Assessment of mild hindlimb lameness during over ground locomotion using linear discriminant analysis of inertial sensor data

Vertical pelvic movement asymmetry and lameness location in ipsilateral combined forelimb and hindlimb lameness cases

BACKGROUND

Compensatory vertical head and pelvis movement asymmetry may occur in trotting horses with a primary cause of lameness in one end of the body due to the weight shifting between limbs, leading to apparent combined forelimb and hindlimb lameness (CFHL). Little is known about CFHL patterns observed with body-mounted inertial sensors (BMIS) and regardless of their underlying mechanisms, compensatory and secondary lameness may complicate the definitive identification of the primary causes of lameness.

OBJECTIVE

Determine associations between vertical pelvic movement asymmetry and location of primary lameness in ipsilateral CFHL cases where hindlimb lameness is solely impact or push-off type.

STUDY DESIGN

Retrospective cohort.

METHODS

From a body-mounted inertial sensor (BMIS) evaluated equine lameness database, we identified cases with a consistent, low-variability ipsilateral impact (IpI) or ipsilateral pushoff (IpP) hindlimb lameness in a straight-line trot and that had definitive diagnoses. Cases were categorised by lameness location to the limb(s), diagnosis, and ratio of the amplitude of forelimb to hindlimb lameness (Forea/Hinda). Differences in the numbers of IpI and IpP cases in these categories were analysed with chi-square tests, effect sizes, and odds ratios.

RESULTS

Among the 2375 total lameness cases screened, 49 IpI and 36 IpP cases met the criteria for consistency, low variability, and definitive diagnosis. IpI cases were more likely than IpP cases to have forelimb-only lameness causes when Forea/Hinda >1 (OR = 43, 95% CI = 2.3-798). IpP cases were more likely than IpI cases to have hindlimb-only causes at both Forea/Hinda >1.0 (OR = 20, 95% CI = 2.2-200) and <1.0 (OR = 14, 95% CI = 2.9-66.7). Compared with IpI, IpP cases were more frequently diagnosed with tendon, suspensory ligament, or high-motion joint disorders in hindlimbs (OR = 3.6, 95% CI = 1.1-12.3) and less with unknown causes (OR = 13.2, 95% CI = 3.2-75.2). In IpI cases, positive forelimb regional anaesthesia often reduced hindlimb lameness, whereas in IpP cases, positive hindlimb regional anaesthesia typically lessened forelimb lameness.

MAIN LIMITATIONS

Most cases were Quarter Horses. The likelihood of location and cause of lameness may be different for other breeds.

CONCLUSIONS

The type of pelvic movement asymmetry observed in IpI and IpP cases is linked to the location and underlying cause of the primary lameness.

Inertial Sensor Technologies-Their Role in Equine Gait Analysis, a Review

Objective gait analysis provides valuable information about the locomotion characteristics of sound and lame horses. Due to their high accuracy and sensitivity, inertial measurement units (IMUs) have gained popularity over objective measurement techniques such as force plates and optical motion capture (OMC) systems. IMUs are wearable sensors that measure acceleration forces and angular velocities, providing the possibility of a non-invasive and continuous monitoring of horse gait during walk, trot, or canter during field conditions. The present narrative review aimed to describe the inertial sensor technologies and summarize their role in equine gait analysis. The literature was searched using general terms related to inertial sensors and their applicability, gait analysis methods, and lameness evaluation. The efficacy and performance of IMU-based methods for the assessment of normal gait, detection of lameness, analysis of horse-rider interaction, as well as the influence of sedative drugs, are discussed and compared with force plate and OMC techniques. The collected evidence indicated that IMU-based sensor systems can monitor and quantify horse locomotion with high accuracy and precision, having comparable or superior performance to objective measurement techniques. IMUs are reliable tools for the evaluation of horse-rider interactions. The observed efficacy and performance of IMU systems in equine gait analysis warrant further research in this population, with special focus on the potential implementation of novel techniques described and validated in humans.

Clinical predictive models in equine medicine: A systematic review

Clinical predictive models use a patient's baseline demographic and clinical data to make predictions about patient outcomes and have the potential to aid clinical decision making. The extent of equine clinical predictive models is unknown in the literature. Using PubMed and Google Scholar, we systematically reviewed the predictive models currently described for use in equine patients. Models were eligible for inclusion if they were published in a peer-reviewed article as a multivariable model used to predict a clinical/laboratory/imaging outcome in an individual horse or herd. The agreement of at least two authors was required for model inclusion. We summarised the patient populations, model development methods, performance metric reporting, validation efforts, and, using the Predictive model Risk of Bias Assessment Tool (PROBAST), assessed the risk of bias and applicability concerns for these models. In addition, we summarised the index conditions for which models were developed and provided detailed information on included models. A total of 90 predictive models and 9 external validation studies were included in the final systematic review. A plurality of models (41%) was developed to predict outcomes associated with colic, for example, need for surgery or survival to discharge. All included models were at high risk of bias, defined as failing one or more PROBAST signalling questions, primarily for analysis-related reasons. Importantly, a high risk of bias does not necessarily mean that models are unusable, but that they require more careful consideration prior to clinical use. Concerns about applicability were low for the majority of models. Systematic reviews such as this can serve to increase veterinarians' awareness of predictive models, including evaluation of their performance and their use in different patient populations.

