Good evening, everybody, and welcome to tonight's webinar, brought to you very proudly by Wimba and the webinar vet, obviously. My name is Bruce Stevenson, and I have the honour and privilege of chairing tonight's webinar. As I said, we are sponsored tonight by Wimba, and it's a big thanks to them.
For their sponsorship because it allows us to bring you this webinar, for free tonight. Little bit of housekeeping for those of you that haven't been with us before or maybe have forgotten. If you have a question for us, just move your mouse over the screen and you will see that the control bar pops up at the bottom.
Click on the Q&A box and send those questions through to us. We will hold them over to the end and get through as many of them as what we possibly can. So tonight, we are very lucky to have Annata with us.
Annata Bohezka, is a veterinarian with over 15 years of experience in the field of neurology, regenerative medicine, orthopaedics, and rehabilitation, as well as sports and working dog medicine. She completed her master's degree at the University of Life Sciences in Rocklaw and her postgraduate specialisation at the University of Warmia in Missouri. Annetta has also got a certificate in veterinary acupuncture and animal rehabilitation.
Currently, Annata runs her own veterinary practise and has a CCRT certificate. Annata, welcome to the webinar vet, and it's over to you. Good evening, everyone.
And can I start this? Please. Yes, OK.
Good evening, everyone. Everyone, I'm Annata Bohenska, and I'm a vet. Primarily, I work with a sports dogs and walking dogs.
I do orthopaedic rehabilitation. And sport medicine with a little bit of narrow stuff. I have to assemble the puzzle, guess, figure out why the dog is limping, moving awkwardly, and doesn't want to move sometimes.
I have to connect the dots and finally fix the problem. Today we are going to talk about orthosis, to use or not to use or not to use. And basically, the question is, do you use orthotic device?
What do you imagine when you hear the word orthosis or orthosis? What do you associate with? Do you have any experience?
How to get to the orthosis user site. You know, only recently, orthosis was not my first choice in treating condition for which it would be worth using orthosis. I thought an orthosis would be nice, but I didn't have a friendly device or equipment or I didn't know orthosis at all.
I needed to learn about how it was used correctly. I had to gain experience, but I fell into a vicious circle, you know, I did not use an orthotic device because I did not have experience. I didn't have experience because I didn't use ortho orthosis at all.
Or I didn't know about suitable, suitable orthosis, or I thought that suitable orthosis was too expensive for my clients, for my patients. It wasn't true. Or, or I thought that good, good quality orthosis were not really available.
It wasn't true, of course. Additionally, I've got in my head, Ide word of orthosis. You know, my orthosis looks like a fairy tale.
The orthosis is fitted well, always like a pair of gloves, comfortable for, for the patient and the patients can immediately walk, run, change position and use orthotic device like their own body, like something natural. But You know, the ideal, ideal, I'm sorry, ideal, ideal world doesn't exist. In my ideal world, we don't have with skin lesions, patients, irritations, and we don't have problem with the, you know, owner.
The owner can put the orthotic device on the dog always correctly and quick without any problems. When I say owner ignorance or better to say inexperience, I don't blame the owner, but sometimes things don't go well. Pets, parents, dog owners have their own ideas how to treat their pets, and, mm, sometimes, you know, the things doesn't go well.
But let's go to my ideal idea of orthosis. Everything go well, works well. The orthotic device and the dogs are fitted, but this scenario.
Is in the ideal world, not the real life. The real life sometimes is brutal and was brutal. Night Marsh started taking the measurement, and then it was like the Hitchcock movies.
Tensions were rising and problems too. Problems with fitting, with skin abrasion. Dogs doesn't, dogs, dog doesn't want, didn't want to move with an orthosis.
So in many cases, I abandoned the idea of orthotics, even if I know that it will be an excellent solution for the patients. But I knew that the prices were the solution to the problem and could help, and I have started looking for the answer. Is it worth this effort?
Yes, yes, the orthotic device can be an excellent tool in orthopaedic and physiotherapeutic baskets. Is any situation when I, I can use this tool. Let's start from, let's start from the beginning.
Orthosis, what, what, what is, is, what is this orthosis . Wait a second. Wait a second.
I need to. I need to go back to the one slide, OK. And we, we need to start from the beginning.
What is this and orthosis? . The kind of orthopaedic range of device is extensive, really extensive.
