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CANINE GAIT ANALYSIS Brittany Jean Carr, DVM, CCRT, ACVSMR Resident, and David L

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CANINE GAIT ANALYSIS Brittany Jean Carr, DVM, CCRT, ACVSMR Resident, and David L RECOVERY & REHAB Peer Reviewed CANINE GAIT ANALYSIS Brittany Jean Carr, DVM, CCRT, ACVSMR Resident, and David L. Dycus, DVM, MS, CCRP, Diplomate ACVS (Small Animal) Veterinary Orthopedic & Sports Medicine Group, Annapolis Junction, Maryland Understanding canine locomotion and gait is evaluating the animal perform its specific tasks, imperative to diagnosing numerous musculoskeletal such as jumping over obstacles or running and neurologic conditions. Prior to any orthopedic • Noting any signs of neurologic abnormalities, or neurologic examination, a gait evaluation should such as ataxia, paw scuffing, or stumbling. be performed. While the walk is often the easiest gait in which Gait evaluation typically includes visual and/or to observe abnormalities because it is the slowest subjective observation of the dog from a number gait, a mild lameness may not be detectable. The of angles at both the walk and trot on a fl at trot is the best gait to use for detecting lameness surface. To the trained eye, lameness can often be as it is the only gait in which the forelimbs and detected upon gait evaluation. However, a more hindlimbs never receive assistance from the subtle lameness may not be apparent on subjective contralateral limb in bearing weight. gait evaluation and can be diffi cult to detect. Recently, new validated objective gait analysis Forelimb Lameness technologies have become available to help Generally, with forelimb lameness, weight is veterinarians quantitate characteristics of gait, shifted caudally, and the head goes “down on which can greatly assist in the detection of a subtle the sound” limb or, conversely, the head goes up lameness as well as response to various treatments. when the lame limb is on the ground (although this observation has not been verifi ed in dogs). NORMAL CANINE GAIT In forelimb lameness, the hindlimbs may also Prior to detecting abnormalities in gait, one must appear tucked under and the back appear arched, understand normal canine locomotion. In dogs, and affected dogs may take short strides with the there are 4 main gaits: walk, trot, canter, and hindlimbs. gallop (Table 1, page 94). Dogs with a shoulder lameness tend to appear Horses use these same 4 gaits; however, dogs short strided, while dogs with an elbow lameness have 2 different ways of cantering and 2 different (eg, medial compartment disease) appear to ways of galloping. Therefore, the canter and gallop circumduct the limb to ease pressure on the medial that dogs perform preferentially are different from aspect of the elbow. those used by horses.1 In addition, dogs have a transitional gait Hindlimb Lameness between the walk and the trot called the amble. On the contrary, with hindlimb lameness, weight is There also is a relatively common, but abnormal, shifted cranially. The forelimbs may be placed more gait in dogs called the pace, which is a normal gait caudally, with the head and neck extended and for some breeds of horses.1 lowered to help offset weight from the hind end. A “hip hike”—in which the hip on the lame side has OBSERVING CANINE GAIT increased vertical motion, making the hip on the Key considerations when evaluating gait include: unaffected side appear lower when observing the • Choosing a surface for observation that is even gait from behind—is often noted on the same side and flat as the lameness. The tail may also rise as the lame • Observing both the walk and trot leg contacts the ground. • Watching the animal from multiple vantage points, including going away, coming toward, METHODS OF GAIT ANALYSIS from both sides, and while circling It is imperative to have a means for objective gait • If the patient is a performance or working dog, analysis because gait is diffi cult to consistently and tvpjournal.com | March/April 2016 | TODAY’S VETERINARY PRACTICE 93 Peer Reviewed RECOVERY & REHAB TABLE 1. Summary of Canine Gaits GAIT FORWARD MOVEMENT EXAMPLE COMMENTS Walk 1. One rear foot 1. RR • 2 or 3 feet on the ground at any given time 2. Ipsilateral front foot 2. RF • Only canine gait in which there are ever 3 feet on 3. Other rear foot 3. LR the ground 4. Front foot on that side 4. LF Amble 1. One rear foot 1. RR • A faster form of the walk but not preferred gait 2. Quickly followed by ipsilateral front foot 2. RF • Moments when 3 feet are on the ground ob- 3. Other rear foot 3. LR served on close inspection or slow motion video 4. Quickly followed by front foot on that side 4. LF • Very ineffi cient gait: Rear end sways from side Begins to appear as if ipsilateral feet are to side; rear feet are not lifted very high, often moving forward together scuffl ing along the ground; wasted horizontal energy and less pleasing to the eye • Should only be used for short periods: transition- ing