Comparison of Asymmetry During Trot In-Hand With Evaluations of Discomfort and Pain in Horses While Exercised

Traditional visual lameness assessment is subjective. Ethograms have been developed for evaluating pain and objective sensors to detect lameness. Heart rate (HR) and heart rate variability (HRV) have been used to evaluate stress and pain. The aim of our study was to compare subjective and behavioral lameness scores, a sensor system measuring movement asymmetry, HR, and HRV. We hypothesized that these measures would show related trends. In 30 horses, an inertial sensor system was used to measure movement asymmetries during trot in-hand. A horse was categorized as sound if each asymmetry was less than 10 mm. We recorded riding to observe lameness and evaluate behavior. Heart rate and RR intervals were measured. Root mean squares of successive RR intervals (RMSSD) were calculated. Five horses were categorized as sound and 25 horses as lame by the inertial sensor system. No significant differences were detected between sound and lame horses in the ethogram, subjective lameness score, HR, and RMSSD. Overall asymmetry, ethogram, and lameness score had no significant correlation with each other, whereas overall asymmetry and ethogram correlated significantly with HR and RMSSD during certain phases of the ridden exercise. The main limitation of our study was the small number of sound horses detected by the inertial sensor system. The association between gait asymmetry and HRV suggests that the more gait asymmetry a horse shows during trot in-hand, the more pain or discomfort it probably experiences when ridden with a higher intensity. The threshold for lameness used by the inertial sensor system may require further evaluation.

Interactive, Browser-Based Graphics to Visualize Complex Data in Education of Biomedical Sciences for Veterinary Students

In veterinary education, data from biomedical or natural sciences are mostly presented in the form of static or animated graphics with no or little amount of interactivity. These kinds of presentations are, however, often not sufficient to depict the complexity of the data or the presented topic. Interactive graphics, which allow to dynamically change data and related graphics, have rarely been considered as teaching tool in higher education of biomedical disciplines for veterinary education so far. In order to study the applicability and the usefulness of interactive graphics in biomedical disciplines for lecturers and students in veterinary education, three different courses from biomedical disciplines were exemplarily implemented as interactive graphics and evaluated in a pilot study by a survey amongst lecturers and students of our university. The interactive graphics were built using the Shiny environment, a web-based application framework for the statistic software R. The survey amongst lecturers and students was based on questionnaires covering questions on the handling and usefulness of the digital teaching tools. In total, n = 327 students and n = 5 lecturers participated in the evaluation study which revealed that the interactive graphics are easy to handle for lecturers and students, and that they can increase the motivation for either teaching or learning. In total, 71% of the students affirmed that interactive graphics led to an increased interest for the presented contents and 76% expressed the wish to get taught more topics with interactive graphics. We also provide a workflow that can be used as a guideline to develop interactive graphics.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01613-x.

A short-term hindlimb massage programme can improve gait symmetry in riding school horses

Musculoskeletal injuries have been reported to be the main contributor to the interruption or dismissal of a horse’s athletic career. The muscles are responsible for the production of forces involved in movement, yet the muscles are often overlooked with regards to pre/rehabilitation. The use of massage therapy as part of a training programme is becoming increasingly popular. The beneficial effects of massage have been widely researched, though much of the research is on the immediate effects, and consistency between studies is lacking. This study was a preliminary investigation into the effects of a short-term massage programme on the gait parameters of riding school horses. 15 clinically sound riding school horses of different breed, age and height were used in a controlled, blind study. The horses were divided in to three groups of five ensuring a mixture of height, breed and age. Group Massage received a 10 min massage at each side on the proximal hindlimb, once a week for three weeks. Group Sham received 10 min groom at each side on the proximal hindlimb, once a week for three weeks; and the Control Group has received no treatment. Gait analysis was conducted on days 1 and 28. In walk, a significant improvement in stride length symmetry index (SI) (P=0.043) and protraction SI (P=0.0043) was found for the Massage Group, with hock flexion SI significantly better for the Massage Group at day 28 (P=0.03). At trot and canter, hock flexion SI was improved in Group Massage (P=0.003 and P=0.024, respectively). A short-term massage programme to the proximal hindlimb improved gait symmetry, particularly hock flexion SI, within riding school horses. An appropriate dosage level for particular results needs to be determined in order to effectively utilise massage within a training programme. Further studies analysing kinetic parameters alongside kinematic parameters will enable further conclusions to be drawn.

Expert visual assessment strategies for equine lameness examinations in a straight line and circle: A mixed methods study using eye tracking

BACKGROUND

A large number of lameness indicators have been suggested for the visual equine lameness assessment. However, it remains unknown which of these are commonly used by experts.

METHODS

Twenty-four expert lameness assessors from 10 leading UK institutions viewed 28 video clips of sound and mildly lame horses (median score 2/10). Horses were shown at trot in a straight line (rear and front view) and circle (side view, left and right rein). Eye tracking data were collected at 60 Hz while participants evaluated each clip. A questionnaire captured contextual information.

RESULTS

During assessment on the straight line, participants consistently looked mostly at the head and pelvis. On the circle, many participants consistently looked at the head, yet the subsequent choice, weighting and order of examined body regions was unsystematic between and within participants, and there was a bias towards prolonged assessment of the horse's front region. Questionnaires revealed different descriptions of lameness indicators for the same body region and different approaches to decision making under uncertainty.

CONCLUSION

In contrast to reasonably high similarity on the straight line, expert veterinarians have not developed a consistent assessment approach when evaluating horses on the circle. The reliability of various lameness indicators on the circle requires a stronger evidence base for a more systematic, repeatable approach.

Linear Discriminant Analysis for Investigating Differences in Upper Body Movement Symmetry in Horses before/after Diagnostic Analgesia in Relation to Expert Judgement

Simple Summary

Identifying the anatomical structures involved in causing pain and an associated lameness in a horse typically requires assessment in straight lines and circles and using regional administration of local anesthetic drugs (diagnostic analgesia). Visual assessment of changes in movement are affected by bias, i.e., expected changes influence decisions. Quantitative measurements with inertial sensors aim at removing this bias. The current study is aimed at investigating how a specific data-driven method, linear discriminant analysis (LDA), may be useful for aiding veterinary decision making about perceived changes in lameness. Changes in movement data after diagnostic analgesia and expert judgements from 53 lame horses were used to study (a) the accuracy of LDA-based decision making, (b) differences between straight-line and circular movement and (c) which commonly used movement features are most useful in this context. Accuracy was comparatively low and varied considerably between 36% and 57%, indicating considerable overlap between movement symmetry data of the diagnostic analgesia categories. The best data-driven separation between categories was observed when the limb in which perineural anaesthesia had been performed was on the inside of the circle (on hard ground for forelimb and on soft ground for hindlimb diagnostic analgesia). Movement features of all three landmarks (head, withers, pelvis) were important for data-driven classification, emphasizing the complexity of the movement pattern changes after diagnostic analgesia observed in lame horses.

