Rehabilitation and Movement Therapy for Your Rabbit

Jan 8, 2013 by

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Caring for a rabbit who suffers from degenerative disease, disability, injury, or paralysis can be a daunting task. However, it can also be an enriching experience to nurture, love, and enhance the quality of your companion’s life.

Like any animal who becomes impaired, a rabbit needs immediate attention, starting with medical care from a veterinarian knowledgeable about treating rabbits. It’s best to get as complete a picture as possible of the bunny’s condition so that you and the veterinarian can establish an appropriate home-care regimen. As the home-therapy program develops, it’s important to include steps to avoid caregiver burnout. Responsibilities may initially seem difficult, but a daily routine will become established. Expect progress to come in small increments, and don’t underestimate your rabbit’s resilience and will to live. If he’s eating and grooming and his attitude is good, he’ll cope and adapt along with you.

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Bunny, Connie Conine’s special rabbit. Read more about him in the photo story at the end of this article.

Connie Conine is an occupational therapist who shared a home with a paraplegic rabbit for six years. She recalls that special time:

I was Bunny’s protector, and I try to convey the importance of that concept in my workshops. He received his sense of security from me, so it was very important to keep him comfortable and to develop a nurturing relationship. When I had to do something he found unpleasant (e.g., express his bladder or clean his bottom), he was less stressed because he trusted me so much. The fact that he was more relaxed made it easier for me to evaluate and treat problems as they occurred.

The primary author agrees with Connie’s assessment of this special time. When the author’s first rabbit, Kali, was rescued, she had a number of disabilities. Initially, she could barely move: she had arthritis, her back legs were very weak, and her front legs so severely splayed that she could not put weight on them. The physical therapy exercises that Connie taught, although seemingly simple, worked marvelously to strengthen some of Kali’s muscles and to develop her balance. So much so that when it was time to receive medication, the little fuzzy lop was able to race down the hall and scoot under the bed – propelled by her back legs only!

The Importance of Being Cautious 

Throughout this article, you will read cautionary statements. They are repeated because it is a challenge to convey in words the “how” of the techniques used in physical therapy. It is intricate work, and there is a sensitivity of touch that is required when handling and treating any physically impaired animal. Though it may sound as though the work is fairly simple (and in some ways, it is), Ms. Conine stresses that there is a “feel” that is necessary in order to gauge what and how much to do. This physical feeling – as much in the therapist’s mind and heart as it is in the fingertips and hands – is a subtle and learned skill.

Never are a rabbit’s joints and muscles forced into a position. On the contrary, trained therapists can feel if there is enough flexibility for a particular therapeutic movement and work within those (sometimes very small) parameters. That is what the various caution statements in this article try to emphasize: always remain cognizant and respectful of your rabbit’s body so that everything you do is beneficial. Always err on the side of caution. This cannot be emphasized enough. Ask for professional assistance as necessary to avoid harming your rabbit.

Evaluating and Handling Your Rabbit

Whether the physical problem is weakness, joint limitation, balance, or something similar, the cause can be determined through evaluation of the rabbit’s condition. This evaluation is best performed by someone who is knowledgeable about rabbit anatomy and physiology, generally by or in consultation with your veterinarian. The treatment plan should take into consideration not only this evaluation but also the physical constitution of the rabbit (e.g., how fragile or sturdy he or she may be) as well as the comfort level and sensitivity of the caregiver.

In her workshops, Ms. Conine helps caregivers develop “the mindset of a therapist” and the skills necessary for helping their companion animal to function at the highest possible level. This encompasses many things, and she emphasizes that one of the most important is recognizing “normal” function and behavior for your particular rabbit. Learn what a normal bunny’s body feels like and how it moves – then you will have a basis for recognizing what problems your rabbit has. Knowing what feels normal also helps you set goals to address your rabbit’s limitations and to improve his or her body’s function.

Developing a therapist’s mindset and skills encompasses many other things as well including: Working with the veterinarian and therapist to develop methods to treat or compensate for the problems. Evaluating whether the methods are getting results, and continuing what works. Discontinuing any therapy that results in increased pain, fatigue, or stress for the bunny. Regularly consulting with the veterinarian and physical therapist.

