Received: 9 March 2023 Accepted: 13 July 2023

DOI: 10.1111/jvim.16829

STANDARD ARTICLE

Diagnosis and management of dogs with degenerative

myelopathy: A survey of neurologists and
rehabilitation professionals

Teryn V. Bouché 1 | Joan R. Coates 2 | Sarah A. Moore 3 | Dominik Faissler 4 |

Mark Rishniw 5 | Natasha J. Olby 1

1
Department of Clinical Sciences, North
Carolina State University College of Veterinary Abstract
Medicine, Raleigh, North Carolina, USA
Background: Antemortem diagnosis of degenerative myelopathy (DM) in dogs is pre-
2
Department of Veterinary Medicine and
Surgery, College of Veterinary Medicine,
sumptive and there are no accepted guidelines for the management of this condition.
University of Missouri, Columbia, Hypothesis/Objectives: Describe current practices of neurology clinicians and physi-
Missouri, USA
3
cal rehabilitation professionals in the diagnosis and management of DM.
Department of Veterinary Clinical Sciences,
College of Veterinary Medicine, The Ohio Animals: None.
State University, Columbus, Ohio, USA Methods: Online surveys examining diagnosis and management of DM were con-
4
Department of Clinical Sciences, Cummings
School of Veterinary Medicine at Tufts
structed and distributed via neurology and rehabilitation listservs.
University, North Grafton, Results: One hundred ninety neurology and 79 rehabilitation professionals from 20
Massachusetts, USA
5
countries participated. Most neurology (142/189) and rehabilitation (23/39) respon-
Department of Clinical Sciences, College of
Veterinary Medicine, Cornell University, dents required genetic testing for the superoxide dismutase 1 (SOD1) mutation and
Ithaca, New York, USA 82/189 neurologists also required spinal magnetic resonance imaging (MRI) for pre-
Correspondence sumptive DM diagnosis. Most neurology respondents recommended exercise
Natasha J. Olby, Department of Clinical (187/190) and physical rehabilitation (184/190). Over 50% (102/190) of neurology
Sciences, North Carolina State University
College of Veterinary Medicine, Raleigh, respondents perform rechecks on dogs diagnosed with DM. Rehabilitation respon-
NC, USA. dents reported preservation or improvement of strength (78/79) and coordination
Email: njolby@ncsu.edu
(77/79) as therapeutic goals. At-home exercises (75/79), underwater treadmill
(64/79), gait training (55/79), and strength building exercises (65/79) were used to
maintain strength (58/79), coordination (56/79), muscle mass (56/79), and improve
overall wellbeing (54/79). Neurology respondents reported that owners elect eutha-
nasia when dogs become nonambulatory paraparetic whereas rehabilitation respon-
dents report euthanasia when paraplegia and incontinence develop.
Conclusion and Clinical Importance: The majority of dogs diagnosed with DM have
not undergone advanced imaging, the combination of history, neurological findings,
and genetic testing is heavily relied upon. Whereas the diagnosis of DM is frequently

Abbreviations: ACVIM, American College of Veterinary Internal Medicine; ACVSMR, American College of Veterinary Sports Medicine and Rehabilitation; CCRP, certified canine rehabilitation
practitioners; CCRT, certified canine rehabilitation therapists; DM, degenerative myelopathy; ECVN, European College of Veterinary Neurology; MRI, magnetic resonance imaging; SOD1,
superoxide dismutase 1.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any
medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2023 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.

