{"paper_id":"08216cc5-8cb4-4225-bf01-922af9562ee2","body_text":"Physiotherapy Enhances Gait Stability in a Forelimb-Amputated Dog Undergoing Postoperative Radiotherapy: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Physiotherapy Enhances Gait Stability in a Forelimb-Amputated Dog Undergoing Postoperative Radiotherapy: a case report Kazuyuki Yoshikawa, Harumi Sawada, Atsushi Fujita, Eri Fukazawa, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6380848/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Oct, 2025 Read the published version in BMC Veterinary Research → Version 1 posted 14 You are reading this latest preprint version Abstract Background: Limb amputation is a standard surgical procedure in dogs for the management of limb tumors such as osteosarcoma, soft tissue sarcoma, and malignant peripheral nerve sheath tumors. While many dogs adapt functionally to limb loss, altered biomechanics, compensatory strain on remaining limbs, and impaired mobility can negatively impact their quality of life. Physiotherapy is recommended to facilitate post-amputation recovery; however, objective data on its effectiveness in dogs remain limited. Furthermore, when radiotherapy is required postoperatively, the necessary daily anaesthesia and cage rest can exacerbate functional decline due to restricted activity. The impact of physiotherapy on gait function in a forelimb-amputee dog undergoing concurrent radiotherapy is described in this report. Case presentation: A 14-year-old neutered male Toy Manchester Terrier underwent left forelimb amputation following the diagnosis of a malignant peripheral nerve sheath tumor at the C6–T1 spinal level. One month postoperatively, the dog began a three-week course of radiotherapy that required daily anaesthesia and prolonged cage rest, raising concerns about mobility deterioration. To mitigate these effects, a structured physiotherapy program was implemented. The program consisted of daily 30-minute sessions focusing on range of motion exercises, balance and proprioception training, weave pole exercises, and cavaletti rail walking. Gait analysis was performed on the first and last days of the physiotherapy program (pre- and post-physiotherapy) using a two-dimensional kinematic system. After three weeks of physiotherapy, a significant reduction in vertical head movement was observed (48.3 cm to 34.5 cm, p < 0.05), indicating improved gait stability. Additionally, shoulder and elbow extension increased during the loading response phase, which is crucial for weight-bearing and locomotor efficiency. Conclusions: This case provides objective evidence supporting the potential benefits of physiotherapy in enhancing gait function and stability in dogs following a forelimb amputation, even when physical activity is restricted due to radiotherapy-related hospitalization. The findings suggest that integrating physiotherapy into post-amputation care may mitigate functional decline associated with prolonged cage rest and optimize recovery. Further studies are needed to investigate the long-term benefits of physiotherapy and effects of physiotherapy on compensatory musculoskeletal adaptations in amputee dogs. Canine Forelimb amputation Gait kinematics Physiotherapy Radiotherapy Functional recovery Figures Figure 1 Figure 2 Figure 3 Background Limb amputation is a standard surgical procedure in dogs for treating malignant limb tumors including osteosarcoma, soft tissue sarcoma, and malignant peripheral nerve sheath tumor (MPNST) [ 1 – 3 ]. Although dogs often adapt to limb loss, optimizing post-operative functional recovery while minimizing compensatory strain on the remaining limbs remains a significant clinical challenge. Multiple studies have shown positive owner satisfaction when limb amputation is performed in canine patients [ 1 , 2 , 4 ]. However, it was also found in those studies that owners observe negative changes in their dogs' mobility, behavior, and quality of life. Furthermore, kinetic and kinematic analyses have revealed that forelimb amputees experience substantial alterations in gait patterns and postural biomechanics, often resulting in asymmetric weight distribution and increased mechanical load on the contralateral limb [ 5 , 6 ]. Physiotherapy has been proposed as a potential modality to address these challenges [ 7 ], but objective data supporting its efficacy in canine forelimb amputees are scarce. Kinematic gait analysis provides precise information for quantitative assessments of locomotion, enabling objective evaluation of rehabilitation interventions [ 8 ]. The purpose of this case report is to document the effectiveness of a three-week structured physiotherapy program, conducted on weekdays, in a dog that underwent left forelimb amputation and concurrent radiotherapy. Given that daily anaesthesia and prolonged cage rest during radiotherapy posed a risk of functional decline due to restricted mobility, physiotherapy was initiated to mitigate these effects and enhance post-amputation gait function. The impact of physiotherapy was objectively evaluated using two-dimensional kinematic gait analysis for assessing changes in gait stability and joint kinematics. Case presentation A 14-year-old neutered male Toy Manchester Terrier presented to his primary care veterinarian with intermittent non-weight bearing of the left forelimb. Magnetic resonance imaging (MRI) was performed and it revealed enlargement of the left eighth cervical spinal nerve. For further evaluation, the dog was referred to our hospital, where a spinal tumor at the left C6-T1 levels was diagnosed. Considering the tumor's location and progression, left forelimb amputation was performed. The surgery proceeded without intraoperative complications, and histopathological examination confirmed a malignant peripheral nerve sheath tumor (MPNST). One month after surgery, to address potential residual tumor cells, a three-week course of radiotherapy was administered on weekdays. For each radiotherapy session, general anesthesia was induced via intravenous administration of propofol (Propofol Intravenous Injection 1%; Maruishi Pharmaceutical Co., Ltd., Japan) at a dose of 5–9 mg/kg body weight, followed by endotracheal intubation. Anesthesia was subsequently maintained with sevoflurane inhalation in an oxygen–air mixture. The depth of anesthesia was continuously adjusted as needed to ensure immobility and patient safety. No anesthesia-related complications were observed throughout the treatment period. As the dog was confined to cage rest during this period, concerns were raised about functional decline due to decreased physical activity. To prevent this decline and promote further functional improvement, a physiotherapy program was initiated. Physiotherapy intervention (Fig. 1) Physiotherapy sessions were conducted once daily for 30 minutes with focus on the following interventions. A) Range of Motion (ROM) Exercises : Passive ROM exercises were performed on the remaining forelimb and both hind limbs to maintain joint flexibility and prevent contractures. B) Balance and Proprioception