Rehab takes center stage in recovery from neurologic EPM
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The Horse this month highlighted a case study on rehabilitating horses recovering from neurologic equine protozoal myeloencephalitis, or EPM, underscoring that recovery doesn't end when antiprotozoal treatment does. The article, by Haylie Pfeffer, centers on slow, progressive exercise to rebuild strength, proprioception, and stability in horses left with neurologic deficits after EPM. That approach aligns with broader equine rehabilitation guidance from sports medicine and neurology experts, who say horses often need months, and sometimes years, of structured rehab after the underlying disease is treated. (thehorse.com)
Why it matters: For veterinary professionals, the message is that EPM management is increasingly a two-part process: treat the protozoal infection, then manage the residual neurologic dysfunction. Experts note that EPM can mimic other neurologic diseases, making careful diagnosis essential, ideally with compatible neurologic signs, exclusion of differentials, and appropriate serum:CSF testing rather than blood testing alone. Once the horse is medically stable, rehabilitation may begin with low-risk physiotherapy such as weight shifting, tail and wither pulls, limb placement work, and cautious progression to balance pads or surface changes only when the horse is safe on flat ground. (thehorse.com)
What to watch: Expect more emphasis on formal rehab protocols, safety criteria, and referral to sports medicine and rehabilitation specialists as equine practices look to improve functional outcomes after neurologic disease. (thehorse.com)
The Horse’s new case study on rehabilitating the neurologic EPM horse puts a spotlight on a familiar clinical challenge: many horses survive equine protozoal myeloencephalitis, but they don't simply return to normal once drug therapy ends. Published April 19, 2026, the piece frames rehabilitation as a slow, progressive process aimed at improving strength and stability in horses recovering from neurologic injury caused by EPM. (thehorse.com)
That framing fits with a broader shift already underway in equine practice. In a 2023 report from The Horse covering a sports medicine and rehabilitation presentation, University of Georgia clinician Katie Ellis said neurologic rehabilitation may take months or even years, depending on severity, and should focus on stimulating proprioceptive pathways, restoring neuromotor control, and promoting strength. More recently, industry commentary from Boehringer Ingelheim’s equine team has described rehab as an increasingly important complement to drugs and time in neurologic cases, rather than an afterthought. (thehorse.com)
The medical backdrop matters here. EPM is a neurologic disease most commonly caused by Sarcocystis neurona, with Neospora hughesi implicated less often, and it can produce a wide range of signs depending on where lesions occur in the central nervous system. Merck Veterinary Manual notes that weakness, incoordination, and muscle atrophy are common, while The Horse’s EPM backgrounder emphasizes that onset may be subtle, asymmetric, and easily confused with other neurologic conditions, including cervical vertebral myelopathy, trauma, and EHV-1 myeloencephalopathy. (merckvetmanual.com)
That diagnostic ambiguity is one reason the rehab conversation matters to veterinarians. Cornell’s Animal Health Diagnostic Center warns that test performance varies considerably across assays and that cerebrospinal fluid-based interpretation is important; blood testing alone can be misleading because exposure is not the same as disease. The Horse’s reporting on EPM diagnostics likewise points to the current clinical standard as a combination of compatible neurologic signs, a positive serum:CSF ratio indicating intrathecal antibody production, and exclusion of other causes. (vet.cornell.edu)
On the rehabilitation side, available guidance is practical and conservative. Ellis’ recommendations include early physiotherapy such as wither and tail pulls, picking up limbs, core work, and gentle weight-shifting exercises. Balance pads can be added, but only once the horse is stable on flat ground and able to pick up all four feet safely; from there, handlers may progress to straight-line walking and eventually controlled serpentine work over changing surfaces. Boehringer’s Sarah Reuss adds an explicit safety framework: survival first, then safe handling, then safe riding, and only later a possible return to full work or competition. (thehorse.com)
Industry and expert commentary also stress expectation-setting. Reuss notes that a horse with EPM isn't headed back to the show ring quickly, and that the realistic outcome may range from pasture soundness to limited athletic function to, in some cases, return to higher performance. She also says horses that are going to respond favorably to medical treatment generally stabilize within the first four weeks, a period that can help clinicians and pet parents gauge prognosis and decide when more active rehabilitation is appropriate. (animalhealth.boehringer-ingelheim.com)
Why it matters: For veterinary professionals, this case study reinforces that neurologic EPM is becoming less of a purely internal medicine problem and more of a cross-disciplinary management issue involving neurology, sports medicine, rehabilitation, and client communication. The practical challenge is not just clearing infection, but deciding when a horse is safe to handle, what deficits are likely to be permanent, and how to structure a rehab plan that improves function without increasing risk to staff or pet parents. Inference: as more practices build referral relationships with ACVSMR-trained veterinarians and rehab services, post-EPM care may become more standardized, especially for horses with residual ataxia or muscle atrophy. (thehorse.com)
What to watch: The next development to watch is whether more equine centers publish staged, diagnosis-specific rehab protocols for EPM and other neurologic diseases, giving practitioners clearer timelines for reassessment, return-to-work decisions, and long-term outcome tracking. (thehorse.com)