Stance and Dynamic Evaluation, Objectivity and Assessment in Canine Rehabilitation

by | Aug 4, 2022 | Small Animal Rehabilitation

In the field of canine rehabilitation, dynamic evaluation and gait assessment has been a topic of interest for some time, as there is a lack of objectivity and repeatability among practitioners using subjective gait analysis measures. The addition of natural variations in the movement of different breeds adds a layer of complexity to gait assessments and documentation when objective measures are missing.

 

The addition of objective measures in the evaluation of stance, posture and gait in the canine patient are essential to accurate patient progress records, evaluation of the effectiveness of treatment techniques, communication and reporting to referring veterinarians, and owner education and compliance.

 

Over a four-week period, Dr Kiki Haeusler presented a series of webinars on objective gait and stance analysis. In today’s blog, we share highlights from this series.

 

Low-budget canine stance and dynamic gait analysis

Kiki highlights the importance of starting with and developing the tools you already have, through experience and repetition. Your eyes and ears remain crucial parts of the gait analysis process, no matter what other tools you have at your disposal. Visual and auditory acuity can be developed through experience.

Smartphones and software

We all have access to smartphones and open-source software that allows us to evaluate aspects of posture and gait at a certain level. Slow motion video analysis alone can be a valuable tool, and the addition of simple skin markers on the patient, together with an app, allows us to evaluate range of motion of specific joints at specific points within the gait cycle. The evaluation of postural photos allows us to objectively assess angulation and posture, and changes that occur over time.

Some of the software available on smartphones includes:

  • Kinovea
  • GaitPy
  • V1 Home
  • PhysMo
  • Tracker
  • Motion Analysis Tool
  • Sports Video Analysis
  • Coaches Eye

Questionnaires and gait analysis forms

There are multiple questionnaire-based forms that have been validated and can provide us with a repeatable outcome measure that involves owner-reported measures. We have a comprehensive list of validated questionnaires that may be incorporated into your evaluations and reassessments; see a previously published blog on Clinical Metrology Instruments.

We can also create our own gait assessment checklists. These allow us to follow a repeatable process in gait analysis and evaluate specific parameters. Personally developed checklists can be comprehensive and include specific measures for different cases, such as neurological dogs vs canine athletes.

 

Canine Stance Analysis tools

Stance analysis tools evaluate the loading and unloading of different limbs in a stance, although different tools will provide us with different data and different kinds of reports. We usually assess the loading pattern or weight distribution of the four limbs; ideally, the weight distribution pattern is 31% in each of the forelimbs and 19% in each of the hindlimbs.

We will also be able to see where the centre of pressure lies between all four legs. Some devices may also give us information on the weight distribution on each paw, and the centre of pressure of individual paws. This helps us to see if there is a higher peak of pressure at one point on one paw, if weight is shifted medially, laterally, caudally or cranially on a paw, and which digits are being loaded or unloaded. This information on the paw can be incredibly valuable and can provide insight into the loading pattern through the rest of the limb and the body.

Companion Stance Analysis system

 The companions Stance Analyzer is a commonly used stance analysis system in canine rehabilitation as well as in general practice. It is easy to use, simple to set up, uses minimal space in the practice and generates clear reports. It also allows you to track weight loss or gain through the rehabilitation period. 

To learn more about the stance analyzer, watch this webinar in the Onlinepethealth Small Animal members portal. 

The use of scales

Four weight scales can be used to perform stance analysis when a stance analysis system is not available. This method has undergone validation and can be incorporated into almost any rehabilitation facility. The use of scales requires a little more effort than a system such as the Companion Stance Analyzer, which makes stance analysis simple, effective and time efficient.

 

Dynamic Canine Gait Assessment

There are a few systems that allow us to perform dynamic gait analysis on our canine patients. Force plates are the gold standard from a research perspective, but more clinically applicable systems include the Tekscan mat and Canid Gait Treadmills.

Force plates require quite an intensive set-up, including assistants and time, with Kiki sharing that for a research project they spent half a day collecting data on each individual dog. One of the challenges with force plates is that they require the subject to step on one plate with one paw. This restricts its use in clinical practice from a time perspective, as well as from a patient variety perspective, as small dogs would not be able to step with a single paw on a single plate.

The pressure-sensitive treadmill that Kiki uses in her practice offers a few advantages, as it can be used both as an assessment tool and as a rehabilitation tool. The multi-functional purpose adds great value to the treadmill in a working rehabilitation centre. In addition, both stance and gait analysis can be performed on the pressure-sensitive treadmill.

Some of the parameters that are reported on the pressure-sensitive treadmill include:

  • Average max load in % body weight
  • Average max pressure plots
  • Separate pressure prints
  • Various gait parameters incl:
    • Step length, front and back
    • Stride length in cm
    • Cadence – step/min
    • Velocity
    • Stance phase for all paws in %
    • Swing phase for all paws in %
  • Center of pressure analysis

 

Knowing and recognising normal gait

Before we can evaluate and assess abnormal gait patterns, we need to know what ‘normal’ is. With a wide range of breeds, sizes, angulations and functions in canines, quantifying normal gait poses some challenges. Despite these challenges, research on normal gait and biomechanics in different breeds is slowly becoming available.

One of the aspects that Kiki and her team are currently investigating is the changes that occur in the gait as puppies mature to adulthood. In a multi-centre study that already includes well over 400 dogs, gait assessment data is being collected on a regular basis through the stages of maturity in young dogs of various breeds. This data will be incredibly valuable for us as rehabilitation therapists, giving us critical information on what is considered normal in specific breeds. I believe that the sporting industry will also find this data valuable, as questions around maturity and readiness for competition remain as yet unanswered.

 

Conclusion

‘It was always a question in my mind before I got the treadmill  – how can I show what I am doing? We are still in a niche where sometimes it’s looked at as something nice we can do for patients, but we don’t have to do it – it will not harm the animal, but who knows if it will help? This really got to me and I was all in to find something to show what we did.’ Kiki Haeusler

Kiki’s statement cuts right to the heart of why gait and stance analysis is important to us as canine rehab therapists, and I have no doubt that each of us resonates with her statement. At the end of the day, incorporating objective gait and stance analysis into our clinical work allows us to participate in research within our field, provides value to patients and referring veterinarians, and allows us to be more accurate and specific in the progression of rehabilitation programmes and the modalities or techniques we use.

 

Resources

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