OrthoPets Blog

Happy New Year from OrthoPets! New Business Hours!

From all of us at OrthoPets, we wanted to wish you all a Happy New Year!

With the new year, we wanted to let you know we have new business hours!

Our new office hours are Monday through Thursday, 9am – 5pm MST.

The change in office hours will not affect our fabrication time-frame. Happy New Year!

November 2018 OrthoPets Case Study for the Canine Rehabilitation Institute: Jerry

Jerry is a three-and-a-half-year-old male goat from a rescue organization in Massachusetts. He has a right carpal injury from an unknown trauma, which left the carpus contracted and unable to extend. He has good range of motion in elbow and shoulder joints, but his carpus was contracted, and he had a hard time getting around. Jerry faced the possibility of amputation until he finally met a veterinarian who brought up the possibility of a custom-made prosthetic/orthotic device for him. 

OrthoPets was able to design an “accommodative device” for Jerry, allowing him to rest his limb in the contracted position while having an extension piece extend downward in a natural position into a faux paw. This eliminated the need for an amputation and would still allow him to ambulate normally. When Jerry was first introduced to his new forelimb prosthetic device, he took to it immediately and ran to chase the other goats. Jerry is now living a normal goat life with the rest of his pasture mates!

August/September 2018 OrthoPets Case Study for the Canine Rehabilitation Institute: Jane

Jane is a 5-year-old German Shorthaired Pointer who was referred to OrthoPets because of a previous Achilles tendon rupture surgery that had failed. About one year post-operatively, Jane was out pheasant hunting with her owner and unfortunately reinjured herself. When she was seen at the veterinarian’s office for limping, she was diagnosed with a new partial tear of her left Achilles.   After reviewing Jane’s case, we reached out to her owner and veterinarian to discuss the goals and outcomes for Jane and her new tarsal orthotic. The owner was hoping Jane could return to partial hunting but decided that she would not be a professional hunter. He decided to decline further surgery and opt to use a tarsal orthosis that would offer Jane long-term support allowing her to continue hunting. Based on the goals, it was decided that we would fabricate a non-articulating tarsus with an articulating paw orthosis to ensure long-term support for Jane during her high intensity activities. 

Since Jane is a high energy dog, we needed to add some additional components to her device to make it extra durable. Some of those components were aluminum in her paw segment, Heavy Duty motion limiters, and carbon reinforcements throughout her device.   Richard reached out with an update at the end of July letting us know how thankful he was for the device and how it has enabled Jane and him to continue to hunt. He even let us know Jane had recently won a hunting competition! 

Richard sent us a picture of the award they had just received for Jane winning the club field trial championship. “There are 6 birds and the dog must find, point, and retrieve with the least shots and in 20 minutes or less. Jane had the fastest time of all the dogs and wouldn’t have been able to do it without your orthosis! I’m so glad she can still hunt with me.” – Richard, Jane’s dad

July 2018 OrthoPets Case Study for the Canine Rehabilitation Institute: Rusty

Rusty is a 3-year-old Australian Shepherd who suffered a severe and complex metatarsal/tarsal luxation with a closed mid-diaphyseal fracture of metatarsals 2-5. The fracture and subluxations were surgically corrected and temporarily stabilized with an implant. However, Rusty’s surgeon wanted to protect the plate as well as avoid the possibility of unintentional arthrodesis and have the option for future plate removal and stabilization through orthosis alone. 

Based on the surgeon’s goals for Rusty, a tarsus/paw orthosis that features a cranial tibial shell with an articulating tarsus and articulating paw segment and dacron motion limiting straps at the articulations was chosen. This design allows free range of motion on the sagittal plane, while offering frontal plane (varus/valgus) restraint and transverse plane control. Several special considerations were included to provide comfort at the suture and plate sites, as well as a prosthetic sock for extra protection of Rusty’s shaved haircoat. 

Rusty took to his orthosis extremely quickly and was able to go hiking on vacation with his owners almost immediately after receiving his device. His biggest challenge so far has been to keep him slow and steady when he is using the orthosis since he would prefer to run and jump.

