Front Matter

288 Canine Sports Medicine and Rehabilitation

Prescription and treatment plan

The treatment plan includes device and reha­
bilitation prescription as well as a follow‐up
plan. The prescription format may vary from
manufacturer to manufacturer. The key compo­
nents are noted in Box 11.4.
The rehabilitation prescription should guide
the canine rehabilitation professional. Setting
specific goals and benchmarks should guide
therapy. Common rehabilitation goals for the
V‐OP patient include: training the client and
patient in proper donning and doffing, device
acclimation, transitions, gait re‐education,
balance and proprioception adaptations,
strength improvement, fitness/endurance, and

return to/refinement of activities of daily living

(e.g., stairs, dog door, car rides).

Follow‐up evaluation

Follow‐up is essential and client expectations

must be aligned appropriately at the outset.

Nearly all custom devices require adjustment in

the first weeks of use. This is because customiza­

tion can only be so accurate and is strongly

dependent on accuracy in fiberglass impression.

Additionally, as the patient acclimates, minor

changes in fit due to muscle loss or development,

material stretching, improved gaiting and limb

alignment, and skin condition may require atten­

tion. Dogs with a thin hair coat or skin are espe­

cially vulnerable to irritation. The use of socks

and friction‐reducing powders can be helpful.

In the months after fitting the device, adjust­

ments may be needed as the patient acclimates,

heals, and progresses in the rehabilitation plan.

Two excellent examples of this are dynamic

Achilles orthoses and postop partial carpal

arthrodesis orthoses. Both are designed to allow

a gradual increase in range of motion of the

affected joint as healing progresses. For patients

whose devices are intended for lifelong use

(e.g., CCL insufficiency, subtotal amputation,

failed tarsal arthrodesis), follow‐ups are typi­

cally provided every 6–12 months. The pur­

poses are to (1) assess patient condition overall

and status of the injury; and (2) assess the con­

dition of the device to ensure it continues to

meet fit and function needs. Replacement of

worn components such as straps, pads, or tread

is common. During these appointments it is

important to assess the original injury and

determine whether the device continues to

meet therapeutic goals. In some cases, changes

in patient condition or excessive wear of the

device require a new device.

Finding a V‐OP fabricating partner

H‐OP and V‐OP scope of practice

As the veterinarian develops a V‐OP practice it is

important to thoroughly understand how H‐OP

devices are prescribed and the training required

Box 11.4 V‐OP prescription

● Signalment (breed, age, gender, weight, body

condition score)

● Affected limb(s) including laterality

● Diagnosis including severity

● Style of device

❍ e.g., simple one‐joint orthosis: carpus, tar­

sus, stifle, elbow

❍ e.g., combination orthosis: stifle– tarsus or

elbow–carpus

❍ e.g., simple prosthesis: above carpus, above

tarsus

❍ e.g., combination prosthesis: below carpus

with elbow cuff and articulation, below met­

atarsals with crural cuff and articulation

❍ e.g., prosthosis (combination of prosthesis

and orthosis)

● Device components

❍ e.g., articulation(s)

❍ e.g., foot segment if needed, with or with­

out heel

❍ e.g., type of extension and foot for

prosthesis

❍ e.g., motion limiters

● Intended use

❍ e.g., short term with intent to heal

❍ e.g., post‐surgical support (alternative to

serial casting)

❍ e.g., permanent solution with no intent to

heal

● Intended wearing schedule

❍ e.g., sport use only (support device)

❍ e.g., all day use

❍ e.g., 24/7 use