Tetanus is a disease caused by the toxin of a bacteria called Clostridium tetani. The bacteria typically live in the soil and can be introduced into an animal via puncture or bite wounds. Once the Clostridium tetani bacteria invade a wound, they produce tetanospasmin toxin which binds to nerves. Ultimately the toxin travels through the neural network and causes loss of inhibition resulting in muscle spasms, rigidity and paralysis. It generally takes 3-21 days for tetanus to appear after the bacteria infects a wound.
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There are two types of tetanus, localized and generalized:
Early signs of the generalized form of tetanus include inability to blink, sensitivity to light, sensitivity to sound and potential seizures. These progress to a classic rigid facial expression known as the sardonic smile where a patient’s lips are pulled back tightly. As the disease progresses, patients become unable to walk and may stand like a sawhorse. Patients may have trouble eating because their jaws become rigid and unable to move. Ultimately the disease can progress to affecting the muscles that patients need to breathe.
There is also a localized form of tetanus where the limb nearest to the inoculation site becomes stiff or can tremor. This form can progress to generalized tetanus.
Unfortunately there is no test for tetanus. Diagnosis is usually based on a patient’s history paired with wound appearance. Antibody levels against tetanus toxin can be measured but this is not commonly performed.
Treatment of tetanus involves antibiotics to kill the Clostridium tetani bacteria. Usually improvement can be seen within a week of starting antibiotics but complete recovery may take a month or more. Other additional medications that may be used in tetanus cases include sedatives, general anesthesia and tetanus antitoxin. Patients are usually kept in a dark room, sometimes blindfolded with little to no stimulation. A special diet may be needed for patients that have a locked jaw.
Vaccination against tetanus is not often performed in dogs or cats because they are considered to be more resistant to tetanus as species compared to other animals.
Physical therapy for Tetanus involves maintaining joint mobility, avoiding muscle contractures, spasms, and decreasing/delaying muscle atrophy through the use of massage, ultrasound, passive range of motion, and balance exercises. We use ultrasound, heat, massage, and stretching to try to loosen these tissues. We also address any secondary pain that may be associated with the contracture. If proprioceptive/neurologic deficits are present our rehab plan may initially focus on bringing back sensation and proprioception through the use of manual stimulation. Our techniques are pulled from what they do in humans and at Walking Paws Rehab we translate them to animals. Once proprioception is improved we work on stability. We start with positional balance exercises and then progress into dynamic movements. We focus on retraining transitions, taking appropriate steps, and overall coordination. The underwater treadmill can be helpful for retraining gait through assisted walking or gait patterning. Muscle recovery can be achieved during hydrotherapy and, when necessary, through the use of electrical muscle stimulation.
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