Braces, prosthetics, and wheelchairs for rehabilitation

Written by Lior Leibovici

A case-based approach that looks at how artificial aids can help a patient recover from many orthopedic and neurological conditions.

Article

Reading time5 - 15 min

Key points

Impaired mobility can be due to a congenital problem, trauma, surgery or old age, and various rehabilitation options can be offered, both to improve a dog’s condition and to help prevent further problems.

It is now widely accepted that it is important to resume a patient’s movement as quickly as possible after orthopedic surgery, although certain limitations do apply.

The clinician’s role in rehabilitating an individual involves a careful assessment of the patient in order to provide the most appropriate treatment, based on its abilities and needs.

Braces, prosthetics and wheelchairs are specially designed devices that provide support, stability, and enhanced mobility for dogs with various orthopedic and neurological issues.

Introduction

In recent years we have witnessed how the bond between dogs and their owners is growing stronger, such that they are now an inseparable part of the family. More and more owners now want to provide their animals with the best possible care, and if a pet has a mobility issue the veterinarian will be expected to offer solutions that will help restore their mobility and vitality, hence improving their quality of life. Due to the growing awareness among owners and their demand for high-quality, advanced treatment for their pet, more advanced diagnostic tools – such as CT scans, MRIs and other technologies – have become commonplace in veterinary medicine. These tools not only help the veterinarian reach a more accurate diagnosis, but they can also allow the clinician to offer more effective medical solutions for both the owner and their pet.

Rehabilitation, although a relatively young field in veterinary medicine, is very much part of providing better veterinary care, and aims to restore a patient’s function and quality of life after experiencing any kind of functional impairment. This can result from trauma or damage to any of the body’s organs, such as the brain, spinal cord, nervous system, bones, joints, ligaments, muscles or tendons, and may be accidental or following surgical intervention.

Braces provide crucial support to the affected limb, helping to reduce pain, prevent further injury, gain more stability and promote faster healing.
Lior Leibovici

Artificial aids for rehabilitation

In the past, orthopedic and neurology surgeons would often recommend prolonged cage rest for dogs in many situations, both following surgery and when managing cases conservatively, even to the extent of forbidding animals from going outside to relieve themselves. Today, however, it is well-recognized that it is very important for a patient to resume movement as quickly as possible when dealing with many orthopedic conditions, although some limitations and advisories do apply, for example:

Avoiding slippery surfaces (such as parquet flooring, or marble, granite or ceramic tiles).
Avoiding jumping, standing on two legs, climbing/going downstairs, sitting like a kangaroo, making sudden directional changes, aggressive play or interaction with large dogs.
Feeding the pet using an elevated food bowl, (e.g., raised to chest height) and with the pet standing on a non-slip, stable mat.
Walking on various surfaces (e.g., grass, dirt, asphalt, sidewalks, rubber, yoga mats and carpets).

Rehabilitation treatments can include options that help improve a dog’s mobility, whether they suffer from a congenital issue, trauma, or even old age, and which may prevent further injuries. The veterinarian’s role in rehabilitation is to assess and diagnose the patient’s functional level in order to provide the most appropriate treatment tailored to the dog’s abilities and needs, and sometimes this can require the use of aids such as braces, prostheses and wheelchairs. These are specially designed devices that can provide support, stability, and enhanced mobility for dogs with various orthopedic and neurological issues, and whether a dog is recovering from surgery, has a limb deformity, or suffers from arthritis, these innovative tools can help improve their daily lives. The following case studies from the author’s hospital will demonstrate how various devices can be incorporated into rehabilitation programs and how they can make a real difference to an animal’s quality of life.

Braces

One common application of braces is in the rehabilitation process following orthopedic surgery (Figure 1). Just like humans, dogs need time to recover and rebuild their strength after procedures such as cruciate ligament repair or hip surgery. Braces provide crucial support to the affected limb, helping to reduce pain, prevent further injury, gain more stability and promote faster healing. Cases that may benefit from a brace include hip/elbow/shoulder dysplasia, joint hyperextension, patellar luxation, anterior cruciate ligament rupture, proprioceptive defects, intervertebral disc herniation, and other orthopedic and neurological problems. The following examples help demonstrate where braces can be beneficial.

Figure 1. A selection of braces designed to assist joint support: Hip brace (1); Carpal brace (2); Hock brace (3); CP and anti-slip brace (4); Carpal brace manufactured with 3D printing (5); Elbow stabilizer and hygroma brace (6); Knee brace (7); Hard carpal and CP brace (8); Hard carpal brace (9). CP: conscious proprioception © VIPet Rehabilitation Center

