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The Latest in Objective Lameness Evaluation

Have Attitudes Toward Using the Equinosis Q in Pre-Purchase Exams Changed?

By Sarah E. Coleman, The Kentucky Horse Council Executive Director The Equinosis Q with Lameness Locator has become a more readily accepted diagnostic tool for detecting lameness, both subtle and overt, in the 11 years since its commercial launch. Though respected as a modality to ensure the health and wellness…

Have Attitudes Toward Using the Equinosis Q in Pre-Purchase Exams Changed?

By Sarah E. Coleman, The Kentucky Horse Council Executive Director

The Equinosis Q with Lameness Locator has become a more readily accepted diagnostic tool for detecting lameness, both subtle and overt, in the 11 years since its commercial launch. Though respected as a modality to ensure the health and wellness of competition and racehorses, some veterinarians are hesitant to use the tool during pre-purchase exams (PPE). This trend was apparent during a survey conducted by Equinosis in 2019, but what, if anything, has changed?

No. of PPEs Performed Per Month
(64 respondents)

In a recent poll of Equinosis Q users, 64 practicing veterinarians responded. 22 vets (34%) performed between two and three PPEs each month and 17 vets performed between four and five PPEs a month. Nine vets completed between six and 10 PPES monthly and 15 did no PPEs or just one. One vet completed more than 10 PPEs each month.

Do You Use The Equinosis Q in Your
Pre-Purchase Evaluations?

In total, 25 (39%) of all the vets polled utilized the Equinosis Q regularly while 19 vets (30%) used the equipment specifically if there was a concern. 6 vets (9%) would use the Equinosis Q in PPEs, but only if a potential buyer requested it. 12 vets (19%) reported they have not used it in a PPE.

Interestingly, every vet polled said he or she sees the value of such a diagnostic tool – so why then, are they reluctant to use it? The No. 1 reason eight vets (12.5%) reported they are reluctant to use the Equinosis Q is they felt it was too sensitive and would measure something they (the evaluating vet) could not see. Only five vets (8%) felt that the system was too difficult to explain to clients, a decline from when the survey was first done in 2019.

Compared with 2019 responses, where 19 of 88 veterinarians (nearly 17 percent) were concerned the system would detect something their eyes would not, the 2021 responses denote that confidence in – and familiarity with – the machine is growing. So why is the Equinosis Q not used in every PPE?

Reasons for Not Using the Equinosis Q During a PPE

Some practitioners feel that the Equinosis Q is too sensitive for pre-purchase examinations and is best reserved for harder-to-diagnose lameness and conversations with established clients, with whom they have developed a repertoire and a level of trust. These veterinarians are concerned that the Equinosis Q might locate an asymmetry on a PPE that is undetectable by the eye and complicate what might otherwise be a straightforward exam.

Tensions can run high during pre-purchase exams, both between the seller and the buyer; the veterinarian performing the exam – and certainly the horse – is privy to the escalations of emotions as expectations rise. The extent of a “standard” PPE can vary by potential owner and veterinarian, but often the depth of evaluation rises with the horse’s asking price. Open lines of communication between vet and potential owners are paramount, as many factors come into play when deciding on a new steed, including age, breed, intended use, rider’s competitive aspirations (if any), rider’s current skill level, horse’s history, and potential for resale. Because of all these potential constraints, the ability for the vet to explain his or her findings – and their clinical significance – is key. The Equinosis Q allows veterinarians to back up their opinions with evidence-based analysis. And in many cases, that same veterinarian will be responsible for the horse’s future medical care.  Acquiring a wellness baseline is a good starting point.

Is Any Horse Actually Symmetrical?

It’s clear to those who understand the technology that the discovery that a horse moves asymmetrically is not often one of dire consequence; it does not mean that the horse may be unserviceable in its intended use.

Successful use of the Equinosis Q in PPEs lies in the ability of the attending veterinarian to explain the findings in a contextual way, including offering an opinion on possible risks or management issues related to the horse. The information provided by the system must be distilled down into a context the client can understand.

