Baited stretches might help improve a horses neurologic function when part of a comprehensive rehab plan. | Taylor PenceIn people and dogs, clinicians commonly use rehabilitation as part of a multimodal approach to managing neurologic disease. Comparable research in horses remains limited. Historically, equine practitioners have hesitated to incorporate rehab exercises into treatment plans for neurologic horses, citing limited knowledge, lack of appropriate facilities, and safety concerns, said Kara Brown, VMD, Dipl. ACVSMR. However, with good communication and case selection, she added, veterinarians can safely pursue rehabilitation on the farm.Brown, an assistant professor of equine sports medicine and rehabilitation at the University of Pennsylvanias New Bolton Center, in Kennett Square, described the topic during her presentation at the 2025 American Association of Equine Practitioners Convention, held Dec. 610 in Denver, Colorado.Creating a rehabilitation plan for a neurologic horse starts with an accurate diagnosis to ensure he receives appropriate treatment, she explained. After veterinarians establish a treatment plan, they can use rehabilitation tools to improve the horses muscle strength, proprioception (awareness of where the limbs are in space), and balance.Improving the Neurologic Horses Muscular StrengthWhen improving muscular strength in horses diagnosed with neurologic disease, Brown says veterinarians might use exercises and tools including:Weight-shifting exercisesDynamic mobilization exercises (carrot or baited stretches)Elastic-resistance-band trainingNeuromuscular electrical stimulationWeigh-shifting exercises can include wither pulls, tail pulls, pelvic pushes, and, if safe to do so, limb lifts, said Brown. With each of these exercises, I recommend holding for 10 seconds, five times on each side, once daily, and three to five times weekly.Dynamic mobilization exercises incorporate active range of motion targeted to activate deep epaxial (back) muscles and improve core strength. Along with the baited stretches mentioned, these can include sternal lifts and pelvic tucks. Its important to note that in horses with severe neck pathology, baited stretches can be harmful, especially if the condition is not treated, said Brown, so she considers case selection for these exercises critical. However, when used correctly, they can improve the horses postural control and balance.Resistance-band training is helpful for strengthening if the horse cant do much because they are too unstable for more substantial activity aside from hand walking, she said. (Veterinarians) need to start very slowly when using this tool because the horse can fatigue quickly.Brown also recommends veterinarians and practice staff try resistance bands on patients prior to advising the owner to use them because some horses can be reactive to stimuli around the abdomen and hindquarters. When used correctly, resistance band training can improve the horses dynamic stability.Neuromuscular electrical stimulation is an electrical current that stimulates motor activity in the horses musculature, creating a muscle contraction. In practice this can be used if the horse struggles to voluntarily contract the muscles and in horses with focal muscle atrophy but is best done by the veterinarian, technician, or very experienced owner because some horses might have a negative reaction, said Brown.Proprioceptive Retraining for Neurologic HorsesWith task-specific training, the horses nervous system can undergo functional and structural reorganization, said Brown; therefore, she encourages veterinarians to utilize proprioceptive retraining to activate these sensorimotor pathways. Stall rest can result in the progression of ataxia due to disuse muscle atrophy, she said, referring to muscle wasting. Controlled exercise and turnout form the basis of the rehabilitation plan and can help with proprioception.Brown recommended veterinarians incorporate hand walking into the horses plan if the owner does not have access to safe turnout. Specifically, walk the horse over a variety of surfaces to provide different types of proprioceptive feedback. Leaving the horse unshod or, if shod, the frog available to touch the ground can also provide tactile feedback and assist with proprioceptive retraining. Using pastern weights and tactile stimulators can also help provide feedback to the lower limb and stimulate flexion, increasing peak hoof height during the flight phase of the stride, said Brown. Horses will, however, habituate to tactile stimulators and pastern weights relatively quickly, so these tools are best used for short periods of time, she added.If safe and feasible, Brown also suggested incorporating in-hand walking over ground poles, which can also provide tactile feedback and increase limb flexion. One to two passes over two to three poles is usually a good starting point but depends largely on the horses degree of ataxia, she explained.Safety Considerations When Rehabilitating Neurologic HorsesI reassess and reevaluate the rehabilitation plan every one to two months and make alterations depending on the horses progression, said Brown, emphasizing the importance of using measurable outcomes to determine the horses improvement for the benefit of both the veterinarian and owner.Any horse with ataxia is at an increased risk of tripping and falling, she said. Veterinarians should always attempt these exercises themselves (with the horse) first before having the owner perform them, said Brown. However, an experienced, informed handler can successfully rehabilitate neurologic horses on the farm, she added.Brown cautioned that horses determined to be a Grade 3 or more on the modified Mayhew scale pose a higher risk when handling on the ground, so veterinarians and handlers should use extra caution with these animals, and they might be unsuitable for rehabilitation on the farm.If a horse shows severe or unpredictable behavioral abnormalities such as aggression toward humans or other animals, unpredictable spooking, or bolting, especially with rapid progression, Brown said veterinarians need to consider the possibility of a more insidious cause of neurologic disease, such as a neurodegenerative disorder (equine degenerative myeloencephalopathy or equine neuroaxonal degeneration), which could also affect handler safety.Take-Home MessageRehabilitation can be a safe, effective addition to a neurologic horses treatment plan when veterinarians start with an accurate diagnosis and clear communication. With the right case selection and appropriate strengthening and proprioceptive exercises, rehabilitation can be an important tool for improving outcomes in neurologic horses. Regular reassessment and safety precautions remain essential.