June 2018 OrthoPets Case Study for the Canine Rehabilitation Institute: Kinley

Kinley is a 12-year-old lab that presents with chronic and severe degenerative changes of the right tarsus. Chronic ligament instability or a previous OCD lesion was ruled out. She has experienced progressive pain and weakness of the stifle and hip joints secondary to the tarsal pathology. A tarsal arthrodesis was not recommended due to the success rate and that she was responding well to the anti-inflammatories. The goals of the orthosis were to return the patient to his 3-mile-a-day walks as well as to avoid further injury or increase of current instabilities of the tarsus and stifle. 

The severity of tarsal instability concurrent with stifle involvement indicated a non-articulating tarsal orthosis with a paw segment coupled to a cranial femoral shell. The femoral shell added global support (multi-plane) to the stifle to reduce the likelihood of a CCL tear. Due to the complexity of the pathomechanics, several custom modifications were added to this unique case to provide Kinley the greatest amount of comfort and support. Kinley adapted to the orthosis quickly and a marked improvement was noted in her gait. With the added support and stability, Kinley was able to return to her 3-mile-a-day walks and was able to experience increased comfort and confidence during gait.

May 2018 OrthoPets Case Study for the Canine Rehabilitation Institute: Cowboy

Cowboy is a 1.5-year-old mixed breed who is a patient through our OrthoPets Michigan Partner Clinic, Pawsitive Steps Rehab and Therapy for Pets. He originally presented in July 2017 as a puppy for a number of issues, but the most severe was his congenital ectrodactyly of both forelimbs. Additionally, he presents with bilateral severe shoulder joint OCD. Cowboy originally saw a number of different specialists around the Midwest who were unable to agree on a suitable surgical intervention or long-term care plan. Chief among these challenges are his age, predicted growth, and numerous deformities and orthopedic issues. Dr. Tari Kern and her staff met him and determined he could benefit from mechanical support to his forelimbs enabling Dr. Kern to focus on his other orthopedic issues. 

During his physical examination, his left forelimb demonstrated increased pain and discomfort. Once he was closer to skeletal maturity, he would be casted for a custom left carpal orthosis. His radiographs and his exam are quite interesting. Just distal to the carpus on the left thoracic limb, the paw is separated into 2 sections featuring the metacarpals separated from each other rather than united as a single structure. The paw is also separated into the 2nd digit and its phalanges and a grouped structure that includes 3rd/4th/5th digits. Cowboy started a rehabilitation program with Dr. Kern in the meantime and was scheduled for arthroscopy of both shoulders to make him as comfortable as possible. 

Top left: Cranial view of forelimb paws. Top right: Left forelimb extremity. Bottom: Left lateral forelimb extremity.

When Cowboy was 1, he returned to Dr. Kern for his V-OP evaluation and fiberglass impression of his left forelimb for his custom orthosis/prosthesis. One of the most important things to discuss with your clients when determining if an orthosis is the right thing for their pet is to review the “goals” for the use of the orthosis. It is very important to inform OrthoPets of the stated therapeutic goals that have been communicated to the client. In some cases, the client goal for the use of the device may not be something that is possible based on the diagnosis and history. In Cowboy’s case the clients and vet had 3 simple goals:

  • Provide support for L FL paw / carpus
  • Reduce discomfort
  • Improve quality of life

Once the goals have been listed and the fiberglass impression and measurements have been received at OrthoPets, Martin Kaufmann (OrthoPets owner/founder) and the OrthoPets case manager are able to take all of those things into consideration and determine the best V-OP plan for the device to meet those goals. OrthoPets utilizes the requested information and data for each patient to perform a comprehensive case review to develop a V-OP fabrication plan that is the most beneficial and useful device for that patient. You can take a look at this process in the video below. 

OrthoPets New Case Checklist

The device that was the best option for Cowboy was one that allowed us to corral the limb into one solid section via the use of a fully removable foam liner. This is one of our hybrid-style devices that is built similar to a prosthesis but has a paw segment and outer shell similar to an orthosis. Due to the severe deformity of the limb and an abnormal carpal joint along with the MCPJs, we were not able to articulate either the paw segment or the carpus segment. The shell of the device was a caudal style non-hinged device. Cowboy was fitted with his device recently and was quite comfortable even at the first fitting, and by the second follow-up visit, he was moving well and really learning to trust his device! 

