History

Medical history

On March 1, 2017, I picked up Sal, a long-haired orange tabby from the Animal Rescue League of Boston (ARL). Sal was brought to the ARL with injuries consistent with being hit by a car. Sal’s right front leg was broken and his left back hip had been dislocated, but had healed with the femoral head on the outside of the pelvis. The level of healing suggested the trauma had occurred a significant amount of time before he was rescued. On February 17, Sal’s right front leg was amputated at the shoulder, and a femoral head ostectomy (FHO) was performed on his hip. Although cats recover well from either of these two surgeries, receiving them simultaneously made recovery more complicated as Sal had fewer limbs to rely on to compensate.

Life history

Sal was estimated to be 1 year old when he was brought into the ARL. It is unclear if he was stray or came from a previous home. He was described as sweet by the staff at ARL and showed no aggression towards me at any time.

Although this case is largely medical, I relied heavily on behavioral interventions during his rehabilitation. I will mention medical goals briefly as a background for why certain behavior-based strategies were necessary.

Sal on Day 1 in my apartment

In foster care 

Living conditions

There are no other pets or people in my household. I live in a small, one-level, one-bedroom apartment. 

Initial behavioral observations

Immediately upon arrival in my home, Sal left his carrier and explored his new surroundings. Sal’s tail was raised within the first hour, and he spent no time hiding. After hobbling through my apartment, he settled on the floor near my feet and allowed me to pet him. He ate a full meal the first night.

Food motivation: Sal ate both wet and dry food, but was not highly motivated by either. He was a slow eater, typically did not finish his wet food, and grazed on dry. He liked Greenies treats, but had difficulty picking them up off the floor.

Play: Sal was HIGHLY motivated to play. He played stalking and chasing games with me, and showed the most interest in lure toys such as a Cat Dancer or anything attached to a stick. He engaged in solo play less often, but occasionally would bat at a ball or a catnip mouse.

Social behavior with people: Sal was very social with people. During our first week together he followed me from room to room, despite his handicap. When I had guests, he approached them at the door, and settled wherever the group did. Sal was not a “lap cat” but often solicited petting. He disliked being picked up, evidenced by evasive wiggling upon being lifted, and the occasional meow after a few seconds. The meow was significant because during the first week Sal did not vocalize at any other time.

Weeks 1-3 

Goals

Sal in the carpeted kitchen

Initially Sal’s foster stay was expected to be less than two weeks, during which he would recover from his surgeries. My tasks were to keep him moving, prevent further injury, and administer medication. I added a goal of increasing the duration of time that he would tolerate being held. 

1. Injury prevention
   The amputation of his right front leg meant that when Sal landed, his left front leg bore all the force. Sal also had to adapt to an unbalanced new gait, which, combined with his weakened hip joint, put him at significant risk for slips and falls. I used antecedent arrangement as my primary strategy for preventing further injury. To stop Sal from slipping I covered as much wood flooring as possible with carpets, mats, and towels to provide traction. I also used books, stools, and boxes (covered with non-slip materials) to reduce the height from which Sal might jump or land. 

2. Exercise

During his first weeks with me, Sal followed me like a shadow so it was not difficult to keep him moving. I used a Cat Dancer toy to encourage him to play after long periods of sitting. Play was mostly restricted to areas low to the ground and on carpeting.

3. Medication

Sal was on 25mg of gabapentin twice a day. The medication was in powder form, and had to be mixed with food. Because he was not highly food motivated it was a challenge to find a way to ensure that he consumed the full dose of medicine. The strategy that I eventually came up with took advantage of his daily routine: Every morning Sal would wake me up and solicit play, I would give him his wet food and top up his dry. He would ignore his food and continue to solicit play, and only after I played with him would he eat some of his wet food.

This allowed for the following medication routine: As soon as I woke up in the morning, I would play with Sal for about ten minutes. I would then mix his medication with only a tablespoon of wet food and place it on the floor. Sal typically finished this small amount of wet food quickly while I supervised. As soon as he finished, I placed his dry (preferred) food on the floor for him. In this sequence, play was both exercise therapy for Sal and a motivating antecedent for him to eat his medication. The dry food then acted as a reward for him finishing the medication. The same procedure worked for his dinner meal.

4. Frequent vet visits

I knew that Sal would be returning to the vet and the ARL frequently, so I tried to desensitize and counter-condition him to his carrier early on. From day 1, the carrier was left in the living room with the door open. During play I occasionally led a lure toy near the carrier, or tossed a mouse in. Whenever I left my apartment for a few hours, I threw Greenies into the carrier for him to find. Sal was not avoidant of the carrier, and would sometimes lie on the open door. When the first vet visit came around, I was able to lure him in with a treat and close the door behind him without a struggle. This worked for subsequent vet visits as well.

