse/min.) and respiration rate (breaths/
showed a significant (P
Clinical and neurological evaluation following treatment with ultrasound and diathermy in dogs suffering from posterior paresis - DOI
Posterior paresis in dogs                                       73

mostly preferred by owners (Dämmrich, 1991)          sudden onset of injury provokes abnormal
and they are more susceptible to trauma due to       physiological and psychological reactions which
their high metabolic activity and aggressive and     may precipitate into complications like increased
wandering behavior as compared to the female         stress response, prolonged recovery, increased
counterparts (Kolata, 1993).                         morbidity, prolongation of disability and at time
         The majority of animals reported in the     death (Kehlet, 1988). Lesions involving spinal
present study are non-descript this might be due     cord segments or lumbosacral nerve roots that
to the fact that Mongrels (non-descript breed)       include femoral, obturator, sciatic, pudendal,
contribute to a major population of stray dogs.      pelvic, and coccygeal nerves result in posterior
Only expensive exotic breeds are kept by             paresis. In the present study, various neurological
people in order to show social status and            tests showed a marked improvement in Group-
comparatively pleasing looks.                        II followed by Group-I after complete treatment.
         Period of illness was observed highest      Proprioceptive reflex showed normal response
in five animals (41.66%) of 1-5 days followed        till day 7 in ten (n=5 in each group) dogs. Similar
by three animals (25%) in 15-20 days, two            finding was seen by Ansari (2012) where the
animals (16.66%) in 5-10 days while rest one         majority of the cases took 7 days to show normal
animal (8.33%) each having duration of illness       reflexes. Zama et al. (2013) also reported that
between 10-15 and 20-25 days, respectively.          animals regained normal postural reflexes and
Gopinathan (2006) also recorded that majority        recovered early subjected to short wave
of the dogs suffering from hind quarter              diathermy followed by therapeutic ultrasound
weakness were reported within a week of the          when used in conjunction with conventional
illness. Sharma (2005) recorded it to be between     treatment. However, Grewal (2016) mentioned
10 to 30 days. Brown (1977), Butterworth and         that proprioception deficit returned to normal
Denny (1991) have reported that the dogs with        after 21 days of treatment in severe cases of
neurological deficit causing pain and inability      posterior paresis.
to bear weight and visible urinary incontinence               Spinal cord injury resulted in depressed
are attended early by the owners as compared         or absent patellar and withdrawal reflexes in
to those showing simple back pain alone or with      pelvic limbs. Grewal (2016) also mentioned that
other less severe deficits.                          patellar reflex got diminished in spinal cord injury
         The results of the present study were in    which improved after continuous treatment. The
accordance with the study by Gopinathan (2006)       present study showed an abnormal patellar reflex
who also noticed maximum cases of posterior          in cases of posterior paresis. The reflexes
paresis with no or unknown history of trauma         returned to normal in five dogs on day 3 and
following falling from a height, automobile          four dogs on day 7 of treatment.
accident and hitting with a hard object                       The cutaneous trunci reflex allows
respectively. Many developmental disorders like      localization of thoracolumbar spinal cord
generalized osteoporosis, hypovitaminosis “D”        lesions. All the spinal cord lesions starting from
and hypocalcaemia exhibited clinical signs of        L5 and continued cranially up to T2, showed a
posterior paresis in the study conducted by          decrease in panniculus/ cutaneous trunci reflex.
Ettinger and Feldman (2010).                         Panniculus reflex returned to normal in three
         The neurological examination provided       dogs (n= 2 in group I and n= 1 in group II) on
very useful information regarding the severity       the 3rd day and in five dogs (n= 2 in group I
and exact location of the injury. However, there     and n= 1 in group II) on day 7. An absent or
was individual variation in the sensitivity among    depressed anal reflex was usually observed in
the animals showing similar clinical symptoms.       lesions of the sacral spinal cord segment (S1 to
Patellar, pelvic withdrawal, panniculus, anal and    S3) or lesions affecting the pudendal nerve. It
conscious proprioception reflexes were recorded      leads to flaccid or dilated anal sphincter
as per Bali (2000). Acute pain associated with       resulting in faecal incontinence. Since the
Clinical and neurological evaluation following treatment with ultrasound and diathermy in dogs suffering from posterior paresis - DOI
74                            Indian Journal of Animal Health, June, 2021
external anal sphincter is innervated by the           interferential therapy in dogs.