We have a lot of possibility. We have custom orthotics, braces, new prints, links, supple wraps, and we have also prosthetics. All of the stuff can be used to supplement or replace surgical treatment as a supporting element of physiotherapy or as a supporting element of physiotherapy.
The orthosis is not questionable as a single therapy and supplement surgical treatment in human medicine. In veterinary still is not a golden standard. In veteranists still we, we don't have a lot of experience with orthosis.
My experience came from the Polish art of veterinary medicine. In Poland, orthosis have yet to be popular. Also, some doctors and physiotherapists use or orthopaedic supplies.
There is a growing awareness among animal caregivers, but we have and we had A little experience with do it yourself, ah. Stabiliser, braces, and you know, kind of rototic device made from pipe, metal rods, plaster, a lot of projects. Are very successful.
Veterinarian can be really creative future owner owner can be a creative person as well. And many invention work really great, but disaster can also happen. That's, that's the reason the slide has a picture from the Czech cartoon but and not.
Tining these two gentlemen has always ended in disaster. That's why I recommended equipment by, by, by professionalists. I saw a lot of disaster cause inappropriate dressing.
In appropriate equipment. Or even medicine ad administered by the caregivers and on his own hands. Medi veterinary medicine is developing and you know, the veterinary VOP came from human human medicine HOP material, idea, methods, mechanical hinges, composite, high temperature plastic, carbon fibre, custom orthotics, many things are really many things could be taken from.
Human HOP human OP. We can draw from the experience of human medicine, but many things can have, but many things had to be adapted for quadruple amlation because difference in anatomy and our patients walking on the for limbs, . Look on this on this movie.
Yeah. Without sound. We see a great video video of moving dog.
This video is perfectly done and captures the movement our for leg patients. Knowing how the dog moves and how the weight of the body is distributed, we can adjust our thoughts to the patient's needs. The I know, I, I love this, this, this movie is, it's so good, it's so good to show.
OK. The main questions about the orthotic device, why, how, where and when may I use it? What is an orthosis?
What is orthotic device? What are the indications for using orthosis? There are many definition of what an orthosis is.
And what its functions are, how it's used, and how it is correctly. Very short definition. Orthotic device means a custom fitted or custom fabricated medical device applied to a part of human body for our needs, of course, animal body to correct deformity, improve function.
Unrelieve this symptom. Part of the body means usually we're thinking about joint, but it could be, we could be thinking about segment of the body or of, of course, about spine. This definition is beautiful, briefly and to the point, but we need a little more.
An orthosis and stabiliser is designed to keep the musculoskeletal skeletal system stable, immobilise, or relieve the pressure on the affected joint. And correct, incorrect body position. Control the range of motion of the, of the joint.
The orthotic device is often used as the alternative to a cluster. It is much lighter and more practical. In additionally stabiliser has the advantage of the adequate airflow and the ability to be sized perfectly to the link.
And you know, sometimes when, when we need to stabilise the joint. Total stabilise, we keep joint in keeping the joints in one position, pick the rigid orthosis, but we also can use soft, movable mobile stabiliser. I, I tried to classify and categorise orthosis in veterinary medicine.
At the beginning, it looks, it looks simple, but it was not so easy. We can divide orthotic orthotics due to the material is made and by stabilisation stage. Soft orthosis, like the neoprints or the similar made of soft quite malleable material, and we have also stiff orthotics made laminates, thermal for plastic, carbon fibre, 3D print, virtual technique, soft orthotic device usually allow for movement.
Usually in the whole normal range of the movement of the motion, but can, can prevent crossing the border. What, what I mean. Prevent extraordinary little action, activities which can be painful and dangerous and cause more damage to the joint.
And steep orthotics, rigid orthotics, is more stable. It's obviously just, just stable, and usually keeps the joint in one position, one peaked position. We also, we have semi-stiff, semi-rigid orthotics.
This device allow allow for control movement, limited deflection and extension, and we also know this, this kind of, of orthotic like dynamic orthosis. We use the orthosis prophylactically, functional, supportive. And rehabilitative.
But often all tasks are fulfilled and this tasks are complementary and intertwined. Mm Prophylactic prophylactic orthotic equipment prevents or reduce the severity of the joint injury, for example, use. An orthotic when a dog has a non-functional pole, I mean knocking over with proproductive deficits on the, on the short video with little Yorkie.
