Clinical and neurological evaluation following treatment with ultrasound and diathermy in dogs suffering from posterior paresis - DOI
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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
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)
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
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
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
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
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
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
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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Received – 29.03.2021, Accepted – 11.05.2021, Published – 01.06.2021
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