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.[caption id="attachment_media-273" align="alignright" width="310"]

Rehabilitation for a stifle orthosis includes gait re-education using
cavaletti poles.[/caption]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.