Training : Static and dynamic exercises on balance discs and wobble boards were performed to improve proprioception and reduce compensatory weight shifting. C) Weave Pole Exercises : This exercise involved consciously incorporating irregular walking patterns by having the dog walk through poles arranged in a zigzag pattern, which helped to improve balance and enhance coordination. D) Cavaletti Rail Walking : This exercise involved stepping over obstacles to improve limb awareness and proprioception, promoting greater joint range of motion and strengthening the remaining limbs by encouraging active flexion and extension movements. Recording methods Video recordings focusing on the sagittal plane were obtained during overground walking at a comfortable speed for the dog. After the dog had become habituated to walking straight on the mat, data for 10 valid gait cycles were acquired. The gait cycle was defined as the period from the right forelimb making contact with the floor until the next contact of the right forelimb. Forelimb joint angles and head movements were assessed using a two-dimensional motion analysis system (ICpro-2D, Hutech Co., Ltd, Tokyo, Japan, 60 Hz). Color markers were attached to anatomical landmarks of the forelimb and head (Fig. 2). The anatomical landmarks included the caudal side of the nasion, the dorsal end of the scapular spine, the greater tubercle of the humerus, the lateral epicondyle of the humerus, the styloid process of the ulna, and the head of the fifth metacarpal bone. Forelimb joint angles were calculated by defining the angles between adjacent segments. All video images were analyzed frame by frame by a single observer. Each joint angle obtained during a gait cycle was normalized to 100 time frames [9]. After normalization, the joint angles were averaged across cycles. The maximum extension and flexion angles of the shoulder, elbow, and carpal joints, as well as the vertical head movement—measured as the peak-to-peak vertical displacement of the head during gait cycles—were compared between the first day (pre-physiotherapy) and the last day (post-physiotherapy) using the Wilcoxon signed-rank test (p < 0.05) with R version 3.6.1 software (R Foundation for Statistical Computing, Vienna, Austria). Outcome A significant reduction in vertical head movement was observed post-physiotherapy, with the mean value decreasing from 48.3 cm (± 11.9 cm) pre-physiotherapy to 34.5 cm (± 9.5 cm) post-physiotherapy (p < 0.05) (Table. 1). Table.1. Comparison of Vertical head movement and forelimb joint angles pre- and post-physiotherapy pre-physiotherapy post-physiotherapy Vertical head movement 48.3 ± 11.9* 34.5 ± 9.5* Shoulder joint Maximum Extension 133.2 ± 4.7* 152.2 ± 4.8* Maximum Flexion 101.1 ± 3.0* 125.5 ± 4.6* Elbow joint Maximum Extension 142.3 ± 8.6* 154.3 ± 6.0* Maximum Flexion 95.6 ± 15.2* 104.0 ± 5.8* Carpal joint Maximum Extension 199.9 ± 8.0 207.0 ± 9.3 Maximum Flexion 92.0 ± 11.3* 111.5 ± 8.4* Values are presented as means ± standard deviation (SD). Vertical head movement is expressed in centimeters (cm) and joint angles are expressed in degrees (°). Maximum extension and flexion angles of the forelimb joints as well as vertical head movement are shown for both pre- and post-physiotherapy conditions. *Indicates a statistically significant difference between pre- and post-physiotherapy values (p < 0.05). Values are presented as means ± standard deviation (SD). Vertical head movement is expressed in centimeters (cm) and joint angles are expressed in degrees (°). Maximum extension and flexion angles of the forelimb joints as well as vertical head movement are shown for both pre- and post-physiotherapy conditions. *Indicates a statistically significant difference between pre- and post-physiotherapy values (p < 0.05). For joint angles, notable differences were observed between pre- and post-physiotherapy conditions (Table. 1). In the shoulder joint, the maximum extension increased from 133.2° (± 4.7°) to 152.2° (± 4.8°) (p < 0.05) and the maximum flexion angle also increased from 101.1° (± 3.0°) to 125.5° (± 4.6°), indicating a reduction in flexion range (p < 0.05). In the elbow joint, the maximum extension angle improved from 142.3° (± 8.6°) to 154.3° (± 6.0°) (p < 0.05) and the maximum flexion angle increased from 95.6° (± 15.2°) to 104.0° (± 5.8°), also suggesting decreased flexion (p < 0.05). In the carpal joint, the maximum flexion angle increased significantly from 92.0° (± 11.3°) to 111.5° (± 8.4°), reflecting reduced flexion (p < 0.05). Although there was an increase in the maximum extension angle from 199.9° (± 8.0°) to 207.0° (± 9.3°), this change was not statistically significant (p > 0.05) In the shoulder joint, the post-physiotherapy condition demonstrated improved maintenance of an extended position during gait compared to the pre-physiotherapy condition, as shown in Fig. 3. Additionally, in both the shoulder and elbow joints, the early phase of the gait cycle—immediately after forelimb contact—exhibited a more gradual flexion in the post-physiotherapy condition, whereas a more rapid flexion was observed pre-physiotherapy. In the latter half of the gait cycle, corresponding to the swing phase, flexion decreased across all forelimb joints in the post-physiotherapy condition. Discussion and Conclusions There were two clinically relevant findings in this study: physiotherapy can improve gait in dogs after a forelimb amputation and combining radiotherapy with physiotherapy is beneficial. Firstly, while physiotherapy is recommended as part of the management for amputee cases, there is a paucity of objective data demonstrating its effectiveness in dogs following a forelimb amputation. In this case, significant improvements were observed after the physiotherapy intervention. There was a notable reduction in vertical head movement during walking, indicating enhanced gait stability. Additionally, there was increased maintenance of extension in the shoulder and elbow joints during the loading response phase, which is crucial as this phase corresponds to the peak vertical ground reaction forces [ 10 ]. Furthermore, excessive flexion during the swing phase was reduced. These objective improvements suggest that physiotherapy can effectively enhance gait patterns in canine forelimb amputees. To our knowledge, this is the first report to provide objective evidence of the effectiveness of physiotherapy in such cases. Secondly, the combination of radiotherapy and physiotherapy proved to be beneficial. During the three-week course of radiotherapy, the dog underwent daily anaesthesia and was confined to cage rest, resulting in significantly reduced activity levels compared to home life. Despite these limitations, implementing physiotherapy during hospitalization led to observable improvements in gait. While physiotherapy is commonly employed after conditions like intervertebral disc herniation or orthopedic surgeries, this case demonstrates that even when radiotherapy is the primary treatment modality, adjunct physiotherapy can enhance gait and quality