We can see No neuro exam. And the Yorkie has Propoceptive deficits on the pelvic gland. The power, the power is turned to the doorsal side.
And it's not corrected or corrected with a significant delay, more than 2 seconds. OK. The orthotic will support the foot, keep the, the foot in correct position, when the dog is wide bearing and is designed to prevent the dorsal source, dorsal wound from developing and other potential trauma to the limb.
Orthotic devices are used in rehabilitation as support after, before, or sometimes even instead, instead of the surgical surgical inter inter intervention. Rehabilitative orthotic support, stabilise a joint while assisting and restricting the range of motion. In the literature, we can often meet.
Example of cranial crucial ligament rupture. Or better to say, maybe cranial cruciate ligament disease. In these cases, the assumptions as follows, we must keep the joint, we must keep the stifle in neutral position to prevent drawer motion.
We have to keep the stifle in the, one position and prevent pathological movements, such are the treatment arrangements. Orthosis can be used also and even more, in my opinion, are indispensable in the situation, supporting the healing process after surgical procedure after surgical suturing the tendons. In my opinion, it's really, it is a really important function of orthosis.
Sometimes orthosis, can, can be part of conservative treatment of healing tendons after damage. Functional orthotics provides stability for chronical unstable joints, the joints and limbs for long term. Dog with hip dysplasia may benefit from functional orthosis that give support while stabilising the hip joint.
You know, the range of motion of the hip joint is control, controlled and prevent, prevent tluation, a sub extension, and the limb is maintained in correct position. Functional, the the pole is maintain maintained the correct sentence position with extension and with flexion. We also, we also can list orthosis for individual joints.
And spine, of course. We have orthosis for thoracic limp. It's very simple, shoulder, elbow carpal, and carpal with poles.
Orthosis with pelvic limbs for, for pelvic limbs, hips, stifle tarsal and torso with poles. And we also, we have spinal orthosis. The spine is not rigid drop, that's obvious.
And it's movable. Intravertebral motion can be limited by spinal orthosis. Mostly spinal braces can be, can be used to limit intervertebral motion in dogs with cervical and thoracic problems, including post-operative braces after surgical stabilisation, .
Even after surgical stabilisation and before surgical stab stabilisation, for example, the dogs with Warler syndrome and Atlanta a sublocation. . What we expect from the orthologist, this what we can expect.
A lot of it. To support A line Position Prevent or correct deformity, even correct deformity, assist the weak muscle or improve function. Provide protected motion within a controlled range.
Avoid or avoid or reduce the severity of the injury. Prevent or relieve contracture is really important. Allow la ligament and joint capsule to shorten and approach normal distance ability.
And provide functional stability for unstable lymph limb segment. That's probably. Not all the advantage of orthosis.
But the most common indication for the use of orthosis, shoulder braces for medial shoulder instability. I love this kind of ortho orthosis. Elbow instability and osteoarthritis.
Carpus, hyperextension, B or three planar instability, collateral ligament injury, arthrodesisports post-surgical, like as a support. And also arthrodesis with arthrodesis failure, . Prophylactic support for contralateral, lateral limb amputation.
With, with, I'm sorry, I'm sorry. OK. Mm Paw injury, including tendon laceration, after a digit amputation, with neuro neurological problem when the power is knocking over, peripheral nerve neuropathy and brachial plexusdal neuropathy.
OK, next one. Pelvic limp, stifle cranial cruciate ligament rupture or cranial crucial, cruciate ligament disease. Patellar luxation, grade 2 and 1, collateral ligament injury, Tarsal hyperextension, collateral ligament injury.
Failed a tend or repair, a tend the rupture or ablution post-operatic support, a hiend of sprain, as a non-surgical treatment without complete disruption or abortion, and a hiendochronic plantigra stances. Torso neurological cases like sciatic neuropathy, with torso, torso, collapse. OK.
Mm Of course, a lot of foot injuries including tendon laceration, and a lot of neurological problems, neurological, like the degenerative neopathy and peripheral neuropathy. This wonderful list came from, wonderful book, Canine Sport Medicine and Rehabilitation, rising and Janet Van Dyke, and chapter about orthosis and prosthetics. My, my personal, my personal list, This is, this list is subjective, pointing to my own experience and My own total subjective.
Carpal hyperextension, join, joint stabilisation after tendo suturing. And mostly with my experience, it's mostly a teno. Problem with superficial digital flexor tendon is this, this, this is the part of the achila tendon before and after surgery, but mostly I use it like, as a conservative treatment.