J Vet Intern Med. 2023;37:1815–1820. wileyonlinelibrary.com/journal/jvim 1815


1816
made by veterinary neurologists, continued care is often performed by rehabilitation
professionals or primary veterinarians.
KEYWORDS
amyotrophic lateral sclerosis, degenerative, rehabilitation, SOD1, spinal cord
1 | I N T RO DU CT I O N
Degenerative myelopathy (DM) in dogs is a neurodegenerative dis-
order first described in 1973, with a breed predisposition for Ger-
man Shepherds.1 DM is observed in many dog breeds including
Boxers, Rhodesian Ridgebacks, Chesapeake Bay retrievers, and
Pembroke Welsh Corgis.2 This progressive, fatal disease initially pre-
sents with asymmetric general proprioceptive ataxia and parapar-
esis. Signs progress to paraplegia and ultimately flaccid tetraplegia.2
Death results from respiratory dysfunction, although most dogs are
euthanized before reaching that point. Homozygosity for a
glutamate-to-lysine missense mutation in the superoxide dismutase
1 gene (SOD1) is identified as a strong risk factor for development
of clinical signs of DM. There is an age-related incomplete pene-
trance, with clinical signs developing variably in dogs that are homo-
zygous for the variant.3 Thus, genetic testing for the SOD1 mutation
should be used to help support a diagnosis of DM. Ante-mortem
diagnosis remains a diagnosis of exclusion, requiring differentiation
from other myelopathies such as intervertebral disc extrusion and
spinal neoplasia. Nonetheless, aging dogs commonly have concur-
rent intervertebral disc protrusions and other diseases. The clinical
contribution of each condition is difficult to gauge but CSF concen-
trations of phosphorylated neurofilament heavy chain are higher in
dogs with DM.4 As such, antemortem diagnosis is considered
presumptive. Definitive diagnosis is based on histopathology of the
spinal cord.5 Histopathologic lesions include axonal and myelin
degeneration at all levels of the spinal cord, with the most severe
lesions in the dorsal portion of the lateral funiculus in the middle to
caudal thoracic spinal cord.1 No medical therapies are shown to alter
the progression of DM. Based on initial anecdotal evidence of effi-
cacy, investigators have examined treatment with ε-aminocaproic
acid, N-acetylcysteine, and supplementation of Vitamins C and E but
found no evidence of benefit in slowing disease progression.6 Daily
physical rehabilitation exercises, including hydrotherapy, have been
reported to increase the median survival time and delay the course
of disease in a small retrospective study that included 9 dogs with
intensive vs 6 dogs with moderate rehabilitation.7 There are cur-
rently no guidelines regarding diagnosis and management of DM in
dogs. The 2 groups of clinicians most involved with the management
of this condition are board-certified veterinary neurologists and
rehabilitation professionals (a combination of board-certified veteri-
narians, veterinary or veterinary technician certificate holders, and
professionals with a special interest in rehabilitation, or training in
human physiotherapy). Thus, the objective of this study was to
19391676, 2023, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jvim.16829 by Cochrane Colombia, Wiley Online Library on [14/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

ET AL.
BOUCHE
describe current practices of neurology clinicians and rehabilitation
professionals in the diagnosis and management of DM.
2 | METHODS
2.1 | Survey development
Separate surveys were developed for neurology clinicians and reha-
bilitation professionals using an online survey platform (Alchemer
Survey Software, formerly SurveyGizmo, Louisville, CO). A trial sur-
vey was tested and approved by the investigators before distribu-
tion. The main goals of both surveys were to determine how these
groups of clinicians make a diagnosis of DM and manage these dogs
after the diagnosis. Because the roles of neurology clinicians and
rehabilitation professionals differ in the management of dogs with
DM, each group completed a different survey.
2.2 | Surveys
For each survey, the first section consisted of demographic information
and experience in diagnosing DM (Data S1). The second section included
closed-ended questions with choice options concerning data on the
diagnostic approach of DM. The third section included open-ended
and closed-ended questions with choice options and write-in options
about treatment of DM. This section was expanded in the survey for
rehabilitation professionals. The last section pertained to client-based
questions on methods of educating owners about DM, euthanasia
decisions, and clinical trial considerations.
2.3 | Survey distribution
Survey links were distributed by email to the ACVIM/ECVN neurology list-
serv and VetRehab rehabilitation listserv. Neurology clinicians and rehabili-
tation professionals were invited to complete them within 2 weeks. A
single reminder was sent after the first week of opening the survey.
2.4 | Data analysis
This was a descriptive study in which responses to questions were
summarized and expressed as fractions and percentages.
 19391676, 2023, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jvim.16829 by Cochrane Colombia, Wiley Online Library on [14/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