Abstract

Diagnostic analgesia and lunging are parts of the equine lameness examination, aiding veterinarians in localizing the anatomical region(s) causing pain-related movement deficits. Expectation bias of visual assessment and complex movement asymmetry changes in lame horses on the lunge highlight the need to investigate data-driven approaches for optimally integrating quantitative gait data into veterinary decision-making to remove bias. A retrospective analysis was conducted with inertial sensor movement symmetry data before/after diagnostic analgesia relative to subjective judgement of efficacy of diagnostic analgesia in 53 horses. Horses were trotted on the straight and on the lunge. Linear discriminant analysis (LDA) applied to ten movement asymmetry features quantified the accuracy of classifying negative, partial and complete responses to diagnostic analgesia and investigated the influence of movement direction and surface type on the quality of the data-driven separation between diagnostic analgesia categories. The contribution of movement asymmetry features to decision-making was also studied. Leave-one-out classification accuracy varied considerably (38.3–57.4% for forelimb and 36.1–56.1% for hindlimb diagnostic analgesia). The highest inter-category distances (best separation) were found with the blocked limb on the inside of the circle, on hard ground for forelimb diagnostic analgesia and on soft ground for hindlimb diagnostic analgesia. These exercises deserve special attention when consulting quantitative gait data in lame horses. Head and pelvic upward movement and withers minimum differences were the features with the highest weighting within the first canonical LDA function across exercises and forelimb and hindlimb diagnostic analgesia. This highlights that movement changes after diagnostic analgesia affect the whole upper body. Classification accuracies based on quantitative movement asymmetry changes indicate considerable overlap between subjective diagnostic analgesia categories.

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.

Detection of Equine Hoof Motion by Using a Hoof-Mounted Inertial Measurement Unit Sensor in Comparison to Examinations with an Optoelectronic Technique - A Pilot Study

This study aimed to determine whether a hoof-mounted inertial measurement unit (IMU) system would provide similar timing characteristics and step lengths, in walk and trot on different grounds, compared to those of an established optoelectronic motion system. The right hoof of one horse was equipped with an IMU sensor with an optical reference marker on top. Fifteen steps on firm ground, and five on penetrable ground, were performed at walk and trot. Level of agreement between the two measurement systems was determined by assessing the concordance correlation coefficients, accuracy, and precision of the duration of different gait events and step length. Timing characteristics and step length were in strong agreement between the two techniques for the majority of assessed parameters in walk and trot on both grounds. The agreement between techniques decreased for breakover and landing duration at trot on penetrable ground. Disparity between the measurement techniques was related to difficulties in accurately defining single parts of the stance phase with marker-based optoelectronic analysis on penetrable ground. Detailed examinations of different parts of the stance phase are more accurately performed using hoof-mounted IMU sensors. Results emphasise the great potential of IMU sensors for equine motion analysis in daily practice.

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.

Agreement among equine veterinarians and between equine veterinarians and inertial sensor system during clinical examination of hindlimb lameness in horses

BACKGROUND

Hindlimb lameness evaluation is known to be challenging. Experience is essential for the ability of equine veterinarians to detect lameness. Nevertheless, even an experienced veterinarian is still subject to bias. Objective lameness detecting methods have been established to aid veterinarians.

OBJECTIVES

1) To estimate the effect of experience on the interobserver agreement and the agreement between a body-mounted inertial sensor system (BMISS) and veterinarians on detecting hindlimb lameness, and 2) to estimate the agreement between the BMISS and highly experienced veterinarians on change in lameness after diagnostic analgesia.

STUDY DESIGN

Cross-sectional study.

METHODS

Twenty-six horses with hindlimb lameness were evaluated in clinical conditions by clinicians and simultaneously measured by the BMISS. Videos of their lameness examination were recorded and shown to 13 veterinarians from three groups of varying experience for evaluation. The interobserver agreement and the agreement between veterinarians and the BMISS were calculated.

RESULTS

Interobserver agreement from all three groups was recorded as 'fair'. The strength of agreement between veterinarians and BMISS was 'fair' for the highly experienced group, 'slight to fair' for the moderately experienced group and 'slight' in the inexperienced group. The BMISS and the highly experienced veterinarians declared a 'strong' agreement in assigning an improvement in lameness after diagnostic analgesia.

MAIN LIMITATIONS

Lameness evaluation through video viewing might be more challenging for some evaluators than live situations.

CONCLUSIONS

Given the task of evaluating videos of horses trotting in a straight line, the more experienced veterinarians did not show more reliability than those with less experience. Due to 1) the moderate agreement between the BMISS and clinicians (highly experienced and moderately experienced) in the live clinical evaluation in determining hindlimb lameness, and 2) the strong association between the BMISS and highly experienced veterinarians in determining improvement of lameness after anaesthesia, therefore the use of the BMISS as a supporting tool for veterinarians is encouraged.

Sensor-based equine gait analysis: more than meets the eye?