Ms. Conine provides some tips for being a rabbit’s physical therapist:

    • Speak slowly in a low, reassuring voice. Repeat important words; consistent usage will allow the bunny to grasp the patterns associated with the  words.
    • Relax and breathe evenly so that tension is not communicated to the bunny.
    • Be consciously aware of touching your rabbit. Conscious touch allows a caregiver to give and receive information.
    • Watch closely for cues that may signal stress or pain, such as elevated respiration rate or flinching.
    • Carefully observe how your bunny moves and feels as well as any abnormal behavior, gut sounds, and respiration rate.
    • Develop and use distraction techniques, if necessary. Kissing or humming on the top of the rabbit’s head, blowing, or scratching can help distract and calm a struggling or fearful bunny. A snack can help, but do not overuse treats – you want your little companion to be comforted by YOU.
    • If your rabbit was abused or not well socialized, help her associate being held with being loved. Hold your bunny for short periods – initially this may be seconds – each day, doing nothing but providing comfort.

Providing therapy is an ongoing, problem-solving process. Ms. Conine reminds caregivers that part of being a good therapist is understanding and respecting a rabbit’s fragile body:

Remember that the joints and bones of a small animal, especially if elderly or disabled, are fragile. It’s so important to be aware of what you are doing and of the bunny’s responses. One of the most rewarding times comes when your special friend starts becoming more independent. What a wonderful feeling it is to begin letting go – with love!

Normal (Automatic) Activity as Therapy

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Sugar climbs up on her therapist-friend to get a small carrot treat – an automatic (normal) activity that helps Sugar’s balance and strengthens her weak, uncoordinated leg muscles. Read her photo story at the end of this article.

Work with your veterinarian or physical therapist to evaluate factors that might influence your rabbit’s function and mobility: muscle tone, strength, stiffness, deformity, pain, fear, depression, boredom, and any “bad habits” (e.g., lying on one side most of the time or with legs in an abnormal position). According to Ms. Conine, the most important treatment tool is normal (automatic) activity. An automatic response is one that is done without thinking or planning, such as reaching out for food, exploring the environment, grooming, and playing. When a rabbit can move and do those things, she’s automatically using her senses, balance, and problematic muscles and joints – the very things you are seeking to improve with therapy.

Some ways to spur a rabbit’s interest are rearranging the furniture (most rabbits love to explore new environments), offering new toys, and playing with him or her. Senses can be stimulated in bunnies who cannot walk by gently massaging and grooming them and by carrying them around the room or yard so they can look at, smell, and “explore” the spots they like. Modify or adapt the rabbit’s surroundings to provide easier access to the litter box, food and water, and comfortable resting places. Make adjustments periodically to reflect any improvement or decline in your rabbit’s abilities. Ms. Conine offers this suggestion:

One of my favorite treatment techniques is to pet or slightly ruffle a rabbit’s fur as I’m walking by. This almost always stimulates the bunny to start grooming. When a rabbit grooms himself, he’s utilizing and strengthening muscles, balancing himself, and maintaining his flexibility. It’s simple but effective therapy.

Patience is important. Observe any responses and improvements, keeping in mind that they may be small and usually happen slowly. It’s very helpful to track progress by keeping an evaluation form, journal, or calendar notes.

Positioning: A Treatment Technique

When working with caregivers or providing guidance for members of the House Rabbit Society, Ms. Conine always discusses the powerful treatment technique called positioning. Therapeutic positioning is putting a rabbit in positions that help maintain or correct normal posture and restore joint and muscle flexibility that a bunny needs to function normally.

Positioning “re-sets” the brain. As happens with people, when a bunny has abnormal posture, uses a limb in an inefficient way, or holds his head tilted to one side, those postures start to feel normal. Positioning helps both the body and the brain return to the healthy patterns of a normal rabbit. The treatment technique can decrease stiffness, maintain or increase joint range of motion, and increase a rabbit’s ability to move, hop and groom.

Positioning therapy also provides comfort and support. As Ms. Conine notes, sitting or lying in a different position can relieve the pressure on particular areas of the body:

If a bunny lies in the same (or in an abnormal) position for long periods, joints and muscles can be over-stretched on one side and shortened on the other. It’s important to encourage normal positioning, because if a rabbit is unable to get or stay in the normal position, he is less likely to be able to hop, sit, or groom. It seems very simple, but positioning is a powerful tool. Observe how healthy rabbits sit and move because it helps you know what you are trying to achieve with a disabled bunny.

