Kinetics/motion measurement

Motion measurement with official HD / ED x-ray

Aim of the kinetic measurement in HD / ED x-ray

 

Since an x-ray image does not speak, we can use the kinetic measurement to objectively quantify and qualify the dog's movement pattern.

 

We know that the problem of HD has a genetic component. It is a polygenic disease. Which means that more than one gene is involved and thus it very difficult to assess the occurrence. X-rays, including early X-rays, taken at the age of 6 months, help in the evaluation. In addition to genetics, the phenotype and the environmental factors, are also important. These include exercise and nutrition. With my new diagnostic method, the kinetic measurement, mentioned above, I can monitor the motion. The HD / ED x-rays only show the radiological representation of the hips and elbows but a conspicuous motion pattern cannot be diagnosed - which then turns out to be a disadvantage when the evaluation results in an A-hip and the elbow is 0. This is desirable, but it does not give an explanation, if the dog has a conspicuous walk. At best you have an evaluation of the C-hips and then might worry about possible disadvantages and the risk of osteoarthritis.

 

To fill this deficiency, we pre-examine our candidates for the official HD / ED X-ray with our new technique, the "canine locomotion analysis". Through the objectively collected parameters, we can quantify and also qualify the dog's movement pattern.

 

Video Patient Oskar 4.11.2015

 

 

 

 

Please note the following:

The red dots are the values before the treatment

The yellow dots are the values after the treatment

 

 

 

Looking at the movement pattern above, we notice the swaying walk as well and the special pattern in the sitting position. The swaying walk is called "cat-walk". The vertical force is clearly altered, with 13.77% and 13.36%. These relative power ratios correspond to a dog with a C-hip according to the German evaluation. According to CH-evaluation this would be a D-hip. This makes it obvious that an alteration is to be expected. The normal relative "vertical force axis" is 20% on both sides. Thus, with a 7% reduction per hind limb, the patient has a significantly reduced leverage. It is striking that after the manual orthopaedic therapy (ORMT), the force axis of the hind hand has improved immediately with an increase of 19.2% on the left side and 16.6% on the right side. This finding is relevant, because now a subsequent physiotherapy for the further development of the muscles, makes sense. Another noteworthy parameter is the increase in symmetry of the hindquarters from 41.59% to 62%, which corresponds to an improvement of 50%.

 

It goes without saying that this positive development and assessment was possible only because the movement pattern was measured reliably and objectively. To achieve further progress, measuring the movement pattern regularly is advisable and if necessary, manual therapy can be carried out.

Motion measurement of early HD diagnosis in the puppy/young dog

Goal of the early HD Diagnosis

  1. Most veterinary practices have no way of performing motion measurements, and hence cannot display movement patterns. We offer the opportunity for dog owners to get an early diagnostic evaluation regarding the status of the hip as young as 16 weeks old. This is important because a conspicuous movement pattern can indicate HD. Using motion measurement and subsequent X-Ray diagnostics, a precise assessment regarding HD can be made. In case a "positive" finding of HD is made, there is a therapeutic solution for this problem! I will provide you with more info on this matter in a separate newsletter.
  2. Another important aspect of the early HD diagnosis pertains to the training of working dogs for the police, the military, blind schools and Redog, etc. Targeted selection permits focusing on the dogs' efficient and professional development.

 

HD (hip joint dysplasia) is a difficult topic, especially when it comes to the cause of this matter. It is an established fact, that the cause has a genetic component, which is a polygenic inheritance. This means that several genes play a role, and these are classified into main and secondary genes. In addition to the genetic components, environmental factors are also involved in the inheritance of the HD. Thus, the disease of the HD is a polygenic, multifactorial disease. It is obvious that the diet as well as exercise are among the most important environmental factors. This is precisely why controlling the movement is imperative, especially between 12 and 20 weeks old, as the most important development of the acetabulum takes place during this period.

 

 

 

 

 

 

 

  

Please note the following:

The red dots are the values of the patient "F"

The yellow dots are the values of a healthy dog

 

AL: front left   AR: front right
PL: rear left   PR: rear right
BF: spine front   BP: spine rear

 

 

 

 

In the standing and the tangential X-Rays of patient "F", we see an optimal canopy as well as a compact and stable hip joint. The kinetic values of the front and rear limbs represent the normal distribution of 60:40, which means the force is evenly distributed with 30% per front limb and 20% per rear limb. These criteria were met by patient “F”. The HD / ED evaluation in the patient "F", one year later, resulted in A / A for the hip and 0/0 for elbow. This is visible in the evaluation below.

