The world of bracing, splinting and orthotics can be daunting for Vetrehabbers to enter, with the many variations of brace types and orthoses available. Additionally, the differences between our individual patients, coupled with the various conditions that may require external support, can leave us feeling ill-prepared and under-equipped to aid in the rehabilitation process when orthoses are required.
By using a simple grading system, we can easily communicate and discuss the degree of support our patients require, and how we aim to achieve that support. This brings the multi-disciplinary team together and provides us with clarity.
In a recent webinar in the Onlinepethealth Small Animal Membership on Orthotics, Diane Messum describes the four grades of orthoses, the conditions that can be treated with these devices, different materials that can be used, the biomechanical considerations, case discussions, and much more.
Diane will present a workshop at the IAVRPT Symposium 2024 in South Africa, taking a deep dive into casting and splinting.
Four Grades of Support
From neoprene sleeves to motion-limiting articulating orthoses with foot support, a grading system allows us to clearly define the degree of support provided by an orthosis. This system also provides information on the materials used and their purpose.
Let’s discuss each grade and what they include.
Grade 1: Neoprene
The 1st grade involves a simple neoprene sleeve or wrap, providing a soft material support.
These braces can provide compression (or mild structural support) to a joint or limb in the absence of significant structural impairment.
They can be used for athletes during the “return-to-sport” phase of rehabilitation after an injury. Additionally, to provide compression when edema is present in a joint, and to provide mild structural support.
Grade 2: Reinforced Neoprene Support
In a grade 2 support, Velcro straps are strategically placed onto a neoprene wrap (or sleeve) to increase the amount of structural support that the wrap provides.
The rigidity of the brace is slightly increased, which allows the practitioner to provide immediate support (without full immobilization) to a patient, as it can be easily assembled in the practice.
Grade 3: Neoprene with Thermoplastic
This grade of brace is used to immobilize a structure or a limb, usually only for a short period as the thermoplastic doesn’t stand up to heavy-use for extended duration.
In some instances, thermoplastics can be remodeled, making it a good option for serial casting tendon contractures. It can also be used for patients that have edema, those that need a static resting splint, or in growing puppies to provide immobilization of a joint for a short period.
These can be also made in the practice with the patient and are more cost-effective than grade 4 orthotics. However, they only provide a short-term solution.
Grade 4: Polypropylene Orthotic
Polypropylene orthotics are used to immobilize or allow graduated movement at a joint. They are often used when long-term support is needed for healing or compromised structures.
These orthoses are custom-made and are essential for long-term solutions, or if you want to grade and control movements where a hinge joint is needed. They are the ideal option in heavy-set or large-breed dogs, as well as when the paw needs to be incorporated into the design.
There are multiple designs available, including articulating orthoses with and without foot segments, non-articulating orthoses with and without foot segments, and motion-limiting designs that allow a graded return to movement or that limit movement in a particular plane of motion.
3-in-1 Support
The benefit of grades 1-3, is that they allow you to up or down-regulate the design according to the needs of the patient and the phase of rehabilitation. They are cost-effective and can be assembled and adjusted in practice.
For example, a neoprene sleeve can be upgraded to a grade 2 or 3 level of support by adding Velcro straps or thermoplastic support.
Similarly, you can downgrade a grade 3 support by removing and replacing the Thermoplastic with Velcro straps, and then to a grade 1 level of support by removing the Velcro straps.
Get Connected
We can’t wait for the IAVRPT symposium next week – where we get to see the Onlinepethealth community in person, in our hometown of Cape Town.
If you are attending the symposium and its workshops, come say “hi!” We might even have something fun and exciting to share with you!
Resources
In the Onlinepethealth Small Animal membership:
- Brace Yourself – understanding how orthotics can help your patient, Diane Messum
- Brace and cast with confidence, Ben Blecha
- Veterinary Orthotics and Prosthetics, Dr Martin Kaufmann
- 4 part webinar series: Veterinary Splinting, orthotics and prosthetics, Dr Patrice Mich
Join us in person at the IAVRPT symposium, in Cape Town from the 30th of October to the 2nd of November.
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