Quantitative gait analysis in the lame horse has gained in popularity, likely related to the potential to remove bias from the clinical decision-making process. Its implementation into clinical practice is, however, not without challenges. This review visits some of the challenges related to the use of thresholds and guideline values in the context of clinical decision making, as well as when applied to scientific studies based on relevant published studies: issues such as ‘normal day-to-day variation’, conformational asymmetry and the often limited number of parameters that are being quantified. Emphasis is put on outlining the basic underlying principles relating to head nod and hip hike, which are explained in the context of Newtonian mechanics associating reduced vertical acceleration of the upper body to reduced force production with the limb that is in contact with the ground during that time period. Further to quantifying what can be seen ‘by eye’, the review also visits phenomena such as asymmetries in weight bearing or pushoff and compensatory mechanisms, with emphasis on measurement of withers movement and thoughts about multilimb lameness. The review concludes with thoughts about additional parameters such as limb movement and movement of the thoraco-lumbo-sacral area, which may provide additional insights into lameness and poor performance but are at current less frequently included into clinical gait analysis in the horse.

Using Movement Sensors to Assess Lying Time in Horses With and Without Angular Limb Deformities

Chronic musculoskeletal pathologies are common in horses, however, identifying related effects can be challenging. This study tested the hypothesis that movement sensors and analgesics could be used in combination to confirm the presence of restrictive pathologies by assessing lying time. Four horses presenting a range of angular limb deformities (ALDs) and four nonaffected controls were used. The study comprised two trials at separate paddock locations. Trial A consisted of a 3-day baseline phase and 2 × 3-day treatment phases, during which two analgesics were administered to two ALD horses and two controls in a standard crossover design. Trial B replicated trial A, except that as no difference between analgesics had been evident in trial A, only one analgesic was tested. Movement sensors were used to measure the horses' lying time and lying bouts. In trial A, ALD horses' basal mean lying time was significantly less than controls (means ± SD for ALD horses 213 ± 1.4 minutes and for controls 408 ± 46.7 minutes, P = .007); with analgesic administration, the difference became nonsignificant. In trial B, ALD horses' basal mean lying time was also significantly less than controls (ALD horses 179 ± 110.3 minutes; controls 422.5 ± 40.3 minutes, P < .001), again becoming nonsignificant with analgesic administration. Given the increases in ALD horses' lying time with analgesic administration, it is possible that their shorter basal lying time is associated with musculoskeletal discomfort. Despite the small sample size, movement sensors effectively measured this behavior change, indicating that they could be a useful tool to indirectly assess the impact of chronic musculoskeletal pathologies in horses.

EquiMoves: A Wireless Networked Inertial Measurement System for Objective Examination of Horse Gait

In this paper, we describe and validate the EquiMoves system, which aims to support equine veterinarians in assessing lameness and gait performance in horses. The system works by capturing horse motion from up to eight synchronized wireless inertial measurement units. It can be used in various equine gait modes, and analyzes both upper-body and limb movements. The validation against an optical motion capture system is based on a Bland-Altman analysis that illustrates the agreement between the two systems. The sagittal kinematic results (protraction, retraction, and sagittal range of motion) show limits of agreement of ± 2.3 degrees and an absolute bias of 0.3 degrees in the worst case. The coronal kinematic results (adduction, abduction, and coronal range of motion) show limits of agreement of - 8.8 and 8.1 degrees, and an absolute bias of 0.4 degrees in the worst case. The worse coronal kinematic results are most likely caused by the optical system setup (depth perception difficulty and suboptimal marker placement). The upper-body symmetry results show no significant bias in the agreement between the two systems; in most cases, the agreement is within ±5 mm. On a trial-level basis, the limits of agreement for withers and sacrum are within ±2 mm, meaning that the system can properly quantify motion asymmetry. Overall, the bias for all symmetry-related results is less than 1 mm, which is important for reproducibility and further comparison to other systems.

Quantification of Equine Sacral and Iliac Motion During Application of Manual Forces and Comparison Between Motion Capture With Skin-Mounted and Bone-Fixated Sensors

Diagnosis of sacroiliac dysfunction in horses includes manual motion palpation of the equine ilium and sacrum. Motion of the ilium and sacrum during manual force application to the equine pelvis has been measured previously in vitro. The aim of this study was to measure the amount and direction of motion in vivo, including comparison of bone-fixated and skin-mounted inertial sensors. Sensors were skin-mounted over tuber sacrale (TS) and third sacral spinous process of six Thoroughbred horses and later attached via Steinmann pins inserted into the same bony landmarks. Orientations of each TS and sacrum were recorded by one investigator during six trials of manual force applied to the pelvis, inducing cranial, caudal, and oblique rotations. Mean values were reported in Euler angles for the three orthogonal planes lateral bending, flexion-extension (FE), and axial rotation (AR). Differences between skin- and bone-fixated markers were determined with significance set at P < .05. The largest mean values recorded during rotations applied to the pelvises were for FE, (2.08° ± 0.35°) with bone-fixated sensors. AR gave the largest values recorded with skin mountings (1.70° ± 0.48°). There was a poor correlation between skin-mounted and bone-fixated markers with AR being the orthogonal plane in which results from skin mounting were closest to results from bone-fixated sensors Bony kinematics during external movement applied to the pelvis cannot be predicted from skin-mounted sensors, due to differences between skin- and bone-mounted sensors.

Effects of sensor position on kinematic data obtained with an inertial sensor system during gait analysis of trotting horses

OBJECTIVE To determine the effects of altering location of right forelimb and pelvic sensors on kinematic data obtained with a commonly used inertial sensor system during gait analysis of trotting horses. DESIGN Experimental study. ANIMALS 12 horses with mild to moderate lameness of at least 1 hind limb, with or without lameness of the forelimbs. PROCEDURES All horses were examined while trotting on a high-speed treadmill. The right forelimb sensor was tested at 3 anatomic locations in random order: dorsal midline and 2 cm medial and lateral to that midline. During another treadmill session, the pelvic sensor was tested at 5 anatomic locations in random order: dorsal midline, 2 cm to the right and left of midline, and 2 cm cranial and caudal to the tubera sacrale on the midline. Laterality of the pelvic sensor was analyzed in 2 ways: sensor toward the right or left and sensor toward or away from the lame or lamest hind limb. Maximum and minimum differences in head and pelvic motion and vector sum values were ranked and compared with values for the midline location by means of mixed-model ANOVA. RESULTS Altering the location of the right forelimb sensor by 2 cm medially or laterally had no significant effect on forelimb or hind limb kinematics. However, location of the pelvic sensor had a significant effect on minimum difference in pelvic motion, regardless of whether the data were analyzed by laterality (right vs left) or toward versus away from the lame hind limb. CONCLUSIONS AND CLINICAL RELEVANCE Results of this study indicated that a 2-cm change in the location of the pelvic sensor during kinematic gait analysis had a significant effect on hind limb kinematic data of the system used. Therefore, placement of this sensor needs to be anatomically accurate.