 

 

 

 

With patient "G", the situation is different. Although the bodymass index is similar, the movement pattern is different. The hind leg, especially the left hind leg, is turned inwards and shows instability, and the valgus misalignment in the left leg is striking. The kinetic parameters also show a clear difference. Above all the force absorption is changed with 15% and 17% respectively. This is an indication of problems with the hindquarters. The kinetic results are supported by the X-Rays. The canopy of the hip can be considered normal, but the connection between the hip-joint and femoral head is too loose, which can be considered an HD problem. The "looseness" of the joint results in considerable friction during movement, which leads to arthrosis. The "looseness" of the hip joints thus explains the conspicuous movement pattern.

 

 

 

 

 

 

Please note the following:

The red dots are the values of patient "G" above

The yellow dots are the values of a healthy dog

 

AL: front left   AR: front right
PL: rear left   PR: rear right
BF: spine front   BP: spine rear

 

 

 

 

Summarizing, the following can be ascertained:

Each puppy should have a check up beginning at 12 weeks old, especially when the puppy shows a conspicuous movement pattern, with knock knees, "Charlie Chaplin" style running, buckling of the hind legs, considerable instability of the hindquarters, as well as "walking like a duck". Through early HD diagnostics with kinetic measurements, as well as standing and tangential X-Ray diagnostics, HD problems can be picked up as early as 16 weeks old, allowing for specific therapeutic interventions like "symphysiodesis" or "pelvic osteotomy". The latter was mentioned in my last newsletter. I will present Symphysiodese in the upcoming newsletter.

 

 

Motion measurements/exertion measurements in the dog

Goal of exertion measurements

  1. Many dogs show a lameness or movement disorder just during or after exertion. The dog can thus be exposed to a physical strain, for example to 45 minutes of cycling. In this diagnostic procedure, the patient is measured kinetically before and after the exertion, which allows the detection of exertion-induced movement disturbances. This cannot be determined with an image based diagnosis (MRI, CT, ultrasound or scintigraphy).
  2. The physical conditioning can be monitored perfectly this way. For example, we can measure the power of the hindquarters before and after a performance and quantify the conditioning. This can be very important for the training of sled dogs, racing dogs (greyhounds) and for military and police, ie. for young dogs during physical conditioning / training.
  3. During rehabilitation, the conditioning can be quantified as well. This is especially important for dogs after back surgery. To give an example, a service dog of the SBB was in my office recently.
  4. Selection of dogs that have to fulfil a certain role can now be made more objectively (for example with guide dogs for the blind).

 

As you can see from the list of goals above, the exertion measurement is an important aspect from a diagnostic point of view. Kinetic and kinematic parameters can provide helpful information, especially when image-diagnostic indications of motion impairment are missing.

 

Even after image-diagnostic modalities such as MRI or CT, with very many dogs there are still no indications to explain the motion disorder. In these cases, it remains open why the dog is limping, and a bad feeling remains. One must acknowledge that an image diagnosis cannot display movement. This is only possible with kinetic or kinematic parameters. To date, these possibilities in the dog's medical treatment have been missing. With our development we can now fill this gap. Finally, there is a possibility to carry out performance assessments with dogs, as it has been customary, everyday work in the treatment of horses for a long time.  

 

A real life example: we have a patient, 2 years old, training to be a working dog. She shows recurring lameness in the rear right limb. Hip and knee x-rays do not give any pathological indications. The suspicion of growth disturbances in the end plates of the vertebral bodies was assumed. When the dog was introduced to me, she was on heat and showed additional problems of an infection as well as an endocrinological disturbance. After further clarifications regarding the hormonal system and MRI, a clear diagnosis was still not available. The dog was then slowly conditioned and trained via exertion-movement diagnostics. After two months of controlled conditioning, the dog is free of lameness and can now continue with her training.

 

 

 

 

 

 

 

 

 

Please note the following:

The red dots are the values before exertion

The yellow dots are the values after 1.5 hours of exertion

 

AL: front left   AR: front right
PL: rear left   PR: rear right
BF: spine front   BP: spine rear

 

 

 

 

 

Objective of exertion measurements

  1. Controlled athletic and conditiong development
  2. Targeted rehabilitation, objective and quantifiable
  3. Follow-up check and the adaptation of therapy / rehabilitation

 

Exertion measurements are a clear advantage of the kinetic / kinematics, which can not be fulfilled by image diagnosis such as x-ray, CT, MRI, since the movement cannot be recorded or measured. This method is also very suitable after back surgery or after an operation of the cruciate ligaments, if despite the operation, lameness or other symptoms still persist.

 

 

Kinetic measurements with the young dog

Goal of measurements with the young dog

The goal of the measurements with a puppy / young dog, basically with the growing dog, is to measure, assess and, depending on the situation, to take therapeutic measures or to extend the diagnostics with objective and reproducible parameters.

 

This is important, since HD, ED or even OCD, along with the genetic component, is manifested by the movement. Common trigger can be a too wild and uncontrolled movement.