ET AL.
BOUCHE 1817

T A B L E 1 Frequency of diagnostic tests utilized by neurology T A B L E 2 Comparison of the frequency of utilization of the SOD1
clinicians (n = 189) when making a presumptive diagnosis of DM genetic test and spinal MRI between North America (NA) and the rest
of the world (ROW) when making a presumptive diagnosis of DM
Diagnostics used Always Sometimes Never
Frequency of use SOD1 Spinal MRI
SOD1 142 (75.1%) 43 (22.8%) 4 (2.1%)
Spinal MRI 82 (43.4%) 101 (53.4%) 6 (3.2%) Always NA: 94/123 (76.4%) NA: 47/123 (38.2%)

CSF analysis 41 (21.7%) 128 (67.7%) 20 (10.6%) ROW: 48/66 (73%) ROW: 35/66 (53%)

Electrodiagnostics 0 (0%) 41 (21.7%) 148 (78.3%) Sometimes NA: 27/123 (22%) NA: 75/123 (61%)

Other 13 (6.9%) 29 (15.3%) 147 (77.8%) ROW: 16/66 (24%) ROW: 26/66 (39%)
Never NA: 2/123 (1.6%) NA: 1/123 (0.8%)
Note: The majority of clinicians always use SOD1 testing with spinal MRI
and CSF analysis less commonly used. Electrodiagnostics and other tests ROW: 2/66 (3%) ROW: 5/66 (7%)
are rarely used.
Note: The frequency of use of both SOD1 testing and spinal MRI were
similar between North America and the rest of the world.

3 | RESULTS

3.1 | Neurologist survey

The survey was distributed to 930 recipients in the ACVIM/ECVN list-

serv. One hundred ninety responses (20.4%) from 17 different countries
were collected between August 17, 2021, and August 31, 2021. A
majority of the responses were from clinicians in the United States of
America (119/190; 62.6%), the United Kingdom (26/190; 13.7%), and
Germany (8/190; 4.2%). Responses from other countries included Italy
(6/190; 3.2%), France (5/190; 2.6%), Canada (5/190; 2.6%), Australia
(4/190; 2.1%), Spain (3/190; 1.6%), Switzerland (3/190; 1.6%),
Netherlands (3/190; 1.6%), Portugal (2/190; 1.1%), and 1 each from
Japan, Finland, Belgium, Singapore, Hong Kong, and Slovenia. Of the
190 respondents, there were 168 neurologists, 17 neurology residents,
and 5 clinicians with practice limited to neurology. Most (183/190;
96.3%) respondents were clinically active with 7 respondents reporting
that they had retired from clinical neurology practice.
One hundred eighty-nine (99.5%) respondents reported routinely
using additional diagnostic tests beyond physical exam and history
F I G U R E 1 Routinely recommended therapeutic interventions by
when presumptively diagnosing DM. Most (n = 142; 75.1%) report
neurology respondents (n = 190). Almost all respondents
always testing for the SOD1 mutation (Table 1). Eighty-two (43.4%) recommended physical rehabilitation and regular exercise with most
and 41 (21.7%) respondents reported always obtaining a spinal MRI recommending assistive walking devices. The majority of respondents
and CSF analysis, respectively. The frequency of use of SOD1 testing did not recommend diet changes nor vitamins/supplements
and spinal MRI when making a diagnosis of DM was similar between
North America and the rest of the world (Table 2). Electrodiagnostic
testing was rarely performed, with 148 respondents (78.3%) reporting recheck examinations ranged from every 4 weeks to yearly. The
that they do not perform electrodiagnostics when trying to establish a majority (77/102; 75.5%) of neurology clinicians who performed
presumptive diagnosis of DM. Thirteen respondents (6.9%) reported recheck examinations themselves recommended times ranging
that they always use “other” diagnostic tests, including complete from 2 to 6 months.
blood count and serum biochemistry (n = 9), infectious disease testing Almost all respondents routinely recommend regular exercise
(n = 8), orthopedic examination, radiography of vertebral column, pel- (187/190; 98.4%) and physical rehabilitation (184/190; 96.8%). A
vic limbs and hips (n = 6), and histopathology of the spinal cord post- majority of respondents (147/190; 77.4%) recommend assistive walk-
mortem (n = 5). ing devices (such as booties/socks, harnesses, wheelchairs), whereas
In presumptively diagnosed cases of DM, 102 respondents only 17.4% (33/190) routinely recommend vitamins/supplements and
(53.7%) reported that they performed recheck examinations after 11.1% (21/190) routinely recommend diet changes (Figure 1).
diagnosis whereas 58 respondents (30.5%) recommended that the For client support, 105 (55.3%) respondents routinely provide
primary care veterinarians perform recheck examinations. Thirty resources about DM to owners utilizing client handouts (85/105;
respondents (15.8%) reported not performing nor recommending 81%), websites (25/105; 23.8%), primary literature (16/105; 15.2%),
recheck examinations. Variation between recommended timing of and information on support groups (8/105; 7.6%). Additionally,