Dr. Rhodes Bell, an equine surgeon with Park Equine Hospital at Woodford in Versailles, KY, uses the Equinosis Q on every lameness evaluation of a horse that has a score of less than a 4 on the AAEP lameness scale. He also uses the tool for all pre-purchase exams.

An avid proponent of using the Equinosis Q to augment his physical exam, Bell is able to explain how the diagnostic tool works immediately after its conclusion. “I have the explanation on a loop in my brain, which I feel has been fine-tuned over the years to explain what I am seeing and how this is represented in the data output of the software,” he says. “I try to explain that it is not voodoo or magic, it simply puts a number on what any good veterinarian is already observing but is not subject to bias (or having a bad day!). I also explain that it [the Equinosis Q] is more sensitive than the human eye by virtue of its increased sampling rate.”

Interestingly, doing a PPE for someone he doesn’t know, which happens often, increases Bell’s desire to use the equipment. A potential buyer’s opinion on whether to pass on a horse often lies in the hands of the vet, Bell notes. “I can say that if every horse that has asymmetry measured during an evaluation was passed on, they would have a very, very tough time finding a horse for purchase.”

“I love when no asymmetry is measured [by the Equinosis Q],” says Bell. “I find PPEs stressful, and I explain that the machine’s ability to find no asymmetry is a very rigid bar to pass. I have a stock phrase for it: I now have to use my toes, but I can very easily count the number of horses that come up as ‘sound’ in all regards,” he says. In addressing the horses that come up not perfectly symmetrical, Bell notes that “The important part is to interpret the meaning of the data correctly – why is the horse asymmetric? Is it just the way the horse moves or is there some pathology contributing to that? Is this a transient issue? A treatable/manageable issue? What further diagnostics do we need to do to answer those questions?”

Bell concludes that “In my opinion, measured asymmetry is not a reason to pass on a horse, it’s a reason to look into things a little deeper. The findings of that investigation should dictate your feelings surrounding the data that is generated by the equipment.”

Though Bell feels the equipment is a wonderful adjunct to lameness and PPE exams, he’s not surprised the device is not in more widespread use because “the data sometimes can be confusing, even to me.  I think the more one uses it, the more comfortable they are using it, which is one of the many reasons I use it on most–if not all–cases.”

Equinosis Q Use Overseas

The use of the Equinosis Q differs between continents and countries, says Dr. Christina Frigast, a veterinarian based in the UK. Frigast has seen a variety of racehorses, pleasure horses and sport horses during her career, and notes that the use of the Q is “a lot more recognized and accepted for use in lameness investigations in recent years in the UK.” In 2016, there were only five systems in the UK; now there are more than 35.

Though she primarily uses the Equinosis Q for lameness diagnostics, including multiple-limb lameness and monitoring of competition horses, she also uses it to help decipher why a horse is performing poorly. Frigast doesn’t use the Q often in pre-purchase exams, but she does use it when she finds a horse has an obvious lameness (on a PPE) to avoid any argument or disagreement. She also uses it for a “second opinion” where asymmetry is seen, but she’s unsure whether it’s consistent and/or of concern.

For Frigast, if she’s going to use the Equinosis Q, she prefers that her client at least be familiar with the machine and/or the principles behind gait analysis systems so they understand how the results are interpreted. Though the Equinosis Q offers information, the vet will need to answer if the asymmetry measured is significant and going to cause problems in the future, she notes.

“I think this does put off a lot of vets from using the Q in a PPE if they don’t feel confident interpreting the results of more complicated cases – you rarely have an obvious lameness in a PPE, so it is bound to be a bit more challenging to interpret the Q reports,” Frigast explains. “In the UK, a five-stage PPE includes ridden exams, so you would get Q reports for both straight line, flexions, lunging and ridden trials, which all adds information that can help you determine if an asymmetry/lameness is significant.”

