Origins of V-OP

Human orthotic and prosthetic (H-OP) practice traces its origins to ancient Egypt and Greece. Earliest assistive devices were made of leather and wood. In the 18th and 19th centuries, these materials were replaced with metal. Not surprisingly, the profession of bracing predates surgery; bone setters and appliance makers were skilled artisans. Modern orthopedic surgery rapidly developed in the 20th century with the advent of implants and safer anesthesia; ultimately, surgery replaced bracing and splinting as the cornerstone of orthopedics. Consequently, bracing became ancillary to surgery. In recent years, improved technology has led to substantial improvements in bracing techniques and a more discriminate parsing of surgical vs. nonsurgical cases. A clear example is the decrease in Achilles tendon surgery in favor of dynamic bracing and rehabilitation for human patients.Today braces are more accurately termed orthoses. Orthoses are defined as any medical device attached to the body to support, align, position, prevent, or correct deformity; assist weak muscles; or improve function.2 The term orthosis implies dynamic control, whereas brace more accurately refers to static control. Both are needed in modern therapy, and “orthosis” is preferred as a general term for both types of mechanical devices. They are not a replacement for necessary surgery, but complementary.Prosthetists were originally black smiths and armor makers. Materials included wood and leather, calling to mind the classical image of the peg-legged pirate. Later, metal was incorporated albeit lending a great deal of weight to these devices. In modern times, a positive consequence of war, if this can be said, includes medical innovation by necessity. The American Civil War resulted in tens of thousands of catastrophic limb injuries. J.E. Hangar is reportedly the first amputee of that war.3 He subsequently built his own prosthetic leg and ultimately the largest human prosthetic limb fabrication company in the United States, Hanger Inc, publicly traded on the New York Stock Exchange as HGR. In the late 1880s, his devices were available by mail order, typically selling for $75- $150, which is approximately $2000-$4000 in today's dollars. These early devices served an important purpose, but were utilitarian at best and truly uncomfortable at worst.Once again driven by human conflict, today lightweight materials, microprocessors, and neural integration have resulted in spectacular improvements in function including sensation and lifelike grasping appendages. These devices have allowed amputees to return to and excel in nearly all human endeavors including sport; no longer are these individuals relegated to “getting by” and “making due” with their injury. The goal is to thrive with few or no boundaries. Amputees still face many challenges, and rehabilitation remains critical to successful return to function, but the list of limitations is shrinking.Over the past decade, there has been a tremendous increase in our understanding of physical fitness for animals coincident with an increased demand for maximizing quality of life for our companion animals. We now know that optimal movement and mobility can significantly affect the physical and mental health of our veterinary patients. Rehabilitation has moved to the forefront of modern veterinary medicine with the debut of the American College of Veterinary Sports Medicine and Rehabilitation.4 Not surprisingly, innovative human orthotists or prosthetists have been tapped to create one-off mechanical appliances to improve the mobility and functionality of the occasional veterinary patient. This seems to mirror the emergence of acupuncture, chiropractic, and rehabilitation therapy for animals in the preceding decades. During this time, human practitioners introduced and, not entirely legally, ministered to veterinary patients owing to a paucity of qualified veterinarians. We are in their debt in terms of introduc- tion; subsequently, veterinary medicine has embraced and advanced these modalities with species-specific scientific vigor. Likewise, many veterinary practice acts have recognized these modalities and redefined the legal use by nonveterinary practitioners. As of this writing, these therapies are emerging as main- stream rather than so-called alternative therapies. Likewise, V-OP is emerging from beneath the wing of H-OP. Recent media productions such as Disney's A Dolphin’s Tale and PBS's My Bionic Dog have recently brought V-OP as a therapeutic option to the public eye. Although these productions still leave the viewer with an impression that such cases are yet novelty, this is far from reality and the current state of the science.