1818
168 respondents (88.4%) report that they or their staff provide
lessons and resources for owners regarding bladder management.
One hundred fourteen (60%) neurology respondents report that
owners most often euthanize when their dog becomes nonambulatory
paraparetic. This was followed by development of incontinence ± para-
plegia (62/190; 32.6%), ambulatory paraparesis (5/190; 2.6%),
paraplegia (5/190; 2.6%), tetraplegia without respiratory compromise
(2/190; 1.1%), and tetraplegia with respiratory compromise (2/190;
1.1%). Lastly, when asked how often the option of necropsy is dis-
cussed with owners for a confirmative diagnosis, respondents reported
that they always (27/190; 14.2%), often (24/190; 12.6%), sometimes
(55/190; 28.9%), or rarely (54/190; 28.4%) discuss necropsy, whereas
30/190 respondents (15.8%) reported that they never discuss the
option of necropsy with owners.
3.2 | Rehabilitation survey
Seventy-nine responses were collected between September 13, 2021,
and September 30, 2021, and included rehabilitation specialists from
8 different countries. The term specialist is used to encompass both
veterinarians and nonveterinarian rehabilitation therapists. A majority of
the responses were from rehabilitation specialists in the United States
of America (66/79; 84%), Canada (6/79; 8%), and the United Kingdom
(2/79; 3%). There was 1 response each from Greece, the Netherlands,
Australia, Russian Federation, and South Africa. Of the 79 respondents,
34 (43%) were both veterinarians and certified canine rehabilitation
therapists (CCRT), 18 (23%) were CCRT but not veterinarians, 6 (8%)
were rehabilitation veterinary technicians and assistants, 5 (6%) were
American College of Veterinary Sports Medicine and Rehabilitation
(ACVSMR) board-certified rehabilitation therapists, 4 (5%) were veteri-
narians without additional qualifications in rehabilitation and 12 (15%)
were “other.” The “other” respondents included certified canine reha-
bilitation practitioners (CCRP), ACVSMR residents, certified canine pain
practitioners, and a human physical therapist. Most (73/79; 92%)
respondents were currently seeing dogs with neurological problems
with only 6 respondents (8%) reporting that they previously worked
with dogs with neurological problems.
Forty-two respondents (53%) reported treating between 1 and
5 dogs with DM annually with 5 respondents (6%) treating more than
20 cases annually. Thirty-nine (49%) of the rehabilitation respondents,
all veterinarians, reported that they have diagnosed dogs with
DM. Twenty-three of these 39 respondents (59%) reported always
testing for the SOD1 mutation. Four (10%) respondents reported
always obtaining a spinal MRI and 2 (5%) reported always performing
CSF analysis to diagnose dogs with DM. Most reported not utilizing
electrodiagnostic testing (32/39; 82%) nor other diagnostic tests
(29/39; 74%) to make a presumptive diagnosis.
Almost all of the respondents agreed that preservation/improvement
of strength (78/79; 99%) and coordination (77/79; 98%) were the goals
of their therapeutic protocols. Twenty-four (30%) and 34 respondents
(43%) reported treatment of spasticity and pain as their goals, respec-
tively. Of the 26 respondents who answered “other” regarding goals of
19391676, 2023, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jvim.16829 by Cochrane Colombia, Wiley Online Library on [14/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