Additionally, insurance companies in the UK will exclude [not insure] any Equinosis Q findings mentioned on the PPE report even if reported as an asymmetry and not a lameness. “I always make this clear to the client before using the Q as it is more likely to pick up an asymmetry than the naked eye. I haven’t had to include the Q reports for PPEs or insurance claims, and insurance companies seems to acknowledge the Q as a diagnostic tool.” Frigast says that she has heard of a few European insurance companies wanting an explanation of what the Equinosis Q is before agreeing to pay for its use.

Because of this, Frigast doesn’t feel that the Equinosis Q should be used in every PPE she performs. “A degree of asymmetry will have to be accepted without exclusions being made” before she can recommend the device be used more often, she explains.

Equinosis Q in a PPE? No Way

Dr. Fernando Cardenas owns and operates the 3H Equine Hospital and Mobile Veterinary Services in New Hill, NC, on the outskirts of Raleigh. He is familiar with the Equinosis Q and uses it every day in his sports medicine and rehab-focused clinic. “We find our clients love it,” he says. He finds the tool extremely useful for horses that are injured, allowing the team of vets to gauge objectively how the horse is progressing through his rehabilitation.

It took a while for him to get his clients – and his dad, Fernando Cardenas Sr., a famed trainer and breeder, and former international dressage competitor – on board with the system. “New anything can be tough,” Cardenas says. “When I told my dad of the technology, he did not embrace it. But the data the Equinosis Q gives is irrefutable,” he says.

Though Cardenas appreciates everything the Equinosis Q can do, he will not use it in PPEs. “My own horse is a great example,” he explains. Quincy Car, a showjumper that competed in the 2018 FEI World Equestrian Games in Tryon, NC, always shows up with a left hind lameness on the Equinosis Q. But he’s not clinically lame,” Cardenas explains. “He’s not lame to the rider or the trainer and his performance is great. Some horses are simply naturally crooked, which shows up as an asymmetric gait.”

“Beginner buyers lock on to that [idea of asymmetry] and you have to record the clinical impression on that leg, though the horse may never have had an observable lameness on that leg,” he says. “PPEs are already difficult; they can be frustrating for buyers, sellers and veterinarians as is. Adding in [the Equinosis Q] can really complicate things.”

Q Inventor Kevin Keegan’s Take

“There are many causes of the clinical sign of lameness: some bad, some not so bad, some completely incidental,” says Dr. Kevin Keegan, Professor of Veterinary Medicine and Surgery at the University of Missouri and part of the team who invented the Equinosis Q. “This is when and where one’s continuing education, clinical experience and judgment are vital. Regular use of the equipment in lameness evaluations will increase confidence in handling these situations”.

“I am aware that there are instances when use of the equipment may make the [pre-purchase] evaluation more difficult, but I think they are outweighed by those where the equipment reinforces my subjective opinion, supplying a veterinarian with evidence to support their clinical impression. In most cases, the information is helpful rather than detrimental to the process,” he continues.

“Here is the bottom line for me: I want to know everything I can to give the buyer the best advice and service. In this respect, I would not shun any information potentially relevant to the evaluation. I am confident that I will be able to clearly express my interpretation of the importance of any abnormality, whether it be lameness evidence from the Lameness Locator or radiographic evidence. It is more likely for a veterinarian to be looked at unfavorably (and possibly sued) concerning a pre-purchase evaluation because something was missed and not because something was found and interpreted to be unimportant,” he concludes.

A Note on Equinosis Q Reporting

It’s important to keep in mind that some asymmetries the Equinosis Q measures may not be due to pain; the asymmetries could be coming from how the horse jogs in hand, surface variations, the horse’s abnormal conformation or neurologic issues. It is the veterinarian’s responsibility to communicate this to the client who has requested the PPE.

