276 Canine Sports Medicine and Rehabilitation
device into the complex biomechanics of locomo
tion. In this paradigm, the therapist provides
physical treatment and the prosthetist/orthotist
provides the device or mechanical support. The
physician (or veterinarian) orchestrates the larger
therapeutic plan based on specific diagnosis and
sequential evaluation. This united effort in human
practice successfully aids the patient in regaining
ambulation in a safe, efficient, and functional
manner (Bechtol, 1967); the same goal can be met
in our veterinary patients.
Modern technology is advancing the sophisti
cation of V‐OP devices. What is lacking is device‐
specific rehabilitation to enable our veterinary
patients to fully realize device potential on par
with human patients. The canine rehabilitation
therapist must have a basic understanding of the
purpose, mechanics, and limitations of the
device. They must recognize complications in a
timely manner to prevent injury and limit time
out of the device. Likewise, the attending veteri
narian (if the rehabilitation therapist is not
the attending veterinarian) must understand
short‐ and long‐term rehabilitation goals, the
bio mechanics of therapeutic exercises, and the
limitations of rehabilitation. The V‐OP fabricator
must understand the diagnosis and therapeutic
goals so that device manufacture and adjustment
are timely and appropriate. Ultimately, shared
information and diverse expertise leads to inter
vention, device modifications/adjustments, and
rehabilitation strategies that maximize patient
comfort, endurance, and overall function
(Pomeranz et al., 2006).
Implications of limb loss or dysfunction
Knowledge of the components of normal quad
ruped gait guides treatment of pathomechanical
deficiencies. Quadrupeds who suffer loss of limb
function or loss of a limb are biomechanically
distinct from bipeds with similar loss.
Asymmetrical loading of the remaining limbs
and functional deficiencies such as loss of plantar
and palmar flexor power in propulsion have not
been quantified for veterinary patients.
Conversely, kinetic and kinematic compensa
tions in human amputees have been extensively
studied. Amputation causes disruption of the
human musculoskeletal system, resulting in
asymmetrical biomechanics (Nolan et al., 2003;
Versluys et al., 2009; Nolan & Lees, 2000; Kent &
Franklyn‐Miller, 2011; Schoeman et al., 2011). The
mechanical alterations of amputation or injury
have implications for mobility and for the long‐
term health of joints, muscles, and spine. Both
human and veterinary populations develop
compensations for functional deficiencies, to
maintain balance and locomotion (DeCamp,
1997; Kirpensteijn et al., 2000; Landman et al.,
2004; Bockstahler et al., 2009; Prinsen et al., 2011;
Abdelhadi et al., 2013; Hogy et al., 2013; Jarvis
et al., 2013; Fuchs et al., 2014; Goldner et al., 2015).
However, such compensatory movements are
not necessarily efficient and frequently lead to
short‐ and long‐term complications.
The biomechanical implications of limb dys
function or limb absence include intact limb
breakdown and the development of pathology
associated with myofascial tissue, joints
(Fujisawa, 1999), and spine (Landman et al.,
2004) by virtue of altered gait and structural
support. In veterinary patients, these patholog
ical changes lead to chronic pain, poor quality
of life, and premature euthanasia. With these
significant consequences in mind, alternative
approaches such as subtotal or elective‐level
amputation, coupled with application of pros
theses, become more appealing. Human medical
practice provides perspective; preservation of
normal proximal limb segments is paramount
and amputation higher than is absolutely
necessary is untenable—an example is the
Syme’s amputation technique for the human
foot (Shurr & Cook, 1990).Thoracic limb deficiency compensatory
changesKinetic studies of canine gait have been avail
able for decades both for normal (Budsberg
et al., 1987, 1993, 1999; Riggs et al., 1993;
McLaughlin & Roush, 1995; Lee et al., 1999;
Bockstahler et al., 2009; Torres et al., 2013) and
abnormal (DeCamp, 1997; Evans et al., 2003;
Bockstahler et al., 2009) motion due to impair
ment. In the late 21st century three reports
were published describing client satisfaction
with amputation (Withrow & Hirsch, 1979;
Carberry & Harvey 1987; Kirpensteijn et al.,
1999). In 1999, Kirpensteijn et al. reported dog
client satisfaction post amputation of a limb,