PHYSIOTHERAPY | REHABILITATION | HYDROTHERAPY
VESTIBULAR DISEASE
In memories of all immobile dogs that were not given a second chance
What is Vestibular Disease?
The vestibular system is what gives most mammals balance and a sense of spatial orientation. Vestibular disease affects the body’s balance systems. There is a peripheral form of the disease arising from outside the central nervous system which is caused by disorders affecting the inner ear.
Central vestibular disease, which is a much less common and more serious form of the condition, originates inside the central nervous system. Peripheral vestibular disease occurs when there’s irritation to the nerves connecting the inner ear with the brain.The result is a loss of balance and other symptoms resulting from vertigo and dizziness. Peripheral vestibular disease can look and feel pretty dramatic to the dog owner, especially the first time it occurs. But fortunately, most cases improve quickly with supportive care and treatment, and of course addressing any underlying cause for the condition.
References
Darryl L. Millis, MS, DVM, DACVS, DACVSMR, CCRP
Professor of Orthopedic Surgery & Director of Surgical Service
Robin Downing, DVM, MS, DAAPM, DACVSMR, CVPP, CCRP
Diplomate of the American Academy of Pain Management, is a a founder and past-president of the International Veterinary Academy of Pain Management.
Janet B. Van Dyke, DVM
Diplomate American College of Veterinary Sports Medicine and Rehabilitation, CCRT, CEO
Ludovica Dragone, DVM, CCRP
Vice President of VEPRA, Veterinary European of Physical Therapy and Rehabilitation Association.
Andrea L. Henderson, DVM, CCRT, CCRP
Resident, Canine Sports Medicine and Rehabilitation
Steven M.Fox, MS, DVM, MBA, PhD
President Securos. Inc
What causes Vestibular Disease in Dogs and are there certain breeds at risk?
The peripheral form of vestibular disease is much more common than the central form. Causes of the condition can include chronic and recurrent inner and middle ear infections, overzealous cleaning of the ears resulting in a perforated eardrum, trauma from head injury, stroke, tumors, polyps, meningoencephalitis, hypothyroidism, as well as certain drugs like the aminoglycoside antibiotics, including drugs like amikacin, gentamicin, neomycin, and tobramycin.
Loop diuretics and also certain ear cleaners that should not be used with ruptured eardrums but accidentally are used can all result in the condition. All of these things can irritate or damage the nerves of the inner ear and cause inflammation.
The disease can be present from birth as a congenital defect. It can also be idiopathic, meaning we haven’t identified a root cause in elderly dogs. An infection of the middle ear is hands down the most common reason the disease occurs in younger dogs. In older dogs, we have to consider a brain tumor as a potential cause of the syndrome.
Causes of central vestibular disease (the less common form) include inflammatory disease, infection, trauma or bleeding in the brain, loss of blood flow, and cancer.
Congenital vestibular disease is usually seen between birth and three months of age. Breeds predisposed to this condition include the German shepherd, Doberman pinscher, Akita, English cocker spaniel, beagle, smooth fox terrier, and the Tibetan terrier.
Signs and Symptoms of Vestibular Disease in Dogs
Signs of vestibular disease include head tilting, loss of coordination, circling and stumbling, staggering, falling and rolling, as well as involuntary, rhythmic, jerking eye movements from side to side or up and down. The abnormal eye movement is called nystagmus.
Dizziness and loss of balance can cause excessive drooling, nausea and vomiting. If the disease affects only one ear, head tilting and circling will be in the direction of the affected ear. If only one side of the head is involved, only the eye on that side may develop nystagmus.
Vestibular disease in geriatric dogs is often mistaken for stroke. The vertigo caused by the disease can be particularly intense in older dogs with symptoms of nausea, difficulty or complete inability to stand up, head tilt, nystagmus, and circling.
The disease in geriatric dogs can make eating and drinking or even going outside to potty very difficult or even impossible. Supportive therapy is often needed in the form of IV fluids and supplemental nutrition.