 

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Bunny, a paraplegic Netherland dwarf, is resting in the meatloaf position. The white object under his left hip is a donut-shaped “brace” that lifts Bunny’s left side. This counteracts the stiffness and spasticity in his right leg, which otherwise pushes him over to the left. The brace allows him to sit and scoot around.

One position that I like to use in a therapy session is the restful “meatloaf” position, where the rabbit’s back legs are folded up on each side of the body like a normal bunny rests. For therapy purposes, the front legs bend at the elbow and the front feet point forward (reference the photo). Note, however, that if a bunny has limited range of motion in any joints, they may not be flexible enough for the rabbit’s body to collapse into the meatloaf position. This is not something to force. Having your veterinarian check the rabbit’s range of motion to determine if the joints can go into the position is the important first step. Have the veterinarian show you how to safely get your bunny into this position and hold him there.

Like all rehabilitative and movement therapy, the “meatloaf” technique must be used with extreme caution or your rabbit can be permanently damaged. Anyone with a rabbit who has joint and muscle problems should be working closely with their veterinarian, who can evaluate the rabbit’s joints and muscles and give instructions on how to safely handle and position a disabled bunny. Ms. Conine comments:

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Disabled Sugar is being gently held in the meatloaf position by her therapist.

Most caregivers will not know the correct position of all the joints, so I cannot emphasize enough the need to consult with a veterinarian, therapist, or other experienced person. Once you have the knowledge, you can sit next to your bunny on the couch or floor and help him get into or hold the position, taking care not to pull or force any joints.

How long should a rabbit be placed or held in a particular position? Ms. Conine recommends initial therapy sessions be only a couple minutes long. Though this may seem too short a time to be effective, she reminds caregivers that a new position (normal though it may be) can be uncomfortable – even painful – for the rabbit. To reduce potential discomfort and allow you to hold him in the position for a couple of minutes, it is important to help your bunny relax. Ms. Conine makes some suggestions:

Be gentle and reassuring, and pay close attention to your rabbit’s reactions. Take some deep breaths to calm and center yourself. Most bunnies will start to relax when you are patient. Achieving that quiet state can be a challenge though, especially at the beginning. So if someone is assisting you, it may be helpful if the person offers a few sprigs of leafy greens as a treat while you work on the positioning. The treat will help distract a rabbit and help him to relax.

However, if your rabbit does not relax or is unable to respond positively to your therapy efforts, or if he continues to struggle or flinch (or show other signs of distress), the positioning may be too frightening or painful. Ms. Conine advises to stop the session immediately. Try again later or seek the assistance of your veterinarian or another experienced therapist. But if your rabbit is able to tolerate the therapy, continue with the short sessions.

Once you and the bunny are comfortable with a normal position for several minutes at a time, it is okay to increase the time to five minutes, then ten. Short sessions, done more frequently, are more beneficial than one long session, so I recommend several short sessions each day as your schedule permits.

 

I encourage you to continue the positioning work once your rabbit has become comfortable and you are seeing better movement or posture. This is a positive sign that the therapy is likely to benefit your bunny. If he can tolerate longer sessions, begin increasing them to fifteen, then twenty minutes. At some point, rather than using your hands, you may be able to provide the support by using bolsters (rolled towels or a pillow). You can also use a padded, bunny-sized oval willow basket or a box.

 

Important note: If the rabbit is paralyzed or has loss of sensation or sensitive skin, keep sessions shorter: fifteen minutes or less.

 

In any case, it is better to increase the number of daily therapy sessions than to increase the length of less frequent sessions. Always keep in mind that “positioning” does not mean having the rabbit in one “normal” position for an extended length of time. Keep sessions to a period no longer than thirty minutes, unless the rabbit is paralyzed or has loss of sensation [noted above]. This rule applies whether the therapy session is conducted by you or a physical therapist or if the rabbit is placed between bolsters or in a basket or box.

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Bunny resting in his roomy cage on the floor, a place of safety when he cannot be monitored. He is lying on a padded mattress and positioned between two bolsters.