Some vets record Equinosis Q findings in their reports in ways that indicate that the system measured something the vet did not see or associate with any clinical significance. It might be noted in a way that states the Equinosis Q measured a lameness that the vet is unable to subjectively observe and therefore presents unknown risk. Options to investigate the finding can be offered and should be noted in the report whether they were accepted or declined.


Why Doctors Reject Tools That Make Their Jobs Easier

From the thermometer’s invention onward, physicians have feared—incorrectly—that new technology would make their jobs obsolete.


I want to tell you about a brouhaha in my field over a “new” medical discipline three hundred years ago. Half my fellow doctors thought it weighed them down and wanted nothing to do with it. The other half celebrated it as a means for medicine to finally become modern, objective and scientific. The discipline was thermometry, and its controversial tool a glass tube used to measure body temperature called a thermometer.

This all began in 1717, when Daniel Fahrenheit moved to Amsterdam and offered his newest temperature sensor to the Dutch physician Herman Boerhaave.* Boerhaave tried it out and liked it. He proposed using measurements with this device to guide diagnosis and therapy.

Boerhaave’s innovation was not embraced. Doctors were all for detecting fevers to guide diagnosis and treatment, but their determination of whether fever was present was qualitative. “There is, for example, that acrid, irritating quality of feverish heat,” the French physician Jean Charles Grimaud said as he scorned the thermometer’s reducing his observations down to numbers. “These [numerical] differences are the least important in practice.”

Grimaud captured the prevailing view of the time when he argued that the physician’s touch captured information richer than any tool, and for over a hundred years doctors were loath to use the glass tube. Researchers among them, however, persevered. They wanted to discover reproducible laws in medicine, and the verbal descriptions from doctors were not getting them there. Words were idiosyncratic; they varied from doctor to doctor and even for the same doctor from day to day. Numbers never wavered.

In 1851 at the Leipzig university hospital in Germany, Carl Reinhold Wunderlich started recording temperatures of his patients. 100,000 cases and several million readings later, he published the landmark work “On the Temperature in Diseases: a manual of medical thermometry.” His text established an average body temperature of 37 degrees, the variation from this mean which could be considered normal, and the cutoff of 38 degrees as a bona fide fever.

Using a thermometer had previously suggested incompetence in a doctor. By 1886, not using one did. “The information obtained by merely placing the hand on the body of the patient is inaccurate and unreliable,” remarked the American physician Austin Flint. “If it be desirable to count the pulse and not trust to the judgment to estimate the number of beats per minute, it is far more desirable to ascertain the animal heat by means of a heat measurer.”

Evidence that temperature signaled disease made patient expectations change too. After listening to the doctor’s exam and evaluations, a patient in England asked, “Doctor, you didn’t try the little glass thing that goes in the mouth? Mrs Mc__ told me that you would put a little glass thing in her mouth and that would tell just where the disease was…”

Thermometry was part of a seismic shift in the nineteenth century, along with blood tests, microscopy, and eventually the x-ray, to what we now know as modern medicine. From impressionistic illnesses that went unnamed and thus had no systematized treatment or cure, modern medicine identified culprit bacteria, trialed antibiotics and other drugs, and targeted diseased organs or even specific parts of organs.

Imagine being a doctor at this watershed moment, trained in an old model and staring a new one in the face. Your patients ask for blood tests and measurements, not for you to feel their skin. Would you use all the new technology even if you didn’t understand it? Would you continue feeling skin, or let the old ways fall to the wayside? And would it trouble you, as the blood tests were drawn and temperatures taken by the nurse, that these tools didn’t need you to report their results. That if those results dictated future tests and prescriptions, doctors may as well be replaced completely?

The original thermometers were a foot long, available only in academic hospitals, and took twenty minutes to get a reading. How wonderful that now they are cheap and ubiquitous, and that pretty much anyone can use one. It’s hard to imagine a medical technology whose diffusion has been more successful. Even so, the thermometer’s takeover has hardly done away with our use for doctors. If we have a fever, we want a doctor to tell us what to do about it, and if we don’t have a fever but feel lousy, we want a doctor anyway, to figure out what’s wrong.