of life. Specifically, the physiotherapy interventions implemented likely contributed to functional improvements through distinct biomechanical mechanisms. A) Range of motion (ROM) exercises helped to maintain and possibly enhance joint flexibility and prevent contractures, which are essential for fluid limb movements and compensatory gait patterns post-amputation [ 7 , 11 ]. B) Balance and proprioception training using balance discs and wobble boards potentially improved neuromuscular control and dynamic stability by enhancing sensory feedback mechanisms, reducing compensatory weight shifting, and facilitating more efficient gait adjustments [ 7 ]. C) Weave pole exercises targeted the dog's coordination and agility, promoting controlled weight shifting and improved lateral stability, which are critical for maintaining balance in gait after limb loss [ 7 ]. D) Cavaletti rail walking may have facilitated functional improvement by enhancing the activation of forelimb extensor muscles and the pectoral girdle muscular sling, particularly the serratus ventralis and rhomboideus muscles. These muscles play a critical role in stabilizing the forelimb and transmitting vertical ground reaction forces from the limb to the trunk during locomotion, thereby contributing to shock absorption upon limb contact [ 12 , 13 ]. Improved function of these muscles may have contributed to the observed reduction in vertical head movement by promoting the maintenance of forelimb extension during the stance phase, ultimately enhancing overall gait stability. Previous studies, such as the study by Kirpensteijn et al., suggested that the adaptation period after amputation is approximately one month [ 1 ]. In this case, physiotherapy was initiated about one month post-amputation. At the onset of physiotherapy, the dog was able to walk without falling; however, significant gait improvements were observed following the three-week physiotherapy intervention. This indicates variability in adaptation periods among individuals and suggests that gait improvements can be achieved through physiotherapy even after the initial adaptation period. Moreover, incorporating physiotherapy—even when it is not the primary treatment focus—can contribute to improved motor function and enhanced quality of life in canine patients. These findings highlight the potential of physiotherapy to enhance gait function in dogs following a forelimb amputation. Additionally, the integration of physiotherapy with radiotherapy may help to mitigate mobility decline associated with prolonged hospitalization and restricted activity. Even when dogs regain the ability to walk after amputation, physiotherapy can further refine gait quality and stability. Moreover, implementing physiotherapy concurrently with specialized treatments such as radiotherapy may optimize overall treatment outcomes. Future research should explore the long-term benefits of physiotherapy in amputee dogs, assess its role in preventing compensatory musculoskeletal strain, and evaluate its effectiveness when combined with other therapeutic modalities. Abbreviations MPNST: Malignant peripheral nerve sheath tumor; MRI : Magnetic resonance imaging; ROM : Range of motion Declarations Ethics approval and consent to participate As this report is a case report, ethical approval was not required. Consent for the use of patient data was obtained at the time of admission to the Japan Small Animal Medical Center. Consent for publication Written informed consent was obtained from the patient's owner for the publication of this report and any accompanying images. Availability of data and materials All data generated or analyzed in this study are presented within this published article. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in commercial or not-for-profit sectors. Authors' contributions Author KY designed the study and wrote the initial draft of the manuscript. Authors HS and AF administered the radiation therapy and performed the surgery, respectively, and contributed to manuscript revision. Author EF served as the attending physician and conducted case examinations. Author KE contributed to manuscript revision. Author AS analyzed the kinematic data and contributed to manuscript revision. Author TK supervised the project and contributed to manuscript revision. All authors contributed to the writing of the manuscript and reviewed and approved the final version. Acknowledgements The authors would like to express their gratitude to the veterinary medical staff and rehabilitation team for their valuable support in the physiotherapy sessions and data collection. We also extend our appreciation to the dog's owners for their cooperation throughout the treatment process. References Kirpensteijn J, Van den Bos R, Endenburg N: Adaptation of dogs to the amputation of a limb and their owners' satisfaction with the procedure . Vet Rec 1999, 144 (5):115-118. Wendland TM, Seguin B, Duerr FM: Prospective evaluation of canine partial limb amputation with socket prostheses . Vet Med Sci 2023, 9 (4):1521-1533. Withrow SJ, Hirsch VM: Owner response to amputation of a pet's leg . Vet Med Small Anim Clin 1979, 74 (3):332, 334. Dickerson VM, Coleman KD, Ogawa M, Saba CF, Cornell KK, Radlinsky MG, Schmiedt CW: Outcomes of dogs undergoing limb amputation, owner satisfaction with limb amputation procedures, and owner perceptions regarding postsurgical adaptation: 64 cases (2005-2012) . J Am Vet Med Assoc 2015, 247 (7):786-792. Jarvis SL, Worley DR, Hogy SM, Hill AE, Haussler KK, Reiser RF: Kinematic and kinetic analysis of dogs during trotting after amputation of a thoracic limb . Am J Vet Res 2013, 74 (9):1155-1163. Cole GL, Millis D: The effect of limb amputation on standing weight distribution in the remaining three limbs in dogs . Vet Comp Orthop Traumatol 2017, 30 (01):59-61. Millis D, Levine D: Canine Rehabilitation and Physical Therapy 2edn. USA: Elsevier Health Sciences; 2014. Gillette RL, Angle TC: Recent developments in canine locomotor analysis: a review . Vet J 2008, 178 (2):165-176. Yoshikawa K, Tsubakishita S, Sano T, Ino T, Miyasaka T, Kitazawa T: Functional assessment of the gluteus medius, cranial part of the biceps femoris, and vastus lateralis in Beagle dogs based on a novel gait phase classification . J Vet Med Sci 2020, advpub . Stark H, Fischer MS, Hunt A, Young F, Quinn R, Andrada E: A three-dimensional musculoskeletal model of the dog . Sci Rep 2021, 11 (1):11335. Millis DL, Ciuperca IA: Evidence for canine rehabilitation and physical therapy . Veterinary Clinics: Small Animal Practice 2015, 45 (1):1-27. Carrier DR, Deban SM, Fischbein T: Locomotor function of the pectoral girdle 'muscular sling' in trotting dogs . J Exp Biol 2006, 209 (Pt 11):2224-2237. Fischer MS, Lilje KE, Lauströer J, Andikfar A: Dogs in motion , 2nd ed edn: VDH Service; 2014. