Measuring the Platelet Rich Plasma Treatment Response - The Visual Assessment

In our first post, we explored the first component of the exam following a PRP treatment - the owner assessment. We defined the takeaways needed to quantify the patient’s progression from the owner’s viewpoint, and now it’s time to take into consideration the second component of the exam - the visual assessment. In this blog, we will outline what to look for in your visual assessment, useful tools you can use to evaluate your patient and explain how these evaluations can aid in gauging the patient’s response to PRP treatment.   

The Visual Assessment

The visual assessment is the most readily available tool available to veterinarians as it is performed each time a patient walks into the exam room. However, it is also the most subjective assessment available as it relies on astute observational skills and the recall of a specific patient’s baseline out of hundreds of patients filed away in the practitioner’s memory. With this in mind, it is important to focus on select key observations during the visual assessment of the patient which will help determine whether they have had a satisfactory response to PRP treatment in the time period since the administration.

Key Observations

• Edema: Does the patient have any edema at the site of injection or in the joint of concern? Has swelling decreased/increased from baseline?
• Stance: How is the patient standing? Is there an obvious shift in weight either on or off of the limb of focus? (Our next blog will cover Stance Analysis which provides a measurable readout of patient stance, weight bearing percentages, and center of gravity).
• Rest/Sitting: Is the patient resting comfortably? Can they sit squarely or is there an adjustment of leg angle to accommodate pain/stiffness?
• Gait: How is the patient moving? On a non-slip surface, observe the gait of the patient moving at a walk and trot at different angles. Is there a noticeable head bob or lameness?
• Demeanor: Is the patient relaxed/calm? Or does the patient exhibit irritation, stress or pain? Look for subtle cues that suggest changes in the patient’s demeanor.
• Palpation: Palpate the patient to check for any obvious signs of muscle soreness, range of motion restrictions, crepitus, etc. Watch for subtle responses from the patient which may indicate pain in the areas being manipulated.

Useful Technologies

While the eyes are one of the best tools the veterinarian has, there are recent developments in technologies that enable visual assessment of patients to become more accessible and objective. Technologies that may want to be considered as part of the visual assessment include:

1. Slow-motion video capture: A great tool that can be found on most smart phones is slow-motion video capture. This tool will enable you to record video of your patient at different gaits and observe subtle changes in stride length, foot placement and head bob to detect any changes in lameness. Videos can be saved which make them a great asset to take both before the procedure and after the procedure during the follow up exam. They also act a communication tool to pet owners for explaining treatment responses and justification for follow-up treatments.
   
   Tips for taking good slow-motion videos:
   • Label videos when saving with prefixes of “Pre-PRP” and “Post-PRP” with the patient name and date.
   • Limit leash pulling as much as possible to enable free movement of the patient.
   • Take video from all angles including front, side and back if possible. If it is not feasible to record from multiple angles, make sure to record consistently from the same angle for each video so a direct comparison can be made to identify possible changes.
   • Make sure all videos are being recorded on a non-slip surface
     
     
2. Heat Mapping/Thermography: Heat mapping has become a much more common technology to have in the veterinary practice for detecting areas of elevated heat which signal areas of inflammation. Heat mapping or thermography can be performed using a small adaptor to a smart phone or through specialized camera systems which process images to portray heat signals through different shades of blues, oranges and reds. Thermography readouts can provide the practitioner with an indication for whether or not inflammation has been affected through treatment (increased or decreased) and provide the client with a visual representation of where inflammation still exists in the pet.

The visual assessment can provide useful, real-time feedback on your patient’s progression since the PRP administration and give you a general sense of how the patient has responded to treatment. Stay tuned for next installment of this series where we explore the final component of the PRP follow up exam, quantitative measurements.