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The use of orthotics and prosthetics in veterinary medicine has started to gain more attention from clinicians and academics alike. Companies across the US have sprung up and partnered with veterinary professionals in creating devices that enable and improve the quality of life for animals with disabilities while gaining interest among the general public as well. While orthotics and prosthetics have been around for a while, the knowledge of the uses, advantages, and developments in this field is still relatively new even for seasoned veterinarians.

Petsthetics, LLC, founder Peter DiPaolo with Jordy and his rear leg prosthesis. Photo credit: Peter DiPaolo.

For a while, the notion has been and also taught in veterinary school, that for many instances of lameness, trauma, or injury, the animal should be euthanized. Over the past several decades,
there has been a shift in focus to not writing these animals off but instead looking to extend their lifespan, provide a device that the animal can use with comfort, and decrease the level of distress in
the animal.

“There’s been a huge social change in how people treat their animals,” says Derrick Campana, CPO, who is the founder of Animal Ortho Care and Bionic Pets along with being featured on an Animal Planet TV series. “When I first started 15 years ago, dogs were being put down for common injuries and now people
treat them as family members that they are willing to do almost anything for. There’s also a huge transition with the veterinarians and veterinary community where it was such an odd thing at first, but now you go to a conference and you’ll see three to four lectures on mobility devices, specifically orthotics and prosthetics.”

The FVMA spoke with some of the leading experts in the field of animal orthotics and prosthetics to discuss the development of these devices. This helpful information can be used as a tool to allow FVMA members to better approach what to do when they’re presented with a patient that either has a disability or already has a prosthetic — allowing for veterinary care to be provided no matter the patient.

The Development and Uses of Animal Orthotics and Prosthetics

The use of orthotics and prosthetics in animals has been around for decades. The intent has always stayed the same, yet technology has improved regarding the types of materials that have been used to allow for more comfortable prosthetic devices with a better range of motion for the animal. Many concepts have been translated from the human side of prosthetics, including fabrication techniques. Over the past decade, the materials available to make animal prosthetics have expanded.

When it comes to assistive devices, neonatal injuries, and trauma are two of the most common reasons for amputation. Veterinarians are often the first line of defense, reviewing an array of factors to determine if the animal is a candidate for a prosthetic limb. Contributing factors include the age of the animal, its size, where the prosthetic is being applied, skin mobility, and the consideration of any orthopedic problems that can affect the range of motion and nearby joints long term.

Chi Chi was a certified therapy dog. With the help of prostheses
designed by Derrick Campana’s Bionic Pets, she brought comfort and inspiration to people
in hospitals, schools, rehab facilities, and senior living centers. Photo credit: Bob Fugate, rqfphoto.com.

One challenge when building an orthosis or prosthesis for an animal is that there isn’t a “standard” way to go about building it. Because animal species widely vary, the bodily mechanics are different for a horse as opposed to a dog. While different in build, orthotics and prosthetics in animals have borrowed many aspects from the human side.

Peter DiPaolo, CPO, LPO, who is the founder of Petsthetics, LLC, works full-time for Hanger Clinic as a human orthotist and prosthetist. He started working on animal prosthetics four years ago and established Petsthetics as his side project that he is extremely passionate about. Because the specialized needs of each animal are different, he often goes to the veterinary clinics or hospitals and does the fittings personally, which provides a personal touch. His ability to be mobile and go to the client’s location provides a concierge-like service when it comes to fitting a brace or limb.

When it comes down to the design of the brace, I always use the experience I have from the human side,” DiPaolo says. “I use the same biomechanics and physics that I apply to humans to animals. The only difference is that you have different shapes and sizes. A dog has a femur like a human does; however, their feet are different in shape and size so you have to take all those factors into consideration.”

The goal, no matter the animal, is to develop a device that will extend their lifespan with a high level of welfare as opposed to adding any additional problems. More often than not, animals can lose a limb or part of it and still function well. When reviewing a patient to see if they’re a good candidate for a prosthetic, other issues need to be considered, such as the location of the lost limb and if that will result in a breakdown of other nearby tissues of the body.

Dr. Michael Walsh, who is a clinical associate professor of aquatic animal health at the University of Florida College of Veterinary Medicine, was the veterinarian who was a part of the team that aided in building the prosthetic fin for Winter the dolphin at Clearwater Marine Aquarium. While many know of the success of the prosthetic device due to the popular book and movie “Dolphin Tale,” the process and development of the prosthetic fin took time, as team members needed to mindfully address all of the issues that could occur.

While a variety of companies submitted proposals to build the prosthetic, some of the proposals were logical but not realistic. Dr. Walsh’s job involved working with Clearwater Marine Aquarium CEO David Yates to explore every possibility to ensure this was achieved. The goal was to not cause more damage and to provide a fin that could augment Winter’s movement. This demonstrates the need for a strong working relationship between the prosthetic design team and the veterinarian, along with any other entities involved.

Campana mentions how 80 percent of the time, he doesn’t even see the patient. His team has developed a system where they are able to send out casting kits. This allows owners or veterinarians to cast their patients, ship the casts to them, and then he can build the prosthetic and treat them from afar. Because of this, it is important for the veterinarian to discuss with the client the best options and needs of the patient.