Post-traumatic osteoarthritis of the ankle: A distinct clinical entity requiring new research approaches

The diagnosis of ankle osteoarthritis (OA) is increasing as a result of advancements in non-invasive imaging modalities such as magnetic resonance imaging, improved arthroscopic surgical technology and heightened awareness among clinicians. Unlike OA of the knee, primary or age-related ankle OA is rare, with the majority of ankle OA classified as post-traumatic (PTOA). Ankle trauma, more specifically ankle sprain, is the single most common athletic injury, and no effective therapies are available to prevent or slow progression of PTOA. Despite the high incidence of ankle trauma and OA, ankle-related OA research is sparse, with the majority of clinical and basic studies pertaining to the knee joint. Fundamental differences exist between joints including their structure and molecular composition, response to trauma, susceptibility to OA, clinical manifestations of disease, and response to treatment. Considerable evidence suggests that research findings from knee should not be extrapolated to the ankle, however few ankle-specific preclinical models of PTOA are currently available. The objective of this article is to review the current state of ankle OA investigation, highlighting important differences between the ankle and knee that may limit the extent to which research findings from knee models are applicable to the ankle joint. Considerations for the development of new ankle-specific, clinically relevant animal models are discussed. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:440-453, 2017.

GaitKeeper: A System for Measuring Canine Gait

It is understood gait has the potential to be used as a window into neurodegenerative disorders, identify markers of subclinical pathology, inform diagnostic algorithms of disease progression and measure the efficacy of interventions. Dogs’ gaits are frequently assessed in a veterinary setting to detect signs of lameness. Despite this, a reliable, affordable and objective method to assess lameness in dogs is lacking. Most described canine lameness assessments are subjective, unvalidated and at high risk of bias. This means reliable, early detection of canine gait abnormalities is challenging, which may have detrimental implications for dogs’ welfare. In this paper, we draw from approaches and technologies used in human movement science and describe a system for objectively measuring temporal gait characteristics in dogs (step-time, swing-time, stance-time). Asymmetries and variabilities in these characteristics are of known clinical significance when assessing lameness but presently may only be assessed on coarse scales or under highly instrumented environments. The system consists an inertial measurement unit, containing a 3-axis accelerometer and gyroscope coupled with a standardized walking course. The measurement unit is attached to each leg of the dog under assessment before it is walked around the course. The data by the measurement unit is then processed to identify steps and subsequently, micro-gait characteristics. This method has been tested on a cohort of 19 healthy dogs of various breeds ranging in height from 34.2 cm to 84.9 cm. We report the system as capable of making precise step delineations with detections of initial and final contact times of foot-to-floor to a mean precision of 0.011 s and 0.048 s, respectively. Results are based on analysis of 12,678 foot falls and we report a sensitivity, positive predictive value and F-score of 0.81, 0.83 and 0.82 respectively. To investigate the effect of gait on system performance, the approach was tested in both walking and trotting with no significant performance deviation with 7249 steps reported for a walking gait and 4977 for a trotting gait. The number of steps reported for each leg were approximately equal and this consistency was true in both walking and trotting gaits. In the walking gait 1965, 1790, 1726 and 1768 steps were reported for the front left, front right, hind left and hind right legs respectively. 1361, 1250, 1176 and 1190 steps were reported for each of the four legs in the trotting gait. The proposed system is a pragmatic and precise solution for obtaining objective measurements of canine gait. With further development, it promises potential for a wide range of applications in both research and clinical practice.

Effects of the rider on the kinematics of the equine spine under the saddle during the trot using inertial measurement units: Methodological study and preliminary results

Many factors associated with the saddle and the rider could produce pain in horses thus reducing performance. However, studies of horse-saddle-rider interactions are limited and determining their effects remains challenging. The aim of this study was to test a novel method for assessing equine thoracic and lumbar spinal movement under the saddle and collect data during trotting. Back movement was measured using inertial measurement units (n = 5) fixed at the levels of thoracic vertebrae T6, T12 and T16, and lumbar vertebrae L2 and L5. To compare unridden and ridden conditions, three horses were trotted in hand then at the rising trot (seated phase: left diagonal, rider seated; standing phase: right diagonal, rider standing). The protraction-retraction angles of the forelimbs and the hind limbs were also calculated in two dimensions (2D) using reflective markers. To compare conditions, linear mixed-effects regression models were used and estimated means (standard error) were calculated. The range of motion (ROM) of the caudal thoracic and thoracolumbar regions decreased respectively by -1.3 (0.4)° and -0.6 (0.2)° during the seated phase compared to the unridden condition. Concomitantly, the ROM of protraction and retraction angles increased in the ridden condition. This study demonstrated the ability of inertial measurement units to assess equine vertebral movements under the saddle. The rider, at the rising trot, affected the horse's global locomotion with measurable changes in the vertebral kinematics under the saddle.

Evaluation of inertial measurement units as a novel method for kinematic gait evaluation in dogs

OBJECTIVE

To evaluate the use of inertial measurement units (IMU) for quantification of canine limb kinematics.

