Asymmetry Thresholds Reflecting the Visual Assessment of Forelimb Lameness on Circles on a Hard Surface.
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ABSTRACT:
SUBMITTER: Macaire C
PROVIDER: S-EPMC10650068 | biostudies-literature | 2023 Oct
REPOSITORIES: biostudies-literature
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Asymmetry Thresholds Reflecting the Visual Assessment of Forelimb Lameness on Circles on a Hard Surface.
Macaire Claire C Hanne-Poujade Sandrine S De Azevedo Emeline E Denoix Jean-Marie JM Coudry Virginie V Jacquet Sandrine S Bertoni Lélia L Tallaj Amélie A Audigié Fabrice F Hatrisse Chloé C Hébert Camille C Martin Pauline P Marin Frédéric F Chateau Henry H
Animals : an open access journal from MDPI 20231025 21
The assessment of lameness in horses can be aided by objective gait analysis tools. Despite their key role of evaluating a horse at trot on a circle, asymmetry thresholds have not been determined for differentiating between sound and lame gait during this exercise. These thresholds are essential to distinguish physiological asymmetry linked to the circle from pathological asymmetry linked to lameness. This study aims to determine the Asymmetry Indices (AIs) with the highest power to discriminate ...[more]
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Project description:Defining whether a gait asymmetry should be considered as lameness is challenging. Gait analysis systems now provide relatively accurate objective data, but their interpretation remains complex. Thresholds for discriminating between horses that are visually assessed as being lame or sound, as well as thresholds for locating the lame limb with precise sensitivity and specificity are essential for accurate interpretation of asymmetry measures. The goal of this study was to establish the thresholds of asymmetry indices having the best sensitivity and specificity to represent the visual single-limb lameness assessment made by expert veterinarians as part of their routine practice. Horses included in this study were evaluated for locomotor disorders at a clinic and equipped with the EQUISYM® system using inertial measurement unit (IMU) sensors. Visual evaluation by expert clinicians allocated horses into five groups: 49 sound, 62 left forelimb lame, 67 right forelimb lame, 23 left hindlimb lame, and 23 right hindlimb lame horses. 1/10 grade lame horses were excluded. Sensors placed on the head (_H), the withers (_W), and the pelvis (_P) provided vertical displacement. Relative difference of minimal (AI-min) and maximal (AI-max) altitudes, and of upward (AI-up) and downward (AI-down) amplitudes between right and left stance phases were calculated. Receiver operating characteristic (ROC) curves discriminating the sound horses from each lame limb group revealed the threshold of asymmetry indice associated with the best sensitivity and specificity. AI-up_W had the best ability to discriminate forelimb lame horses from sound horses with thresholds (left: -7%; right: +10%) whose sensitivity was greater than 84% and specificity greater than 88%. AI-up_P and AI-max_P discriminated hindlimb lame horses from sound horses with thresholds (left: -7%; right: +18% and left: -10%; right: +6%) whose sensitivity was greater than 78%, and specificity greater than 82%. Identified thresholds will enable the interpretation of quantitative data from lameness quantification systems. This study is mainly limited by the number of included horses and deserves further investigation with additional data, and similar studies on circles are warranted.