CASE STUDY 1

Brace for tendon rupture and carpal hyperextension

Benjamin, an entire 3-year-old male Kerry Blue Terrier. At six months old, Benjamin stepped on glass, which caused him to have long-term lameness on his left front leg, and he eventually presented at the rehabilitation center at the age of two years. He was found to have a torn tendon in the third phalange and hyperextension of the left carpal joint; in addition to the torn tendon, scar tissue had developed after the injury, which was interfering with his walking and proper weight-bearing, leading to loss of muscle mass. The decision was made to stabilize the leg using a carpal brace and a special boot to provide support for the toes. Benjamin wore the brace for a total of eight months, while also participating in hydrotherapy treatment (both in the pool and on an underwater treadmill), physiotherapy, balance work, stability training and muscle strengthening. Additionally, he received daily laser therapy at home on the carpal joint to reduce pain and accelerate healing of the inflammation and injuries in the area. At a follow-up examination four months after the initial presentation, hyperextension of the carpal joint was still visible, and it was decided to continue using the brace for additional three to four months. After eight months of treatment, Benjamin’s gait had improved, the muscle mass discrepancy between the two forelegs was completely resolved, and the hyperextension was corrected. Currently, Benjamin continues to attend hydrotherapy sessions to strengthen and maintain his posture, and can walk and run without the need for the brace.

CASE STUDY 2

Brace for hip dysplasia in a young dog

Chaos, a 2-year-old entire male German Shepherd dog. Chaos presented at the rehabilitation center at 7 months of age with weakness in his hind legs and back, along with unstable tarsal joints and poor muscle mass; this was attributed to the fact that he had been housed on slippery surfaces during his first few months of life. A radiograph confirmed the main problem to be hip dysplasia (Figure 2). To address the issues, Chaos was fitted with a pelvic stabilization brace (Figure 3) that supported and cushioned the area where the femoral head articulates with the pelvis (i.e., the acetabulum). The brace was gradually stretched every two weeks, and in parallel Chaos received physiotherapy and hydrotherapy, TENS (transcutaneous electrical nerve stimulation) and EMS (electrical muscle stimulation) treatments, and laser therapy, which successfully strengthened his muscles and balanced the hind legs. The clinic also worked on correcting the kyphosis in his back, improving his posture and creating better movement patterns while standing, walking and running. At 20 months of age, radiography showed almost complete correction of the hip dysplasia (Figure 4), and shortly afterwards Chaos participated in a dog show, where he received positive feedback from the judges who noted his “good proportions, strong shoulders, straight topline and a powerful rear end”.

Figure 2. Chaos presented with bilateral grade 1 hip dysplasia, which together with other abnormalities gave him a weak gait. © VIPet Rehabilitation Center

Figure 3. A pelvic stabilization brace helped support and strengthen the dog’s rear end. © VIPet Rehabilitation Center

Figure 4. A pelvic radiograph at 20 months of age showed marked improvement in the hip dysplasia. © VIPet Rehabilitation Center

Prostheses

Where a dog has had a limb amputated or has a limb deformity, a prosthetic device can be a game-changer. These are custom-made and are designed to replicate the function of a missing or impaired limb, allowing an animal to walk, run and play with greater ease and comfort. There are currently two main options for producing prosthetics; the first is to take a negative mold of the stump using plaster bandages, onto which the prosthesis is then applied, the second is to utilize 3D printing to manufacture prosthetics (a technique which can also be used for braces). The prosthetic can be attached to the body or limb stump by one of three ways: by vacuum, via a harness using Velcro or clips, or by screwing into the bone. Prosthetics not only improve mobility but also help prevent secondary issues such as muscle atrophy and joint strain.

CASE STUDY 3

Prosthesis after forelimb amputation

Louis, a 5-year-old neutered male Maltese Terrier. Louis was hit by a car at the end of 2022 and suffered injuries to the right side of his body, sustaining torn nerves in his right foreleg which led to paralysis of the limb. Before coming to the rehabilitation center, he had been undergoing physiotherapy at home, but had shown no improvement. He had also received acupuncture treatment for three months, which resulted in some improved sensation around the shoulder, but the neurological deficits below the elbow remained, with no reflexes and no deep pain sensation. Louis was referred to the clinic for hydrotherapy and physiotherapy treatments, alongside TENS/EMS therapies. After a month and a half no significant improvement was observed, and at the same time he severely damaged his paw by chewing it. Due to these circumstances, and after consulting with a specialist neurologist, amputation from the elbow down was recommended. Two and a half months after the amputation, measurements were taken for a prosthesis, and Louis continued hydrotherapy to strengthen his right shoulder and his body in general. After another month and a half (a total of 4 months after the amputation), the prosthesis was fitted. It now helps Louis balance his body, provides support that reduces the strain on his right foreleg, and prevents further aggravation of co-existing patellar luxation in both hindlimbs, as well as other injuries.

