Proximal hindlimb flexion in the horse: Effect on movement symmetry and implications for defining soundness

Visually Assessing Equine Quality of Movement: A Survey to Identify Key Movements and Patient-Specific Measures

Outcome measures are essential for monitoring treatment efficacy. The lack of measures for quality of movement in equine physiotherapy and rehabilitation impairs evidence-based practice. To develop a new field-based outcome measure, it is necessary to determine movements most frequently observed during assessment of rehabilitation and performance management cases. An online survey of 81 equine sports medicine veterinarians and equine allied-health clinicians was conducted. The key movements identified included walk and trot on both firm and soft surfaces in a straight line and on a small circle, plus step back, hind leg cross-over, transitions and lunging at walk, trot and canter. The main barriers to observing some movements are access to suitable surfaces and the training level of the horse and handler. Subjective visual assessment of live or videoed horses was the most common method used to track progress of complex movements. The majority (82%) of survey participants agreed or strongly agreed that a modified Patient-Specific Functional Scale would be useful for measuring complex movements. Comments from all professions show a desire to have outcome measures relevant to their needs. This survey identified 24 in-hand movements, which can be used to form the foundation of a simple field-based outcome measure for quality of movement.

Short Communication: changes in gait after 12 wk of shoeing in previously barefoot horses

Farriery can impact gait symmetry and lameness outcomes, but there is limited scientific data documenting these effects. We hypothesized that shoeing previously barefoot horses with plain stamp shoes on the hind hooves would increase gait symmetry, alter hock angles and increase range of motion, and improve lameness scores more than shoeing with traditional fullered shoes. At the start of the study, gait symmetry via wireless inertial motion sensors (IMS), kinematic gait analysis (hock angle and range of motion), and American Association for Equine Practitioner's (AAEP) lameness scoring were completed for 14 barefoot horses. Horses were then trimmed and hind hooves were shod (wk 0) in three-quarter fullered shoes or plain stamp style shoes. Horses were trimmed and re-shod at week 6. At the end of 12 wk, the IMS analysis, kinematic gait analysis, and lameness scoring were repeated. Differences between shod and barefoot values were calculated for each horse, and impact of shoe type was analyzed via t-test. Significance was determined at P ≤ 0.05. No differences were observed in the IMS scores, hock angles or range of motion, or AAEP lameness scores between horses shod in fullered or plain stamp shoes (P ≥ 0.08). As no variables were determined to be significantly different between the two shoe types, data from all horses were combined to analyze the differences between the barefoot and shod state. Shoeing increased the maximum angle of the right and left hocks (P ≤ 0.03) and the minimum angle of the left (P = 0.02) but not right hock (P = 0.23) relative to barefoot conditions. No differences in hock range of motion were observed in either hock. Lower AAEP lameness scores were observed in horses when shod compared with barefoot (P = 0.001). In conclusion, shoeing previously barefoot horses improved AAEP lameness scores and increased hock angles, regardless of the type of shoe.

Upper Body Movement Symmetry in Reining Quarter Horses during Trot In-Hand, on the Lunge and during Ridden Exercise

Veterinary lameness examinations often comprise assessing ridden horses. Quantitative movement symmetry measurements can aid evidence-based decision making. While these are available for ‘English’ style riding, they are not for ‘Western’ style riding. This quantitative observational study quantified movement symmetry in reining Quarter Horses (QHs). Movement symmetry of the head, withers and sacrum (differences between minima, maxima and upward amplitudes) were quantified with inertial sensors in N = 30 medium/high level reining QHs during trot in-hand, on the lunge and ridden by one experienced rider (straight-line/circles) on reining-purpose riding surfaces. Mixed linear models for movement symmetry assessed the effects of ridden exercise and movement direction (fixed factors), stride time (covariate) and horse (random factor): single factors and two-way interactions with Bonferroni correction at p < 0.05. Three withers and pelvic parameters showed marginally more symmetrical movement when ridden (p ≤ 0.044; 1−5 mm differences). Three withers, three sacrum and one head parameter were significantly affected by movement direction (all p ≤ 0.026), five showed increased asymmetry on the inside rein, and two, quantifying vertical displacement maximum difference, showed the opposite. Riding QHs in ‘Western’ style showed small movement symmetry differences. Circular exercise confirmed increases in weight bearing asymmetry on the inside rein and in pushoff asymmetry on the outside rein. This should be further investigated for differentiating between different causes of lameness.

