Historical Perspective of Veterinary Orthotics and Prosthetics (V-OP)
The use of orthotics and prosthetics to assist humans in ambulation and functional independence was first recorded in 2700BC and 1500BC, respectively (Seymour 2002). Throughout the ensuing centuries design of such devices has been advanced by increasing demand from catastrophic wartime injuries, sports injury, and complications of diabetes. In the past century veterinary medicine has also advanced in technology and sophistication co-incident with the increasing value and importance of companion animals. Not surprisingly, the use of mechanical appliances such as orthotics and prosthetics to protect, support, and improve function, is no longer the purview of human medicine alone. State-of-the-art veterinary health care now includes a new industry called Veterinary Orthotics and Prosthetics (V-OP). The acronym distinguishes it from the human specialty, referred to as H-OP.
The techniques and materials used in H-OP are easily translated into use for veterinary patients with specific modifications to account for quadruped ambulation and the significantly greater magnitude of force these patients generate relative to human beings. V-OP has made great strides in the past decade from simple adaptation of PVC pipes, aluminum rods, thermoplastics, and fiberglass/plaster casting to the use of veterinary specific hinges, vacuum-molded composite high-temperature plastics, titanium, carbon fiber, custom paws, and dynamic motion-assist mechanics, alongside a growing understanding of the intricacies of quadruped mobility and biomechanics (Adamson, et al, 2005). The advantages afforded by custom orthoses and prostheses include prevention of cast-related wounds; management of primary pain generators associated with functional impairments; improvement of biomechanics, allowing for greater activity and a significant decrease in secondary (compensatory) pain; return to active lifestyle, resulting in decreased obesity and associated co-morbidities; improvement in quality of life and functional independence, both of which can prevent a premature decision to euthanize; and the availability of treatment options where none existed before.
The application of a mechanical device is not a panacea and not without challenges. Return to full function or at least to functional independence requires re-education of the body as a whole including muscles, nerves, and the mind. Early pioneers of H-OP did not anticipate the need for such rehabilitation. However, in modern practice it is clear a mechanical device must be coupled with rehabilitation to maximize its use and the patient’s success to attain the highest level of function. Indeed, at the 2004 Veterans Affairs SOTA Conference prosthetic researchers, physical therapists, and engineers, met to discuss creative ways to study barriers to prosthetic use, and the ways in which physical therapists can promote amputee rehabilitation with the use of properly prescribed prostheses. This committee named post prosthetic amputee rehabilitation as one of 6 areas of critical importance in Veterans Affairs (Kerkovich, 2004).
The main aim of rehabilitation is to restore and preserve maximum independence of action and functionality (Geertzen 2001). With respect to veterinary patients an additional aim is to prolong active and comfortable life in order to prevent premature euthanasia. Rehabilitation isa medical specialty concerned with the prevention, diagnosis, treatment, and management of disabling diseases, disorders, and injuries typically of a musculoskeletal, cardiovascular, neuromuscular, or neurological nature by physical means (websters online dictionary).
Biomechanics encompasses anatomy, kinesiology, neurophysiology, mechanics, physics, and mathematics (Bedotto, et al, 2006). Pathomechanics deals with the abnormal effect of static and dynamic forces on the body as a result of neurologic, muscular, and skeletal disorders. Pathomechanics provides understanding of the underlying cause of gait deviation and the implication of forces acting on the injured body during movement: ground reaction force (GRF), inertia (acceleration), and gravity.
The specialty of orthotics and prosthetics addresses pathomechanics through the use of corrective forces including alignment of body position, muscular control, and external mechanical systems. (Bedotto, et al, 2006). The addition of an orthosis or prosthesis adds additional challenge to rehabilitative manipulation of movement. Comprehensive treatment of a pathomechanical injury requiring use of a device involves marrying the mechanics of the device with the mechanics of the body; the device must become part of the biomechanical system. The rehabilitation therapist plays an integral part in uniting the mechanics of body (muscle and nerve activation and integration patterns) and device into the complex biomechanics of locomotion. In this paradigm the therapist provides physical treatment and the prosthetist/orthotist provides the device or mechanical treatment. As early as 1967 the importance of the close cooperation of prosthetist (orthotist) and rehabilitation therapist was recognized as absolutely essential to the achievement of any degree of success (Bechtol, 1967). The goal of this united effort in human practice is to allow the patient to ambulate in a safe, efficient, and functional manner.
Modern technology has advanced the sophistication of veterinary orthotics and prosthetics. What is lacking is device-specific rehabilitation to enable our veterinary patients to fully realize device potential on par with human patients. Rehabilitation of the V-OP patient requires diagnosis; assessment; prognosis; a goal-oriented, device-specific treatment plan; and outcomes measurement to determine efficacy of the plan. It requires communication between the rehabilitation therapist and the V-OP professional in order to provide unified and efficient delivery of care.
The veterinary rehabilitation therapist must have a basic understanding of the purpose, mechanics, and limitations of the device. They must recognize complications in a timely manner in order to prevent injury and limit time out of the device. Likewise, the V-OP professional must understand short and long term rehabilitation goals, the biomechanics of therapeutic exercises, and the limitations of rehabilitation. Ultimately, shared information and diverse expertise leads to intervention, device modifications, or training strategies that maximize patient comfort, endurance, and overall function (Pomeranz 2006).
