The subacute phase starts one week after the insult or compression or first development of the symptoms of pain or loss of function. It is the phase that responds best to stem cell therapy as described above. Other therapeutic modalities also work best during this phase including:
Therapeutic laser. Laser Therapy is using photons of light at certain frequencies and power to modulate cellular functions. The light from the laser stimulates photoreceptors inside the cells to produce more energy, to increase production of protein, collagen and DNA. Laser therapy to damaged spinal cords reduces degenerative changes in the neurons and helps induce healing. Myelin is an important protein that covers the nerves like insulation covers wires. Myelin production is increased by the application of therapeutic laser. Nerve associated healing cells (astrocytes and oligodendrocytes) are stimulated by laser application.
Electrostimulation. Electrostimulation Therapy or Neuromuscular Electrical Stimulation (NMES) is the electrical stimulation of muscles or the nerves that feed muscles. The purpose is to make the muscle contract. This contraction of muscles is necessary when there is nerve damage to the brain, spinal cord or other nerves that feed the muscles and they cannot move on their own or in cases where there is trauma or surgery to the bone or joint or muscle that makes it too painful for the muscle to move without electrostimulation. With stem cell therapy the movement of the muscles sends neurological impulses to the spinal cord. These impulses reach the damaged area and the stem cells within the damaged area are stimulated to repair nerve function. This repair comes in the form of chemical mediators released from the nerve endings. These chemical mediators are called cytokines. Cytokines stimulate local stem cells to adapt to the needs of the tissues resulting in healing. Pain control with transcutaneous electrical nerve stimulation (TENS) is different from NEMS in that the electrical stimulation is to the skin with TENS and to the muscles and nerves with NMES.
Passive range of motion. Passive range of motion (PROM) exercise external force such as your hands used to move a limb through its range of motion. The range of motion refers to the controlled movement of the limbs and joints in flexion, extension, adduction (moving the limb toward the body), and abduction (moving the limb away from the body) by you with no effort being exerted by the animal. IVDD pets with neurologic disease need PROM to reduce muscle atrophy, and improve blood flow, more importantly are the neurologic signals that are sent from the paralyzed leg up to the spinal cord then to the area in the spinal cord where the compression or damage is. These damaged nerves will receive the movement signals generated by PROM causing them to secrete chemicals of healing, chemicals that attract and activate local stem cells to heal the spinal cord.
PROM and other therapy modalities that improve muscle, nerve, spinal cord communication enhance the likely of a successful outcome for your pet.
Acupuncture. Acupuncture uses needles to induce changes in soft tissues. Acupuncture is believed to activate the built-in survival mechanisms that normalize the body and promote self-healing. Acupuncture points coincide with tissues that can elicit a strong neurohumoral response when irritated. These include nerves, neurovascular complexes, Golgi tendon apparatuses, and other sensitive tissues.
- Release of physical and emotional stress through its effect on the limbic system in the brain
- Activation of immune and anti-inflammatory mechanisms through the stimulation of connective tissue
- Acceleration of healing through the release of cytokines
- Pain relief secondary to endorphin, serotonin release as well as modulation of many other neurochemicals.
Acupuncture stimulates the same systems as certain electrotherapy currents with the same results.
Therapeutic exercise. Starting two weeks after the initial injury more physical therapy can be initiated including sit to stand exercises, water treadmill and so on. The greater the intensity of physical therapy the better. Exercise is being recognized as an important part of rehabilitation and the earlier the better. Controlled active therapeutic exercise may be safely performed when closely assisted and attended to by the therapist or the attentive owner. The benefits of therapeutic exercise are abundant. Exercise helps build strength, muscle mass, agility, coordination, and cardiovascular health. In addition, therapeutic exercise may be used as a preventive measure to improve general health, reduce obesity, and increase performance in all pets. Prior to initiating therapy, all animals must be fully evaluated and assessed by a veterinary rehabilitation specialist.
- Walking with assistance
- Sit to Stands and Sit to Downs
- Walking up or down stairs
- Using inclines and hills to walk
- Weight shifting using inflatable devices.
When performed appropriately and in consultation with the veterinarian or rehab specialist, these activities can be performed early in the postoperative recovery period and modified and intensified to promote cardiovascular and musculoskeletal fitness
Environmental enrichment. involves engaging the brain of the pet in fun, exciting, challenging activities to interest the pet in recovery. The nervous system is highly sensitive to experiential complexity. This means that experiences perceived through the senses promote neural activity,
complex experiences promote neural healing through the growth of neurons, and synapses. An environment that provides greater possibilities for physical and social stimulation and/or interaction is considered an enriched environment. Animals that are exposed to enriched environments show superior performance in cognitive tests. Test also show increased number of dendrites and synapses as well as increased concentrations of nerve affecting chemicals. These chemicals have important roles in nerve signaling and nerve growth. We must acknowledge that pets kept in crates for 6 weeks’ experience less environmental enrichment and are less likely to heal optimally. Did you notice the dog to the right exercising with only three legs?