Differential Rotational Movement of the Thoracolumbosacral Spine in High-Level Dressage Horses Ridden in a Straight Line, in Sitting Trot and Seated Canter Compared to In-Hand Trot

Assessing back dysfunction is a key part of the investigative process of "loss of athletic performance" in the horse and quantitative data may help veterinary decision making. Ranges of motion of differential translational and rotational movement between adjacent inertial measurement units attached to the skin over thoracic vertebrae 5, 13 and 18 (T5, T13, T18) lumbar vertebra 3 (L3) and tuber sacrale (TS) were measured in 10 dressage horses during trot in-hand and ridden in sitting trot/canter. Straight-line motion cycles were analysed using a general linear model (random factor: horse; fixed factor: exercise condition; Bonferroni post hoc correction: p < 0.05). At T5-T13 the differential heading was smaller in sitting trot (p ≤ 0.0001, 5.1° (0.2)) and canter (p ≤ 0.0001, 3.2° (0.2)) compared to trotting in-hand (7.4° (0.4)). Compared to trotting in-hand (3.4° (0.4)) at T18-L3 differential pitch was higher in sitting trot (p ≤ 0.0001, 7.5° (0.3)) and canter (p ≤ 0.0001, 6.3° (0.3)). At L3-TS, differential pitch was increased in canter (6.5° (0.5)) compared to trotting in-hand (p = 0.006, 4.9° (0.6)) and differential heading was higher in sitting trot (4° (0.2)) compared to canter (p = 0.02, 2.9° (0.3)). Compared to in-hand, reduced heading was measured in the cranial-thoracic area and increased in the caudal-thoracic and lumbar area. Pitch increased with ridden exercise from the caudal-thoracic to the sacral area.

Influence of orthopedic examination on lameness scores and interobserver and intraobserver agreement in dogs with naturally occurring elbow osteoarthritis

OBJECTIVE

To determine the influence of orthopedic examination on numerical rating score (NRS) and visual analog score (VAS) when scoring lameness in dogs with elbow osteoarthritis (OA) and to evaluate interobserver and intraobserver agreement in NRS and VAS on the basis of video-graphic gait analysis.

DESIGN

Prospective blinded study.

ANIMALS

Eighteen client-owned dogs with radiographically confirmed elbow OA.

METHODS

Videos were obtained for all dogs at a walk and at a trot both prior to and immediately after orthopedic examination. All videos were randomly sequenced. Six observers, unaware of the timing of the video, independently assigned both NRS and VAS twice, with at least a 2-week interval. Scores were evaluated with mixed analysis of variance, and the agreement among observers was accessed by intraclass correlation coefficient (ICC).

RESULTS

No difference was detected between NRS and VAS at walk or at trot before and after orthopedic examination. Numeric rating score and VAS at walk were lower than those at trot before an orthopedic examination by scores of 0.17 (P = .0018) and 3.54 (P = .0019), respectively. The ICC for both scores for all observers was >0.9.

CONCLUSION

An orthopedic examination did not exacerbate the NRS and the VAS for dogs with elbow OA. Interobserver and intraobserver agreement was high for both lameness scores.

CLINICAL SIGNIFICANCE

Lameness may be scored after gait evaluation in dogs with elbow OA irrespective of the timing of a comprehensive orthopedic examination.

Lameness Evaluation of the Athletic Horse

Lameness examination is commonly performed in the athletic horse. A skilled lameness diagnostician must have keen clinical and observational skills. Evaluation starts with a detailed history and thorough physical examination. Next, gait evaluation in the moving horse is performed. Lame horses have asymmetrical body movement due to unconscious shift of body weight. Recognition of the resultant head nod and pelvic hike is the basis for lameness diagnosis. Lameness identification is enhanced by circling, limb flexions, and riding. Most lame horses do not exhibit pathognomonic gait characteristics, and therefore, diagnostic analgesia is the best way to authenticate underlying sites of pain.

