June 28, 2017
While progress has been slow in the field of veterinary orthotics and prosthetics, it has not stalled. Veterinary specialists say advancements in materials, increased awareness, published studies, more educational opportunities and customization represent promising developments in this field.
One benefit of such measured progress is not allowing “well-meaning enthusiasm to get the best of us,” said Patrice M. Mich, DVM, MS, Dipl. ABVP, Dipl. ACVAA, Dipl. ACVSMR, CCRT. “We need to work hard on evidence for best application of this technology in veterinary species.”
Dr. Mich is senior veterinarian at Wheat Ridge Veterinary Specialists in Colorado and a specialist in sports medicine, pain management, rehabilitation, and orthotic and prosthetic devices.
“A quick search of the internet will reveal a number of companies offering veterinary orthotic and prosthetic devices,” Mich said. “In truth, a lack of thorough understanding of the differences between human and veterinary species in terms of anatomy, biomechanics and common pathologies can easily lead to inappropriate treatment and even injury.”
Brian S. Beale, DVM, Dipl. ACVS, of Gulf Coast Veterinary Specialists in Houston, said some of the most recent material advancements in veterinary orthotics and prosthetics include carbon fiber and silicone padding. He described carbon fiber as lightweight, strong and waterproof, and he said the energy return restores life to a pet’s leg.
Borrowing from technology used with people suffering from diabetes or ulcers, manufacturers are utilizing silicone padding, which functions better than traditional foam, said Dr. Beale, an adjunct assistant professor at the Texas A&M College of Veterinary Medicine.
Also trickling down from human medicine is custom orthotics.
“We now have custom fits derived from molds made from the patient’s limb, providing sizing for the 3- to 10-pound patient to the 100- to 150-pound patient,” said William Henry Jr., DVM, Dipl. ACVS. “They can be either open-toed to allow contact weight bearing or closed to prevent abrasions to the toes in patients with neurologic deficits.”
A benefit Dr. Henry has experienced with customization is using the prosthesis in older patients who would have required joint arthrodesis.
“Those surgeries are expensive, so in elderly patients where cost is a barrier to care, today’s available prosthesis are an ideal economical alternative to surgery,” said Henry, a veterinary advisory board member at pet health insurer Trupanion in Seattle. And “because they are custom-fit, the patients wear them comfortably and seldom try to remove them.”
The availability of more orthotics and prosthetics locally, instead of through mail order, has made custom fits and modifications easier, Beale said.
Another development is that instead of traditional casts, more specialists are enlisting orthotic braces, which are easier to care for and cause fewer problems with wounds, Beale said. He added that range-of-motion hinges may be incorporated in orthotics and prosthetics as well to prevent stiff joints and muscle atrophy.
Much of the progress seen in this field stems from growing client interest, accompanied by a drive for creativity from orthotists, prosthetists, physical therapists, rehabilitation therapists and veterinarians.
“Awareness is rapidly increasing, [and we are] able to save limbs that previously were amputated,” Beale said.
Client interest and demand has helped fuel the evolution of the field and profession, and veterinarians now can find more published studies as well as opportunities to learn about veterinary orthotics and prosthetics at meetings.
This profession and field are growing in exciting ways. For example, more veterinarians are seeking consults with an orthotist or a prosthetist. Beale has witnessed greater applications and “the expansion into different species—dog, cat, tortoise, ram, horse, duck, goose, flamingo and Komodo dragon, just to name a few.”
Some pet insurance providers reported seeing rising use of prosthetics and orthotics, although because of how the companies track claims, the devices are not always listed.
Liz Watson, chief marketing officer at Hartville Pet Insurance Group in Akron, Ohio, reported that less than 1 percent of claims relate to orthotics or prosthetics. Trupanion reported paying about $67,000 in claims for prosthetics and orthotics since 2010, with 50 percent occurring in 2015 and 2016.
Veterinary specialists point to increased applications such as thorax, spinal, knee, hip and wounds as a key highlight for the future of orthotics and prosthetics.
In particular, Beale presupposed using orthotics after joint surgery and incorporating it “with physical therapy after ortho- or neurosurgery because orthotics can function in a water environment and hinges allow range of motion.”
Experts agreed that more research, as well as obtaining and publishing outcome data on the use of orthotics, is necessary for continued progress.
Just as continuing education is important for veterinary professionals, Mich said, specialists need more training on “how to do this work from assessment and diagnosis to prescription, fitting adjustment and follow-up.
“Setting a case up correctly from the start is critical to success, and that point-of-care adjustment is really the best way to do this work,” she said. “Devices can be ordered online, but, inevitably, adjustments are needed to manage skin irritation, optmize fit and dynamize the device as the case progresses. Sending off for adjustment is not practical.”
Beale would like to see “development of commercially available intraosseous prosthetics for dogs and cats because they do not have to be removed intermittently to give skin a rest, and they are linked better, more convenient and more stable.” However, “infection, wounds and bone fractures remain a potential problem with them,” he added.
Mich called for more competition in fabrication, but with proper fabrication backed with solid knowledge.
As three-dimensional printing continues to advance and be tested, it conceivably will be used mainstream in pet orthotics and prosthetics.
Whether an animal suffers from a crippling birth defect or traumatic injury, prosthetics and orthotics can provide them with improved quality of life. As education and creative technological advances evolve, even more veterinarians and specialists can help these animals live fuller lives.
“Veterinary orthotics and prosthetics do work,” Mich said. “It can be a lifesaving and life-changing therapy in the right cases.”
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