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Hi Laurie,

Another request for any insight you may have.  I am seeing Lexi who had her RFL traumatically amputated just below the elbow while in an abusive situation in May 2014.   Since then, she has (thankfully) been rescued, brought to VT and now is part of a wonderful and dedicated family.

I started seeing Lexi  pro bono in November 2014 about 5 months ago. A local human prosthetist made her a prosthesis (also pro bono) and the ultimate long term goal has been for her to learn to use it for functional ambulation.  When I first saw her in November,  she would carry the prosthesis mostly as a “wing”, not a limb, ie, she would flex the shoulder behind her and hold the prosthesis almost parallel to the ground totally NWB along her trunk and use a 3 leg hop to ambulate.  Behaviorally, she’s a bit wary (understandably given history) but otherwise sweet and responsive to treats and healthy and not overweight.

Both hind limbs and the LFL are strong and painfree.  There are no problems with the stump.  The elbow is held in relative extension while in the prosthesis and in general seems to fit well and not cause her any pain.  She doesn’t seem to like it/never has – seems she perceives it as more problematic than helpful. She did ‘walk’ via hopping pattern for ~ 6 months until she got her prosthesis.

Her musculoskeletal system shows some of the typical compensations you would expect to see with almost 6 months of  3 leg hopping – kyphotic lumbar spine and LFL  compensations.   We have been addressing those on a regular basis  (including stretching scapula on rib cage) and Lexi has a carpal wrap for the L and  she has remained remarkably painfree, flexible and strong in trunk/spine/LFL .  Owners regularly carry out a home exercise program that addresses preventing/minimizing these issues.  Initially, she had severe atrophy on the stump side but has now developed sufficient muscle mass to even do a ‘shake paw R”  in sitting/stand and can WB through the prosthesis to do a ‘shake paw L”.   She does many exercises for trunk/LFL/BHL strengthening and she does well  using donut and rocker board for balance and weight shifts.

While she has improved with individually being able/willing to do WB through prosthesis and also in swinging it forward – getting her to combine these two basic movements into a walking pattern has not happened.  I have recently been having her walk CCW in a semi-circle and over some low poles duct-taped to the ground.  I’ve used clicker training to get her to place prosthesis on yellow targets on the ground  as she ‘walks’ and we’ve even started her recently using her FLs only on a land treadmill.  We also just do a lot of slow walking  with me trying to encourage her to weight bear and me assisting her swing forward  with the prosthesis.  Even though we slow her down, it’s still very hard to get her to NOT hop.  And, she never spontaneously uses the RFL (prosthesis side) in gait – she will turn, and even back up using a hopping pattern.  That darn hopping pattern just seems so ingrained, we can’t seem to change it.  She no longer holds the prosthesis in a total ‘wing’ pattern parallel to the floor as she did initially when walking – the limb hangs lower  now, almost perpendicular to the ground – but she still hops.   I  originally thought I would work to  try and change this pattern for as long as she had been hopping (ie about 6 months).  We are now rapidly approaching that landmark and while Lexi has improved in a million different positive ways, the ultimate goal of using the prosthesis in functional walking has not been achieved.    Owners are a bit disappointed as am I.  However, I also feel need to be realistic.

So… I guess I am reaching out to see if you have any other ideas I might try – or maybe I should just face fact that she may never accept its functional use.  I really can’t find any ms/sk reason why she can’t transfer her skills – no pain, no joint limitations, no muscle length/pain problems, good fit of prosthesis, etc.

Thanks a lot for any input you might have!

Nancy

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Hey N,

Interesting case!  Poor thing!

So, I would try getting her to walk in any direction on the treadmill - forwards, backwards, sideways.  And in forwards motion... slowly increase speed to see if you can get her to use it... (eventually).

On land (or maybe on treadmill) try walking with a boot on the left front leg... maybe put some tinfoil in the bottom of it.  Or maybe tape on the bottom of that foot.

Maybe try using a tensor bandage / ace bandage wrap (loosely tie the left front and right hind leg together...)

Maybe try slow walking up hill (or if your treadmill has incline, crank it way up)

Will she use it walking up stairs (slow / on leash)?

Clicker train at a walk... on treadmill... front legs only?

Since it's not sounding to be pain related... then it is likely just a learned non-use.  I first wondered if it had anything to do with the abuse... but as you describe what you've done and how she will use the leg to balance etc... I go back to learned non-use.

Worth a bit more trying... (with fingers crossed)

Let me know if you figure out the magical solution!  Good luck!

Laurie

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L.,

Will do - I so would like to see it happen.  Tried all 4's on land treadmill today - was a bit of a disaster.  Treadmill I have at its slowest is 1 km/hr - not sure if that is a factor or not.  Today, think it was more of a matter of Lexi being very surprised that she had to move ALL 4 limbs at same time (we've only been doing FLs on the treadmill with HLs off so far and I have to help move the RFL [prosthesis side] fwd for her.)  I think it also showed me how difficult that 4 leg/trunk integrated motor pattern really is for a dog who has been 3 leg hopping for so long.  I'll try to get a third person in to help next time - I just couldn't coordinate all the limbs, keep her upright at same time (owner is busy uses some peanut butter in cup in front of her and he also has to do machine controls which are up front of machine  - it's a donated one, not perfect, but works!).

I did have Lexi also try just putting BHLs on treadmill with FLs on ground - which meant she was walking backwards.  She also seemed a bit shocked at first, but got used to this after a little while with less disaster!  And then, when we went back to the 'easiest' original method - BFLs on treadmill, BHLs off, walking fwd with me helping move prosthetic side fwd - she actually had several times when she actively was making attempt to bring that RFL fwd - Yay!  I'm going to count that as a success.

What a pleasure to be able to even try to help these animals - and so appreciative of all you do to keep us all motivated and educated in this effort!  Thank you.

N

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Thanks for the update.  

Ideally, slower than 1km/hr would be preferable... but you go with what you've got.  

Often time, and especially when the dogs are learning the treadmill, I just straddle the treadmill, hang onto them around the middle and let them sort it out.  If you were co-ordinated enough, you could hang on around the middle with one arm and use the other one to place the leg... be sure to bend your knees to help support your back!!  It's not pretty, but it works!

I would agree that it sounds like a success!  Congratulations and keep it up!

Cheers,

Laurie