Stabilisation of tarsi joint very helpful if erosive inflammation after surgery, I mean, after, after, arthroscopic procedure. Mm, and I'm really a lot of use orthosis in erotic inflammation, tarsal aerosive inflammation. I love, I love orthosis with medial in medial shoulder instability.
I'm such a fan of it. Brachial plexus distal neuropathy, especially radial nerve injury, and sciatic nerve trauma. Usually arogenicrogenic damage.
And I love Ortezis with . Neurogenic, usually in, problems of neurogenic origin associated with distal parts of the limb, pulse, hand and foot, when the patient is not able to position pulse correctly, the pulse is putting on the dorsal side. And in these cases, I use something like the total orthosis, orthosis on the tarsal and orthois on the carpus with whole foot, whole hand, and we, usually call it boot or boots.
In my practise. As well all do. I have a lot of patients with cranial cruciate ligaments.
This is cranial cruciate ligament rupture, and I've got a lot of questions about conservative treatment about this situation. And I did not have experience. My experience with knee orthosis so far is, I'm sorry, is, How dull crucial ligament injury.
I had one patient, a gent dog with caudal cruciate ligament. This situation was confirmed by MRI examination. It was, second degree damage.
And we decided on conservative conservative treatment. Also, because lack of idea for surgical treatment, then we decided for orteis. And you know, the treatment was successful.
The dog is still running agility, but it was hard to treat. We started with massive skin abrasion. The damage was in a sensitive area around the penis.
Knee ortho had fixation around the torso as well, and straps wrapped, wrapped on the abdomen. And the patients survived this difficult time and until now it's it's really nice and everything is OK, OK, but, it was, it was probably my 1st, 1st situation when I, I use orthosis on the, on the knee. And number one with my patients and orthosis is hyperextension on wrist joint and problem with the wrist joint.
And, what is hyperextension of the wrist? Why using orthosis in these cases can be really, really effective. The wrist structure is complex and consists of 7 tiny bones.
Which allowed the motion between pole and rest of the limb. These bones are arranged in the row, dividing into the dividing the carpus into the several smaller joints, radiocarpal joints, intercarpal joints, and carpal metacarpal joints. The structure of the wrist is connected by ligaments located on the side, on the back, and on the front.
Very complicated, very sophisticated. In healthy dogs, these ligaments hold the carpus in place and, and maintain it at normal angle when the dog is standing. A normal active range of motion when the dog is walking and the joint is moves.
Hyperextension occurs when the carpus extends beyond the normal or healthy range of motion. Let's look on the movie. Mm.
Right. It's just I would to say wonderful, but it's not wonderful, but it's a wonderful example for carpal hyper hyperextension. The carpus literally is lying down on the, on the ground.
Carpal hyperextension is caused by Damage to the ligaments that stabilise the carpus. We had, we can say we had 3 situations, puppies, trauma situation, and all the dogs. You, in young puppies, the most common reason.
For this Appearance Is An abnormality in development that cause is mainly idiopathic. I hate this word, idiopathic, which means the causes is unknown. Idiopathic is uppercase words to cover up our ignorance.
I don't like to not know, but Its cost cannot be determined centrally. Probably we, we can, we can think about, inadequate nutrition or some external influences, but we don't know what is the main reason, carpal hyperextension in young puppies. Carpal hyper hyperextension of course cause injury.
Trauma, sprain, dislocation, strain, . And in the, in a mild cases of carpal hyperextension, the ligament may only be stretched or strained. Several cases, the ligament may be complete rupture.
A lack of carpal stability leads to carpus to sack toward the ground or become hyperextended. And the situation worsening when the dog is bearing weight. And third situation is carpal hyper hyper hyperextension present in all dog.
It is typical degenerative. It is age-related weakness, the ligaments that support the entire joint to lose their structural strength. The ligaments are, the ligaments are stretched.
I don't know if it, if it, if this is a good comparison, but Are stretched like a worn out rubber band. The result is incorrect position of the wrist, large bit or heavily overweight dog may be more susceptible to this condition to the increased weight load on each carpus. In many cases, in really many cases, the.
The carpal hyperextension orthosis, is a perfect solution. The orthosis positioned the wrist in the correct position, literally holds the wrist, doesn't allow. Movement outside the proper range.