pudendal nerve, which also originates in the                    The non-significant rise in the rate of
sacral segments, the perineal (anal) reflex            respiration in dogs following therapy was in
provides a good assessment of sacral spinal cord       agreement with findings of Sharma et al., (2017)
function. Similar findings were seen in dogs           which that an increase in the blood supply and
with a spinal injury where diminished anal             muscle contractions has enhanced the function
reflexes returned to normal within 7 days in all       of the hypothalamus respiratory center, which
the dogs. Urinary incontinence was observed            could be responsible for an increase in the rate
in three animals on the day of presentation            of respiration after treatment.
leading to tonic urinary bladder and dribbling                  The primary means of confirming a
of urine. The pudendal nerve innervates the            diagnosis and initial assessment with reference
urethral skeletal muscle. Lesions of the sacral        to neuromuscular disease remains conventional
segments will also result in loss of innervation       diagnostic radiography as suggested by Luttgen
to the skeletal muscle of the urethra. Lesions         et al., (1988) and McKee (1992). However, in
involving the pelvic nerves, sacral cord               the present study initial assessment was made
segments, or pathways to and from the                  based on various neurological tests along with
brainstem will abolish the micturition reflex. As      other signs shown by the animals and then a
a result of minimal urethral resistance, manual        plain radiographic examination was conducted.
expression of the bladder is easy in such cases.       All the cases revealed a normal ventro-dorsal
Thus, animals with sacral cord lesions may             and lateral radiograph with no lesion in the
suffer from continual overflow incontinence.           vertebral column or any part of the limb which
The micturition reflex returned to normal on           signaled the condition to be of musculo-skeletal
the 3 rd day of treatment in all the affected          origin. The findings were in agreement with the
animals.The observations were in accordance            studies of Gopinathan (2006) and Ansari (2012)
with the study by Grewal (2016) where he               in dogs suffering from posterior paresis.
mentioned that if a lesion is at the lumbo-sacral               It is concluded that numeric pain score
level of the spine then the animal shows a             was found to be reduced significantly after
decrease in voluntary micturition and easily           treatment in both the groups indicative of
expressible bladder.                                   improvement in pain and hind limb weakness
         In the present study, non-significant         in dogs with posterior paresis. Improvement in
increase in rectal temperature following               neurological response and early ambulation
physiotherapy might be due to increased blood          was observed in Group-II animals as compared
circulation and release of endorphin as also           to Group-I. Thus, shortwave diathermy was
observed by Bromiley (1991). The tiny mineral          found to be more effective as compared to
ions in the blood become attracted to the              therapeutic ultrasound in the management of
magnetic field creating electrical currents in the     posterior paresis in dogs.
blood stream. This, in turn, creates an increase       Conflict of interest: Authors have no conflict
in blood flow and heat in the area (Steyn et al.,      of interest in this study.
2002).
         A significant increase in heart rate and      ACKNOWLEDGEMENT
pulse rate from day 0 to 3rd in both the groups               The authors are highly thankful to the
was recorded following therapy. It was believed        Professor and Head of the department for
that the electrical stimulation increased blood        providing the necessary facilities. Part of the
flow over the site of treatment and muscle             study was funded through research grants from
contraction (Hurley et al., 2001; Johnson and          the Department of Veterinary Surgery and
Tabassam, 2003). The increase in heart rate and        Radiology, College of Veterinary Sciences,
pulse rate were in concurrence with the finding        Lala Lajpat Rai University of Veterinary and
of Maiti et al. (2007) on ultrasound and               Animal Sciences, Hisar, Haryana.
Posterior paresis in dogs                                            75

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       Veterinary Research Institute (Deemed                     diathermy on oxidant-antioxidant balance in
       University), Izatnagar- 243 122, Uttar Pradesh,           dogs suffering from hind quarter weakness. J Appl
       India                                                     Anim Res, 41(1): 82-86, doi: 10.1080/
Sharma AK, Gupta OP, Singh GR, Pawde AM and Maiti                09712119.2012.738217

Received – 29.03.2021, Accepted – 11.05.2021, Published – 01.06.2021
Section Editor: Prof. S. K. Nandi, Associate Editor
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