from walk to trot or resting trotting muscles Pace 1. Ipsilateral legs move forward together 1. RF–RR • Abnormal gait for all dog breeds while other 2 legs bear weight 2. No ground • Very ineffi cient gait: Center of gravity keeps 2. Moment when body is suspended in the air contact shifting from side to side; energy expended to 3. Other 2 legs move forward together 3. LF–LR keep recentering weight Only 2 feet on ground at any given time • Cannot respond quickly when a change in speed is required • Wide range of speeds for movement unavailable unless dog slows to amble or speeds up to trot Trot 1. Two diagonal front and rear feet 1. RF–LR • Most effi cient gait 2. Moment when body is suspended in the air 2. No ground • Often gait of choice for gait evaluation: The front 3. Other diagonal front and rear feet contact and rear leg must support the body without help 3. LF–RR from opposite leg Rotary 1. One rear leg 1. RR • Predominant canter in dogs (90%) Canter 2. Both legs on other side of body together 2. LR–LF • Allows very sharp turns with greater drive from 3. Other front leg 3. RF the rear Different lead legs in front and rear • Referred to as cross cantering in horses Transverse 1. One rear foot 1. RR • Less effi cient for dogs; only used in about 10% of Canter 2. Other rear foot and diagonal front foot 2. LR–RF cantering together 3. LF • Used predominantly by horses 3. Other front foot Same side leads in the front and rear Rotary 1. Spine fl exes, with both rear feet on ground; 1. RR–LR • Used by dogs preferentially Gallop lead foot slightly ahead of the other 2. LF–RF 2. Spine extends, stretching front feet 3. RR–LR forward, which hit ground at same time, one slightly ahead of the other, with lead front on opposite side of lead rear 3. Spine fl exes to bring rear feet forward Different lead legs in front and rear Transverse 1. Spine fl exes, with both rear feet on ground; 1. RR–LR • Very uncommon dog gait Gallop lead foot slightly ahead of the other 2. RF–LF • Gallop used by horses 2. Spine extends, stretching front feet 3. RR–LR forward, which hit ground at same time, one slightly ahead of the other, with lead front on same side as lead rear 3. Spine fl exes to bring rear feet forward Same side leads in the front and rear LF = left front; LR = left rear; RF = right front; RR = right rear 94 TODAY’S VETERINARY PRACTICE | March/April 2016 | tvpjournal.com RECOVERY & REHAB Peer Reviewed TABLE 2. Methods for Canine Gait Analysis Subjective: • Visual observation of gait (eg, numerical rating scale, visual analog scale) Objective: • Kinematic gait analysis • Kinetic gait analysis (force plate analysis) • Temporospatial gait analysis (pressure sensing walkways) reliably assess subjectively. Objective analysis is especially important when developing treatment plans and monitoring patient progress. Numerous methods for gait analysis have been developed (Table 2). FIGURE 1. Example of the visual analog scale (VAS): The animal is graded on a 10-cm line, with one end of the line representing “sound” and the other end representing “non–weight-bearing.” An “X” is placed along Visual Observation of Gait the scale, noting the degree of lameness, and then the VAS can be A systematic and disciplined approach must be placed into the patient’s record. Either the veterinarian or a trained staff used to clinically evaluate a patient’s gait. To member typically completes the VAS. Previous VASs can be compared to document this clinical evaluation in the medical determine if there is improvement, decline, or no change. record, fi ndings are often semiquantifi ed using a numerical rating scale (Table 3) or visual analog The observer only identifi ed 11% of the 131 dogs scale (Figure 1). that were 6 months post surgery as being abnormal Both types of scales were developed to provide compared with force plate analysis, which revealed a systematic approach to visual observation of that 75% of the 131 dogs failed to achieve ground gait. However, it is important to realize that, reaction forces consistent with sound Labrador while visual or subjective gait analysis is often For more retrievers. helpful in identifying lameness, the gold standard While force plate analysis has been shown to be information, for quantifying lameness is quantifi cation of superior to visual observation, visual observation visit tvpjournal.com gait characteristics with a form of objective gait and select is still a practical tool in clinical practice, and its Clinical analysis, such as force plate analysis. Resources to importance should not be discounted. Evans and colleagues compared visual observation download the of gait to force plate analysis.2 This study evaluated numerical rating 148 Labrador retrievers—131 that were 6 months Kinematic Gait Analysis scale and visual post surgery for unilateral cranial cruciate ligament Kinematic gait analysis quantifi es the positions, analog scale injury and 17 that were free of orthopedic disease.
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