Canine Geriatric Rehabilitation: Considerations and Strategies for Assessment, Functional Scoring, and Follow Up

Evaluation of the effect of cannabidiol administration with and without nonsteroidal anti-inflammatory drugs in dogs with mobility disorders: a prospective, double-blind, crossover, placebo-controlled study

Introduction

With rapidly growing interest in the use of cannabidiol (CBD) in the management of pain and other conditions, more information is needed on the safety and efficacy of this supplement, particularly its co-administration with commonly used pharmaceuticals such as non-steroidal anti-inflammatory drugs (NSAIDs). This study sought to assess the effect of CBD in dogs with mobility impairments, as well as evaluate the clinical tolerance of CBD used together with NSAIDs.

Materials and methods

Forty-two client-owned dogs with diagnosed mobility impairments were enrolled in this prospective, double-blind, crossover, placebo-controlled study. Baseline data were collected for 10-14 days followed by random allocation to either placebo or CBD oil for 45 days with a 30-day washout period in between. CBD was dosed at 5 mg/kg orally every 12 h with masked placebo administered at equal volume. Outcome measures included objective gait analysis, accelerometry, and clinical metrology instruments. CBD plasma levels and serum biochemistry were also collected along with hepatic ultrasound if warranted.

Results

Thirty-eight dogs finished the study with thirty-nine included for at least partial analysis. Compared to baseline, dogs receiving CBD showed evidence of improved outcomes based on blinded veterinary assessments and accelerometer data. Compared to placebo, dogs receiving CBD showed some evidence of improved outcomes on CBPI, CSOM, and blinded veterinary assessments, but not for objective outcome measures. There was evidence of increased ALP when CBD was co-administered with NSAIDs compared to CBD administration alone. Additionally, there was evidence of ALT elevations with CBD and NSAID co-administration, but this elevation did not show evidence of an increase over CBD use alone.

Discussion

These results suggest a potential therapeutic benefit in the administration of CBD for the management of mobility impairments, but greater ALP elevations were seen when administered with NSAIDs. While the sample size of dogs that received further hepatic work-up for liver enzyme elevations is small, chosen diagnostics varied, and liver biopsies were not performed, there did not appear to be clinically apparent liver damage. Further research is needed to better understand the efficacy of CBD in a larger population of dogs and patient tolerance and safety when administered with NSAIDs or other medications long term.

Mobility, functionality and functional mobility: A review and application for canine veterinary patients

Mobility is an essential aspect of a dog's daily life. It is defined as the ability to move freely and easily and deviations from an animals' normal mobility capabilities are often an indicator of disease, injury or pain. When a dog's mobility is compromised, often functionality (ability to perform activities of daily living [ADL]), is also impeded, which can diminish an animal's quality of life. Given this, it is necessary to understand the extent to which conditions impact a dog's physiological ability to move around their environment to carry out ADL, a concept termed functional mobility. In contrast to human medicine, validated measures of canine functional mobility are currently limited. The aim of this review is to summarise the extent to which canine mobility and functionality are associated with various diseases and how mobility and functional mobility are currently assessed within veterinary medicine. Future work should focus on developing a standardised method of assessing functional mobility in dogs, which can contextualise how a wide range of conditions impact a dog's daily life. However, for a true functional mobility assessment to be developed, a greater understanding of what activities dogs do on a daily basis and movements underpinning these activities must first be established.

Ursolic Acid Induces Beneficial Changes in Skeletal Muscle mRNA Expression and Increases Exercise Participation and Performance in Dogs with Age-Related Muscle Atrophy

Muscle atrophy and weakness are prevalent and debilitating conditions in dogs that cannot be reliably prevented or treated by current approaches. In non-canine species, the natural dietary compound ursolic acid inhibits molecular mechanisms of muscle atrophy, leading to improvements in muscle health. To begin to translate ursolic acid to canine health, we developed a novel ursolic acid dietary supplement for dogs and confirmed its safety and tolerability in dogs. We then conducted a randomized, placebo-controlled, proof-of-concept efficacy study in older beagles with age-related muscle atrophy, also known as sarcopenia. Animals received placebo or ursolic acid dietary supplements once a day for 60 days. To assess the study's primary outcome, we biopsied the quadriceps muscle and quantified atrophy-associated mRNA expression. Additionally, to determine whether the molecular effects of ursolic acid might have functional correlates consistent with improvements in muscle health, we assessed secondary outcomes of exercise participation and T-maze performance. Importantly, in canine skeletal muscle, ursolic acid inhibited numerous mRNA expression changes that are known to promote muscle atrophy and weakness. Furthermore, ursolic acid significantly improved exercise participation and T-maze performance. These findings identify ursolic acid as a natural dietary compound that inhibits molecular mechanisms of muscle atrophy and improves functional performance in dogs.