Effect of a unilateral hind limb orthotic lift on upper body movement symmetry in the trotting horse

In trotting horses, movement asymmetry is associated with ground reaction force asymmetry. In humans, limb length differences influence contralateral force production. Here we investigate whether horses, in immediate reaction to limb length changes, show movement asymmetry adaptations consistent with reported force differences. Aim of this study was to quantify pelvic and compensatory head and withers movement asymmetry as a function of limb length changes after application of orthotic lifts. In this experimental study movement asymmetry of eleven trotting horses was calculated from vertical displacement of poll, withers, sacrum and left and right tuber coxae with inertial sensors. Horses were assessed in-hand under 5 conditions (all with hind limb boots): without orthotic lifts, and with a 15mm or 30mm orthotic lift applied to the left hind or right hind. A linear mixed model investigated the influence of orthotic lift condition (P<0.05, pairwise posthoc Bonferroni correction). Pelvic movement asymmetry showed increased pelvic downward movement during stance of the shorter limb and increased pelvic upward movement during and after stance of the longer limb (P<0.001) with asymmetry changes of 3-7mm (4-10mm) for 15mm (30mm) lifts. Hip hike (tuber coxae movement asymmetry) was unaffected (P = 0.348). Head and withers movement asymmetry were affected less consistently (2 of 3 respectively 1 of 3 head or withers parameters). The small sample size of the study reduced generalizability, no direct force measurements were conducted and only immediate effects of orthotic lifts were assessed with no re-assessments days or weeks after. Conclusions about mechanical consequences (weight bearing, pushoff) are based on published movement-force associations. Pelvic movement asymmetry with an artificial change in limb length through application of an orthotic lift indicates increased weight support with the shorter limb and increased pushoff with the longer limb. This may be of relevance for the management of horses with different hoof shapes between contralateral limbs, for example some chronically lame horse.

Head, withers and pelvic movement asymmetry and their relative timing in trot in racing Thoroughbreds in training

BACKGROUND

Horses show compensatory head movement in hindlimb lameness and compensatory pelvis movement in forelimb lameness but little is known about the relationship of withers movement symmetry with head and pelvic asymmetry in horses with naturally occurring gait asymmetries.

OBJECTIVES

To document head, withers and pelvic movement asymmetry and timing differences in horses with naturally occurring gait asymmetries.

STUDY DESIGN

Retrospective analysis of gait data.

METHODS

Head, withers and pelvic movement asymmetry and timing of displacement minima and maxima were quantified from inertial sensors in 163 Thoroughbreds during trot-ups on hard ground. Horses were divided into 4 subgroups using the direction of head and withers movement asymmetry. Scatter plots of head vs. pelvic movement asymmetry illustrated how the head-withers relationship distinguishes between contralateral and ipsilateral head-pelvic movement asymmetry. Independent t test or Mann-Whitney U test (P<0.05) compared pelvic movement asymmetry and timing differences between groups.

RESULTS

The relationship between head and withers asymmetry (i.e. same sided or opposite sided asymmetry) predicts the relationship between head and pelvic asymmetry in 69-77% of horses. Pelvic movement symmetry was significantly different between horses with same sign vs. opposite sign of head-withers asymmetry (P<0.0001). Timing of the maximum head height reached after contralateral ('sound') stance was delayed compared to withers (P = 0.02) and pelvis (P = 0.04) in horses with contralateral head-withers asymmetry.

MAIN LIMITATIONS

The clinical lameness status of the horses was not investigated.

CONCLUSION

In the Thoroughbreds with natural gait asymmetries investigated here, the direction of head vs. withers movement asymmetry identifies the majority of horses with ipsilateral and contralateral head and pelvic movement asymmetries. Withers movement should be further investigated for differentiating between forelimb and hindlimb lame horses. Horses with opposite sided head and withers asymmetry significantly delay the upward movement of the head after 'sound' forelimb stance.

Associations of force plate and body-mounted inertial sensor measurements for identification of hind limb lameness in horses

OBJECTIVE

To investigate associations between inertial sensor and stationary force plate measurements of hind limb lameness in horses.

ANIMALS

21 adult horses with no lameness or with mild hind limb lameness.

PROCEDURES

Horses were instrumented with inertial sensors and evaluated for lameness with a stationary force plate while trotting in a straight line. Inertial sensor-derived measurements of maximum and minimum pelvic height differences between right and left halves of the stride were compared with vertical and horizontal ground reaction forces (GRFs). Stepwise linear regression was performed to investigate the strength of association between inertial sensor measurements of hind limb lameness and amplitude, impulse, and time indices of important events in the vertical and horizontal GRF patterns.

