1. Lady Ehrenberger
Case Study
Caroline Adrian PT, PhD, CCRP
Director, Rehabilitation Services
VCA Animal Hospitals
VCA Veterinary Specialists of Northern
Colorado

2. Medical Diagnosis
Amy Komitor, [credentials]
Traumatic C4-5
dorsal
subluxation
Right
communiuted
scapular fracture
Multiple bite
wounds of dorsal
right scapular
region and left
fore paw
11-21-12

3. Surgery
C4-5 screw-bar-polymethylmethacrylate
(PMMA) ventral internal fixation for
vertebral stabilization
11-21-12

4. One Day Post Op
Non-ambulatory tetraparetic to plegic
Superficial pain intact
Normal reflexes in all four limbs
Intact cranial nerves
Cervical ROM, postural reactions,
proprioception, weight bearing not assessed
Appropriate tone and cutaneous trunci intact
Minimal movement of head to right side
Prognosis for ambulation: fair

5. Rehabilitation – Initial Consult
2 weeks post ventral slot
– Proprioception: intact R TL/PL; absent L TL/PL
– Motor R > L
– Able to right herself from both sides
– Pushing up and crawling
– Turns head to L
– Low head carriage
– Supports self in grass if placed
– Extensor tone in B PLs (L > R)
– Motor in all 4 limbs (R > L)
– Decreased neck extension
12-3-12

6. Plan of Care
• HEP:
– Sphinx lie
– Neck extension
– Tone reduction
– Transfer side lying to sit
– Weight shifts
– Walkabout harness
• Rehab 1x/week (drop off) for 8
weeks

7. Progression – Month 1
Neck ROM – side flexion, extension
Weight bearing / shifting
Transfers
Challenged standing
Therapy ball
Falls forward with fatigue (use of walkabout
for support)
Slow leash walks (no leash around neck)
Underwater treadmill

8. Progression – Month 2
Shoulder extension
Dynamic exercise
– Figure 8’s, slowly (tended to ‘jump and turn’)
– Underwater treadmill
– Obstacle course (cavalettis)
– Reduce ataxia using weighted vest
– Uneven surfaces
– Plank walk
– Stairs
‘Shake’ to encourage scapular movement/extension – avoid circumduction
Scapular mobilizations
Core stabilization
Balance activities
‘Sit pretty’
Increase walks
Stairs
NO tug-o-war (ever!)
Rolling okay

9. Outcome
Mild, occasional loss of balance
Mild L TL proprioceptive deficits
Weak core
– Sit pretty for short periods without falling
Mild ataxia