Great job to Cowboy’s rehab team and his dedicated family for working so hard to keep him happy and healthy from the start!

Left: Standing, lateral view. Right: Cranial view.

April 2018 OrthoPets Case Study for the Canine Rehabilitation Institute: Sampson

Sampson is a 3-year-old Rottweiler who presented to an OrthoPets Partner Clinic for right hind limb lameness. He was diagnosed with a right cranial cruciate ligament tear and severe hip dysplasia. When surgery isn’t an option due to age, health, financial, or other reasons, OrthoPets can offer an alternative solution via a custom-made orthosis. 

Left: Sampson’s hips. Right: Good hips. Image credit: “Hip Dysplasia.” Orthopedic Foundation for Animals, www.ofa.org/diseases/hip-dysplasia.  

Patients with hip issues can be more of a challenge to create the fiberglass impression, as they can be more uncomfortable then other patients when standing for an extended period of time. There are a few options to aid patients to remain standing during the casting. To help make the impression process easier on the pet, we advise using towels or slings to aid in helping stand the patient up or positioning a yoga ball underneath their abdomen allowing the patient to lay over the ball. This position supports the patient while allowing access to the flank and groin areas. 

It was determined that a standard stifle orthosis would be the best option for Sampson due to his weight and therapeutic goals. OrthoPets utilizes a variety of mechanical hinges and chooses the appropriate set of hinges for the patient’s needs. The completed device was shipped to the OrthoPets Partner Clinic to fit the device properly and discuss the recommended wearing schedule with Sampson’s owners. 

Sampson has been wearing the device for a few weeks and has been able to go on walks again. In the beginning stages of device use, speak with your veterinarian about exercise restrictions. As your treatment plan progress, your veterinarian will guide you in how to restore activities safely. 

Left: Sampson, pre stifle device. Right: Sampson, post stifle device.

Sampson’s owner reports: “Sampson has been doing great! He loves the brace and it enables him to do all the things he loves to do! I’m so pleased that he can go for walks again and dispel his nervous energy!”

Veterinary Orthotics and Prosthetics (V-OP) in Small Animal Rehabilitation and Pain Management: Summary

There are many advantages afforded by orthoses and prostheses. Many injuries are amenable to these devices, and subtotal amputation provides a substitute for quality of life, altering total amputation. Simply put, V-OP devices offer treatment options where none existed before. For chronic or catastrophic injuries, they play an important role in pain management, and can significantly improve, comfort, quality of life, and functional independence as well as limit premature decisions to euthanize. In the severe case, these devices serve as safe alternatives to traditional casting and splinting while providing the opportunity to initiate rehabilitation earlier. Many patients can return to an active lifestyle, which can reduce the risk of obesity and its associated comorbidities. Secondary or compensatory pain can be minimized by correcting or improving gait mechanics and re- establishing quadruped locomotion.

With increasing numbers of fabricators and internet suppliers, veterinarians must educate themselves to advocate for their patients and clients. V-OP devices are valuable therapeutic tools. However, paraprofessionals cannot and should not prescribe and treat. In the absence of knowledgeable and supportive veterinarians, this is the risk and reality. Providing these solutions within the primary care practice is possible and appropriate.

Rehabilitation and V-OP: A Team Approach With a Precedent

Human patients receiving a prescription orthosis or prosthesis work with a physical therapist to learn how to use the device properly. There is a common misconception that orthoses are static, causing muscle atrophy, diminished joint range of motion, and dependence on the device. This is not true of modern dynamic orthoses. These devices are hinged and actually promote muscle development, normalize range of motion, and assist in balance and coordination by stabilizing an unstable limb segment. Rehabilitation provides the link between patient and device.

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Rehabilitation for a stifle orthosis includes gait re-education using
cavaletti poles.

