lameness diagnosis support with gaitsmart...

GAITSMART

CASE STUDY

Lameness Diagnosis Support with GaitSmart Pegasus

www.gaitsmart.com [email protected] +44 (0) 1438 822822

On Tuesday 22nd March 2016, Diana Hodgins and Steve Goode from GaitSmart went to meet with Rick Farr MRCVS

and Nicki Pursey MRCVS from Farr and Pursey Vet Practise in Tring to demonstrate the GaitSmart Pegasus system. Rick

had a horse in mind for the demonstration, Lenny, an 18-year-old Welsh Cob Section D owned by Stephen Jones. Lenny

had shown movement issues, which would be classified as lame, but the actual cause of the problem had proved hard

to identify.

Lenny had previously been blocked up to the hock, but had a varying blocking pattern & it was therefore inconclusive.

One of the main reasons that Rick wanted to use the GaitSmart Pegasus gait analysis system, was to help differentiate

improvement as a result of a block. Also, it had been made even more difficult to visually recognize any improvement

as Lenny had quite significant muscle asymmetry.

The process that we agreed was that we would analyse Lenny with the GaitSmart Pegasus system so that we had a

baseline movement profile for comparison. Rick then planned to use a tibial peroneal block on Lenny, following which

we would analyse Lenny again. GaitSmart Pegasus can be used anywhere and on any surface and we had a nice long

paved area in the yard and we agreed that this would be the area for “running up”.

We prepared Lenny for the gait analysis. We placed boot style wraps on Lenny for the cannon sensors, and hock straps

for the hock sensors. Once these were in place, we synchronized the sensors and placed them into the pockets on the

straps. Stephen then walked and trotted Lenny up and back.

We could see that Lenny was not moving as he should, but it was not possible to distinguish the exact cause of the

problem with the naked eye.e prepared Lenny for the analysis. We placed boot style wraps for the cannon sensors,

and hock straps for our hock sensors, and then we placed the sensors into the pockets on the straps. Stephen then

walked and trotted Lenny up and back. We could see that Lenny was not moving as he should, but it was not possible

to distinguish the exact cause of the problem with the naked eye.

Figure 1 - Lenny on one of his many trot-ups!

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CASE STUDY



Figure 2 - Excerpt from GaitSmart Pegasus report - Lenny 1st analysis

Once Lenny had completed his walk and trot we removed the sensors and analysed the data. The whole process only

took a few minutes. As you could see from the excerpt from the report in figure 2 above, there was a noticeable

difference in movement between left and right hock and left and right tibia.

Rick then proceeded with the next phase, which was to administer a right tibial peroneal block (nerve block). First,

Rick sedated Lenny to help with any discomfort. Once the sedative had taken effect, Rick then administered the

blocking injections.

Lenny was left to stand for a period of time so that the block could begin to take effect. When the time was up, we

synchronized the GaitSmart Pegasus sensors again and we placed them back into the retaining pockets on the straps.

Stephen then repeated his walk and trot which allowed a visual inspection while the sensors were capturing movement

data. Once again, it was not possible to see any differences in Lenny’s movement, so we waited for the GaitSmart

Pegasus report.

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Figure 3 - Excerpt from GaitSmart Pegasus report 2 - Lenny following tibial-peroneal nerve block

As you can see from the report excerpt in figure 3 above, the situation had not really changed. There was still a

noticeable asymmetry in the hocks and while the right tibia (green) achieved a lower maximum flexion, you can see

that the action is still being timed later. GaitSmart Pegasus provided us with objective data to support the diagnosis

process and to help Rick decide on his next steps.

Rick then decided to apply a femoro-tibial block (a block that affects the next section of the leg above the hock) see

figure 4 below.

Figure 4 - Rick applying the femoro-tibial nerve block to Lenny

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Rick said that he would like to analyse Lenny 10-15 minutes post block and then at approximately 40 minutes post

block.

After 10 to 15 minutes, we synchronized the GaitSmart Pegasus sensors and we placed them back in the retaining

pockets on the straps. Stephen, once again, had the honours of running Lenny up and down the yard for our visual

inspection and once again, it was still inconclusive as to what improvement, if any, had been made.

Figure 5 - Excerpt from GaitSmart Pegasus report 3 - Lenny 1st analysis post femoro-tibial nerve block

We connected the sensors back to the GaitSmart Pegasus software and reviewed the report. Once again, as you can

see from the report excerpt in figure 5 above, there was very little change from the previous report.

We then had to wait a further 25 – 30 minutes and then analyse Lenny again. Once again, the sensors were

synchronized and placed back on Lenny. Stephen walked and trotted Lenny up and down the yard again. As before,

we could not achieve a consensus on any improvement in Lenny, while in hand, and we certainly could not quantify

improvement or deterioration.

There appeared to be a noticeable clinical improvement following the stifle block, but again the significant muscle

asymmetry makes it difficult to ascertain and introduced doubt into the process. The advantage of using the GaitSmart

Pegasus sensor-based system is to eliminate elements of scepticism, judgement or clinician error.

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CASE STUDY



Figure 6 - Excerpt from GaitSmart Pegasus report 4 - Lenny 2nd analysis post femoro-tibial nerve block

We removed the sensors from Lenny and connected them back to the GaitSmart Pegasus software and, as you can

see in figure 6 above, Lenny was now back moving as we would have expected. His hock angles were symmetrical and

both were following the profile that we would expect for a sound horse. The tibias also demonstrated a nice

symmetrical movement and they also showed the small increase in angle, prior to maximum flexion, that we would

have expected to see.

GaitSmart Pegasus was able to show, using accurate, objective data, exactly what improvement had been achieved

with the nerve block.

This identified to Rick that the area of concern was the stifle. Rick is now planning to radiograph the stifle joint, in

addition to looking at the soft tissue structures of the stifle with ultrasound. This examination the next day confirmed

that Lenny’s problem was indeed in the stifle and treatment has begun.

GaitSmart Pegasus provides objective data to underpin the diagnosis and treatment of the veterinarian with objective

data. GaitSmart Pegasus can show you detail that it is not possible to see with the human eye. GaitSmart Pegasus also

allows you to see exactly what all other limbs are doing at any point during the stride. When a horse is trotting, allowing

refresh time for the human eye, it is just not possible to see everything that you need to see to gauge the detail of the

movement, deterioration or improvement.

The demonstration took place over a 2-3 hour period and in that time, we performed 4 detailed gait analyses, which

only took a few minutes more than the regular trot up would have taken. GaitSmart Pegasus is the only system that

can do this.

We would like to thank Stephen and Lenny, as well as Rick and Nikki from Farr and Pursey Equine vets.

lameness diagnosis support with gaitsmart...

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