Braces, orthotics and assistive devices (Proceedings)

There are more and more options out there for our patients in the way of braces, orthotics and assistive devices. They can provide much needed help during or after rehab, surgical recovery, as an alternative to surgery and our geriatric patients.

Braces/supports

Braces and other forms of support can provide comfort, protection or improve confidence for rehab patients. The braces, wraps and supports typically come in multiple sizes although they are not custom made or custom fit to a specific patient. A number of companies make neoprene wraps or braces tailored to different areas of the body. Common ones are carpal or hocks braces or wraps to provide extra support. These can be considered for patients with osteoarthritis (OA) associated with those joints or mild hyperextension, varus or valgus issues. They will not provide enough support for moderate to severe problems. DogLeggs (www.DogLeggs.com) makes an elbow wrap for dogs with hygromas or similar issues along with one for amputees. They are even willing to do custum work if they feel they can benefit the patient. Thera-Paw (www.Therapaw.com) makes combination boot/wrap that aide dogs that have problems with dragging or knuckling of the paw. They make both a front and hindlimb 'Dorsi-Flex Assist' although technically it should be a 'Dorsi-Extend Assist' for the front.

Orthotics/prosthetics

Orthotics are used to support, straighten or improve the function of a body part. Prosthetics are used to replace a portion of a missing limb. Custom orthotics and prosthetics is an emerging field in veterinary medicine although it has been around for a long time in the human field. There are several human orthotists that have expanded their interests to include veterinary patients on a commercial level. In addition, there may be someone on a local level that may be interested on a case by case basis in your area. A thorough evaluation of the patient and disease condition should be performed prior to selecting orthotics since they typically cost several hundred dollars. Typically a cast or mold of the area needing support is made and shipped to the orthotist who then makes the orthotic based on the cast. Good communication with the orthotist is important. Since the orthotics are made from a static cast yet placed on a moving patient there may be the need for modifications to the product. The patient should gradually wear the orthotic for longer periods of time each day similar to breaking in a new pair of shoes. The device can be worn for an extended period of time after the break-in period and adjustments are made. This is typically during daytime hours or during high activity periods. They are not intended to be worn 24-7. Both the patient and the orthotic should be assessed for wear points, pressure points or other surprises. It is not uncommon for the device to be returned to the orthotist for modifications several times before getting the 'right fit'.

Assistive devices

Slings are a common device for use in the hospital, rehab facility or at home. The slings can be used to support the rear or front end. They may simply slip under the patient, fasten around or have leg/arm holes to keep them from slipping or shifting. The straps should be long enough so the person using the sling is not bent over or straining their back.

A harness is another device that can be used in the hospital, rehab facility or at home. Several companies produce harnesses with low-profile handles that the patient can wear comfortably for extended periods of time that allow the rehabber or client to assist the pet in rising. These are especially useful for geriatric patients with osteoarthritis and some degree of neurologic deficits that struggle to get up for walks or have trouble on slicker surfaces. They are also nice for neurologic patients or orthopedic patients in the recovery stage.

Boots or booties can be used to increase a pets traction on slippery surfaces, increase proprioceptive awareness and protect feet of neurologic patients that are prone to soft tissue injury and nail wear from scuffing or dragging. The boots typically have a rubber sole to aid in traction and minimize wear and tear. Most have a Velcro strap to secure them around the pet's foot but some use straps or elastic bands similar to tube socks. Some are very functional but some are strictly for the cuteness factor alone without much function. Pawz (www.pawzdogboots.com) makes a disposable, biodegradable, reusable, waterproof boot that is easy to use and low cost. These are nice because they come in multipacks and are low cost so if you lose one or wear through it you can easily grab another. They are good option if the pet is not expected to need boots for an extended period of time.

Certain types of flooring, especially tile, hardwood and linoleum, can be a problem at home for some pets. Carpet runners with nonslip backing, yoga mats and rubber floor mats can be used to improve traction. Antislip tape or stair treads can be used to improve traction on stairs or other areas around the house.

Some pets love to be up on the couch or bed with their owner. Some disease processes like osteoarthritis make it harder for the pet to jump up on the furniture like they used to do. When it is not contraindicated due to the disease process, such as a postoperative fracture repair, pet stairs can be used to make getting on and off the furniture easier. There are many companies that can be found on the internet that make pet stairs in a variety of materials, price, size and quality. Along the same lines, a lot of pets need help getting in and out of the car. Many companies also make a variety of ramps to aid pets and their owners. If you really want to get carried away you can get the 2011 Honda Element with a Dog Friendly Package that includes among other things a stowable ramp and dog bed.

Bedding is another important thing for rehab patients especially the geriatric and neurologic patients that may spend more time lying down. Lying on hard surfaces can increase the risk of pressure sores and make arthritic joints stiffer. One or more good quality orthopedic beds are important especially if the pet likes to spend time in different places around the house.

Carts

Carts or wheelchairs are another way to assist our rehab patients. There are several companies that make carts for dogs and other small animals. The carts can be 2 or 4 wheeled depending on the needs of the patient. Careful assessment of the patient and their needs is important before deciding if a cart is appropriate. In the case of posterior paralysis secondary to intervertebral disk disease (IVDD) or a similar condition physical rehabilitation should be pursued prior to ordering a cart. Once an owner starts using a cart for their pet they may forgo or not put as much effort into their pet's rehab. This can delay or compromise potential improvement. Along the same lines carts are not appropriate for ambulatory dogs with orthopedic conditions.

Most carts are constructed to meet the pet's needs and size. Careful measurements should be taken to aid the company in constructing the appropriate cart. Similar to a new pair of shoes, cart use should be gradual. The pet should be monitored for errors of wear, irritation, sores and impediment of motion by straps, harness or bars. The pet should not be left alone in the cart because accidents can happen like falling down stairs, tipping or becoming stuck on an object. Also the pet should have time out of the cart to rest and lie down especially bigger dogs. Food and water bowls may need to be elevated to accommodate a pet in a cart.

Generally pets adapt very well to carts and learn how to maneuver in very little time. Most carts can handle a variety of terrain, some even handling water. Again, a pet should always be supervised in a cart.

Additional Resources (This is not an endorsement, just other places you can look)

Braces and supports:

     • DogLeggs – www.DogLeggs.com

     • Therapaw – www.Therapaw.com

Orthotics and prosthetics:

     • Animal Ortho Care – www.animalorthocare.com

     • Ortho Pets – www.orthopets.com

     • K9 Orthotics – www.k-9orthotics.com

     • My Pets Brace - www.mypetsbrace.com

Slings and harnesses:

     • Help 'em up low profile handles – www.helpemup.com

     • Ruff Wear harnesses – www.ruffwear.com

     • Walkabout front or rear harness – www.walkaboutharnesses.com

Boots:

     • Therapaw – www.Therapaw.com

     • Ruff Wear boots – www.ruffwear.com

     • Pawz dog boots – www.pawzdogboots.com

Carts:

     • K9 Carts – www.k9-carts.com

     • Walkin' Wheels – www.walkinwheels.com

     • Eddie's Wheels – www.eddieswheels.com

     • Dog Quality – www.dogquality.com