| S-EPMC9774792 | biostudies-literature
Project description:Reasons for performing studyLungeing is an important part of lameness examinations as the circular path may accentuate low-grade lameness. Movement asymmetries related to the circular path, to compensatory movements and to pain make the lameness evaluation complex. Scientific studies have shown high inter-rater variation when assessing lameness during straight line movement.ObjectivesThe aim was to estimate inter- and intra-rater agreement of equine veterinarians evaluating lameness from videos of sound and lame horses during lungeing and to investigate the influence of veterinarians' experience and the objective degree of movement asymmetry on rater agreement.Study designCross-sectional observational study.MethodsVideo recordings and quantitative gait analysis with inertial sensors were performed in 23 riding horses of various breeds. The horses were examined at trot on a straight line and during lungeing on soft or hard surfaces in both directions. One video sequence was recorded per condition and the horses were classified as forelimb lame, hindlimb lame or sound from objective straight line symmetry measurements. Equine veterinarians (n = 86), including 43 with >5 years of orthopaedic experience, participated in a web-based survey and were asked to identify the lamest limb on 60 videos, including 10 repeats. The agreements between (inter-rater) and within (intra-rater) veterinarians were analysed with κ statistics (Fleiss, Cohen).ResultsInter-rater agreement κ was 0.31 (0.38/0.25 for experienced/less experienced) and higher for forelimb (0.33) than for hindlimb lameness (0.11) or soundness (0.08) evaluation. Median intra-rater agreement κ was 0.57.ConclusionsInter-rater agreement was poor for less experienced raters, and for all raters when evaluating hindlimb lameness. Since identification of the lame limb/limbs is a prerequisite for successful diagnosis, treatment and recovery, the high inter-rater variation when evaluating lameness on the lunge is likely to influence the accuracy and repeatability of lameness examinations and, indirectly, the efficacy of treatment.
| S-EPMC4964936 | biostudies-literature
Project description:Visual evaluation of hindlimb lameness in the horse is challenging. Objective measurements, simultaneous to visual assessment, are used increasingly to aid clinical decision making. The aim of this study was to investigate the association of pelvic movement asymmetry with lameness scores (UK scale 0-10) of one experienced veterinarian. Absolute values of pelvic asymmetry measures, quantifying differences between vertical minima (AbPDMin), maxima (AbPDMax) and upward movement amplitudes (AbPDUp), were recorded during straight-line trot with a smartphone attached to the sacrum (n = 301 horses). Overall, there was a significant difference between lameness grades for all three asymmetry measures (p < 0.001). Five pair-wise differences (out of 10) were significant for AbPDMin (p ≤ 0.02) and seven for AbPDMax (p ≤ 0.03) and AbPDUp (p ≤ 0.02). Receiver operating curves assessed sensitivity and specificity of asymmetry measures against lameness scores. AbPDUp had the highest discriminative power (area under curve (AUC) = 0.801-0.852) followed by AbPDMax (AUC = 0.728-0.813) and AbPDMin (AUC = 0.688-0.785). Cut-off points between non-lame (grade 0) and lame horses (grades 1-4) with a minimum sensitivity of 75% were identified as AbPDUp ≥ 7.5 mm (67.6% specificity), AbPDMax ≥ 4.5 mm (51.9% specificity) and AbPDMin ≥ 2.5 mm (33.3% specificity). In conclusion, pelvic upward movement amplitude difference (AbPDUp) was the asymmetry parameter with the highest discriminative power in this study.
| S-EPMC8228485 | biostudies-literature
Project description:BackgroundQuantitative gait analysis offers objective information to support clinical decision-making during lameness workups including advantages in terms of documentation, communication, education, and avoidance of expectation bias. Nevertheless, hardly any data exist comparing outcome of subjective scoring with the output of objective gait analysis systems.ObjectivesTo investigate between- and within-veterinarian agreement on primary lame limb and lameness grade, and to determine relationships between subjective lameness grade and quantitative data, focusing on differences between (1) veterinarians, (2) live vs video assessment, (3) baseline assessment vs assessment following diagnostic analgesia.Study designClinical observational study.MethodsKinematic data were compared to subjective lameness assessment by clinicians with ≥8 years of orthopaedic experience. Subjective assessments and kinematic data for baseline trot-ups and response to 48 diagnostic analgesia interventions in 23 cases were included. Between and within-veterinarian agreement was investigated using Cohen's Kappa (κ). Asymmetry parameters