In June 2018, Campana was featured on Animal Planet’s new TV series “Dodo Heroes” for working with Jabu, a bull elephant in Botswana whom he built an orthotic for. In addition to this, he has experience working across a wide range of species — from dogs, like Chi Chi, to birds to even a fox. Their environments and even personalities differ so greatly, and that can be challenging. While creating the brace is a challenge, a bigger challenge is having the animal accept the device and relearn how to move with it.

Providing Comfort and Pain Relief

When it comes to prosthetics and orthotics for animals, a big part of the process is getting the animal to realize that the assistive device is helping them. They also must like it and learn to want to use it. It’s easier to explain to a human that it’s something that you want them to use as a tool and is a positive thing, making sure they react to it in a good way.

Ronnie Graves, who himself has been an amputee since he was 20 years old, has been working in prosthetics for almost 40 years, specializing in large animal prosthetics for the last 20 years. Graves’ company — Veterinary Inclusive Prosthetics/Orthotics — fills a gap in the field because there are only a handful of individuals or companies that do prosthetics and orthotics for large animals.

Graves describes how the process of the animal relearning how to move with a prosthetic or orthotic needs to be taken in steps, along with ensuring that both the prosthetist and veterinarian make sure the owner is following a fitting schedule that is specific for that animal.

“The most challenging part is not in creating the device — and that is a challenge, believe me — but educating the owner and determining in advance whether they’re going to be compliant,” Graves says. “There’s a rigorous fitting schedule that I’ve developed. With a human, I can sit down with that person and I can explain to them ‘Look, you’re going to put this artificial leg or brace on and in about two hours, your leg is going to get tired and sore. You’re going to need to take it off and give it a rest.’ But you can’t tell that to a horse, cow, or donkey.

Jingles had a full-limb amputation due to cancer. This is a vest-style, full-limb prosthesis to accommodate the amputation. Photo courtesy of Bionic Pets.

“I have to educate the owners that even though your horse looks like it’s having a lot of fun, it’s helping and they’re getting around great, you have to go on a specific timetable — two hours on and two hours off — for the first seven days and don’t let them wear it at night. Gradually, you increase that wear time.”

Graves says that losing his leg, combined with his lifelong love for animals, allows him to understand and provide compassion for the animals he works with. It also allows him to better explain to the owners how the animal might be feeling, providing a more personal way to connect with his clients.

He also talks about how one of the biggest goals of prosthetics and orthotics is these devices relieve the distress the animal is feeling. Like Campana, a lot of his work is done long distance where he doesn’t get to meet or see the patient. Because of this, he will often request that the owner or veterinarian provide X-rays, video, and/or photographs of the animal both before, during, and after the fitting stages. This allows Graves to see if the device is doing its job properly and working with rather than against the animal’s body mechanics.

“When you put a brace or a leg on, the anatomy is going to change over time,” Graves says. “If they keep me updated, I can make recommendations on something as simple as putting another sock onto the leg to make up for weight loss or volume change in their leg because we’re compressing it from the outside.”
Dr. Walsh also says there are many different ways to look at pain, depending on the patient and what its needs are. There’s pain that causes the animal to be dysfunctional to where it can’t ambulate because of discomfort related to what’s happened. There’s also the type of pain that can manifest as part of a long-term chronic relationship as another appendage — like the other leg on a biped — starts to break down from eventual arthritis development. Dr. Walsh says that while the owner and veterinarian need to be ready for things like musculoskeletal change over time, the goal for the prosthetist or orthotist working with the patient is to design a system to avoid those long-term problems. Luckily, there have been many strides in this field, along with a positive outlook for the future of orthotics and prosthetics.

The Future of Orthotics and Prosthetics

In recent years, there have been many advancements in the field of animal prosthetics and orthotics, including 3D printing and the development of more malleable materials used to build assistive devices.

Veterinary Inclusive Prosthetics/Orthotics Owner Ronnie Graves with his three-legged donkey patient Luigi. A congenital birth defect left Luigi born without his left front leg. Graves helped build a prosthetic limb for him. Photo credit: Ronnie Graves.

While new technologies are becoming available, this doesn’t necessarily mean it will be a good fit for your patient just because it’s new. DiPaolo says one of the disadvantages is how sometimes people want to jump to try something new when it hasn’t really been tested. Just because an assistive device is developed, that doesn’t mean it is going to necessarily work for that patient.

This is where more research is necessary to see the long-term benefits of these devices on different species and have quantitative data to guide product development. Many companies are working with academics, prosthetists/orthotists, and teaching hospitals to collect data to publish white papers. DiPaolo says another crucial component is social media. It has been a key player in exposure by getting the word out and educating people.

Another major milestone has been the shift in how veterinary medicine has viewed animals with disabilities, where many institutions — like Cornell University and the University of Tennessee — are now emphasizing option-based thinking. Many of these universities are now promoting the use of prosthetics and orthotics in animals with disabilities.

“When you think about it, that’s a major milestone,” Graves says. “We’re starting to change opinion, yet we still got a long way to go in that arena. The young veterinarians are coming along and graduating, and they’re really open to these ideas.”

Whether it’s Graves who is building a brace for a lame horse or DiPaolo who is building a prosthetic for a dog, it is evident that the use of prosthetics and orthotics is becoming a more viable option for many animals to hopefully extend and improve their quality of life — for both the pet and its owner.

“Seeing the reaction of a pet that has regained mobility or has started to walk maybe for the first time in their life, that’s probably the most exciting thing,” Campana says. “Just the reaction of the owner, a lot of them will break down and cry because they’re so happy that they’ve gotten their family member back.”

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