External mechanical perturbations challenge postural stability in dogs

This study aimed to explore the effect of external mechanical perturbations on postural stability (PS) in dogs using the body center of pressure (COP). Thirteen sound adult dogs were included in this study. PS was tested during quiet standing on a pressure measurement plate. The conditions included a standard standing measurement and external mechanical perturbations conducted using six settings on a motorized training platform with different intensities of speed and amplitude. Measurement conditions were compared using linear mixed-effects models, followed by multiple comparisons using Sidak's alpha correction procedure. Compared with the standing measurement, external mechanical perturbations resulted in a significant increase in almost all COP parameters, indicating a challenge for the PS. Furthermore, an increase in amplitude had a greater effect than an increase in speed, whereas the combination of the highest intensities of amplitude and speed was not well tolerated by the dogs. The mediolateral COP displacement was significantly greater than the craniocaudal COP displacement during standing measurement and conditions with a small amplitude, whereas no significant difference was observed during settings with an increased amplitude. To the best of our knowledge, this is the first study to demonstrate the effects of a balance training device in dogs. Therefore, the intensity of the training programs on motorized platforms or similar devices can be controlled by the wobbling amplitude of the platform.

Functional measurement of canine muscular fitness: refinement and reliability of the Penn Vet Working Dog Center Sprint Test

Working, sporting, and companion dogs require muscular fitness to perform their daily tasks, competitive activities, and operational functions effectively and with a low risk of injury. There are currently no methods to measure the muscular fitness of dogs who are not debilitated. Sprint performance is highly correlated with muscular fitness in humans, and various sprint assessments are used to measure performance for sporting and tactical athletes. The Penn Vet Working Dog Center Sprint Test (ST) is a 25 m maximal effort sprint from a down position and was developed to be a low-cost measure of muscular fitness suitable for field use. The purpose of this project was to describe the refinements to the ST, detail the performance and measurement protocol, evaluate the measurement inter-rater and intra-rater reliability, characterize the acceleration profile, and explore the inter-day reliability. Both naïve and experienced raters demonstrated excellent intra-rater and inter-rater reliability. The acceleration profile of the dogs in this study was similar to that of average adult human sprinters and demonstrated the role of muscular fitness in performance over this short distance. Finally, a small group of dogs showed moderate inter-day reliability and provided initial performance data to inform future studies. The ST appears to be a reliable measure of canine muscular fitness and could be used to assess performance in healthy dogs and guide the return to sport or work of debilitated dogs.

Use of Rehabilitation Therapy in Palliative Care Patients

Palliative care is a unique area of veterinary medicine, where primary goals include maintaining quality of life, as opposed to treating with a curative intent. Using the disablement model and client partnership allows for the development of a function-targeted treatment plan individualized to patient and family needs. Rehabilitation modalities, especially when combined with adaptive pain management, are well-suited to palliative care because they can greatly enhance a patient's ability to achieve improved function and quality of life. These areas join in a concept called palliative rehabilitation which combines the unique needs of these patients and the tools accessible to the rehabilitation practitioner.

Rehabilitation to Return-to-Work for Working Dogs

This article highlights the differences between working dog careers, unique protocols associated with health care of a working dog and provides a practical guide to creating and managing a return-to-work program. The rehabilitative approach to a working dog consists of four distinct sequential phases: activity restriction, rehabilitation, return-to-work, and maintenance. The timeline through each phase is dependent on the degree of injury, treatment intervention, prior health status of the dog, and compliance of the handler. Return-to-work for a working dog is considered a success if the dog can perform all career-related activities safely and proficiently.

Physical Rehabilitation in Zoological Companion Animals

Animal physical rehabilitation is one of the fast-growing fields in veterinary medicine in recent years. It has become increasingly common in small animal practice and will continue to emerge as an essential aspect of veterinary medicine that plays a vital role in the care of animals with physical impairments or disabilities from surgery, injuries, or diseases.1 This is true now more than ever because of the increasing advances in lifesaving treatments, the increased lifespan of companion animals, and the growth of chronic conditions, of which many are associated with movement disorders. The American Association of Rehabilitation Veterinarians (AARV) defines APR as "the diagnosis and management of patients with painful or functionally limiting conditions, particularly those with injury or illness related to the neurologic and musculoskeletal systems." Rehabilitation not only focuses on recovery after surgical procedures but also on improving the function and quality of life in animals suffering from debilitating diseases such as arthritis or neurologic disorders. The overall goal of APR is to decrease pain, reduce edema, promote tissue healing, restore gait and mobility to its prior activity level, regain strength, prevent further injury, and promote optimal quality of life. Typically, a multimodal approach with pharmaceutical and nonpharmaceutical interventions is used by APR therapists to manage patients during their recovery. The purpose of this article aims to provide knowledge and guidance on physical rehabilitation to help veterinarians in the proper return of their patients with ZCA safely after injury and/or surgery.