for kinematic data ('forelimb lame pattern', 'hindlimb lame pattern', 'overall symmetry', 'vector sum head', 'pelvic sum') were determined, and used as outcome variables in mixed models; explanatory variables were subjective lameness grade and its interaction with (1) veterinarian, (2) live or video evaluation and (3) baseline or diagnostic analgesia assessment.ResultsAgreement on lame limb between live and video assessment was 'good' between and within veterinarians (median κ = 0.64 and κ = 0.53). There was a positive correlation between subjective scoring and measured asymmetry. The relationship between lameness grade and objective asymmetry differed slightly between (1) veterinarians (for all combined parameters, p-values between P < .001 and 0.04), (2) between live and video assessments ('forelimb lame pattern', 'overall symmetry', both P ≤ .001), and (3) between baseline and diagnostic analgesia assessment (all combined parameters, between P < .001 and .007).Main limitationsLimited number of veterinarians (n = 4) and cases (n = 23), only straight-line soft surface data, different number of subjective assessments live vs from video.ConclusionsOverall, between- and within-veterinarian agreement on lame limb was 'good', whereas agreement on lameness grade was 'acceptable' to 'poor'. Quantitative data and subjective assessments correlated well, with minor though significant differences in the number of millimetres, equivalent to one lameness grade between veterinarians, and between assessment conditions. Differences between baseline assessment vs assessment following diagnostic analgesia suggest that addition of objective data can be beneficial to reduce expectation bias. The small differences between live and video assessments support the use of high-quality videos for documentation, communication, and education, thus, complementing objective gait analysis data.
| S-EPMC9786350 | biostudies-literature
Project description:BackgroundThere is a paucity of research describing the gait pattern of lame horses at the walk.ObjectivesTo describe the changes in motion pattern and vertical ground reaction forces (GRFz) in horses with induced forelimb lameness at the walk and compare those changes with the changes observed at the trot.Study designExperimental study.MethodsIn 10 clinically sound Warmblood horses, moderate forelimb lameness was induced using a sole pressure model followed by trot and walk on a treadmill. Kinematic data were collected using 3D optical motion capture (OMC), and GRFz by an instrumented treadmill. Mixed models were used to compare sound baseline versus forelimb lameness (significance was set at P < .05).ResultsLameness induction significantly reduced peak GRFz on the second force peak, and vertical impulse in the lame limb. Stride and stance duration in all limbs were reduced. Lameness significantly affected the vertical movement symmetry of the head and withers. Maximum limb retraction angle, fetlock extension and protraction speed were reduced in the lame limb. Body centre of mass (COM) translation was reduced in the side-to-side direction and increased in the vertical and fore-aft directions. Several compensatory kinetic and kinematic changes were observed in the nonlame limbs. The observed changes in both kinetics and kinematics were generally smaller at walk with fewer variables being affected, compared to the trot.Main limitationsOnly one degree and type of orthopaedic pain (sole pressure) was studied.ConclusionsCompensatory strategies of forelimb lameness at the walk include alteration of several kinetic and kinematic parameters and have some specific patterns and inter-individual differences that are not seen at the trot. However, much like at the trot, head movement and forelimb vertical force symmetry seem to be the most useful parameters to detect forelimb lameness at walk.
| S-EPMC8048804 | biostudies-literature
Project description:The forelimbs and hindlimbs of vertebrates are bilaterally symmetric. The mechanisms that ensure symmetric limb formation are unknown but they can be disrupted in disease. In Holt-Oram Syndrome (HOS), caused by mutations in TBX5, affected individuals have left-biased upper/forelimb defects. We demonstrate a role for the transcription factor Tbx5 in ensuring the symmetric formation of the left and right forelimb. In our mouse model, bilateral hypomorphic levels of Tbx5 produces asymmetric forelimb defects that are consistently more severe in the left limb than the right, phenocopying the left-biased limb defects seen in HOS patients. In Tbx hypomorphic mutants maintained on an INV mutant background, with situs inversus, the laterality of defects is reversed. Our data demonstrate an early, inherent asymmetry in the left and right limb-forming regions and that threshold levels of Tbx5 are required to overcome this asymmetry to ensure symmetric forelimb formation.