Next, next video. In the video we see Malamud Alaska Malamud. Quite Big dog.
With orhosis. And in this case, orthosis helps a lot. OK.
For each treatment, we ask ourselves questions about contraindication. Contraindication for the. Use of or of orthosis.
We don't have many of them. It is important to choose the right orthosis for the patient and the cause. Patient-related contraindication include being challenging to handle because of an aggressive personality.
And we also have patients, there are patients who cannot tolerate anything on their body. And in many cases, we can change that with the right approach, learning to use the orthosis, and we can use. Physiotherapist and even behaviourist, physiotherapist and even and behaviourist are indispensable in these cases.
Contra indication, . When we cannot put orthosis on the patient, severe skin problems. It's really important, wound, open wound, old wound, any wound, skin abrasion.
Contact allergy to the material from which the orthod is made. As with everything, the orthosis must be well chosen and properly selected for patients need. How to, to start with the orthosis, take it easy.
What, what is important, you know, the unfortunately, putting an orthosis on the patients is not a magnificent solution. The challenge is beginning. Returning, returning to the functional independence requires re-education on the body, including muscle, nerves, and the mind.
Don't forget about dog's mind. And we have to, integrate the patient with the orthotic device. Our goal is to integrate the patient with orthotic device.
The orthotic device must, must become, must be. A part of the patient's body and device must become part of the biomechanical system, like in the sport. Who of you is playing sport with equipment?
I do kendo, you know, the guys with the special sport called shinai and with special armour, . And the swohina is extension of my our body. I have to feel swore like my hand and my mind.
Maybe it sounds poetic. Maybe it sounds so crazy. The orthotic device, part of the body.
But We can understand much more if we start thinking about orthosis device like part of the patient's body. Before it happens. The orthotic device must be coupled with rehabilitation to maximise its use and patient success.
Look on this, look on this. Moving. In this case, Or do this Become part of the biomechanical system.
OK. We try to restore the physiological distribution of body weight and physiological activity as close as possible. Sometimes it is impossible, but, however, we try to get as close as possible.
Patients who suffer from loss of limb function, limb loss of joint function, loss of the body segment, always develop compensation for functional deficiency to maintain balance and locomotion. Priorities, priority is to move. However, such compensatory movements are not necessarily efficient and frequently leads to short and long-term complication.
For example, the, an obvious example of compensation is compensation in the skeletal system. Look at the X-ray. The bending of the radius bone, radius curvus.
Leads to deformity on the wrist and elbow. Always, always, when we have deformity, when we have deformity, . With one part of body.
Problems with with one body part leads to another, always, it's compensation. And to use of orthosis is. Is designed to avoid and in fact, minimise the adverse effect of the, of compensation.
In many cases, using orthotics to ensure a normal life and most important, life without pain. There are patients For whom the only things we can do is provide life without pain. It's already a lot.
How to start and how long can I use orthosis for the for for for the first time? We often, it depends. We often have to put ours on the patient and keep.
We don't have any choice, for example, for example, after 10 to 3 surgery, But essential is owner education. And the owner should be. Train and should be ah.
Carefully observe the limb. And should we should explain in detail the purpose of the orthosis, how to put it on, how to pay attention to, how to be aware of. Well, sometimes doctors make mistakes.
Hanna, tried twice as hard to fix it. You're using your inhaler? All the time, go through one a week.
Sure you're using it right. Do I look like an idiot? No Once you show me how your inhaler works.
Like I said, essential owner, essential is owner education. Doctor Haqui, all but current every time when I see this passage, the author knows, I, I think the elder knows the, the problem of doctor and pets well. OK.
Mm. In good practise, it is good practise for the dog's handler dog's owner to put the orthosis on a few times with us. We have to Explain everything to the owner.
For example, that keeping orthosis on all the time can provide them on the limb, and the owner should react and regulate the pressure, control how strong and how fitted orthotic devices are. We all know the cases of, of necrosis caused by ischemia. But when we have time, it's good to get patients and their skin used to the orthosis.
But if we have the time and ability, we can start every 5, 1015 minutes each. Each walk in case when the dog mostly rest at home or the device should be off. .
Really rest. That is important, but in many cases, the patient has to use the orthosis at home because it doesn't rest at home. But the good news or bad news is the most pro often problem with the orthosis skin is with the orthois skin abrasion.
