Medical records of sixty cats admitted to the physiotherapy center with a spinal cord injury were retrospectively reviewed. Twenty-nine cats met the inclusion criteria and were enrolled in the study (Fig 1). Seven cats were included in the control group.
Data regarding signalment, type of lesion, neurologic signs, delay in the onset of physiotherapy and duration of the rehabilitation program are detailed in Table 1.
All patients received physical therapy for a minimum of 15 days. Follow-up data obtained from recorded neurological examinations at 45 and 90 days were available for 19 (66%) and 8 (27%) cats, respectively (Tab.2).
PP Group
Seven cats (24%) had pelvic limb PP at the time of presentation and during the whole treatment. All of them recovered motor function at the end of the rehabilitation program (100%). Pelvic limb PP was significantly associated with functional recovery of voluntary locomotion (p=0.01) and voluntary micturition (p= 0.00006).
At the time of the first examination, five cats (71%) showed a non-ambulatory paraparesis while the other two (29%) had ambulatory paraparesis. Micturition dysfunction affected three cats (43%) and, at the end of the treatment, two of them (67%) recovered voluntary micturition.
Spinal trauma was reported in five patients (71%) while the other two cats were affected by disc herniation (29%). Two cats (29%) had full-time hospitalization. Surgery, aimed to the stabilization of the spine after the trauma, was performed in two cases (29%). The time between the onset of clinical signs and the beginning of rehabilitation ranged from 3 to 271 days with a median of 44 days. The median duration of physiotherapy treatment was 58 days (range 19-206) (Tab.3).
NoPP Group
Twenty-two cats (76%) had absence of pelvic limb PP at the time of initial presentation and during the whole treatment. On admission, all patients were paraplegic and, at that time, eight cats (36%) already showed the presence of some involuntary movements. Incompetent bladder was present in all cats and partial reflex bladder emptying was reported in three of them (14%). At the end of rehabilitation treatment, the acquisition of autonomous spinal locomotion (SW) was achieved in ten cats (45%), while none of the patients regained a voluntary micturition.
Sixteen cats (73%) were affected by spinal trauma (vertebral fracture/luxation). Three cats (14%) had an acute disc herniation and three (14%) a contusive/hemorrhagic lesion of the spinal cord. Fifteen patients (68%) were hospitalized and surgery, aimed to stabilization of the spine, was performed in eight cats (36%). Delay in the onset of physical therapy ranged from 5 to 900 days and the median value was 20 days. The median duration of the rehabilitation program was 46 days (range 15-302 days). Crossed extensor reflex was observed in sixteen cats (73%) soon after the beginning of the physiotherapy.
Clinical and follow-up data of the NoPP-group cats, expressed according to the acquisition/no acquisition of SW, are detailed in Tables 4 and 5, respectively.
No SW cats
At the end of the rehabilitation program, of the 22 cats of the NoPP group, twelve (55%) did not develop an autonomous spinal locomotion. On admission, crossed extensor reflex was observed in 6 cats (50%). Detailed data are shown in tables 4 and 5.
SW cats
At the end of the treatment, of the 22 cats of the NoPP group, ten cats (45%) developed autonomous spinal locomotion (SW). (tables 4 and 5).
At 15 days, three cats achieved SW and were discharged. At 45 days, five further cats achieved autonomous spinal locomotion. Five cats underwent physical therapy for 90 days and three of them (60%) acquired autonomous spinal locomotion at the end of the rehabilitation period.
On admission, crossed extensor reflex was observed in eight cats (80%) and resulted significantly associated with the acquisition of SW (p= 0.008).
Improvement in assisted walking/UWTM was found to be significantly associated with higher possibility to achieve SW at the end of the treatment (p=0.04).
There was no significant association between the duration of the rehabilitation program and the acquisition of SW.
Breed, sex, age, BCS, type of lesion, full-time hospitalization, surgical treatment and presence of voluntary micturition at the time of presentation were not found to be correlated with the acquisition of SW.
Control Group
The control group included seven cats. Absence of pelvic limb PP was observed in four patients (57%). Four cats (57%) were affected by spinal trauma, while disc herniation and contusive/hemorrhagic lesions were reported, respectively, in one (14%) and two (29%) cats. At the time of presentation, six patients (86%) were paraplegic whilst another one (14%) showed non-ambulatory paraparesis. Incompetent bladder was reported in six cats (86%). None of the cats regained voluntary micturition or ambulatory condition after at home exercises.
When comparing cats that underwent the rehabilitation program and the control group, accomplishment of an intensive rehabilitation program was significantly associated with a higher possibility to regain functional locomotion (p= 0.005). Recovery of voluntary micturition did not show significant differences among the control group and the cats that underwent physical therapy.