| S-EPMC5215935 | biostudies-literature
Project description:BackgroundThe main criteria for lameness assessment in horses are head movement for forelimb lameness and pelvic movement for hindlimb lameness. However, compensatory head nod in horses with primary hindlimb lameness is a well-known phenomenon. This compensatory head nod movement can be easily misinterpreted as a sign of primary ipsilateral forelimb lameness. Therefore, discriminating compensatory asymmetries from primary directly pain-related movement asymmetries is a prerequisite for successful lameness assessment.ObjectivesTo investigate the association between head, withers and pelvis movement asymmetry in horses with induced forelimb and hindlimb lameness.Study designExperimental study.MethodsIn 10 clinically sound Warmblood riding horses, forelimb and hindlimb lameness were induced using a sole pressure model. The horses were then trotted on a treadmill. Three-dimensional optical motion capture was used to collect kinematic data from reflective markers attached to the poll, withers and tubera sacrale. The magnitude and side (left or right) of the following symmetry parameters, vertical difference in minimum position, maximum position and range-up were calculated for head, withers, and pelvis. Mixed models were used to analyse data from induced forelimb and hindlimb lameness.ResultsFor each mm increase in pelvic asymmetry in response to hindlimb lameness induction, withers movement asymmetry increased by 0.35-0.55 mm, but towards the contralateral side. In induced forelimb lameness, for each mm increase in head movement asymmetry, withers movement asymmetry increased by 0.05-0.10 mm, in agreement with the head movement asymmetry direction, both indicating lameness in the induced forelimb.Main limitationsResults must be confirmed in clinically lame horses trotting overground.ConclusionsThe vertical asymmetry pattern of the withers discriminated a head nod associated with true forelimb lameness from the compensatory head movement asymmetry caused by primary hindlimb lameness. Measuring movement symmetry of the withers may, thus, aid in determining primary lameness location.
| S-EPMC6175082 | biostudies-literature
Project description:We describe here a novel forelimb locomotor assessment scale (FLAS) that assesses forelimb use during locomotion in rats injured at the cervical level. A quantitative scale was developed that measures movements of shoulder, elbow, and wrist joints, forepaw position and digit placement, forelimb-hindlimb coordination, compensatory behaviors adopted while walking, and balance. Female Sprague-Dawley rats received graded cervical contusions ranging from 200 to 230 ("mild," n=11) and 250-290 kdyn ("moderate," n=13) between C5 and C8. Rats were videotaped post-injury as they walked along an alley to determine deficits and recovery of forelimb function. Recovery of shoulder and elbow joint movement occurred rapidly (within 1-7 days post-injury), whereas recovery of wrist joint movement was slower and more variable. Most rats in all groups displayed persistent deficits in forepaw and digit movement, but developed compensatory behaviors to allow functional forward locomotion within 1-2 weeks post-injury. Recovery of forelimb function as measured by the FLAS reached a plateau by 3 weeks post-injury in all groups. Rats with mild contusions displayed greater locomotor recovery than rats with moderate contusions, but exhibited persistent deficits compared to sham controls. Reliability was tested by having seven raters (three internal, four external) from different laboratories, independently and blindly score videos of all rats. The multivariate correlation between all raters, all animals, and all time points ranged from r(2)=0.88-0.96 (p<0.0001), indicating a high inter-rater reliability. Thus, the FLAS is a simple, inexpensive, sensitive, and reliable measure of forelimb function during locomotion following cervical SCI.