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 21 Oct, 2025 Read the published version in BMC Veterinary Research → Version 1 posted Editorial decision: Revision requested 14 Aug, 2025 Reviews received at journal 12 Aug, 2025 Reviews received at journal 11 Aug, 2025 Reviewers agreed at journal 11 Aug, 2025 Reviews received at journal 30 Jul, 2025 Reviews received at journal 16 Jul, 2025 Reviewers agreed at journal 13 Jul, 2025 Reviewers agreed at journal 12 Jul, 2025 Reviewers agreed at journal 11 Jul, 2025 Editor invited by journal 23 Jun, 2025 Reviewers invited by journal 02 May, 2025 Editor assigned by journal 17 Apr, 2025 Submission checks completed at journal 16 Apr, 2025 First submitted to journal 16 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6380848\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Case Report\",\"associatedPublications\":[],\"authors\":[{\"id\":452253941,\"identity\":\"4b856d05-aac0-4b28-a74c-7854dc42414f\",\"order_by\":0,\"name\":\"Kazuyuki 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08:38:06\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-6380848/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6380848/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s12917-025-05075-2\",\"type\":\"published\",\"date\":\"2025-10-21T16:17:13+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":82352526,\"identity\":\"15c089a0-368e-4724-9482-23c79b4e822c\",\"added_by\":\"auto\",\"created_at\":\"2025-05-09 11:01:56\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":738420,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eKey components of the physiotherapy program: (A) Range of Motion Exercises, (B) Balance and Proprioception Training, (C) Weave Pole Exercises, and (D) Cavaletti Rail Walking.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6380848/v1/9132c4e17a19607739e1e7e9.png\"},{\"id\":82351259,\"identity\":\"21248e7f-954a-4f55-a65e-75f94a35ad93\",\"added_by\":\"auto\",\"created_at\":\"2025-05-09 10:53:59\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":240441,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePlacement of colored markers on anatomical landmarks including the caudal side of the nasion, the dorsal end of the scapular spine, the greater tubercle of the humerus, the lateral epicondyle of the humerus, the styloid process of the ulna, and the head of the fifth metacarpal bone.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6380848/v1/ad2720f7ece726e3b027f227.png\"},{\"id\":82351198,\"identity\":\"bb7b8c8f-1534-4299-9e9d-72533144acf3\",\"added_by\":\"auto\",\"created_at\":\"2025-05-09 10:53:50\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":204233,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eTemporal changes in shoulder, elbow, and tarsal joint angles throughout the gait cycle pre- and post-physiotherapy. Each plot represents the mean (solid line) ± SD. The gray line represents pre-physiotherapy (pre) conditions, and the black line represents post-physiotherapy (post) conditions. The x-axis indicates the percentage of the gait cycle, where 0% corresponds to the initial contact of the right forelimb and 100% represents the subsequent contact of the same forelimb. The y-axis represents joint angles in degrees, illustrating variations over time during gait progression. Changes in joint kinematics following physiotherapy intervention highlight alterations in range of motion and temporal coordination across the gait cycle.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6380848/v1/fc0484b7eaa3d07812421ca9.png\"},{\"id\":94490273,\"identity\":\"ca6232e6-6386-4e48-bbc1-8784a616303b\",\"added_by\":\"auto\",\"created_at\":\"2025-10-27 17:08:49\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":2461662,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6380848/v1/44aee68a-d6ee-4fe1-925c-b34c876d7ce3.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Physiotherapy Enhances Gait Stability in a Forelimb-Amputated Dog Undergoing Postoperative Radiotherapy: a case report\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eLimb amputation is a standard surgical procedure in dogs for treating malignant limb tumors including osteosarcoma, soft tissue sarcoma, and malignant peripheral nerve sheath tumor (MPNST) [\\u003cspan additionalcitationids=\\\"CR2\\\" citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. Although dogs often adapt to limb loss, optimizing post-operative functional recovery while minimizing compensatory strain on the remaining limbs remains a significant clinical challenge.\\u003c/p\\u003e \\u003cp\\u003eMultiple studies have shown positive owner satisfaction when limb amputation is performed in canine patients [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. However, it was also found in those studies that owners observe negative changes in their dogs' mobility, behavior, and quality of life. Furthermore, kinetic and kinematic analyses have revealed that forelimb amputees experience substantial alterations in gait patterns and postural biomechanics, often resulting in asymmetric weight distribution and increased mechanical load on the contralateral limb [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003ePhysiotherapy has been proposed as a potential modality to address these challenges [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e], but objective data supporting its efficacy in canine forelimb amputees are scarce. Kinematic gait analysis provides precise information for quantitative assessments of locomotion, enabling objective evaluation of rehabilitation interventions [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe purpose of this case report is to document the effectiveness of a three-week structured physiotherapy program, conducted on weekdays, in a dog that underwent left forelimb amputation and concurrent radiotherapy. Given that daily anaesthesia and prolonged cage rest during radiotherapy posed a risk of functional decline due to restricted mobility, physiotherapy was initiated to mitigate these effects and enhance post-amputation gait function. The impact of physiotherapy was objectively evaluated using two-dimensional kinematic gait analysis for assessing changes in gait stability and joint kinematics.\\u003c/p\\u003e\"},{\"header\":\"Case presentation\",\"content\":\"\\u003cp\\u003eA 14-year-old neutered male Toy Manchester Terrier presented to his primary care veterinarian with intermittent non-weight bearing of the left forelimb. Magnetic resonance imaging (MRI) was performed and it revealed enlargement of the left eighth cervical spinal nerve. For further evaluation, the dog was referred to our hospital, where a spinal tumor at the left C6-T1 levels was diagnosed. Considering the tumor\\u0026apos;s location and progression, left forelimb amputation was performed. The surgery proceeded without intraoperative complications, and histopathological examination confirmed a malignant peripheral nerve sheath tumor (MPNST).