Many older dogs are really stressed by episodes of vestibular disorder, so natural calming agents like the amino acid L-theanine, as well as herbs such as passionflower, hops, skullcap, valerian, and chamomile can be given to senior dogs to help them cope.
Other remedies such as tryptophan, GABA, flower essences, and homeopathics can also be very beneficial in calming overwhelmed dogs.
Vestibular Disease – The importance of a proper diagnosis process
A physical examination including a neurological assessment will determine if the vestibular disease is peripheral or central. If the much more common peripheral form of the condition is identified, an otoscope will be used to look deep into your pet’s ear. Sometimes X-rays are needed. Blood tests, culture and sensitivity, and cytology are all required to help eliminate other potential causes of specific symptoms.
Your vet may recommend a surgical biopsy for tumors and polyps that are found. If the condition is determined to be central vestibular disease, usually an MRI or CT scan, as well as spinal fluid taps, may be needed to identify the root cause. Obviously, if infection is the root cause, it must be resolved.
The importance of Rehabilitation and Physiotherapy for Dogs with Vestibular Disease
Rehabilitation has an important role to play when caring for a pet affected by vestibular disease. Our rehabilitation practitioner initially undertakes a thorough assessment of your dog and then formulates treatment aims and goals which is compiled into a rehabilitation treatment plan uniquely designed for your dog. The degree to which an individual is affected can vary from patient to patient, possible aims and treatment options are listed below. It is essential than on going evaluation and adjustment of the care program takes place.
Rehabilitation Aims
In the initial days following diagnosis of vestibular disease:
- Provide supportive management of postures and transferring from one position to another
- Increase sensation and awareness of body position
- Maintain soft tissue flexibility
Following on from this and depending on your pet’s progress, the aims might include:
- Improve core stability
- Further raise awareness of body position and posture and posture
- Advance functional transfers of weight
- Facilitate supportive gait patterns
Once good recovery is established further aims are defined:
- Continue to strengthen core muscles
- Further enhance gait patterns including pace
- Enhance exercise tolerance and cardiovascular fitness
- Return to normal function or how to manage any residual disabilities
Rehabilitation Options
One of the most important element of physiotherapy treatment for pet owners dealing with vestibular diesease in their pets are the the advices that will be given during the initial phase after diagnosis. How you handle your pet, the environment of your pet, exercise restriction and the use of proper braces and supports are essential. All these will be taught during your sessions with us.
For those who are keen to learn, it is important to provide your pet with soft tissue massages and sensory stimulation. In addition, an approporiate series of home performed exercises can be important for your pet. There are specific exercises that can be used to stimulate the body awareness and strengthening of essential muscle groups. Hydrotherapy can be introducted for strengthening, gait re-education, core stability promotion and improving cardiovascular fitness.It is necessary however that your pets home exercise and physiotherapy program is assessed and adjusted frequently to ensure the correct treatment plan and care is being provided. This will be performed throughout your pets hospitalisation (should that be required), or through out outpatient rehabilitation centre here at the hospital.
The following table gives an example of a rehabilitation plan which may be designed in the management of a patient with vestibular disease
| Timeline | Physiotherapy Aims | Rehabilitation Therapy options |
|---|---|---|
| Week 0 to 2 | Management (if at home) including Support posture and transfers |
|
| Increase sensation and awareness of body position |
| |
| Week 2 to 4 | Improve core stability |
|
| Progress awareness of body position, maintaining soft tissue length and flexibility. |
| |
| Maintain soft tissue length and flexibility |
| |
| Management at home |
| |
| Week 4 to 6 | Increase sensation and awareness of body position and improve gait. |
|
| Week 6 to 12 | Increase exercise tolerance |
|
| Continue to increase core stability | Home exercise program considering land and water based exercises | |
| Week 12 onwards | Return to full function or establish deficits and advise regarding long term management. | Progress to off lead exercise and previous exercise level if appropriate. |