what physiotherapy interventions have evidence for slowing progression in dogs with degenerative myelopathy?

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Daily intensive physical rehabilitation is the only intervention shown to slow progression of degenerative myelopathy (DM) in dogs, with survival time reported at approximately 8 months with daily intensive rehabilitation, compared to 6–12 months as the typical window before euthanasia in dogs managed without intensive protocols.72 Intensive rehabilitation outperforms moderate rehabilitation in prolonging survival. Dogs receiving intensive rehabilitation had a median survival time that exceeded those receiving moderate rehabilitation, based on a comparison of 9 dogs with intensive versus 6 dogs with moderate protocols.2 The addition of allogeneic mesenchymal stem cell transplantation to an intensive neurorehabilitation protocol extended mean survival to 438 days, compared to 274 days in dogs receiving rehabilitation alone, though stem cell therapy remains investigational.7 Hydrotherapy is a core component of the rehabilitation protocols associated with these outcomes. Daily physical rehabilitation exercises including hydrotherapy are specifically identified as the intervention associated with increased median survival time and delayed disease course.2 The veterinary literature does not currently specify a standardized session frequency, duration, or intensity protocol for hydrotherapy in DM beyond the designation of "daily" and "intensive." No pharmacologic adjuncts have demonstrated benefit in slowing DM progression. Epsilon-aminocaproic acid, N-acetylcysteine, and supplementation with Vitamins C and E have all been evaluated and found to have no evidence of benefit in slowing disease progression.2 Curcumin administration showed a signal toward slowing progression in Pembroke Welsh Corgis, but the veterinary literature does not yet support a definitive treatment recommendation.3 Physical rehabilitation is palliative, not curative. There is no treatment that alters the underlying neurodegenerative process.12 Rehabilitation goals should be framed around quality of li