ET AL.
BOUCHE
F I G U R E 2 Routinely recommended treatments by rehabilitation
respondents (n = 79). The majority of respondents recommended at-
home exercises, strength building exercises, underwater treadmill and
gait training exercises. Few recommended the use of overland
treadmill
treatment, 9/26 (35%) involved some aspect of client education and sup-
port of owners in helping with management and quality of life for their
dogs. Various answers included helping to treat pain from compensation
in other areas, delaying progression of the disease, maintaining activities
of daily life, and helping provide support with assistive walking devices
(such as booties/socks, harnesses, and wheelchairs). Respondents most
commonly recommended at-home exercises (75/79; 95%), followed by
strength building exercises (65/79; 82%), underwater treadmill (64/79;
81%), and gait training exercises (55/79; 70%; Figure 2). Only 9/79 (11%)
respondents reported routinely recommending overland treadmill use as
part of their rehabilitation protocol. Additionally, most (69/79; 87%)
respondents utilize adjunctive modalities such as laser (67/69; 97%), acu-
puncture (49/69; 71%), and pulsed electromagnetic fields (39/69; 57%).
All respondents recommend regular exercise at home. The most common
form of exercise recommended for owners was regular walking, often
with suggestions of hill walking (46/79; 58%). Other at-home exercise
regimens included simple exercises like sit-to-stand and perturbation of
balance, with many respondents noting that they tailored the regimens to
the dog. Ninety-four percent (74/79) recommend assistive walking
devices whereas only 52% (41/79) and 35% (28/79) routinely recom-
mend vitamins/supplements and diet changes respectively as at-home
management strategies.
All but 1 respondent routinely recommends that dogs with DM
be treated with in-clinic rehabilitation and the majority recommend
once weekly (34/79; 43%) or twice weekly (25/79; 32%) sessions.