Still, the same debate about technology replacing doctors’ rages on. Today patients want not just the doctor’s opinion, but everything from their microbiome array and MRI to tests for their testosterone and B12 levels. Some doctors celebrate this millimeter and microliter resolution inside patients’ bodies. They proudly brandish their arsenal of tests and say technology has made medicine the best it’s ever been.

The other camp thinks Grimaud was on to something. They resent all these tests because they miss things that listening to and touching the patient would catch. They insist there is more to health and disease than what quantitative testing shows and try to limit the tests that are ordered. But even if a practiced touch detects things tools miss, it is hard to deny that tools also detect things we would miss that we don’t want to.

Modern CT scans, for example, perform better than even the best surgeons’ palpation of a painful abdomen in detecting appendicitis. As CT scans become cheaper, faster, and dose less radiation, they will become even more accurate. The same will happen with genome sequences and other up-and-coming tests that detect what overwhelms our human senses. There is no hope trying to rein in their ascent, nor is it right to. Medicine is better off with them around.

We are told the machines’ autopilot outperforms us so we sit quietly and get weaker, yawning and complacent like a mangy tiger in captivity. We wish we could do as Grimaud said: “distinguishing in feverish heat qualities that may be perceived only by a highly practiced touch, and which elude whatever means physics may offer.”

A children’s hospital in Philadelphia tried just that. Children often have fevers, as anyone who has had children around them well knows. Usually, they have a simple cold and there’s not much to fuss about. But about once in a thousand cases, feverish kids have deadly infections and need antibiotics, ICU care, all that modern medicine can muster.

An experienced doctor’s judgment picks the one in a thousand very sick child about three quarters of the time. To try to capture the remainder of these children being missed, hospitals started using quantitative algorithms from their electronic health records to choose which fevers were dangerous based on hard facts alone. And indeed, the computers did better catching the serious infections nine times out of ten, albeit also with ten times the false alarms.

The Philadelphia hospital accepted the computer-based list of worrisome fevers, but then deployed their best doctors and nurses to apply Grimaud’s “highly practiced touch” and look over the children before declaring the infection was deadly and bringing them into the hospital for intravenous medications. Their teams were able to weed out the algorithm’s false alarms with high accuracy, and in addition find cases the computer missed, bringing their detection rate of deadly infections from 86.2 percent by the algorithm alone, to 99.4 percent by the algorithm in combination with human perception.

Too many doctors have resigned that they have nothing to add in a world of advanced technology. They thoughtlessly order tests and thoughtlessly obey the results. When, inevitably, the tests give unsatisfying answers they shrug their shoulders. I wish more of them knew about the Philadelphia pediatricians, whose close human attention caught mistakes a purely numerical rules-driven system would miss.

It’s true that a doctor’s eyes and hands are slower, less precise, and more biased than modern machines and algorithms. But these technologies can count only what they have been programmed to count: human perception is not so constrained.

Our distractible, rebellious, infinitely curious eyes and hands decide moment-by-moment what deserves attention. While this leeway can lead us astray, with the best of training and judgment, it can also lead us to the as of yet undiscovered phenomena that no existing technology knows to look for. My profession and other increasingly automated fields would do better to focus on finding new answers than on fettering old algorithms.



Gina Siddiqui is an emergency room physician at Elmhurst Hospital in Queens, NY and a health systems delivery entrepreneur. She lives with her husband and son in Philadelphia, PA.


Why Doctors Reject Tools That Make Their Jobs Easier

Author: Gina Siddiqui

Publication: Scientific American

Publisher: SCIENTIFIC AMERICAN, a Division of Springer Nature America, Inc.

Date: Oct 15, 2018

Copyright © 2018, Scientific American, Inc.

Sensing Serious Injury: What Can Motion Detection Devices Tell Us About Horse Health?

