Postoperative rehab of a Hemilaminectomy

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Post-operative rehab of a Hemilaminectomy

• Kim Knap

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History

• Trevor
• Presented to the U of I VTH after becoming
  acutely paralyzed.
• He was non-ambulatory paraparetic
• Emergency surgery was performed to decompress the
  spinal cord.

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Rehabilitation evaluation Problems

• Unable to stand or ambulate
• Had lost motor function
• Weakness, discomfort
• Unable to control urination

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Rehab evaluation

• Neurologic Deficits were
• The lower reflexes of the hind legs were normal
• Did have pain sensation
• Did not have voluntary motor function
• Had negative conscious proprioception of the hind
  legs.

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Rehab plan Day 0-3

• (Four times a day)
• Passive range of motion
• massage
• Assisted standing and balancing exercises
• cold therapy

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Rehab plan Day 3 to release

• Once the incision was healed, and Trevor was more
  comfortable, we got more aggressive with rehab.
• Our goal was to improve comfort, balance, and
  function.

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Day 3-Day 10

• Rehab Regime 3 times a day
• PROM
• Massage
• Assisted standing 2 min
• Balancing exercises 5 min
• Underwater treadmill 10-18 min.

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Results

• By Day 4
• Trevor had
• regained motor function
• could urinate own
• able to stand and ambulate with support
• Pain was easily controlled with mild pain
  medication

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Results

• By Day 10
• Trevor had
• Could walk-ataxic (ambulatory paraparetic)
• Could urinate own
• Was able to return home with home exercises

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Plan-Home exerecises

• Go home exercises (twice each day)
• Passive range of motion (PROM) to all joints of
  the affected legs. 10 repetitions to each joint.
  
• Massage the hind limbs for 5 minutes each.
• Balancing exercises, Stand the dog up and gently
  shift his weight from side to side for 5 minutes.
• 5 assisted stand exercises
• Short controlled leash walks, with sling support,
  increasing to 15 minutes/walk. During these
  walks, you may
• Walk very slowly to encourage proper limb usage.
• You may add large circles and weaves to encourage
  balance awareness.
• Be sure to walk her on a non slippery surface.
• Swimming and water walking once each day for up
  to 15 minutes.

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Final Results

• At 6 week recheck
• CP was normal
• Muscle mass was normal
• He could walk well and was no longer ataxic
• He was released to all normal activities.