METHODS

Sixteen clinically healthy, medium-sized dogs were enrolled. Baseline kinematic data were acquired using an optical motion capture system. Following this baseline data acquisition, a harness system was used for attachment of IMU to the animals. Optical kinematic data of dogs with and without the harness were compared to evaluate the influence of the harness on gait parameters. Sagittal plane joint kinematics acquired simultaneously with IMU and the optical system were compared for the carpal, tarsal, stifle and hip joints. Comparisons of data were made using the concordance correlation coefficient (CCC) test and evaluation of root mean squared errors (RMSE).

RESULTS

No significant differences were demonstrated in stance duration, swing duration or stride length between dogs instrumented with or without the harness, however, mean RMSE values ranged from 4.90° to 14.10° across the various joints. When comparing simultaneously acquired optical and IMU kinematic data, strong correlations were found for all four joints evaluated (CCC: carpus = 0.98, hock = 0.95, stifle = 0.98, hip = 0.96) and median RMSE values were similar across the joints ranging from 2.51° to 3.52°.

CONCLUSIONS AND CLINICAL RELEVANCE

Canine sagittal plane motion data acquisition with IMU is feasible, and optically acquired and IMU acquired sagittal plane kinematics had good correlation. This technology allows data acquisition outside the gait laboratory and may provide an alternative to optical kinematic gait analysis for the carpal, tarsal, stifle, and hip joints in the dog. Further investigation into this technology is indicated.

Decision-tree analysis of clinical data to aid diagnostic reasoning for equine laminitis: a cross-sectional study

The objective of this cross-sectional study was to compare the prevalence of selected clinical signs in laminitis cases and non-laminitic but lame controls to evaluate their capability to discriminate laminitis from other causes of lameness. Participating veterinary practitioners completed a checklist of laminitis-associated clinical signs identified by literature review. Cases were defined as horses/ponies with veterinary-diagnosed, clinically apparent laminitis; controls were horses/ponies with any lameness other than laminitis. Associations were tested by logistic regression with adjusted odds ratios (ORs) and 95% confidence intervals, with veterinary practice as an a priori fixed effect. Multivariable analysis using graphical classification tree-based statistical models linked laminitis prevalence with specific combinations of clinical signs. Data were collected for 588 cases and 201 controls. Five clinical signs had a difference in prevalence of greater than +50 per cent: 'reluctance to walk' (OR 4.4), 'short, stilted gait at walk' (OR 9.4), 'difficulty turning' (OR 16.9), 'shifting weight' (OR 17.7) and 'increased digital pulse' (OR 13.2) (all P<0.001). 'Bilateral forelimb lameness' was the best discriminator; 92 per cent of animals with this clinical sign had laminitis (OR 40.5, P<0.001). If, in addition, horses/ponies had an 'increased digital pulse', 99 per cent were identified as laminitis. 'Presence of a flat/convex sole' also significantly enhanced clinical diagnosis discrimination (OR 15.5, P<0.001). This is the first epidemiological laminitis study to use decision-tree analysis, providing the first evidence base for evaluating clinical signs to differentially diagnose laminitis from other causes of lameness. Improved evaluation of the clinical signs displayed by laminitic animals examined by first-opinion practitioners will lead to equine welfare improvements.

Effect of the rider position during rising trot on the horse׳s biomechanics (back and trunk kinematics and pressure under the saddle)

Knowledge about the horse-saddle-rider interaction remains limited. The aim of this study was to compare the effect of the rider׳s position at rising trot on the pressure distribution, spine movements, stirrups forces and locomotion of the horse. The horse׳s back movements were measured using IMUs fixed at the levels of thoracic (T6, T12, T16) and lumbar (L2, L5) vertebrae, the pressure distribution using a pressure mat and stirrups forces using force sensors. The horse׳s and rider׳s approximated centres of mass (COM) were calculated using 2D reflective markers. To compare both trot phases (rider seated/rider standing), three horses were trotted at the rising trot by the same rider. Means±SD of each parameter for sitting and standing were compared using a Student׳s t test (p=0.05). Stirrups forces showed two peaks of equal magnitude in every stride cycle for left and right stirrups but increased during the standing phase. Simultaneously, the pressure for the whole mat significantly increased by +3.1kPa during the sitting phase with respect to standing phase. The T12-T16 and T16-L2 angular ranges of motion (ROM) were significantly reduced (-3.2° -1.2°) and the T6-T12 and L2-L5 ROM were significantly increased (+1.7° +0.7°) during sitting phase compared to standing phase. During rising trot, the sitting phase does not only increase the pressure on the horse׳s back but also reduces the back motion under the saddle compared to the standing phase. These results give new insights into the understanding of horse-rider interactions and equine back pain management.

Movement asymmetry in working polo horses

REASONS FOR PERFORMING STUDY

The high, repetitive demands imposed on polo horses in training and competition may predispose them to musculoskeletal injuries and lameness.

OBJECTIVES

To quantify movement symmetry and lameness in a population of polo horses, and to investigate the existence of a relationship with age.

STUDY DESIGN

Convenience sampled cross-sectional study.

METHODS

Sixty polo horses were equipped with inertial measurement units (IMUs) attached to the poll, and between the tubera sacrale. Six movement symmetry measures were calculated for vertical head and pelvic displacement during in-hand trot and compared with values for perfect symmetry, compared between left and right limb lame horses, and compared with published thresholds for lameness. Regression lines were calculated as a function of age of horse.

RESULTS

Based on 2 different sets of published asymmetry thresholds 52-53% of the horses were quantified with head movement asymmetry and 27-50% with pelvic movement asymmetry resulting in 60-67% of horses being classified with movement asymmetry outside published guideline values for either the forelimbs, hindlimbs or both. Neither forelimb nor hindlimb asymmetries were preferentially left or right sided, with directional asymmetry values across all horses not different from perfect symmetry and absolute values not different between left and right lame horses (P values >0.6 for all forelimb symmetry measures and >0.2 for all hindlimb symmetry measures). None of the symmetry parameters increased or decreased significantly with age.

CONCLUSIONS

A large proportion of polo horses show gait asymmetries consistent with previously defined thresholds for lameness. These do not appear to be lateralised or associated with age.