Remaining in one position too long impairs circulation and can cause sores to develop over bony areas like heels and elbows. Make sure your rabbit is on a well-padded, absorbent surface and that his position is changed often (or make sure he has room to change position himself). Very gentle massage can increase circulation. If your bunny gives any indication of stress or discomfort, consult with your veterinarian or therapist. Always let your rabbit be your guide – follow the bunny’s lead. When it comes to therapeutic change in a disabled rabbit’s body, Ms. Conine reminds caregivers that changes are often accomplished in tiny increments and may seem negligible. But the cumulative effect is positive.

Neurological Impairment

Neurological impairment can cause muscles to become tight and over-reactive or paralyzed (temporarily or permanently). Increased or decreased muscle tone must be addressed, but in different ways, so receiving training from a knowledgeable veterinarian or therapist is very important. Ms. Conine briefly explains:

Stimulating spastic muscles, which already have increased tone, makes them even tighter. On the other hand, muscles that have little tone – perhaps from a neurological injury – provide little resistance. Performing therapy requires a thorough working knowledge of the differences as well as the specific therapeutic approaches. I always advise caregivers to use extreme caution in these situations to prevent injury to the rabbit. Learning from an experienced person is so important; I cannot emphasize this enough.

 

A neurological injury usually results in the muscles closest to the center of the body recovering first (e.g., shoulder or hip muscles respond before the feet). Sometimes I’ll see a barely perceptible contraction – it might be just one flicker of movement – but I know it’s a start. It may be a sign that more muscles will begin to recover their strength.

There are various causes of paralysis that require veterinary care, including spinal cord injury, stroke, and damage from an E. cuniculi infection. If recovery from paralysis occurs, it generally happens within six months, although it can take a year or more. Ms. Conine finds that recovery is generally quite slow, comes in small steps and, depending on the severity of the damage, can come to a halt at any time. Be aware that other issues can develop from neurological impairment. Spinal cord injury causes the loss of bowel and bladder control and makes the skin vulnerable to injury and sores because of poor circulation and the loss of sensation. Stroke can cause eating and swallowing problems, as well as weakness and balance issues. E. cuniculi may present in various ways in rabbits.

Finding a Therapist

Good therapy is as much about what not to do as what should be done. Though some of the movements and therapy techniques may seem simple, working with muscles and joints, especially in a small animal, is often done in tiny increments. While a good therapist can feel and see a rabbit’s reactions, those same reactions may not be noticeable to a caregiver, and a simple mistake can undo the entire healing process and even harm the bunny. Individuals who wish to do therapy with their rabbit should consult their veterinarian, who may know of a qualified therapist who will provide hands-on and printed instruction. A rescue group may also provide referrals. For best results, stay in close contact with your veterinarian – provide updates, discuss questions, and request clarification and perhaps additional evaluation.

Learn from your rabbit. Recognize how his or her body functions and what is normal. Monitor each progression and the changes that come with it. Remember that short frequent therapy sessions are much more effective than one long one, and always watch for signs of discomfort, fatigue, or other stress factors. Honor your rabbit’s signal that he or she has had enough. Learn how to administer some gentle massage strokes and Tellington-TTouch®. (Reference the articles “Deepening the Bond: How to Connect with Your Rabbit through Massage” and “Tellington TTouch for a Happy and Healthy Rabbit.”)

In an ideal world, a rabbit would never need rehabilitation or movement therapy. Ms. Conine stresses that prevention is your best bet. In addition to keeping your bunny healthy with exercise, proper diet, and socialization (with human and animal companions), be sure to rabbit-proof your home and ensure proper handling by adults and children alike.

Caring for the Caregiver

At the beginning of this article, brief mention was made about the importance of avoiding caregiver burnout, which can become an issue for anyone who cares for the sick or injured. The work can be exhausting, both physically and emotionally. It can seem nearly overwhelming as you try to set up a routine and figure out what works best. Ms. Conine shares her thoughts:

Not everything you try will improve your rabbit’s health and, sadly, there is only so much you can do. Some aspects of your bunny’s condition simply cannot be changed, and if you focus on that, neither you nor your rabbit will be happy. Instead, I want to emphasize that there is much caregivers can do and improvements that can be made. With that focus, you can help your bunny live a good life.

At first, it may seem as though your life revolves around the daily care. Initially, some tasks may be daunting (e.g., giving subcutaneous fluids, expressing a bladder). But after obtaining veterinary guidance, these basic skills become easy, reducing the frequency of veterinary visits and thus reducing your rabbit’s stress. What at first may seem intimidating can actually become a confidence builder.

