2011, Vol. 6 No. 1, Article 82
Rehabilitation of a Paraplegic Kitten with Acute Depression
Bombay Veterinary College, Parel, Mumbai – 400012
e-mail address: firstname.lastname@example.org
A 3 month old stray kitten was admitted to the Bombay SPCA Hospital in a paraplegic state due to fractures of the T-11 and T-12 vertebrae. The patient exhibited faecal incontinence and urine retention along with loss of motor control and sensation in the lower half of her body. A recurring abscess exerting pressure on the area of spinal trauma further complicated the injury. Clinical therapy resulted in the reversal of paraplegia. However, the patient experienced acute depression following the traumatic injury which resulted in lethargic behaviour. The lack of adequate exercise caused a delay in the satisfactory recovery of the patient’s motor skills. The mitigation of physical complaints was only made possible by the use of physiotherapy coupled with psychological support.
Cat, paraplegia, depression, physiotherapy.
Spinal trauma is a serious medical condition in all species. However, veterinary cases of spinal trauma are especially grave, as most patients exhibiting paralysis are likely to be euthanized. The absence of deep pain sensation is generally considered to be a sign of complete spinal cord transection; these patients are usually euthanized without attempting medical or surgical intervention (Bruce et al, 2005). This is despite studies which have shown that some paraplegic cats regain normal ambulatory functions following an initial absence of deep pain sensation in the hind limbs (Olby et al, 2003). Cage rest with restricted movement was found to be adequate for the recovery of cats with dog-bite wounds on the spine (Chai et al, 2007).
The role of physiotherapy in the rehabilitation of injured animals is well known, but there are few reports of the extent of improvement that can be achieved by physiotherapy in paretic patients. Another aspect of rehabilitation which remains professionally neglected in veterinary therapeutics is the value of psychological support.
In the rehabilitation of the kitten particular to this case, carefully planned exercise and intensive psychological support was employed towards the recovery of the patient
HISTORY AND PRESENTING SIGNS
The patient was bitten by a dog and was cachetic and paraplegic on presentation. On physical examination, the patient did not demonstrate any superficial sensation in the caudal half of the body and deep pain could not be elicited by application of pressure to digital bones of the hind limbs with forceps. There was pronounced atrophy of hind limb muscles. On palpation, an abnormal elevation was felt over the thoracic spinal region. Abdominal and urinary bladder distension was noted.
A lateral X-ray revealed fractures of the T-11 and T-12 vertebrae, with small bone fragments lodged in the adjacent muscle. Upon observation for the first 48 hours following admission, it was found that the patient’s appetite remained normal but faeces were passed only once. Periodic manual expression of urine was required as urine retention was noted. Within 72 hours of admission, the kitten developed a soft, fluctuating abscess, 5 cm in diameter at the location of the bite. Gentle palpation of the abscess elicited an intensely painful response from the patient.
The immediate treatment administered to the patient upon admission consisted of Mannitol (M-20 4g iv for 3 days), Cefotaxime (Taxim 10mg im for 5 days), Dexamethasone (Decamycin 0.25mg po for 5 days), Buprenorphine (Buprigesic 0.01mg oral transmucosally for 5 days) and Vitamin B Complex (Neurobion 0.1ml im for 10 days).
Ascending paralysis was observed as the abscess developed and enlarged, which eventually lead to paralysis of forelimbs as well. Eventually, the patient was left in a quadriplegic state. The growing abscess was speculated to be causing compression of vertebral column. The maturation of the abscess was hastened by Infrared Light Therapy and the topical application of Iodex ointment, which is a Proprietary Ayurvedic drug containing resublimed Iodine in Methyl Salicylate. The mature abscess was incised, drained of pus and the cavity was flushed with Hydrogen Peroxide. This lead to the immediate reversal of forelimb paralysis, accompanied by some amount of sensation regained in the digits of the hind limbs. Flushing of the cavity with hydrogen peroxide was followed by insertion of a fresh seton soaked in tincture iodine on a daily basis for one week. The kitten’s bladder was manually emptied for the first month while she was under medication and recovering from dehydration and anaemia. As urine was freely expressed on manual emptying of bladder, urinary blockage was ruled out and bladder atony was suspected to be the cause. Upon regaining good body condition, a course of Bethanechol was started as 4.5 mg, TID orally for 3 days, followed by 4.5 mg BID orally for 2 days and finally 4.5 mg SID orally for 3 days. A tapering dose was used as the administration of high doses of Bethanechol resulted in diarrhoea. Bladder control was regained after eight days of treatment. There was spontaneous recovery from faecal incontinence a week after the abscess was drained.
Four weeks of rest and proper diet lead to a dramatic change in the patient’s condition. Upon examination, no signs of paresis remained in any region of the body and full range of motion of all limbs was regained. However, it was observed that the kitten had lost her natural tendency to play and explore. Time spent on grooming was less than normal and there was a marked lack of interest in her surroundings. Thus, despite the physical potential to regain normal motor skills, full recovery was protracted due to these apparent signs of depression. A course of physiotherapy was instated, consisting of 10 repetitions of flexion and extension of the hind limbs alternately. Hind limbs were also massaged in an upward direction from paws to the hip joint, following the path of the sciatic nerve. The patient was laterally supported by hand and made to walk a few meters at a time using food as an incentive. Initially, the patient resisted physiotherapy and would not cooperate for more than 10 minutes at a stretch. A conscious effort was made to affectionately pet the kitten and speak to her in an encouraging tone for a few minutes prior to starting and during the physiotherapy. Eventually, she associated the physiotherapy sessions with positive experiences and began to actively participate in the exercise. It was noted that the patient was willing to walk for a markedly longer duration when accompanied by people as opposed to when she was allowed to roam and explore alone. Clinical therapy consisted of Infrared Light therapy and Faradic current therapy. Twice daily use of an Infrared Light Lamp on the hind region for five to ten minutes was followed by the application of Faradic current along the spine and hind limbs. This aided the development of hind limb muscle tone and normal ambulatory capability.
During the initial evaluations of paraplegic humans, 22% had major depression and 8% had minor depression. Non-recovery from depression was associated with a lack of social support (Kishi et al, 1994). The therapeutic worth of psychological support may be underestimated in veterinary cases. It can be suggested that the extent of the kitten’s recovery and the time taken to achieve it may not have been possible without the deliberate psychological encouragement that she was given.
Spinal trauma in animals when treated medically requires substantially longer reaching optimal status rather than those treated surgically (Selcer et al, 1991). However, medical treatment may be sufficient if the extent of spinal trauma is not severe. A conservative medical approach was used in this case as there were signs of spontaneous improvement without surgical intervention.
Locomotor function beneath the level of a spinal cord lesion can be restored even if the cord is completely transacted, as regions of critical importance for locomotion can be confined to a restricted portion of the spinal cord. It is suggested that this is due to the existence of an autonomous network of neurons capable of generating a locomotor pattern independently of supraspinal inputs (Rossignol et al).
Despite the poor prognosis that accompanied the patient’s initial condition, complete recovery was eventually achieved. If concerted efforts are made by owners towards recovery of the pets, euthanasia is not the only option for paraplegic animals.
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