But we can minimise orthosis problem, this orthosis problem. Orthosis should be checked daily. We should, we should warn patient's owner.
About some situation, HOP developers didn't have to think about this topic about veterinarian patients sometimes feel like eating the orthosis. And orthosis for use in animals should be made of non-toxic material, materials, and in the first period of using the orthosis, the patient should not be left with orthosis unattendant. Pay attention to skin damage at red and redness, after pulling it where mild swelling may occur, so orthosis should be, should have a specific range of adjustment.
Or consider slightly slight variation in the circumference. A limp limp circumference may change slightly during the day, that is physiological. However, time to time.
At least once a week maybe. We have to check the circumference of the limb, do the possibility of both muscle atrophy and muscle gain. How to prevent skin irritation, choose the right braces, right orthosis, and spec orthosis regularly.
Check for exposed metal change to its fabric and damage, and this is trivial, but a really effective. Keep orthosis clean. And sometimes we need some dressing pads under the orthosis.
For my experience and observation, very delicate are greyhounds, and in these cases, I recommended using additional parts, very soft materials. How to choose the orthosis orthotics, when I think about orthosis, I'm thinking about pair of gloves. Customised prices are more efficient stabiliser of bones and joints than pre-made, but, and custom, custom device disappears correctly force over the larger surface, .
But sometimes we don't have time and must use primate orthosis. Well fitted primate orthosis also fulfil their function, really nice. However, regardless of our solution, the orthosis will be well suited to that problem and the patients and, you know, measure, measure, measurement is crucial.
Sometimes even millimetre matters, size matters. We can see the movie with new solution that is to scan the patient with the smartphones and special programme. Always refer to the manufacturer guidelines and measure the patients carefully and correctly.
Common question and even thesis is that the wearing orthosis cause muscle weakness. And that depends, but overall, this is not true. .
When we use rigid orthosis, there are usually limited to when the tissue is healing. In these cases, for example, bone fracture, it's obvious that we have to use stabiliser. For example, instability of cervical vertebra, WA syndrome, and the surgery, that's obvious we should stabilise this problem.
Of course, I'm not discussing situation where we use a rigid stabiliser permanently due to joint dysfunction. In such cases, we have no other choice. As far as for different situations, using a rigid orthosis is usually time-limited and brings more positives than casts.
And I didn't find conclusive scientific evidence to suggest that orthosis results severe muscle weakness. Orthotic supplies really can be a game changer in many cases. And I would show cases when the orthosis was used, 3D print, new design from Wimba, wonderful orthosis, the orthosis, .
These orthologies are easy and effective. When I mean easy, I mean easy to put and keep on the patients, really light and almost invisible for the patients. It is it is, personalised, customised orthopaedic supplies, like a glove, really.
. And really nice or orthotic device. We have, we have Lexis, 5 years old, quite a big girl. 36 kilogrammes and during one of the on the walk, Alexis was hit by a car.
which, caused a rupture of medial dorsal ligament between the 1st and 2nd radialcalar carpal bones, and, that decided to reconstruct the ligament and stabilise the wrist and Lexis used, orthosis after surgery, . Mm That is cool. We, we started with stabilised orthosis and then after, after first stage of rehabilitation, we, changed the orthois from, from stable to movable orthosis.
We use some, we use some, I use token. Token is part of the windba orthosis is the round button, button, and, the token. Can, an element of the orthosis and token is tangible and, we can have a token which completest stab stabilise the orthosis and we can switch, to the, to the token, which allow the full normal range, range of motion, .
Mm And . Wimba orthosis really help Lexis, came from normal, normal life and, normal walk and normal, normal, just normal life. It was classical situation to supplement of surgical treatment and help the whole dog with quicker recovery.
Next one is quite typical situation, bilateral cal carpal hyperextension. O dog, 11 years old, quite big, even over, overweight. The patients began, show, shows a problem with, movement.
Avoid movement and the owner had, you know, difficulty, difficulty with daily activities such as walking and walking on the, on the stairs. That's recommended weight reduction, . And some painkillers, some anti-inflammatory, some anti-inflammatory drugs, and stabilise the carpal, the wrist by ortho orthotics.
OK, we have the We've got the movie with Max. It's quite, quite big, 33 kilogrammes. It's really better.
Mm, wait a second, I. I to show you the angle. Angle before Orthois, orthosis?