Caregiving also entails self-discipline – working with finances, establishing priorities, and maintaining the balancing act inherent in a busy life. Fitting the care of yourself into that busy schedule is important too. Remaining happy and healthy is important for anyone, and there are many ways to do this: good diet, regular exercise, time in nature, laughter, socializing, and quiet time. Find what works for you.

Providing special care for an animal who is ill or injured is an opportunity to provide gentle, loving service to one who is vulnerable and in need. It’s also an opportunity to meet a challenge – to think creatively outside normal parameters. Special-needs care – short- or long-term, curative or palliative – offers the opportunity to explore noninvasive alternative treatments, which often add to a rabbit’s vitality and strength. (Articles about various alternative modalities are posted on this website.)

Sometimes you must simply focus on the positives, finding humor even during the trying times. Often, all that is necessary is the awareness and observation of a rabbit’s way of looking at life. He doesn’t worry or fret. She doesn’t carry around regrets. Ms. Conine says it well:

Even though you may not be able to fix everything for your companion, an animal lives in the present. If your bunny is loved and has a good appetite and attitude, then he is happy. You may be sad about the realities of the situation and worried about what tomorrow will bring … but your bunny isn’t! That is his wonderful gift to you. Enjoy the moment – each moment – with your sweet little friend.

Additional Considerations

Consider researching and using alternative therapies as a wellness measure to prevent illness or, if your rabbit is already ill, to facilitate support and healing. Keep in mind a rabbit’s intolerance for pain and the potentially life-threatening problems that can quickly arise if the pain and underlying issue are not treated in a timely manner. Always consult with your veterinarian as necessary, discuss the diagnosis, and seek appropriate treatment. When your rabbit needs a veterinarian’s help, alternative modalities can act as a complement to standard veterinary care.

Carefully select the veterinarian or other professional who will provide care for your rabbit, reviewing training and qualifications. Consider also the condition of your rabbit as well as the physiology, nature, and needs of these small creatures. Be clear and realistic about your expectations and goals for treatment, which should prioritize your rabbit’s comfort and quality of life.

by Marie Mead with Connie Conine, OTR

© Copyright 2013 by Marie Mead. Used by permission. All rights reserved.

I wish to extend my sincere gratitude to Connie Conine for sharing her expertise in this article. Warm thanks also to Cheryl Abbott, Sandi Ackerman, Heidi Anderson, Dr. Stephanie Crispin, Nancy and Gary McConville, Dr. Anthony Pilny, Criz Stavast, CMT, and Karen Witzke for their review of and suggestions for this article.  – Marie Mead

Connie Conine, OTR, is an occupational therapist (and stained glass artist) who has assisted rabbits, including her own, recover from injury or disease. As an occupational therapist, she worked primarily with adults suffering from neurological injuries, stroke, or spinal cord injuries. She continues to assist disabled rabbits through her work with the House Rabbit Society (HRS) and its members. As a stained-glass artist, she creates myriad pieces, including windows, three-dimensional and kinetic sculptures, and animals (including rabbits) made with the copper-foil method of soldered glass, which allows her to focus on additional detail. The creative use of fused glass in her pieces has helped make them a big hit at HRS fundraisers.

 

My Beloved Bunny

Photo story by Connie Conine, OTR

Bunny was a Netherland Dwarf who became a paraplegic when he jumped out of a cage at the veterinarian’s office. His backs legs were completely paralyzed following the injury, but he recovered enough muscle strength in the first few months to scoot around the room in a sitting position, with a little assist from his left leg.

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Dad holding Bunny. Notice his “braces:” a sock on the right leg and a “donut” on the left. The sock prevented Bunny’s toes from dragging, and it also kept him from chewing his toenails, which he probably did because of the abnormal sensations. Because his right leg was stiffer and also more spastic (increased muscle tone), it caused him to fall to the left. Therefore, a “donut” made of soft, resilient foam, “jacked” Bunny up on his left, allowing him to remain more balanced. He wore it full-time, and it helped keep him from falling over. The donut didn’t rub his fur, probably because Bunny was lightweight and the donut was very soft.

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Bunny in my lap on a towel getting a little morning cleanup with the squirt bottle, filled with warm water. After being thoroughly dried, he was eager to be off on his own adventures.