5. Carrying

I used desensitization and positive reinforcement to increase Sal’s tolerance for being held. I began by only lifting Sal to transfer him from the ground to a couch or bed, or vice versa. Not only did this prevent injury, but also the new location acted as a reward (I only transferred him if he was standing in front of the bed or couch and looking at it, a likely indication that he was interested in being relocated). If at any time Sal did vocalize, I immediately replaced him to build trust and strengthen that form of communication for him.

When I held Sal, I did so for very short periods of time, as little as a few seconds, and set him down before he vocalized. While I held him, I tried to position myself in front of a window or near a high countertop that he was not able to access on his own. The new vantage points seemed to distract him from the fact that he was being held, and were also potentially rewarding. By the end of his time with me, I was able to carry Sal around my apartment while he was relaxed.

Weeks 3-5

After two weeks, Sal returned to the ARL for a vet check and adoption evaluation. He appeared to be healing well, but avoided bearing weight on his back left leg. The vet felt that physical therapy would create a better foundation for Sal prior to placement. I volunteered to be his caregiver during that process and shifted his goals from basic recovery to improved mobility.

Physical therapy goals from Sal’s vet

1. Reintroduce pain meds (this may allow him to put weight on the left hind foot and build muscle in the hip).

Pain meds were reintroduced using the same procedure of play-wet feed-dry feed used during the first two weeks. 

2. Use a warm compress and gentle massage to limbs before doing range-of-motion exercises 

Sal was reluctant to let me touch his left hind leg, and was not sufficiently motivated by food or petting to allow for counter-conditioning. Without an extra pair of hands to safely restrain Sal for his exercises, warm compress, or massage, I did not feel that I could perform them correctly. The least intrusive, minimally aversive (LIMA) solution that I came up with was to lightly massage Sal’s legs while he was sleeping or drowsy. I also observed Sal’s level of hip extension when he performed a full body stretch, and photographed it for the vet. 

3. Encouraging ambulation on the left hind limb through play on carpeted surface: laying area rugs and/or yoga mats to provide traction on other more slippery surfaces 

This was accomplished almost entirely through play. I continued to use the Cat Dancer and other similar lure toys that encouraged Sal to run around. Sal also engaged in stalking play with me, which involved lots of running and pouncing. I used a Kong Kickeroo toy to elicit a kicking motion with both Sal’s hind legs. This was one of the only times that Sal would use substantial force with his left hind leg. I allowed him to pounce on and kick my socked feet as well, but later on realized this was a poor choice.

Sal looking out the window in an elevated standing position

4. Balancing exercises—having Sal stand on a sofa cushion with some gentle weight shifting of the pelvic limbs.

I tried this by luring Sal onto the couch with the Cat Dancer and moving it from side to side. Unfortunately, when required to shift weight to bat at the toy, Sal opted to roll over onto his side. A suggestion for the future was to manually shift him from side to side when he was standing or eating. 

5. Elevated stands—by placing the one forelimb on a raised surface such as a couple of books then having the rear legs on the ground/floor with good traction. Have Sal take a treat or lick wet food off of finger for count of ten seconds. Rest for five seconds and repeat for three sets. 

Although the suggested method of treating Sal or having him lick food off of a finger did not work, I found four other ways that did:

1. I lured Sal into a standing position on cardboard steps by waving the Cat Dancer above him for ten seconds.

2. I manually placed him in a standing position with his front leg on a windowsill and his back legs on a step. Because he could now see out the window, he would remain standing for at least ten seconds.

3. I cut a hole in the top of a cardboard box as well as a side “door.” Sal would enter the box and stand up through the top hole to bat at a toy I dangled above.

4. 

   Sal retrieving a Greenie from a picture frame.

   When Sal eventually showed interested in searching for Greenies, I placed them in areas that he needed to stand to reach.

Sal during laser therapy

Weeks 5-8 

Physical therapy

After four weeks I brought Sal back to the ARL for physical therapy and laser treatment. Sal was putting more weight on his left hind leg but there was still room for improvement. The therapist added some exercises to his existing routine to improve proprioception and build muscle: ambulation on uneven surfaces and walking over obstacles. 

For an uneven surface, I used the down comforter on my bed, and lured Sal with my fingers under the comforter. For obstacles, I laid broomsticks and pillows on the floor and used lure toys to lead Sal over them. 

Behavior modification

Sal’s sleeping position

As Sal became more comfortable in my home physically and psychologically, he started to show some new behaviors. In particular, his play style of stalking and pouncing started to culminate in biting. In part this was due to my initially allowing him to hold on to my socked feet for biting and kicking. Unfortunately (and predictably), my foot became his preferred target. I added some behavior modification goals to his plan for the last four weeks that I had him because I felt they would better prepare him for placement. The remainder of this case study will focus on the behavioral modification, the main goals of which were to reduce Sal’s biting of people during play, and reduce the behavior of biting to instigate play.