CASE STUDY 4

Prosthesis for bone deformity and poor bone growth secondary to trauma

Shelbi, a 4-year-old male neuter Doberman. Shelbi was injured in a car accident when he was only a month old, which subsequently led to abnormal bone development and shortening of his left foreleg. Additionally, he developed a bony swelling around the left elbow and external rotation of the leg (Figure 5). After examination and consultation with an orthopedic specialist, it was decided to fit a prosthesis to lengthen the leg, rather than perform surgery on the elbow. Measurements showed a 10 cm discrepancy in the length of the left leg compared to the right, which caused excessive strain on the right foreleg, shoulder girdle and back, alongside a significant limp. It was decided to use a 9 cm platform shoe (fitted with a non-slippery sole) to balance Shelbi’s standing and movement (Figure 6). With the prosthesis in place, his walking improved over time and became more balanced; his limb muscles developed, and the excessive gap between the two forelegs narrowed, preventing possible future problems caused by imbalance and excessive strain on the other limbs.

Figure 5. Following a car accident Shelbi developed abnormal bone development and shortening of his left foreleg, with swelling of the elbow and external rotation of the limb. © VIPet Rehabilitation Center

Figure 6. A platform shoe, fitted with a non-slippery sole, helped to balance Shelbi’s posture and movement. © VIPet Rehabilitation Center

Wheelchairs

Wheelchairs are engineered and designed to accommodate a range of physical limitations that can occur in dogs, from degenerative conditions and spinal cord injuries to neurological disorders and the effects of old age. These wheelchairs typically consist of a frame, wheels, support straps and a harness to keep the dog secure. With the correct fit and proper training, these assistive devices can help distribute the dog’s weight evenly, allowing for smoother, more effortless movement. As can be seen in Figure 7, the correct way to adjust a wheelchair is that the frame should be in the middle of the dog’s chest, the harness should be correctly fitted close to the body, and the wheels should be angled away from the frame. The benefits of canine wheelchairs extend far beyond just physical mobility; they can also have a profound impact on a dog’s mental well-being, reducing the stress and depression that are often associated with limited mobility.

Figure 7. Correct fitting of a wheelchair is essential to allow a dog full mobility. The frame should be in the middle of the chest, with the harness adjusted so that it is close to the body (a); the wheels should be angled away from the frame (b). It may be useful to dress the hind paws to prevent excoriation (c). © VIPet Rehabilitation Center

CASE STUDY 5

Wheelchair for hindlimb paralysis

Ace, a 2-year-old entire male German Shepherd Dog. Ace was infected by Spirocerca lupi as a young dog. This parasite, a 2 cm long nematode, is transmitted to dogs by ingestion of dung beetles, and can cause narrowing and obstruction of the esophagus, or even rupture of the aorta, which is life-threatening. In rare instances, aberrant migration can result in the parasite producing neurological defects. This is what had happened to Ace; following infection a granuloma had formed in the spinal cord, leading to paralysis of his hind legs and loss of deep pain sensation. Despite intensive treatment following a spirocercosis standard treatment protocol, Ace remained paralyzed in his hind legs, and it was decided to fit a wheelchair for him. From the moment he was placed in the wheelchair, Ace started running and playing happily, as if the wheels were his own legs, without showing any limitations or signs of incapacity. His mood improved dramatically, and he became active and energetic again, just as he was before the paralysis.

CASE STUDY 6

Wheelchair to provide balance support

Lucy, a 10-year-old female neutered mixed-breed dog. Lucy had been diagnosed about three months previously with a degenerative spinal disease and had been losing strength in her hind legs. She showed muscle weakness, reduced Range of Motion (ROM) and instability, and was unable to squat to toilet. When she arrived at the rehabilitation center, she could only go for short walks to relieve herself, and spent the rest of the day lying at home without moving. Given these circumstances, it was decided to fit her with a set of mobility wheels. Following the introduction of a wheelchair Lucy has become more active (Figure 8); her walks have become longer and her posture is more stable; as a result, she is strengthening her hind legs and using them more. Although still at the beginning of her journey, it is thought that the wheelchair will help improve her long-term mobility and enhance the quality of life for both her and her owners.

Conclusion

Dog braces, prosthetics, and wheelchairs represent significant advancements in veterinary medicine and pet rehabilitation. These innovative solutions not only address physical limitations but also contribute to the emotional well-being of our pets, giving them a second chance at a fulfilling, happy life. When presented with a patient that is facing mobility challenges, the clinician is reminded that effective solutions are within reach and are increasingly available, and indeed that the options continue to improve as awareness grows and technology advances.

Lior Leibovici

DVM, CCRP, The Center for Veterinary Physical Rehabilitation, Tel Aviv area, Israel

Dr. Leibovici graduated from Romania’s University of Agricultural Sciences and Veterinary Medicine Ion Ionescu de la Brad in 2011 and worked as a general practitioner in an Israeli private clinic for five years. During this time, he started an independent business offering home visits for pets, and also served petting zoos treating various exotic animals. He was certified as a Canine Rehabilitation Practitioner (CCRP) by the University of Tennessee College of Veterinary Medicine, USA in 2017 and shortly afterwards began working as a rehabilitation practitioner. Two years later he opened Israel’s largest and leading rehabilitation center for dogs and cats, where the team treat a wide range of cases, including neurological, orthopedic and geriatric conditions, as well as working and sporting dogs.

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