RESULTS

Difference in minimum pelvic position was moderately (Ra(2) = 0.60) associated with the difference in peak vertical GRF but had little association with any horizontal GRF measurements. Difference in maximum pelvic position was strongly (Ra(2) = 0.77) associated with a transfer of vertical to horizontal ground reaction impulse in the second half of the stance but was not associated with difference in peak vertical GRF.

CONCLUSIONS AND CLINICAL RELEVANCE

Inertial sensor-derived measurements of asymmetric pelvic fall (difference in minimum pelvic position) indicated a decrease in vertical GRF, but similar measurements of asymmetric pelvis rise (difference in maximum pelvic position) indicated a transfer of vertical to horizontal force impulse in the second half of the stance. Evaluation of both pelvic rise and fall may be important when assessing hind limb lameness in horses.

An inertial sensor-based system can objectively assess diagnostic anaesthesia of the equine foot

REASONS FOR PERFORMING STUDY

In order for changes in lameness to be accurately and repeatably detected and recorded during diagnostic investigations, an objective measure of lameness is required.

OBJECTIVES

To ascertain whether an inertial sensor-based system can distinguish between a positive and negative response to diagnostic anaesthesia of the foot and objectively assess the effect of a positive response on the trot.

STUDY DESIGN

Restrospective clinical study.

METHODS

Data obtained during lameness investigations undertaken between August 2011 and December 2012 in which either a palmar digital or abaxial sesamoid nerve block was performed were retrospectively reviewed. Response to diagnostic anaesthesia was categorised as positive (n = 14) or negative (n = 9) by one of 2 evaluators before analysis of kinematic data (i.e. blinded). Changes in maximum and minimum head difference (ΔHDMax and ΔHDMin) and change in head movement asymmetry/change in pelvic movement asymmetry (ΔHMA/PMA, measure of asymmetry) allocated to each limb were calculated. A Kruskal-Wallis one way analysis of variance on ranks was performed. Receiver operating characteristic (ROC) curves were generated for ΔHDMax, ΔHDMin and ΔHMA for the blocked limb to identify cut-off values to distinguish positive and negative responses to the block.

RESULTS

Median ΔHDMax and ΔHDMin were significantly greater after a positive response to diagnostic anaesthesia (P<0.01). Change in head movement asymmetry allocated to the blocked limb and contralateral forelimb and ΔPMA allocated to the contralateral hindlimb were significantly greater in the positive response group (P<0.05). Change in head movement asymmetry allocated to the blocked limb and ΔHDMax and ΔHDMin are useful diagnostic tests for identifying positive response to anaesthesia (area under the curve = 0.98, 0.83 and 0.96 respectively).

CONCLUSIONS

An inertial sensor-based system can identify a positive response to diagnostic anaesthesia of the foot. Symmetry of movement allocated to the blocked limb, contralateral forelimb and contralateral hindlimb significantly improve, and head movement significantly decreases in horses with a positive response to the block. Cut-off values for a positive response have been identified with good sensitivity and specificity. Forelimb lameness significantly affects contralateral hindlimb movement, which has implications for the investigation of multi-limb lameness.

Understanding hind limb lameness signs in horses using simple rigid body mechanics

Hind limb lameness detection in horses relies on the identification of movement asymmetry which can be based on multiple pelvic landmarks. This study explains the poorly understood relationship between hind limb lameness pointers, related to the tubera coxae and sacrum, based on experimental data in context of a simple rigid body model. Vertical displacement of tubera coxae and sacrum was quantified experimentally in 107 horses with varying lameness degrees. A geometrical rigid-body model of pelvis movement during lameness was created in Matlab. Several asymmetry measures were calculated and contrasted. Results showed that model predictions for tubera coxae asymmetry during lameness matched experimental observations closely. Asymmetry for sacrum and comparative tubera coxae movement showed a strong association both empirically (R(2)≥ 0.92) and theoretically. We did not find empirical or theoretical evidence for a systematic, pronounced adaptation in the pelvic rotation pattern with increasing lameness. The model showed that the overall range of movement between tubera coxae does not allow the appreciation of asymmetry changes beyond mild lameness. When evaluating movement relative to the stride cycle we did find empirical evidence for asymmetry being slightly more visible when comparing tubera coxae amplitudes rather than sacrum amplitudes, although variation exists for mild lameness. In conclusion, the rigidity of the equine pelvis results in tightly linked movement trajectories of different pelvic landmarks. The model allows the explanation of empirical observations in the context of the underlying mechanics, helping the identification of potentially limited assessment choices when evaluating gait.