Biting to instigate play

Sal typically went to bed with me and slept near my head for the duration of the night. Although he climbed up and down from the bed on his own during the day, Sal rarely left my bed before me in the morning. When he woke up first (which was often), he would approach my face or arm, and gently bite me. This woke me up, reinforcing the biting with attention.

I tried to tackle this in three ways: by decreasing his motivation for biting (needing attention), by removing the reinforcer (attention), and by reinforcing alternative behaviors (anything other than biting).  I ruled out his morning feeding as a possible reinforcer, because he had dry food available at night and was uninterested in food when it was given (unless he had played first).

1. Decreasing motivation—I attempted to decrease Sal’s need for attention in the morning by playing with him more frequently at night before bed. I would also avoid sleeping late because it increased the likelihood of Sal waking up before me and starting the bite sequence.

2. Removing the reinforcer—Removing the reinforcer for biting was more difficult because I was unable to avoid waking up from the bite. I was, however, able to change what waking up meant. Rather than standing up and moving in any way that led to play (walking allowed Sal to chase my legs, etc.) I rolled over and hid my extremities in my blankets. (The difficulty here was not laughing when he attempted to burrow into the blankets, due to the relative absurdity of hiding from a determined three-legged kitten first thing in the morning.)

3. Reinforcing alternative behaviors—When Sal was no longer biting me or was exploring the room independently; I got out of bed and immediately played with him. On days when Sal did not bite me, I also played with him right away to reinforce whatever non-biting behavior he was engaged in.

Sal’s various eye dilation levels

Biting during play

When Sal became over-stimulated during play, he would bite my hands or feet and actively pursue exposed areas of skin on ankles. Here I did not want to stop play altogether, but I did not want it to lead to biting. I used two different approaches: identify the immediate antecedents for biting in order to stop the sequence before a bite, or, if biting occurs, redirect biting to an appropriate target.

1. Identifying antecedents—Like most cats, Sal’s pupils would dilate significantly during play and when he was aroused. Over time I was able to identify when his pupils reached a point after which he was likely to bite. At this point I would leave the room or pause until he relaxed. He typically redirected his energy towards grooming. When his pupils reflected a more relaxed state, I would resume play.

2. Appropriate target replacement—When possible I would have the Kong Kickeroo nearby and replace my hand or foot with it.

There were times when I was not observant enough to prevent the biting, and I did not have an object to use as an appropriate target. Pulling my body part away or remaining motionless resulted in either prolonged biting or another chase. I felt that both of those outcomes reinforced the biting behavior, so in these circumstances I did attempt to use a handclap near where he was biting to end it. This was effective in stopping the biting, but it did not prevent future bites. Therefore it was ineffective as a punisher. I was not willing to increase the volume or proximity of the clap to make it more effective, so I stopped using it.

Conclusion

After two months in foster care, Sal had made an excellent recovery. He was bearing his weight evenly enough that the ARL felt he could be listed for adoption. He was able to walk up and down a full flight of wooden stairs, be held by visitors, and sleep in a carrier in a car without protest. Sal was showing great quality of life: sleeping, grooming, playing, and eating regularly.

Sal’s level of energy steadily increased as he recovered. His biting to instigate play decreased, and I was better able to identify the critical period before for biting during play. The biting did not diminish altogether, however, so I came up with an alternative solution. Sal’s biting and play styles were not inappropriate for a cat, they were just inappropriate for a human playmate. Therefore, I recommended that he be placed with another cat. This would give him an outlet for his energy and a partner for his stalking games. Additionally, cats that are missing limbs can benefit from having a companion to groom them in areas that they are unable to reach. Within five days of being made available for adoption, Sal had seven prospective adopters.

Sal sleeping near and being groomed by his new companion

Follow-up

Sal was placed in a wonderful home with another young male cat, Zak, who was missing his left hind leg. I contacted the new owners recently and received the following report:

Sal doesn’t nip or playfully bite us at all. He and Zak groom and playfully bite each other. Zak has stopped nipping at us so much as well. They spend a lot of time playing together. 

I am grateful that the ARL veterinarians were able to give Sal a second chance, and that I was able to have been a part of his recovery. It was the best ending anyone could have hoped for, and I have a new appreciation for the abilities of cats to heal!

Lillian Ciardelli has a masters in animal behavior from Hunter College and has spent the last few years working with everything from primates to sea lions. She currently resides in Massachusetts where she splits her time between working as a canine rehabilitation aide at Flowdog (https://flowdog.net/), and apprenticing with Adria Karlsson at (Dog Willing) http://www.dogwillingma.com/. She also contributes to the environmental travel blog One World Two Feet (https://oneworldtwofeet.com/tag/lillian-ciardelli/).