Neurorehabilitation in Degenerative Myelopathy: Can Physical Therapy Improve Survival in Dogs?

Degenerative myelopathy (DM) is a progressive spinal cord disease that severely affects mobility and quality of life in aging dogs. As the disease advances, dogs develop proprioceptive ataxia, spastic paraparesis, and eventually paraplegia due to degeneration of spinal cord tracts¹. Because no curative treatment exists, veterinary medicine has increasingly focused on rehabilitation strategies aimed at prolonging mobility and preserving neurological function. 

Recent research suggests that intensive neurorehabilitation may significantly improve both survival time and functional independence in dogs affected by DM¹. 

Understanding the Goals of Rehabilitation 

The primary objective of neurorehabilitation is to stimulate neuroplasticity, the nervous system’s ability to reorganize and adapt after injury or degeneration. In DM, rehabilitation attempts to preserve remaining neural pathways and maintain muscle function despite progressive spinal cord damage¹. 

Locomotor training is one of the most important rehabilitation approaches. Through repetitive task-based exercises, dogs are encouraged to relearn coordinated stepping patterns and maintain muscle strength^2,3. These exercises stimulate sensory receptors and spinal neural circuits responsible for generating rhythmic movement patterns¹. 

Bodyweight-supported treadmill training (BWSTT) is particularly valuable because it reduces stress on weakened limbs while promoting coordinated gait patterns and reducing spasticity (87–89). Underwater treadmill therapy further enhances these benefits by improving range of motion and stimulating the neuromuscular system with reduced joint impact¹. 

Functional Electrical Stimulation and Neural Recovery 

Another key component of neurorehabilitation is functional electrical stimulation (FES). This technique applies low-intensity electrical currents to stimulate motor neurons and induce controlled muscle contractions. Sessions typically use frequencies between 25 and 50 Hz for approximately 15–20 minutes^1,4. 

FES plays an important role in modulating neural circuitry and improving communication between remaining neural pathways. In dogs with DM, where progressive muscle atrophy and connective tissue changes occur over time, electrical stimulation may help preserve muscle mass and delay disuse atrophy during earlier disease stages^1,5,6. 

Researchers have also noted that FES promotes repetitive sensory input and output cycles, which may reduce abnormal synaptic activity and improve motor coordination. These effects are particularly important because DM eventually causes extensive axonal degeneration, astrogliosis, distal axonopathy, and loss of proprioceptive function¹. 

Evidence Supporting Intensive Rehabilitation¹ 

A prospective controlled blinded cohort study conducted between 2015 and 2023 evaluated the effectiveness of intensive neurorehabilitation in dogs with DM. Dogs undergoing intensive protocols demonstrated marked improvement in Open Field Scores (OFS), indicating better ambulatory function over time. 

The rehabilitation protocol included locomotor training, electrical stimulation, underwater treadmill exercises, and home-based proprioceptive activities such as leash walking, cavaletti rails, ramps, stairs, backward treadmill work, and balance exercises. Significant neurological improvement was observed between treatment stages, particularly during the early rehabilitation period (p ≤ 0.001). 

The survival outcomes were equally important. Previous literature reported survival times of approximately 255 days in dogs receiving intensive physiotherapy. In the recent study, dogs undergoing intensive neurorehabilitation combined with stem cell support reached a mean survival time of 438 days, with some dogs surviving beyond two years. 

Long-Term Quality of Life Matters¹ 

Although DM remains a progressive and ultimately fatal disease, rehabilitation appears capable of delaying functional decline and improving quality of life. Many dogs maintained ambulatory ability for extended periods when consistent therapy and home exercise programs were continued. 

The study authors emphasized that rehabilitation should begin as early as possible, before advanced neurodegeneration and severe muscle wasting occur. Early intervention may maximize the potential for neuroplasticity and preserve remaining spinal cord function. 

The disease process itself involves significant astrogliosis, degeneration of dorsal spinocerebellar tracts, and progressive loss of proprioception, which explains why continuous locomotor and kinesiotherapy exercises remain essential even after discharge. Home exercise programs performed multiple times daily may therefore contribute to maintaining neurological stimulation and delaying progression. 

Conclusion 

Neurorehabilitation is becoming an increasingly important component in the management of degenerative myelopathy. While it may not stop the disease entirely, intensive rehabilitation strategies such as locomotor training, underwater treadmill therapy, and functional electrical stimulation can meaningfully improve mobility, coordination, and survival time. As research continues to evolve, early and structured rehabilitation may offer dogs with DM a better quality of life, greater independence, and more valuable time with their families. 

 Reference 

1. Gouveia D, Correia J, Cardoso A, Carvalho C, Oliveira AC, Almeida A, Gamboa Ó, Ribeiro L, Branquinho M, Sousa A, Lopes B. Intensive neurorehabilitation and allogeneic stem cells transplantation in canine degenerative myelopathy. Frontiers in Veterinary Science. 2023 Jul 13;10:1192744. https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2023.1192744/pdf 

2. Martins Â, Gouveia D, Cardoso A, Carvalho C, Coelho T, Silva C, Viegas I, Gamboa Ó, Ferreira A. A controlled clinical study of intensive neurorehabilitation in post-surgical dogs with severe acute intervertebral disc extrusion. Animals. 2021 Oct 22;11(11):3034. https://www.mdpi.com/2076-2615/11/11/3034 

3. Gouveia D, Cardoso A, Carvalho C, Almeida A, Gamboa Ó, Ferreira A, Martins Â. Approach to small animal neurorehabilitation by locomotor training: an update. Animals. 2022 Dec 18;12(24):3582. https://www.mdpi.com/2076-2615/12/24/3582 

4. Martins Â, Gouveia D, Cardoso A, Carvalho C, Coelho T, Silva C, Viegas I, Gamboa Ó, Ferreira A. A controlled clinical study of intensive neurorehabilitation in post-surgical dogs with severe acute intervertebral disc extrusion. Animals. 2021 Oct 22;11(11):3034. https://www.mdpi.com/2076-2615/11/11/3034 

5. Shinozaki M, Nagoshi N, Nakamura M, Okano H. Mechanisms of stem cell therapy in spinal cord injuries. Cells. 2021 Oct 6;10(10):2676. https://www.mdpi.com/2073-4409/10/10/2676 

6. Kowal JB, Verga SA, Pandeya SR, Cochran RJ, Sabol JC, Rutkove SB, Coates JR. Electrical impedance myography in dogs with degenerative myelopathy. Frontiers in Veterinary Science. 2022 May 27;9:874277. https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2022.874277/pdf