\\u003c/p\\u003e\\n\\u003cp\\u003eOne month after surgery, to address potential residual tumor cells, a three-week course of radiotherapy was administered on weekdays. For each radiotherapy session, general anesthesia was induced via intravenous administration of propofol (Propofol Intravenous Injection 1%; Maruishi Pharmaceutical Co., Ltd., Japan) at a dose of 5\\u0026ndash;9 mg/kg body weight, followed by endotracheal intubation. Anesthesia was subsequently maintained with sevoflurane inhalation in an oxygen\\u0026ndash;air mixture. The depth of anesthesia was continuously adjusted as needed to ensure immobility and patient safety. No anesthesia-related complications were observed throughout the treatment period. As the dog was confined to cage rest during this period, concerns were raised about functional decline due to decreased physical activity. To prevent this decline and promote further functional improvement, a physiotherapy program was initiated.\\u003c/p\\u003e\\n\\u003cdiv id=\\\"Sec3\\\"\\u003e\\n \\u003ch2\\u003ePhysiotherapy intervention (Fig. 1)\\u003c/h2\\u003e\\n \\u003cp\\u003ePhysiotherapy sessions were conducted once daily for 30 minutes with focus on the following interventions.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cstrong\\u003eA)\\u0026nbsp;\\u003c/strong\\u003eRange of Motion (ROM) Exercises\\u003c/strong\\u003e: Passive ROM exercises were performed on the remaining forelimb and both hind limbs to maintain joint flexibility and prevent contractures.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cstrong\\u003eB)\\u0026nbsp;\\u003c/strong\\u003eBalance and Proprioception Training\\u003c/strong\\u003e: Static and dynamic exercises on balance discs and wobble boards were performed to improve proprioception and reduce compensatory weight shifting.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cstrong\\u003eC)\\u0026nbsp;\\u003c/strong\\u003eWeave Pole Exercises\\u003c/strong\\u003e: This exercise involved consciously incorporating irregular walking patterns by having the dog walk through poles arranged in a zigzag pattern, which helped to improve balance and enhance coordination.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cstrong\\u003eD)\\u0026nbsp;\\u003c/strong\\u003eCavaletti Rail Walking\\u003c/strong\\u003e: This exercise involved stepping over obstacles to improve limb awareness and proprioception, promoting greater joint range of motion and strengthening the remaining limbs by encouraging active flexion and extension movements.\\u003c/p\\u003e\\n \\u003ch3\\u003eRecording methods\\u003c/h3\\u003e\\n \\u003cp\\u003eVideo recordings focusing on the sagittal plane were obtained during overground walking at a comfortable speed for the dog. After the dog had become habituated to walking straight on the mat, data for 10 valid gait cycles were acquired. The gait cycle was defined as the period from the right forelimb making contact with the floor until the next contact of the right forelimb. Forelimb joint angles and head movements were assessed using a two-dimensional motion analysis system (ICpro-2D, Hutech Co., Ltd, Tokyo, Japan, 60 Hz). Color markers were attached to anatomical landmarks of the forelimb and head (Fig. 2). The anatomical landmarks included the caudal side of the nasion, the dorsal end of the scapular spine, the greater tubercle of the humerus, the lateral epicondyle of the humerus, the styloid process of the ulna, and the head of the fifth metacarpal bone.\\u003c/p\\u003e\\n \\u003cp\\u003eForelimb joint angles were calculated by defining the angles between adjacent segments. All video images were analyzed frame by frame by a single observer. Each joint angle obtained during a gait cycle was normalized to 100 time frames [9]. After normalization, the joint angles were averaged across cycles. The maximum extension and flexion angles of the shoulder, elbow, and carpal joints, as well as the vertical head movement\\u0026mdash;measured as the peak-to-peak vertical displacement of the head during gait cycles\\u0026mdash;were compared between the first day (pre-physiotherapy) and the last day (post-physiotherapy) using the Wilcoxon signed-rank test (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) with R version 3.6.1 software (R Foundation for Statistical Computing, Vienna, Austria).\\u003c/p\\u003e\\n \\u003ch3\\u003eOutcome\\u003c/h3\\u003e\\n \\u003cp\\u003eA significant reduction in vertical head movement was observed post-physiotherapy, with the mean value decreasing from 48.3 cm (\\u0026plusmn;\\u0026thinsp;11.9 cm) pre-physiotherapy to 34.5 cm (\\u0026plusmn;\\u0026thinsp;9.5 cm) post-physiotherapy (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) (Table. 1).\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTable.1.\\u0026nbsp;\\u003c/strong\\u003eComparison of Vertical head movement and forelimb joint angles pre- and post-physiotherapy\\u003c/p\\u003e\\n \\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"455\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 103px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003epre-physiotherapy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003epost-physiotherapy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 103px;\\\"\\u003e\\n \\u003cp\\u003eVertical head\\u003cbr\\u003e\\u0026nbsp;movement\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e48.3 \\u0026plusmn; 11.9*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e34.5 \\u0026plusmn; 9.5*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 103px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 103px;\\\"\\u003e\\n \\u003cp\\u003eShoulder joint\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003eMaximum\\u003cbr\\u003e\\u0026nbsp;Extension\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e133.2 \\u0026plusmn; 4.7*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e152.2 \\u0026plusmn; 4.8*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 103px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003eMaximum\\u003cbr\\u003e\\u0026nbsp;Flexion\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e101.1 \\u0026plusmn; 3.0*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e125.5 \\u0026plusmn; 4.6*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 103px;\\\"\\u003e\\n \\u003cp\\u003eElbow\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003ejoint\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003eMaximum\\u003cbr\\u003e\\u0026nbsp;Extension\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e142.3 \\u0026plusmn; 8.6*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e154.3 \\u0026plusmn; 6.0*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 103px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003eMaximum\\u003cbr\\u003e\\u0026nbsp;Flexion\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e95.6 \\u0026plusmn; 15.2*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e104.0 \\u0026plusmn; 5.8*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 103px;\\\"\\u003e\\n \\u003cp\\u003eCarpal\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003ejoint\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003eMaximum\\u003cbr\\u003e\\u0026nbsp;Extension\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e199.9 \\u0026plusmn; 8.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e207.0 \\u0026plusmn; 9.