Lungeing on hard and soft surfaces: Movement symmetry of trotting horses considered sound by their owners

REASONS FOR PERFORMING STUDY

Lungeing is often part of the clinical lameness examination. The difference in movement symmetry, which is a commonly employed lameness measure, has not been quantified between surfaces.

OBJECTIVES

To compare head and pelvic movement symmetry between surfaces and reins during lungeing.

STUDY DESIGN

Quantitative gait analysis in 23 horses considered sound by their owners.

METHODS

Twenty-three horses were assessed in-hand and on the lunge on both reins on hard and soft surfaces with inertial sensors. Seven movement symmetry parameters were quantified and used to establish 2 groups, namely symmetrical (n = 9) and forelimb-lame horses (n = 14), based on values from straight-line assessment. Movement symmetry values for left rein measurements were side corrected to allow comparison of the amount of movement symmetry between reins. A mixed model (P<0.05) was used to study effects on movement symmetry of surface (hard/soft) and rein (inside/outside with respect to movement symmetry on the straight).

RESULTS

In forelimb-lame horses, surface and rein were identified as significantly affecting all head movement symmetry measures (rein, all P<0.0001; surface, all P<0.042). In the symmetrical group, no significant influence of surface or rein was identified for head movement symmetry (rein, all P>0.245; surface, all P>0.073). No significant influence of surface or rein was identified for any of the pelvic movement symmetry measures in either group.

CONCLUSIONS

While more symmetrical horses showed a consistent amount of movement symmetry across surfaces/reins, horses objectively quantified as lame on the straight showed decreased movement symmetry during lungeing, in particular with the lame limb on the inside of a hard circle. The variation within group questions straight-line movement symmetry as a sole measure of lameness without quantification of movement symmetry on the lunge, ideally on hard and soft surfaces to evaluate differences between reins and surfaces. In future, thresholds for lungeing need to be determined using simultaneous visual and objective assessment.

Estimation of vertical tuber coxae movement in the horse from a single inertial measurement unit

Pelvic movement is altered in hind limb lame horses. A simple method using one inertial measurement unit (IMU) attached to the sacrum, which objectively measures 'hip hike', will help detecting hind limb lameness in large scale studies. In this study, IMUs over the sacrum and the left and right tuber coxae (TC) quantified vertical movement symmetry (MS) in 10 clinically lame horses. A simple geometrical model was used to estimate TC movement from the sacrum IMU. The differences between measured and estimated MS values (mean±SD) and MS changes during different exercise conditions (straight, circle, flexion) were quantified using established MS parameters to assess the performance of the sacral IMU for estimating TC movement. Mean differences between measured and estimated MS values were variable between horses and ranged from 5 to 30 mm, SD of differences ranged from 7 to 14 mm. However, the difference between measured and estimated change in MS induced by lungeing or flexion test, was lower, with a value <1 mm for one MS measure, which assesses differences between left and right TC movement. Estimating TC movement from sacral movement does not accurately quantify the true state of TC MS since limits of agreement (LoA) overlap the decision boundaries for detecting mild lameness. The LoA of changes in vertical TC movement between exercises compared favourably with the average changes between exercise conditions. While in moderate to severe cases, changes in TC movement may be estimated from a single sensor over the sacrum, in mildly lame horses it should be measured with additional sensors.

The effect of trotting speed on the evaluation of subtle lameness in horses

Equine lameness is a significant and challenging part of a veterinarian's workload, with subtle lameness inherently difficult to assess. This study investigated the influence of trotting speed on perceived and measured changes in movement asymmetry. Ten sound to mildly lame horses were trotted at a 'slow', 'preferred' and 'fast' speed on a hard surface, both on a straight line and in a circle on left and right reins. Video recordings of the horses were visually assessed by six experienced equine clinicians. Vertical movement of head, withers and pelvis was derived from inertial sensor data and several features calculated. On the straight line, more horses were subjectively declared sound at higher speeds, whilst different objective asymmetry measures showed only slight and inconsistent changes. On the circle, speed had no significant effect on the subjective assessment, with an increase in objectively measured asymmetry at higher speeds possibly balanced by a decrease in sensitivity of the observers for this asymmetry. Horses visually examined for subtle lameness on the straight should therefore be evaluated at a slow speed. Trotting speed should be consistent on repeated occasions, especially during objective gait analysis on the circle, to avoid the interaction of treatment effects and speed effects.