 

Patient, one year old, Blanc Suisse breed: The symptom, presented to me, is "gnawing the root of the tail". The previous examination by the vet gave no indication of a skin problem or fleas. The orthopaedic and neurological examination, performed by me, indicated a transitional vertebra. The kinetic measurement and the X-ray image confirmed this suspicion. After reviewing the radiological findings, the patient was treated orthopaedically manually.

 

 

 

 

Please note the following:

The red dots are the values before the treatment

The yellow dots are the values after the treatment

 

AL: front left   AR: front right
PL: rear left   PR: rear right
BF: back front   BP: back rear

 

 

 

 

 

The patient was presented to me again after one month. The gnawing of the tail had stopped immediately after the first treatment and the movement pattern was smooth again. Subsequently the dog underwent an official radiological examination for HD / ED by the family vet. The comparison with the initial examination, revealed that the vertical force axis, with 17.35% on the left side and 16.14% on the right, was slightly but clearly altered. This could indicate a pathology of the hind leg and was also a reason for the chewing of the tail's root. After manual orthopaedic treatment, the force absorption was significantly improved. The dog responded well to the manual treatment, and the symptoms disappeared.

The evaluation of the official radiological examination confirmed the transitional vertebra and beyond that, showed different angles of the hips.

Transient vertebrae, especially when asymmetric, result in the tipping of the pelvis, which in turn leads to an altered pressure-pull mechanism in the acetabulum by the thigh. Thus it is possible that the canopy of the thigh and the "depth" of the acetabulum is reduced.

 

 

 

 

 

 

 

 

In the control examination, the hindquarters showed a normal movement, but a strongly altered force in the right and left shoulder.

See below: left shoulder 37.79%, right shoulder 25.43%. This is a big difference of 12%. After orthopaedic manual treatment, a normal force vector was determined in both limbs during the subsequent measurement, 31.14% in the left shoulder and 30.71% in the right shoulder. The difference was reduced to 0.5%, which is absolutely represents the norm.

This is another advantage of kinetic measurement. It can show a change immediately after a treatment. This cannot be achieved by any radiological study. Thus, we can also determine the course of therapy and, depending on the situation, make adjustments to the therapeutic modalities.

 

 

Kinetic measurement during rehabilitation

Goal of the kinetic measurement

The goal of the kinetic measurement of patients during rehabilitation is to make an objective and quantifiable assessment of the improvement during therapy. Especially when CT / MRI or X-ray cannot detect any image-related causes!

 

Case documentation

A 10 year old mongrel shows problems in the front and hind limbs, loses muscle mass quickly, walks reluctantly and is clearly in pain. A lameness, starting from the right shoulder, is clearly recognisable. Both forelegs are placed wide apart and his head posture is low.

Besides visiting the family vet, the dog was presented in a clinic! The neurological examination showed a clear deficit of the nerve reflexes as well as a strong reduction in muscle mass in the shoulder and rear limbs.

The subsequent CT revealed a degenerative intervertebral disk, located at the second cervical vertebra, as well as a finding of bloody cerebrospinal fluid. Unfortunately, no definite diagnosis and therapy could be made based on on those findings.

 

Then the patient came to my office...

See the movement pattern below!

 

Video Sweety 15.4.2016

 

 

The orthopaedic neurological examination showed a clear reduction of the cervical spine's mobility upwards, downwards and towards the right side. Furthermore, the restriction of the ROM in the right shoulder was noticeable! Subsequently, the cervical spine, the neck-thoracic spine and the right shoulder were treated orthopaedically manually!

 

Based on the kinetic measurements a clear restriction in the shoulder was evident.
Right → Energy Before ORMT (orthopaedic manual therapy)  = 36J
  After ORMT  = 52J

Stride and walk length showed only slight changes during the first consultation before and after the ORMT!

Subsequently, the dog was strengthened by exercising on the treadmill and additionally treated with electro stimulation therapy!

In the control examination at the end of May 2016, the dog showed a very good clinical development! The lameness spreading from the right shoulder was no longer visible and the atactic movement pattern had also significantly improved!

The clear progress is very well represented by our kinetic measurements (see below)!

 

Video Sweety 30.5.2016

 

 

 

 

 

Even though the dog's clinical symptoms were very noticeable in April 2016 and the prognosis was made very cautiously, the dog has made good progress! This was only possible because clear indications of the affected regions had been obtained through the extended diagnostics of the kinetic measurement.

 

Orthovet Information

orthoVET

Dr. med. vet.

Patrick Blättler Monnier

Fasanenstrasse 13

4402 Frenkendorf

Tel. 061 903 11 11

Fax 061 903 11 13

info@orthovet.ch

www.orthovet.ch

 

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We comply with the tariff recommendations of the Swiss Society of Veterinarians (GST). Our costs are based on the time that we need for your dog / cat, as well as on the nature and extent of examination and treatments that we have to perform. We are happy to discuss the costs with you before the examination so that you can decide which tests and treatments you want.