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 103px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003eMaximum\\u003cbr\\u003e\\u0026nbsp;Flexion\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e92.0 \\u0026plusmn; 11.3*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e111.5 \\u0026plusmn; 8.4*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003c/div\\u003eValues are presented as means \\u0026plusmn; standard deviation (SD). Vertical head movement is expressed in centimeters (cm) and joint angles are expressed in degrees (\\u0026deg;). Maximum extension and flexion angles of the forelimb joints as well as vertical head movement are shown for both pre- and post-physiotherapy conditions. *Indicates a statistically significant difference between pre- and post-physiotherapy values (p \\u0026lt; 0.05).\\u003cp\\u003eValues are presented as means\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation (SD). Vertical head movement is expressed in centimeters (cm) and joint angles are expressed in degrees (\\u0026deg;). Maximum extension and flexion angles of the forelimb joints as well as vertical head movement are shown for both pre- and post-physiotherapy conditions. *Indicates a statistically significant difference between pre- and post-physiotherapy values (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/p\\u003e\\n \\u003cp\\u003eFor joint angles, notable differences were observed between pre- and post-physiotherapy conditions (Table. 1). In the shoulder joint, the maximum extension increased from 133.2\\u0026deg; (\\u0026plusmn;\\u0026thinsp;4.7\\u0026deg;) to 152.2\\u0026deg; (\\u0026plusmn;\\u0026thinsp;4.8\\u0026deg;) (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) and the maximum flexion angle also increased from 101.1\\u0026deg; (\\u0026plusmn;\\u0026thinsp;3.0\\u0026deg;) to 125.5\\u0026deg; (\\u0026plusmn;\\u0026thinsp;4.6\\u0026deg;), indicating a reduction in flexion range (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). In the elbow joint, the maximum extension angle improved from 142.3\\u0026deg; (\\u0026plusmn;\\u0026thinsp;8.6\\u0026deg;) to 154.3\\u0026deg; (\\u0026plusmn;\\u0026thinsp;6.0\\u0026deg;) (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) and the maximum flexion angle increased from 95.6\\u0026deg; (\\u0026plusmn;\\u0026thinsp;15.2\\u0026deg;) to 104.0\\u0026deg; (\\u0026plusmn;\\u0026thinsp;5.8\\u0026deg;), also suggesting decreased flexion (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). In the carpal joint, the maximum flexion angle increased significantly from 92.0\\u0026deg; (\\u0026plusmn;\\u0026thinsp;11.3\\u0026deg;) to 111.5\\u0026deg; (\\u0026plusmn;\\u0026thinsp;8.4\\u0026deg;), reflecting reduced flexion (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Although there was an increase in the maximum extension angle from 199.9\\u0026deg; (\\u0026plusmn;\\u0026thinsp;8.0\\u0026deg;) to 207.0\\u0026deg; (\\u0026plusmn;\\u0026thinsp;9.3\\u0026deg;), this change was not statistically significant (p\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05)\\u003c/p\\u003e\\n \\u003cp\\u003eIn the shoulder joint, the post-physiotherapy condition demonstrated improved maintenance of an extended position during gait compared to the pre-physiotherapy condition, as shown in Fig. 3. Additionally, in both the shoulder and elbow joints, the early phase of the gait cycle\\u0026mdash;immediately after forelimb contact\\u0026mdash;exhibited a more gradual flexion in the post-physiotherapy condition, whereas a more rapid flexion was observed pre-physiotherapy. In the latter half of the gait cycle, corresponding to the swing phase, flexion decreased across all forelimb joints in the post-physiotherapy condition.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003c/div\\u003e\"},{\"header\":\"Discussion and Conclusions\",\"content\":\"\\u003cp\\u003eThere were two clinically relevant findings in this study: physiotherapy can improve gait in dogs after a forelimb amputation and combining radiotherapy with physiotherapy is beneficial.\\u003c/p\\u003e \\u003cp\\u003eFirstly, while physiotherapy is recommended as part of the management for amputee cases, there is a paucity of objective data demonstrating its effectiveness in dogs following a forelimb amputation. In this case, significant improvements were observed after the physiotherapy intervention. There was a notable reduction in vertical head movement during walking, indicating enhanced gait stability. Additionally, there was increased maintenance of extension in the shoulder and elbow joints during the loading response phase, which is crucial as this phase corresponds to the peak vertical ground reaction forces [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. Furthermore, excessive flexion during the swing phase was reduced. These objective improvements suggest that physiotherapy can effectively enhance gait patterns in canine forelimb amputees. To our knowledge, this is the first report to provide objective evidence of the effectiveness of physiotherapy in such cases.\\u003c/p\\u003e \\u003cp\\u003eSecondly, the combination of radiotherapy and physiotherapy proved to be beneficial. During the three-week course of radiotherapy, the dog underwent daily anaesthesia and was confined to cage rest, resulting in significantly reduced activity levels compared to home life. Despite these limitations, implementing physiotherapy during hospitalization led to observable improvements in gait. While physiotherapy is commonly employed after conditions like intervertebral disc herniation or orthopedic surgeries, this case demonstrates that even when radiotherapy is the primary treatment modality, adjunct physiotherapy can enhance gait and quality of life.\\u003c/p\\u003e \\u003cp\\u003eSpecifically, the physiotherapy interventions implemented likely contributed to functional improvements through distinct biomechanical mechanisms. A) Range of motion (ROM) exercises helped to maintain and possibly enhance joint flexibility and prevent contractures, which are essential for fluid limb movements and compensatory gait patterns post-amputation [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. B) Balance and proprioception training using balance discs and wobble boards potentially improved neuromuscular control and dynamic stability by enhancing sensory feedback mechanisms, reducing compensatory weight shifting, and facilitating more efficient gait adjustments [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. C) Weave pole exercises targeted the dog's coordination and agility, promoting controlled weight shifting and improved lateral stability, which are critical for maintaining balance in gait after limb loss [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. D) Cavaletti rail walking may have facilitated functional improvement by enhancing the activation of forelimb extensor muscles and the pectoral girdle muscular sling, particularly the serratus ventralis and rhomboideus muscles. These muscles play a critical role in stabilizing the forelimb and transmitting vertical ground reaction forces from the limb to the trunk during locomotion, thereby contributing to shock absorption upon limb contact [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Improved function of these muscles may have contributed to the observed reduction in vertical head movement by promoting the maintenance of forelimb extension during the stance phase, ultimately enhancing overall gait stability.