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Giving me a kiss as I express (a very gentle squeeze) urine from his bladder. (A veterinarian can teach a caregiver how to do this.)

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Bunny rests against a bolster on a padded mattress outside his cage. The fabric used for all his adaptive devices was ripstop nylon (easy to clean and resistant to bunny teeth) or cotton knit from old soft tee shirts (also easy to clean and somewhat resistant to ingesting).

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Bunny asleep, faced into his bolster. He is in his cage on a padded, absorbent mattress. The front edge of the cage has a pillow for a ramp (the red and blue stripe) so he can get in and out by himself.

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Bunny enjoys the sights, sounds, and smells while looking out the window. It’s Bunny-TV!

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Bunny having a nice nap under his well-chewed blanket. There are some rabbit pellets within reach.

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A picture of Bunny after his injury. You can just see the ripstop nylon “sock” (purple and red) that he wore on the right leg to protect his toes and help keep them from dragging when he scooted across the floor. In spite of his injury, he never lost his “bunny attitude!”

Bunny lived six years as a paraplegic. He will forever be missed.

 

Sugar, The Bunny Who Couldn’t Hop Straight

Photo story by Connie Conine, OTR

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Sugar, a sweet-tempered bunny rescued by the House Rabbit Society, was diagnosed with a stroke. However, she wasn’t disabled on one side, as normally happens with a stroke. Instead, she had poor coordination, weakness in the right back leg and left front leg, and balance problems. Sugar tended to circle in one direction trying to keep her balance, but she’d often fall to her side and then thrash around because she was unable to get back up. It seemed as though there was some brain involvement in her disability because her responses were slightly delayed and she had little seizure-like episodes. Though she tested negative for an E. cuniculi infection, she seemed to improve when given E-c meds.

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The House Rabbit Society made arrangements for Sugar to live for several weeks with a former bunny mom who was also a certified massage therapist. Her amazing dog, Juan, is a lover and protector of all small creatures, and he and Sugar immediately became friends. She’d hop in circles around him and use him as her support/bolster to keep from falling over. Her therapist capitalized on that relationship by encouraging Sugar to use Juan for support as she reached out for some of her favorite greens (an oat, barley, wheat, rye grass mix). This simple exercise – an automatic (normal) activity – helped strengthen and normalize Sugar’s back and front legs and also improved her balance.

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Sugar receiving more assistance from her dog friend, Juan. You can see that she did not use her right leg very efficiently as she reached out for the greens, an example of normal (automatic) activity. Sugar’s right back leg was weak and uncoordinated so she did not always put her weight on it. The continued use of this simple exercise helped strengthen and normalize both the back and front legs and greatly improved her balance.

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Sugar standing up for a treat. This exercise encouraged her back legs to work together; her right leg was the weak one. Her left front leg was also very weak and uncoordinated, and that shows in this photo – you can see how she is unable to use that foreleg as she attempts to stand and get a tiny piece of carrot. Care was taken not to feed too many carrot treats, as the emphasis was on overall health, not just physical therapy. So Sugar’s diet consisted mainly of unlimited grass hay, a controlled amount of leafy greens, and a limited amount of grass-hay-based pellets.

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Sugar standing and actually making a little climb up the body of her therapist-friend. This continues the story from the previous photo, where Sugar is working to get the little piece of carrot. Again, this was a way to make her work on balance and strength issues. Sugar was such a sweet rabbit, and she good-naturedly participated in all the exercises and challenges that she faced in therapy.

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Feeding time for Sugar and Juan. You’d never know from this photo that Sugar had her own bowl of leafy green vegetables, but she did. She’d quickly consume hers because she knew Juan also had a few leafy greens in his bowl. As soon as she finished her bowl, she’d run over in her ungainly fashion to eat some of his veggies. She never touched his dog food though (and that wouldn’t have been allowed anyway), and Juan seemed happy to share.

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Sugar and Juan in his backyard. After several weeks of therapy, Sugar was more symmetrical in body and definitely steadier on her feet. She was now able to hop around on uneven ground. Sugar had been taught how to get back up from a side-lying position, so on those rare occasions when she fell over, she could regain her feet on her own. (Note: Though the backyard was fenced and Juan always around, an adult human was always on hand to monitor the furred companions.) By the time Sugar finished her therapy, it was virtually impossible to tell that she ever had coordination problems.