Mm. And after. When the mugs get orthosis, the dog increased frequence of walks, reduced their body weight, and Did not take an a side anymore and the flexion didn't did not worsen, and angles were maintained and the dog is really, really happy and the owner.
To OK. Accurate diagnosis, well cho chosen and measured supplies, rehabilitation and owner education, . This is important in orthosis.
Question. Right. And it's, that was very interesting, and certainly creates a, a completely different perspective on all these sorts of problems that, we as vets have been dealing with for quite some time now.
Just, there are a couple of questions. One I'd like to jump to first was about Max, that hyperextension, with those orthosis that you used a permanent feature? Did you have to live on those for the rest of the time?
Could you repeat again, please? The the the hypertension, are they lifelong? Yes, yes, for, for the rest of the, of his life.
Yes. OK. Another question that's come through is about physiotherapy.
If you're using these orthoses and orthotic devices for a, a period of time to help with healing, once you start to remove them, do you need to then provide sort of physiotherapy and try and rebuild the muscles, or is that not necessary? It it is necessary, it is necessary. I do a lot of rehabilitation and rehabilitation in this case is really important.
And the time when I want to remove the orthosis, I do, you know, I, I do it, I do rehabilitation and, a lot of, a lot of cases I put, for example, in the underwater treadmill. OK. Yeah.
Another question that we've got coming through. If you're using these, devices post-surgically, at what stage do you put them on? How long after surgery would you apply them?
That, that, that, that, that depends. usually I start with orthosis when the edoema after surgery is, is gone because, we don't wanna put orthosis on the edoema orema limb edoema joint with edoema. And usually I have to keep like the 6 weeks, sometimes longer, but usually it's the 6 weeks.
OK. And you spoke about, the maintenance of and the care of these, these devices and that sort of thing. Do you need multiple devices?
Or how do you wash them and keep them clean while still supporting the animal? Usually, for, for, for example, we, I can wash it and it's dry really fast, but when I have another stuff, I probably want to have more than one. OK.
And then another question that's come through for you, the use of these devices for elbow dysplasia. Are they successful? Do you use them?
Oh my God, it is, it's brilliant question but really difficult. Elbow dysplasia is like the Worn the, the, the part of the worm. Yes, but I've got one patient with elbow dysplasia with the orthotic device, orthosis, and this, this case, it goes really well with ortho orthotics, but I don't have many, many situations with, with elbow dysplasia and orthotics device.
But elbow dysplasia is a frustrating situation, really. Yeah. Yeah.
And then with these orthoses, with tendon ruptures, you mentioned it at one point, but could you use it on, on sort of all tendon cases, like, for example, a, a patella problem, say a lux patella that's had surgical correction that you use it for post-op support? Yes, I don't have many cases with, with palluxation and orthotics device, but it could be really a game changer. Now I'm working on, stifle, stifle orthotics, and I hope it will be work on the total relaxation.
Excellent, excellent. Another great question that we've had through from, from Natalie is the use of these orthotic devices in puppies with large breeds, for example, with the valgus deformations to try and correct those. I prefer in this cases, I prefer operate operating, procedure.
OK. And then maybe using it as a post-operative support? Yeah, probably, probably will be, will be really nice, but in, in the puppy cases, you know, the owner education and the change, supplies is really, really important because the puppies are growing.
Sure, sure. Yeah. Last question for you.
Would you use, one of these orthotic devices, rather than recommending a, an arthrodesis? I don't like arthrosis. I meet a lot of failure of orthois, you know, ortho looks really nice and really simple in the books, but you know, I'm sorry, I know maybe it's, it's controversial situation, but in many cases, even, even if ar this was performed.
I have to additional give some support and give some or or or orthotic device and I want to, I wanna say yes, sometimes orthotics is better than orthod. Fantastic. Good answer good answer.
OK, thank you very much for your time and challenging. I really did well and I, you've opened up a whole world of, of devices for us. And thank you to Wimba, who sponsored you tonight.
They have a, a very detailed website that people can go and look at as well to get some more information from it. So thank you to Wimba for, for sponsoring, and thank you again for your time tonight. We really appreciate it.
Thank you. Bye. Thank you to everybody for attending tonight.
We do appreciate your time and I hope you found it insightful. And last but definitely not least, to dawn my controller in the background. Thank you for making everything happen, seamlessly tonight.
From myself, Bruce Stevenson, it's good night until next time.