Effect of forelimb lameness on hoof kinematics of horses at a trot

OBJECTIVE

To determine kinematic changes to the hoof of horses at a trot after induction of unilateral, weight-bearing forelimb lameness and to determine whether hoof kinematics return to prelameness values after perineural anesthesia.

ANIMALS

6 clinically normal Quarter Horses.

PROCEDURES

For each horse, a sole-pressure model was used to induce 3 grades (grades 1, 2, and 3) of lameness in the right forelimb, after which perineural anesthesia was administered to alleviate lameness. Optical kinematics were obtained for both forelimbs with the horse trotting before (baseline) and after induction of each grade of lameness and after perineural anesthesia. Hoof events were identified with linear acceleration profiles, and each stride was divided into hoof-contact, break-over, initial-swing, terminal-swing, and total-swing segments. For each segment, kinematic variables were compared within and between limbs by use of mixed repeated-measures ANOVA.

RESULTS

During hoof-contact, the left (nonlame) forelimb hoof had greater heel-down orientation than did the right (lame) forelimb hoof, and during break-over, the nonlame hoof went through a larger range of motion than did the lame hoof. Maximum cranial acceleration during break-over for the lame hoof was greater, compared with that at baseline or for the nonlame hoof. Following perineural anesthesia, the sagittal plane orientation of the hoof during hoof-contact did not vary between the lame and nonlame limbs; however, interlimb differences in maximum cranial acceleration and angular range of motion during break-over remained.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that hoof kinematics may be useful for detection of unilateral, weight-bearing forelimb lameness in horses that are trotting.

Design and validation of a computer-aided learning program to enhance students' ability to recognize lameness in the horse

The ability to recognize lameness in the horse is an important skill for veterinary graduates; however, opportunities to develop this skill at the undergraduate level are limited. Computer-aided learning programs (CALs) have been successful in supplementing practical skills teaching. The aim of this study was to design and validate a CAL for the teaching of equine lameness recognition (CAL1). A control CAL was designed to simulate learning by experience (CAL2). Student volunteers were randomly assigned to either CAL and tested to establish their current ability to recognize lameness. Retesting occurred both immediately following exposure and 1 week later. At each test point, the number of correct responses for forelimb and hind limb cases was determined. Student confidence was assessed before and after CAL exposure, with previous opportunities to recognize lameness taken into account. Immediately following exposure, the number of correct responses was significantly higher for CAL1 than for CAL2, both overall and for forelimb cases but not for hind limb cases. After 1 week, the CAL1 group performed significantly better overall compared to the CAL2 group, with no significant difference between forelimb and hind limb cases. Student confidence and ability to recognize lameness were significantly improved following exposure to CAL1. When considered as one category, students in years 4 and 5 performed significantly better than year 3 students. Gender did not significantly affect performance. CAL1 could be used to supplement current lameness recognition opportunities. CAL1 is, however, limited in its ability to improve lameness recognition, especially in relation to hind limb lameness where it was unable to attain a significant difference from CAL2.

Use of a wireless, inertial sensor-based system to objectively evaluate flexion tests in the horse

OBJECTIVES

A wireless, inertial sensor-based system has previously been validated for evaluation of equine lameness. However, threshold values have not been determined for the assessment of responses to flexion tests. The aim of this investigation was to evaluate a sensor-based system for objective assessment of the response to flexion.

METHODS

Healthy adult horses (n = 17) in work were recruited prospectively. Horses were instrumented with sensors on the head (accelerometer), pelvis (accelerometer) and right forelimb (gyroscope), before trotting in a straight line (minimum 25 strides) for 2 consecutive trials. Sensors measured 1) vertical pelvic movement asymmetry (PMA) for both right and left hindlimb strides and 2) average difference in maximum and minimum pelvic height (PDMax and PDMin) between right and left hindlimb strides in millimetres. A hindlimb was randomly selected for proximal flexion (60 s), after which the horse trotted a minimum of 10 strides. Response to flexion was blindly assessed as negative or positive by an experienced observer. Changes in PMA, PDMax and PDMin between baseline and flexion examinations were calculated for each test. Statistical analysis consisted of a Pearson's product moment test and linear regression on baseline trials, Mann-Whitney rank sum test for effect of flexion and receiver operator curve (ROC) analysis of test parameters.

RESULTS

There was a strong correlation between trials for PMA, PDMin and PDMax measurements (P < 0.001). A positive flexion test resulted in a significant increase in PMA (P = 0.021) and PDMax (P = 0.05) only. Receiver-operator curve analysis established cut-off values for change in PMA and PDMax of 0.068 and 4.47 mm, respectively (sensitivity = 0.71, specificity = 0.65) to indicate a positive response to flexion.

CONCLUSIONS

A positive response to flexion resulted in significant changes to objective measurements of pelvic symmetry.

POTENTIAL RELEVANCE

Findings support the use of inertial sensor systems to objectively assess response to flexion tests. Further investigation is warranted to establish cut-off values for objective assessment of other diagnostic procedures.

Accuracy and precision of equine gait event detection during walking with limb and trunk mounted inertial sensors

The increased variations of temporal gait events when pathology is present are good candidate features for objective diagnostic tests. We hypothesised that the gait events hoof-on/off and stance can be detected accurately and precisely using features from trunk and distal limb-mounted Inertial Measurement Units (IMUs). Four IMUs were mounted on the distal limb and five IMUs were attached to the skin over the dorsal spinous processes at the withers, fourth lumbar vertebrae and sacrum as well as left and right tuber coxae. IMU data were synchronised to a force plate array and a motion capture system. Accuracy (bias) and precision (SD of bias) was calculated to compare force plate and IMU timings for gait events. Data were collected from seven horses. One hundred and twenty three (123) front limb steps were analysed; hoof-on was detected with a bias (SD) of -7 (23) ms, hoof-off with 0.7 (37) ms and front limb stance with -0.02 (37) ms. A total of 119 hind limb steps were analysed; hoof-on was found with a bias (SD) of -4 (25) ms, hoof-off with 6 (21) ms and hind limb stance with 0.2 (28) ms. IMUs mounted on the distal limbs and sacrum can detect gait events accurately and precisely.

