Rehabilitation and V-OP: A team approach with a precedent
When people receive a knee or ankle orthosis, they work with a physical therapist to learn how to use the device properly.
They find out how to protect the injured joint and do exercises to increase proprioception, strength and range of motion.
There is a common misconception that orthoses are static, causing muscle atrophy, diminished joint range of motion and dependence
on the device. This is just not true of modern dynamic orthoses. These devices are hinged and actually promote muscle development,
normalize range of motion and assist in balance and coordinaton—all by stabilizing an unstable limb segment.
V-OP has created a new challenge for veterinary rehabilitation therapists: assistive device-specific rehabilitation. Animals
adapt and will learn ways of ambulating in an orthosis or a prosthesis. However, using the human experience as a precedent,
it is reasonable to suggest that patients are more likely to return to highest-level function faster with professionally guided
assistance. Veterinary patients present a seemingly endless variety of injury types and an exceptional drive to recover. For
the creative rehabilitation therapist this is an exciting area for professional growth.
The V-OP evaluation
A V-OP patient evaluation must be thorough enough to provide a specific device prescription. At least five separate examinations
should be conducted to fully define the presenting deficit, characterize biomechanical implications, identify complicators
or co-morbidities and diagnose all primary and secondary pain generators. These examinations should include a general wellness
examination in addition to orthopedic, myofascial, biomechanical and neurologic examinations. The case must be understood
from the standpoint of the following issues:
- Injury or deficit
- Functional and mechanical impairment resulting from the injury or deficit
- Comorbidities or complicators
- Lifestyle, environment, family dynamics, sport or activity
- Goals and intended outcome as defined by the client and veterinarian
- Alignment of goals with the proposed orthotic or prosthetic device.
Once a plan is developed and the device is designed, the next step in creating a custom orthosis or prosthesis is cast molding
of the limb. This step is critical for optimal fit and correct function of the device. Casting the limb in a thin layer of
fiberglass tape requires a bit of artistic acumen and a clear sense of device purpose. The limb is cast in the properly aligned
position. This fiberglass cast is used to create a plaster model from which the custom device will be fabricated.
Manufacturing requires skilled modification of the model by hand to build plaster reliefs, which accommodate limb topography
and create appropriate corrective forces when the completed device is applied to the limb. The modified plaster model is the
structure upon which a thermo-plastic shell is vacuum formed. The shell is then hand cut, trimmed and ground to the final
shape, or shapes, in the case of a multishell device. A custom foam lining designed to change color with abnormal skin contact
is added along with appropriate hinges, straps and pads. The final product is typically completed in about a week at an average
cost of $600 to $850, depending on the components required.
V-OP is a hands-on specialty, so each case should be managed carefully from diagnosis to device orientation using a cohesive
team approach. The ideal team includes the pet owner, the family veterinarian, a certified rehabilitation therapist and a
V-OP specialist skilled in custom design, fabrication and fitting of devices for quadrupeds. This growing specialty has made
options available to animals with mobility issues that did not exist when I was in general practice. As veterinarians, we
owe it to our patients and their owners to be familiar with orthotic and prosthetic devices and how they can be used to improve
the quality of an animal's life. The squirrels probably won't appreciate our efforts, but the dogs that can chase after them
again certainly will.
Dr. Mich is a faculty member of the Canine Rehabilitation Institute in Wellington, Fla., and co-owner and medical director of OrthoPets
Center for Animal Pain Management and Mobility Solutions in Denver, Colo.
1. Meeson RL, Davidson C, Arthurs GI. Soft-tissue injuries associated with cast application for distal limb orthopaedic conditions.
Vet Comp Orthop Traumatol 2011; 24(2): 126-131.