ET AL.
BOUCHE
Only 4/79 (5%) routinely recommend that dogs return for in-clinic
rehabilitation once every 2 weeks and 1/79 (1%) recommend once
per month. Of the 13 (17%) respondents who chose “other” regard-
ing frequency of in-clinic rehabilitation, 7/13 (54%) reported that it
depends on the individual dog and owner needs/requirements. Most
respondents believed their treatment helps the dogs maintain
strength (58/79; 73%), coordination (56/79; 71%), and muscle mass
(56/79; 71%) with 68% (54/79) perceiving an improvement in over-
all wellbeing. Most (72/79; 91%) also believed that their treatment
helps delay disease progression.
When asked about the stage at which most owners elect eutha-
nasia, 38/79 (48%) respondents reported that it occurs when the dogs
develop incontinence ± paraplegia. This was followed by nonambula-
tory paraparesis and by tetraplegia without respiratory compromise
(14/79; 18% each), paraplegia (7/79; 9%), tetraplegia with respiratory
compromise (3/79; 4%), and ambulatory paraparesis (2/79; 3%). Most
respondents reported never (30/79; 38%) or rarely (27/79; 34%) dis-
cussing the option of necropsy with owners for a more confirmative
diagnosis. The remaining 22 respondents reported that they some-
times (15/22; 68%), often (3/22; 14%), or always (3/22; 14%) discuss
the option of necropsy.
4 | DISCUSSION
The goal of this study was to describe current practices of neurology cli-
nicians and rehabilitation professionals in the diagnosis and manage-
ment of DM. Our study found that most neurology clinicians use
testing for the SOD1 mutation to establish a presumptive diagnosis of
DM, while substantially fewer additionally require either MRI or CSF
analysis to establish the diagnosis. In addition, nearly 50% of rehabilita-
tion professionals (all of whom were veterinarians) reported that they
presumptively diagnose the condition, typically with SOD1 testing
alone. Neurology clinicians do not routinely use any specific medical
therapies but recommend routine exercise and refer dogs to rehabilita-
tion clinicians for ongoing care. Rehabilitation professionals then pro-
vide ongoing management of DM. Rehabilitation professionals use a
combination of exercises and reported that their treatment delays pro-
gression. The stage at which owners elect euthanasia differs between
neurologists and rehabilitation professionals, with the former reporting
nonambulatory paraparesis whereas the latter report incontinence ±
paraplegia as the most common endpoints. Our study highlights the cur-
rent approach to diagnosis and management of DM, assisting with the
development of future clinical guidelines.
The SOD1 test was the most commonly utilized diagnostic test by
both neurology and rehabilitation clinicians when diagnosing dogs
with DM. Approximately 45% of neurology and 10% of rehabilitation
clinicians reported always obtaining spinal MRI. This is important to
note because the SOD1 testing only identifies dogs at risk of develop-
ing DM because of incomplete penetrance of the mutation.4 Conse-
quently, the test is inadequate as a sole diagnostic test. The reliance
on SOD1 testing alone for presumptive diagnosis likely reflects a com-
bination of owner reluctance to pursue MRI because of anesthesia
19391676, 2023, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jvim.16829 by Cochrane Colombia, Wiley Online Library on [14/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1819
risks and costs, as well as clinician preference. Regardless, reports of
outcomes in dogs that have not undergone spinal MRI in addition to
genetic testing should be interpreted with caution because of the risk
of misdiagnosis.
Because of the chronic, progressive disease course, the question
of follow-up and ongoing care provided to dogs that have been diag-
nosed with DM is important. Based on responses by the neurology
clinicians, this care is often passed on to a rehabilitation profes-
sional. Because neurology clinicians frequently do not reevaluate
their DM dogs, most are unable to accurately document neurological
progression beyond major thresholds (such as inability to walk with-
out support); therefore, concurrent conditions and secondary com-
plications also are not well documented. Recommendations for
recheck examination timing varied from every 4 weeks to yearly. In
the absence of being able to offer an effective treatment, dogs
affected with DM and their owners fall into a care void. It would be
interesting to poll the owners of dogs diagnosed with DM about
their perception of the follow-up care and the impact of caring for a
dog with DM on the carer's quality of life.
The majority of the rehabilitation professionals were in agree-
ment on most commonly used treatments, suggesting there is a core,
standard protocol that could include at-home exercises, strength
building exercises, and underwater treadmill use. The majority of
respondents also reported anecdotally that their exercise regimens
were effective. One study reported that 9 dogs treated with intensive
daily physical rehabilitation (gait exercise 3-5 times daily and either
passive range of motion and massage 3-5 times daily or daily hydro-
therapy) survived longer and remained ambulatory longer than 6 dogs
with moderate or no rehabilitation.7 This small study provides the
basis for the common recommendation to provide exercise and reha-
bilitation treatment. However, the observational (retrospective) nature
of the study results in unavoidable biases that could affect the out-
come. Nevertheless, these initial findings warrant further investigation
into the efficacy of physical rehabilitation in dogs affected with DM.8
Median survival time of dogs with DM is from 10 to 36 months.2,9
Given the progressive, fatal nature of DM, humane euthanasia is most
often pursued before the end-stage of disease. The current study found
that neurology clinicians report euthanasia is most often pursued when
dogs become nonambulatory paraparetic whereas rehabilitation special-
ists report incontinence (±paraplegia) as the stage at which owners decide
to euthanize. Owners who pursue physical rehabilitation programs might
also be more motivated to manage dogs with DM longer than those who
do not. However, the support that a rehabilitation facility provides to an
owner who is managing a dog with a progressive neurodegenerative con-
dition likely plays a role in their threshold for euthanasia.
5 | CONC LU SION
This study identified the most common diagnostic tools and manage-
ment strategies used by neurology and rehabilitation clinicians for
dogs with DM. Most clinicians use SOD1 testing for a presumptive
diagnosis whereas fewer perform spinal MRI, particularly among the