\\u003c/p\\u003e \\u003cp\\u003ePrevious studies, such as the study by Kirpensteijn et al., suggested that the adaptation period after amputation is approximately one month [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. In this case, physiotherapy was initiated about one month post-amputation. At the onset of physiotherapy, the dog was able to walk without falling; however, significant gait improvements were observed following the three-week physiotherapy intervention. This indicates variability in adaptation periods among individuals and suggests that gait improvements can be achieved through physiotherapy even after the initial adaptation period. Moreover, incorporating physiotherapy\\u0026mdash;even when it is not the primary treatment focus\\u0026mdash;can contribute to improved motor function and enhanced quality of life in canine patients.\\u003c/p\\u003e \\u003cp\\u003eThese findings highlight the potential of physiotherapy to enhance gait function in dogs following a forelimb amputation. Additionally, the integration of physiotherapy with radiotherapy may help to mitigate mobility decline associated with prolonged hospitalization and restricted activity. Even when dogs regain the ability to walk after amputation, physiotherapy can further refine gait quality and stability. Moreover, implementing physiotherapy concurrently with specialized treatments such as radiotherapy may optimize overall treatment outcomes. Future research should explore the long-term benefits of physiotherapy in amputee dogs, assess its role in preventing compensatory musculoskeletal strain, and evaluate its effectiveness when combined with other therapeutic modalities.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eMPNST: Malignant peripheral nerve sheath tumor; \\u003cstrong\\u003eMRI\\u003c/strong\\u003e: Magnetic resonance imaging; \\u003cstrong\\u003eROM\\u003c/strong\\u003e: Range of motion\\u003c/p\\u003e \"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAs this report is a case report, ethical approval was not required. Consent for the use of patient data was obtained at the time of admission to the Japan Small Animal Medical Center.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWritten informed consent was obtained from the patient's owner for the publication of this report and any accompanying images.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll data generated or analyzed in this study are presented within this published article.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis research received no specific grant from any funding agency in commercial or not-for-profit sectors.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors' contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAuthor KY designed the study and wrote the initial draft of the manuscript. Authors HS and AF administered the radiation therapy and performed the surgery, respectively, and contributed to manuscript revision. Author EF served as the attending physician and conducted case examinations.\\u003c/p\\u003e\\n\\u003cp\\u003eAuthor KE contributed to manuscript revision. Author AS analyzed the kinematic data and contributed to manuscript revision. Author TK supervised the project and contributed to manuscript revision. All authors contributed to the writing of the manuscript and reviewed and approved the final version.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors would like to express their gratitude to the veterinary medical staff and rehabilitation team for their valuable support in the physiotherapy sessions and data collection. We also extend our appreciation to the dog's owners for their cooperation throughout the treatment process.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eKirpensteijn J, Van den Bos R, Endenburg N: \\u003cstrong\\u003eAdaptation of dogs to the amputation of a limb and their owners\\u0026apos; satisfaction with the procedure\\u003c/strong\\u003e. \\u003cem\\u003eVet Rec \\u003c/em\\u003e1999, \\u003cstrong\\u003e144\\u003c/strong\\u003e(5):115-118.\\u003c/li\\u003e\\n\\u003cli\\u003eWendland TM, Seguin B, Duerr FM: \\u003cstrong\\u003eProspective evaluation of canine partial limb amputation with socket prostheses\\u003c/strong\\u003e. \\u003cem\\u003eVet Med Sci \\u003c/em\\u003e2023, \\u003cstrong\\u003e9\\u003c/strong\\u003e(4):1521-1533.\\u003c/li\\u003e\\n\\u003cli\\u003eWithrow SJ, Hirsch VM: \\u003cstrong\\u003eOwner response to amputation of a pet\\u0026apos;s leg\\u003c/strong\\u003e. \\u003cem\\u003eVet Med Small Anim Clin \\u003c/em\\u003e1979, \\u003cstrong\\u003e74\\u003c/strong\\u003e(3):332, 334.\\u003c/li\\u003e\\n\\u003cli\\u003eDickerson VM, Coleman KD, Ogawa M, Saba CF, Cornell KK, Radlinsky MG, Schmiedt CW: \\u003cstrong\\u003eOutcomes of dogs undergoing limb amputation, owner satisfaction with limb amputation procedures, and owner perceptions regarding postsurgical adaptation: 64 cases (2005-2012)\\u003c/strong\\u003e. \\u003cem\\u003eJ Am Vet Med Assoc \\u003c/em\\u003e2015, \\u003cstrong\\u003e247\\u003c/strong\\u003e(7):786-792.\\u003c/li\\u003e\\n\\u003cli\\u003eJarvis SL, Worley DR, Hogy SM, Hill AE, Haussler KK, Reiser RF: \\u003cstrong\\u003eKinematic and kinetic analysis of dogs during trotting after amputation of a thoracic limb\\u003c/strong\\u003e. \\u003cem\\u003eAm J Vet Res \\u003c/em\\u003e2013, \\u003cstrong\\u003e74\\u003c/strong\\u003e(9):1155-1163.\\u003c/li\\u003e\\n\\u003cli\\u003eCole GL, Millis D: \\u003cstrong\\u003eThe effect of limb amputation on standing weight distribution in the remaining three limbs in dogs\\u003c/strong\\u003e. \\u003cem\\u003eVet Comp Orthop Traumatol \\u003c/em\\u003e2017, \\u003cstrong\\u003e30\\u003c/strong\\u003e(01):59-61.\\u003c/li\\u003e\\n\\u003cli\\u003eMillis D, Levine D: \\u003cstrong\\u003eCanine Rehabilitation and Physical Therapy \\u003c/strong\\u003e2edn. USA: Elsevier Health Sciences; 2014.\\u003c/li\\u003e\\n\\u003cli\\u003eGillette RL, Angle TC: \\u003cstrong\\u003eRecent developments in canine locomotor analysis: a review\\u003c/strong\\u003e. \\u003cem\\u003eVet J \\u003c/em\\u003e2008, \\u003cstrong\\u003e178\\u003c/strong\\u003e(2):165-176.\\u003c/li\\u003e\\n\\u003cli\\u003eYoshikawa K, Tsubakishita S, Sano T, Ino T, Miyasaka T, Kitazawa T: \\u003cstrong\\u003eFunctional assessment of the gluteus medius, cranial part of the biceps femoris, and vastus lateralis in Beagle dogs based on a novel gait phase classification\\u003c/strong\\u003e. \\u003cem\\u003eJ Vet Med Sci \\u003c/em\\u003e2020, \\u003cstrong\\u003eadvpub\\u003c/strong\\u003e.