| S-EPMC2771771 | biostudies-literature
Project description:BackgroundHorses commonly show asymmetries that manifest as left (L)-right (R) differences in vertical excursion of axial body segments. Moving on a circle confounds inherent individual asymmetries. Our goals were to evaluate individual and group asymmetry patterns and compare objective data with subjective impressions of side preference/laterality in horses walking on L and R circles.MethodsFifteen horses walked on L and R circles unridden and ridden on long and short reins. Optical motion capture (150 Hz) tracked skin-fixed markers. Variables were trunk horizontal angle; neck-to-trunk angle; vertical range of motion (ROM) for the head, withers and sacrum; ROM for pelvic roll, pitch, and yaw; mean pelvic pitch; and ROM for hip, stifle and tarsal joints. Differences between inside and outside hind steps were determined for vertical minima and maxima of the head (HMinDiff/HMaxDiff), withers (WMinDiff/WMaxDiff) and sacrum (PMinDiff/PMaxDiff). Subjective laterality was provided by owners. Data analysis used mixed models, first without and then with subjective laterality. Iterative k-means cluster analysis was used to associate biomechanical variables with subjective laterality.ResultsPMaxDiff, PMinDiff and WMaxDiff indicated R limb asymmetry in both directions. WMinDiff indicated L (inside) fore asymmetry for L direction but was close to zero for R direction. Hip ROM was significantly smaller for the inside limb in both directions (L inside/outside: 16.7° vs. 20.6°; R: 17.8° vs. 19.4°). Stifle ROM was significantly larger for the inside limb in both directions (L: 43.1° vs. 39.0°; R: 41.9° vs. 40.4°). Taking the general direction effect into account the R hip and L stifle had larger ROM. Adding laterality to the models (seven horses L- vs. six horses R-hollow), PMaxDiff R hind asymmetry was more obvious for L-hollow horses than for R-hollow horses. L-hollow horses had greater pelvic roll ROM moving in L vs. R direction. L-hollow horses had smaller inside and greater outside hip joint ROM in L vs. R direction. R-hollow horses had a significant difference in HMinDiff between L (0 mm) and R (-14 mm) directions, indicating less head lowering at outside forelimb midstance in R direction, and larger outside tarsal ROM in R (38.6°) vs. L (37.4°) direction (p ≤ 0.05). The variables that agreed most frequently with subjective laterality in cluster analysis were pelvic roll ROM, followed by HMinDiff and PMaxDiff.ConclusionDifferences between horses walking in L and R directions were found both at group and individual levels, as well as evidence of associations with subjective laterality. Horses maintained more symmetric hip and stifle ROM and withers vertical motion when walking on the R circle. Findings suggest that left and right lateralised horses may not be perfect mirror images. Pelvic roll ROM emerged as a promising variable to determine laterality in walk as perceived by the rider, especially when considered together with other variables.
| S-EPMC10625764 | biostudies-literature
Project description:Assessment of lameness in cattle after foot surgery is important to monitor the recovery period, to improve the long-term success and the cows` welfare. This longitudinal multicenter retrospective study was carried out to evaluate the usefulness of automated tools of weight bearing and gait analysis following foot surgery to support the clinician to monitor lameness in cattle. For this purpose, the effect of involvement of different anatomical structures and the use of different surgery methods on gait parameters of post-operative recovery was assessed. The study consisted of 2 experiments and included cattle with unilateral foot pathologies located in the digital region which needed 1 (experiment 1; n = 30) or 2 (experiment 2; n = 4) surgical interventions. The surgical techniques were debridement, joint lavage, partial resection of bones, tendons or synovial structures, total resection of the sesamoid bone and digit amputation. Two accelerometers (400 Hz; kinematic outcome = stance phase duration; kinetic outcome = foot load and toe-off), a 4-scale weighing platform (difference of mean weight distribution across the limbs; Δweight) and a subjective locomotion score were used to evaluate gait parameters every 3 to 4 days after surgery. A repeated measures ANOVA was used in experiment 1 and a receiver operator characteristic analysis was used to determine the optimal cutoff values in experiment 2. Results showed that the differences across limbs for the pedogram variables of stance phases and peaks of foot load and toe-off, Δweight and the locomotion score were highest if joints or sesamoid bones were involved, suggesting that these cattle were more severely lame compared to cattle with more superficial foot pathologies. There was a significantly lower degree of lameness after surgical debridement and after digit amputation compared to partial and total resection of anatomical structures of the foot. The use of accelerometers and a 4-scale weighing platform represent promising objective tools for post-operative monitoring of lameness and can support the clinician in gait assessment to improve the long-term success of surgical interventions in the area of the foot.
| S-EPMC6310356 | biostudies-literature