Comparison of an inertial sensor system of lameness quantification with subjective lameness evaluation

REASONS FOR PERFORMING STUDY

Subjective evaluation of mild lameness has been shown to have poor interobserver reliability. Traditional methods of objective lameness evaluation require specialised conditions and equipment. Wireless inertial sensor systems have been developed to allow for simple, rapid, objective lameness detection in horses trotted over ground.

OBJECTIVE

The purpose of this study was to compare the sensitivities of an inertial sensor system and subjective evaluation performed by experienced equine practitioners at detecting lameness in horses. We hypothesised that the inertial sensor system would identify lameness at a lower level of sole pressure than a consensus of 3 experienced equine veterinarians.

METHODS

Fifteen horses were fitted with special shoes that allowed for lameness induction via sole pressure. Horses were simultaneously evaluated by 3 equine veterinarians and a wireless inertial sensor system. Horses were subjected to multiple trials: 1) before inserting the screw; 2) after inserting the screw to just touch the sole; and 3) after tightening the screw in half turn increments. The number of screw turns required for lameness identification in the correct limb by the inertial sensors and by consensus of 3 equine veterinarians was compared using the Wilcoxon test.

RESULTS

The inertial sensor system selected the limb with the induced lameness after fewer screw turns than did the 3 veterinarians (P<0.0001). The inertial sensor system selected the correct limb before the 3 veterinarians in 35 trials (58.33%), the evaluators selected the correct limb before the inertial sensors in 5 trials (8.33%), and in 20 trials (33.33%) they selected the correct limb at the same time.

POTENTIAL RELEVANCE

The inertial sensor system was able to identify lameness at a lower level of sole pressure than the consensus of 3 equine veterinarians. The inertial sensor system may be an effective aid to lameness localisation in clinical cases.

Inertial sensors for assessment of back movement in horses during locomotion over ground

REASONS FOR PERFORMING STUDY

Assessing back movement is an important part of clinical examination in the horse and objective assessment tools allow for evaluating success of treatment.

OBJECTIVES

Accuracy and consistency of inertial sensor measurements for quantification of back movement and movement symmetry during over ground locomotion were assessed; sensor measurements were compared to optical motion capture (mocap) and consistency of measurements focusing on movement symmetry was measured.

METHODS

Six nonlame horses were trotted in hand with synchronised mocap and inertial sensor data collection (landmarks: T6, T10, T13, L1 and S3). Inertial sensor data were processed using published methods and symmetry of dorsoventral displacement was assessed based on energy ratio, a Fourier based symmetry measure. Limits of agreement were calculated and visualised to compare mocap and sensor data. Consistency of sensor measurements was assessed using Pearson correlation coefficients and linear regression to investigate the effect of speed on movement symmetry.

RESULTS

Dorsoventral and mediolateral sensor displacement was observed to lie within ± 4-5 mm (± 2 s.d., 9-28% of movement amplitude) and energy ratio to lie within ± 0.03 of mocap data. High levels of correlation were found between strides and trials (0.86-1.0) for each horse and each sensor and variability of symmetry was lowest for T13 followed by T10, T6, L1 and S3 with no significant effect of speed at T6, T10 and T13.

CONCLUSIONS

Inertial sensor displacement and symmetry data showed acceptable accuracy and good levels of consistency for back movement. The small mediolateral movement amplitude means that changes of <25% in mediolateral amplitude (also unlikely to be detected by visual assessment) may go undetected. New sensor generations with improved sensor sensitivity and ease of use of equipment indicate good potential for use in a field situation.

Quantification of equine sacral and iliac motion during gait: a comparison between motion capture with skin-mounted and bone-fixated sensors

REASONS FOR PERFORMING STUDY

Information regarding movement at the ilium and sacrum in nonlame horses during normal gait may assist in understanding the biomechanics of the equine sacroiliac joint.

OBJECTIVES

To determine the amount and direction of motion at the ilium and sacrum using 3D orientation sensors during walk and trot in sound Thoroughbreds. To compare results from sensors fixed to the skin with results from sensors fixed to bone-implanted pins.

METHODS

Three 3D wireless orientation sensors were mounted to the skin over the tuber sacrale (TS) and sacrum of 6 horses and motion at the ilium and sacrum was recorded for lateral bending (LB) flexion-extension (F-E) and axial rotation (AR) during walk and trot. This process was repeated with the orientation sensors mounted to the same pelvic landmarks via Steinmann pins.

RESULTS

Mean walk values were greater than trot values using pin-mounted sensors for all planes of movement (P < 0.05). Walk had 1.64 ± 0.22° (mean ± s.e.) more LB than trot (pin-mounted) yet 0.68 ± 0.22° less than trot when skin-mounted; 3.45 ± 0.15° more F-E (pin- and skin-mounted), and 4.99 ± 0.4° more AR (pin-mounted), but trot had 3.4 ± 0.40° more AR than walk with skin mounting. Using pinned sensors for trot resulted in less LB (2.47 ± 0.22°), F-E (1.12 ± 0.15°) and AR (10.62 ± 0.40°); and for walk less F-E (1.12 ± 0.15°) and AR (2.15 ± 0.40°) compared to skin-mounted. Poor correlation existed between mean values for skin- and pin-mounted data for walk and trot, for all planes of motion.

CONCLUSIONS

Movements were smaller at trot with bone-fixated sensors compared to walk, suggesting increased muscular control of movement at the trot. The apparent increase in skin motion at the trot and no clear correlation between skin- and bone-mounted sensors indicates inaccuracies when measuring sacral and iliac movement with skin mounting.