\\u003c/li\\u003e\\n\\u003cli\\u003eStark H, Fischer MS, Hunt A, Young F, Quinn R, Andrada E: \\u003cstrong\\u003eA three-dimensional musculoskeletal model of the dog\\u003c/strong\\u003e. \\u003cem\\u003eSci Rep \\u003c/em\\u003e2021, \\u003cstrong\\u003e11\\u003c/strong\\u003e(1):11335.\\u003c/li\\u003e\\n\\u003cli\\u003eMillis DL, Ciuperca IA: \\u003cstrong\\u003eEvidence for canine rehabilitation and physical therapy\\u003c/strong\\u003e. \\u003cem\\u003eVeterinary Clinics: Small Animal Practice \\u003c/em\\u003e2015, \\u003cstrong\\u003e45\\u003c/strong\\u003e(1):1-27.\\u003c/li\\u003e\\n\\u003cli\\u003eCarrier DR, Deban SM, Fischbein T: \\u003cstrong\\u003eLocomotor function of the pectoral girdle \\u0026apos;muscular sling\\u0026apos; in trotting dogs\\u003c/strong\\u003e. \\u003cem\\u003eJ Exp Biol \\u003c/em\\u003e2006, \\u003cstrong\\u003e209\\u003c/strong\\u003e(Pt 11):2224-2237.\\u003c/li\\u003e\\n\\u003cli\\u003eFischer MS, Lilje KE, Laustr\\u0026ouml;er J, Andikfar A: \\u003cstrong\\u003eDogs in motion\\u003c/strong\\u003e, 2nd ed edn: VDH Service; 2014.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-veterinary-research\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"\",\"sideBox\":\"Learn more about [BMC Veterinary Research](http://bmcvetres.biomedcentral.com/)\",\"snPcode\":\"12917\",\"submissionUrl\":\"https://submission.nature.com/new-submission/12917/3?\",\"title\":\"BMC Veterinary Research\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Canine, Forelimb amputation, Gait kinematics, Physiotherapy, Radiotherapy, Functional recovery\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6380848/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6380848/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eLimb amputation is a standard surgical procedure in dogs for the management of limb tumors such as osteosarcoma, soft tissue sarcoma, and malignant peripheral nerve sheath tumors. While many dogs adapt functionally to limb loss, altered biomechanics, compensatory strain on remaining limbs, and impaired mobility can negatively impact their quality of life. Physiotherapy is recommended to facilitate post-amputation recovery; however, objective data on its effectiveness in dogs remain limited. Furthermore, when radiotherapy is required postoperatively, the necessary daily anaesthesia and cage rest can exacerbate functional decline due to restricted activity. The impact of physiotherapy on gait function in a forelimb-amputee dog undergoing concurrent radiotherapy is described in this report.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCase presentation:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA 14-year-old neutered male Toy Manchester Terrier underwent left forelimb amputation following the diagnosis of a malignant peripheral nerve sheath tumor at the C6–T1 spinal level. One month postoperatively, the dog began a three-week course of radiotherapy that required daily anaesthesia and prolonged cage rest, raising concerns about mobility deterioration. To mitigate these effects, a structured physiotherapy program was implemented. The program consisted of daily 30-minute sessions focusing on range of motion exercises, balance and proprioception training, weave pole exercises, and cavaletti rail walking. Gait analysis was performed on the first and last days of the physiotherapy program (pre- and post-physiotherapy) using a two-dimensional kinematic system.\\u003c/p\\u003e\\n\\u003cp\\u003eAfter three weeks of physiotherapy, a significant reduction in vertical head movement was observed (48.3 cm to 34.5 cm, p \\u0026lt; 0.05), indicating improved gait stability. Additionally, shoulder and elbow extension increased during the loading response phase, which is crucial for weight-bearing and locomotor efficiency.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis case provides objective evidence supporting the potential benefits of physiotherapy in enhancing gait function and stability in dogs following a forelimb amputation, even when physical activity is restricted due to radiotherapy-related hospitalization. The findings suggest that integrating physiotherapy into post-amputation care may mitigate functional decline associated with prolonged cage rest and optimize recovery. Further studies are needed to investigate the long-term benefits of physiotherapy and effects of physiotherapy on compensatory musculoskeletal adaptations in amputee dogs.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Physiotherapy Enhances Gait Stability in a Forelimb-Amputated Dog Undergoing Postoperative Radiotherapy: a case report\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-05-09 10:53:23\",\"doi\":\"10.21203/rs.3.rs-6380848/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-08-14T18:51:28+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-08-12T06:53:02+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-08-11T14:15:54+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"280078206218442461631634361896552721022\",\"date\":\"2025-08-11T06:00:38+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-07-30T23:15:29+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-07-16T14:18:42+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"92584485374068133643666270828777027655\",\"date\":\"2025-07-13T11:10:01+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"308505294983099517242371448262834694810\",\"date\":\"2025-07-12T12:24:09+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"286896144042826742269743064669455453545\",\"date\":\"2025-07-11T22:07:13+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-06-23T17:48:49+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-05-02T18:10:12+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-04-17T05:19:28+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-04-16T09:39:10+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Veterinary Research\",\"date\":\"2025-04-16T09:38:05+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-veterinary-research\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"\",\"sideBox\":\"Learn more about [BMC Veterinary Research](http://bmcvetres.biomedcentral.com/)\",\"snPcode\":\"12917\",\"submissionUrl\":\"https://submission.nature.com/new-submission/12917/3?\",\"title\":\"BMC Veterinary Research\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"7c25cc04-38e1-45c0-a187-b2ac6395bfb8\",\"owner\":[],\"postedDate\":\"May 9th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-10-27T16:33:12+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-6380848\",\"link\":\"https://doi.org/10.1186/s12917-025-05075-2\",\"journal\":{\"identity\":\"bmc-veterinary-research\",\"isVorOnly\":false,\"title\":\"BMC Veterinary Research\"},\"publishedOn\":\"2025-10-21 16:17:13\",\"publishedOnDateReadable\":\"October 21st, 2025\"},\"versionCreatedAt\":\"2025-05-09 10:53:23\",\"video\":\"\",\"vorDoi\":\"10.1186/s12917-025-05075-2\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12917-025-05075-2\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6380848\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6380848\",\"identity\":\"rs-6380848\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}