1820
rehabilitation clinicians who report diagnosing DM. While many neurol-
ogy clinicians reevaluate dogs diagnosed with DM, continued care is
often referred to rehabilitation professionals or primary care veterinar-
ians. Treatment recommendations most often include regular exercise
and rehabilitation. Many rehabilitation professionals report stabilization
of progression and improved well-being of dogs with DM undergoing
physical rehabilitation.
ACKNOWLEDGMENT
No funding was received for this study. The authors are grateful to
the individuals who responded to their respective listservs to com-
plete the surveys.
CONF LICT OF IN TE RE ST DEC LARAT ION
Authors declare no conflict of interest.
OFF- LABE L ANT IMICR OBIAL DE CLARAT ION
Authors declare no off-label use of antimicrobials.
INS TITUTIONAL ANIMAL CARE AND U SE C OMMITTEE
(IACUC) OR OTHER APPROVAL DECLARAT ION
Authors declare no IACUC or other approval was needed.
HUMAN ETHICS APPROVAL DECLARATION
Authors declare human ethics approval was not needed for this study.
ORCID
Sarah A. Moore https://orcid.org/0000-0002-4311-6199
Mark Rishniw https://orcid.org/0000-0002-0477-1780
Natasha J. Olby https://orcid.org/0000-0003-1349-3484
RE FE R ENC E S
1. Averill DR Jr. Degenerative myelopathy in the aging German shepherd
dog: clinical and pathologic findings. J Am Vet Med Assoc. 1973;
162(12):1045-1051.
19391676, 2023, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jvim.16829 by Cochrane Colombia, Wiley Online Library on [14/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

ET AL.
BOUCHE
2. Coates JR, March PA, Oglesbee M, et al. Clinical characterization of a
familial degenerative myelopathy in Pembroke welsh corgi dogs. J Vet
Intern Med. 2007;21(6):1323-1331.
3. Awano T, Johnson GS, Wade CM, et al. Genome-wide association anal-
ysis reveals a SOD1 mutation in canine degenerative myelopathy that
resembles amyotrophic lateral sclerosis. Proc Natl Acad Sci USA. 2009;
106(8):2794-2799.
4. Toedebusch CM, Bachrach MD, Garcia VB, et al. Cerebrospinal fluid
levels of phosphorylated neurofilament heavy as a diagnostic marker of
canine degenerative myelopathy. J Vet Intern Med. 2017;31(2):513-520.
5. Johnston PEJ, Barrie A, McCulloch MC, et al. Central nervous system
pathology in 25 dogs with chronic degenerative radiculomyelopathy.
Vet Rec. 2000;146(22):629-633.
6. Polizopoulou Z, Koutinas A, Patsikas M, Soubasis N. Evaluation of a
proposed therapeutic protocol in 12 dogs with tentative degenerative
myelopathy. Acta Vet Hung. 2008;56(3):293-301.
7. Kathmann I, Cizinauskas S, Doherr MG, Steffen F, Jaggy A. Daily con-
trolled physiotherapy increases survival time in dogs with suspected
degenerative myelopathy. J Vet Intern Med. 2006;20(4):927-932.
8. Miller LA, Debbie T, de Taboada L. Retrospective observational study
and analysis of two different photobiomodulation therapy protocols
combined with rehabilitation therapy as therapeutic interventions for
canine degenerative myelopathy. Photobiomodul Photomed Laser Surg.
2020;38(4):195-205.
9. Kobatake Y, Nakata K, Sakai H, et al. The long-term clinical course of
canine degenerative myelopathy and therapeutic potential of curcu-
min. Vet Sci. 2021;8(9):192.
SUPPORTING INF ORMATION
Additional supporting information can be found online in the Support-
ing Information section at the end of this article.
How to cite this article: Bouché TV, Coates JR, Moore SA,
Faissler D, Rishniw M, Olby NJ. Diagnosis and management of
dogs with degenerative myelopathy: A survey of neurologists
and rehabilitation professionals. J Vet Intern Med. 2023;37(5):
1815‐1820. doi:10.1111/jvim.16829