Most veterinary patients adapt quickly, and behavioral techniques can facilitate this. Device-specific rehabilitation focuses on specific skills. Skills include transitions (sitting, lying down, and getting up), stairs, getting into and out of vehicles safely, managing on different types of surfaces (ground, carpet, hardwood floor, etc.), and managing dog doors. Orthopedic injury leads to compensatory abnormal movement and associated muscle strain and weakness. Gait re-education focuses on resolving these issues. The best way to ensure the highest level of success with a V-OP device is to follow a rehabilitation plan established by a certified canine rehabilitation professional (CCRT or CCRP). Each patient’s condition and abilities are unique, and as such, an individualized rehabilitation program is needed. Furthermore, although V-OP devices can get wet, water therapy (swimming and underwater treadmill) comprises a small component of the overall rehabilitation plan. Land- based therapeutic exercise is essential. Balance, proprioception, muscle timing (neuromuscular retraining) and coordination lay the foundation for proper device use; these must be mastered on land so that the patient can learn response to normal ground reaction forces and shifts in their total body force vectors. The buoyancy of water complicates such mastery and does not represent the patient’s home environment. Additionally, daily home exercises are an important part of the rehabilitation plan. Most clients do not have daily access to water therapies, thus practical land-based exercises make up the bulk of in home therapy.

As in the past for human physical therapists, OP is creating a new challenge for veterinary rehabilitation therapists: assistive device-specific rehabilitation. Animals are adaptive and will learn ways of ambulating in an orthosis or a prosthesis. This is not always the most efficient, safe, or functional method of ambulating. Therefore, using the human experience as a precedent, it is reasonable to suggest that veterinary 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, Fitting, and Assessment Processes

A V-OP patient evaluation must be thorough enough to provide a specific device prescription. It must take into account the entire patient from a mechanical and physiological perspective in addition to a clear understanding of the primary injury. The V-OP examination must fully define the presenting deficit, characterize biomechanical implications, identify complicators or comorbidities, and diagnose all primary and secondary pain generators. The examination should include a general wellness assessment in addition to orthopedic, myofascial, biomechanical, and neurologic examinations. Additionally, the case must be understood from the standpoint of lifestyle, environment, family dynamics, sport or activity, goals and intended outcome as defined by client and veterinarian, and alignment of goals with proposed orthotic or prosthetic device. The good news is that with the help of a qualified fabricator as noted previously, the general practitioner can succeed in providing V-OP devices.

Once a plan is developed and the device is designed, the next step in creating a custom orthosis or prosthesis is fiberglass impression molding of the limb. This step is critical for optimal fit and correct function of the device. Creating a precise replica of the limb in a thin layer of fiberglass tape requires a bit of artistic acumen and a clear sense of device purpose. This fiberglass impression is used to create a plaster model from which the custom device will be fabricated. Therefore, the limb must be molded in the properly aligned position. Just as a poorly positioned or exposed radiograph is less than adequate for accurate diagnosis, a poorly molded fiberglass impression is equally useless in fabricating the best device.

Manufacturing requires skilled modification of the model by hand or using computer-assisted design to build reliefs, which accommodate limb topography and create appropriate corrective forces when the completed device is applied to the limb. The modified model is the structure on which a thermoplastic shell is vacuum formed. The shell is then hand cut, trimmed, and ground to the final shape. Materials used to pad and line the shell vary. Hinges, straps, pads, and motion-limiting components complete fabrication. The typical custom V-OP device cost varies with components and materials and averages $600-$1000. This does not include the necessary appointments to ensure proper fit and function along with client education.

An important advantage to veterinarian-guided use of a V-OP device is fit and function assessment and adjustment. Adjustments are expected and are a normal part of the custom process. Reputable custom fabricators strive to accurately fit the device; however, variations in injury severity, gaiting pattern, and level and intensity of activity all affect the accuracy of initial fit and cannot be predicted in all cases. Couple this with a dynamic process such as Achilles tendon therapy and the necessity for adjustability is clear. Pressure and friction irritation are the most common reasons for adjustment followed by the natural progression of the case. Fortunately, with a removable device, such issues are quickly recognized and corrected; this is an advantage over casts and splints that are changed weekly at best.

Orthoses and prostheses are considered “durable medical devices.” This means that proper use is necessary to meet therapeutic goals and to ensure safe application over the lifetime of the patient or the duration of injury healing. Typically, several follow-up assessments are advised in the first few months. Thereafter, annual to twice-annual appointments, depending on injury, age, and activity of the patient, are needed. At these appointments, the orthopedic condition of the patient and the condition or fit of the device should be evaluated. Lastly, short- and long-term plans are adjusted.