Researchers update progress and new findings at the 5th Annual Tex Cauthen Memorial Seminar.

By Sara E. Coleman

Increased attention has been given to racehorse welfare in recent years, with key players working diligently to determine the best ways to keep these athletes safe and sound. Held virtually, the fifth annual Tex Cauthen Memorial Seminar brought farriers, veterinarians and researchers together to discuss racetrack safety and the use of motion-sensor technologies to monitor racehorse health, among a variety of other equine issues.

It has become increasingly evident that serious injuries and catastrophic breakdowns of racehorses do not appear from nowhere; it is now thought that these injuries are the result of minor physical issues that go unnoticed. It’s important to note that as horses are prey animals, any lameness or injury puts their survival at risk. Because of this, most horses will hide lameness and injury, potentially compensating on other limbs. 

Gathering Data

Until recently, the gold standard for equine lameness evaluations on racetracks was the completion of a subjective exam. Though many vets can notice overt lameness, small changes in equine gait may be imperceptible to the human eye. The morning session of the Tex Cauthen seminar focused on how data from advanced diagnostics like the Lameness Locator can provide data to help recognize lameness in racehorses and prevent more-serious injuries.

Dr. Abigail Haffner presented an overview of a pilot study that used body-mounted inertial sensors to monitor 73 racing and training Thoroughbreds at Thistledown Racino near Cleveland, Ohio, and Mahoning Valley Race Course in Youngstown, Ohio. The 16-week study sought to identify trends in Lameness Locator measurements over time that may indicate a horse was at risk of injury. The study was initiated by Drs. Clara Fenger and Brad Brown, and funded by the Equine Health and Welfare Association, and the Indiana and Ohio Horsemen’s Benevolent and Protective Associations. Haffner collected data alongside Dr. Margaret Smyth of Shell Equine, based in Chagrin Falls, Ohio. 

One aim of the study was to determine if horses display a gait signature–a pattern of asymmetry that is consistent overtime–and if deviations from this gait signature may be an early indication of musculoskeletal pathology. Information garnered from the study will help the research team see how stable the gait signature is from week to week, as well as determine the optimal frequency of inertial sensor exams to identify changes. 

For the study, researchers placed Lameness Locator sensors on the horse’s right front pastern, pelvis and head, and trotted the horse in-hand on a straight line for approximately 25 strides. Two trials were obtained for each exam to confirm consistency of the results. The horses were subjectively evaluated by Drs. Haffner and Smyth at the same time. Dr. Haffner estimated each evaluation from sensor application to data collection to returning to stall was approximately 3 to 4 minutes. 

Most horses were given Lameness Locator exams weekly or every other week; 59 horses were evaluated at least five times and 41 horses were evaluated at least 10 times. Though evaluation of the information gleaned is ongoing, many horses involved in the study were found to be lame, but no breakdowns occurred.

Interpreting the Information 

Dr. Kevin Keegan was the next panelist to present during the morning session and he deciphered some of the initial information gathered from the study for attendees. Keegan acknowledged that racehorse injuries are a complex, multifaceted problem. “We don’t really know if lameness is a substitute measure or proxy for a pre-existing injury or if lameness is itself a mediator or direct cause of injury,” he said. If lameness is associated with catastrophic injury, the body-mounted inertial sensors of the Lameness Locator can detect it—possibly preventing future injuries. 

Keegan notes that lameness is a clinical sign and not a disease. Keegan stressed that the sensors provide data, but no context with which to interpret the data—that onus is on the veterinarian. The data reported by the Lameness Locator is shown in both numerical and graph forms for veterinarians to interpret. Keegan emphasizes the importance of collecting multiple strides in a row, as was done in the study. By collecting many contiguous strides, the veterinarian can look for a central tendency. 

Establishing Thresholds for Change in Thoroughbreds 

Dr. Keegan compared some early analysis of the Ohio study data to a previous study using inertial sensors conducted in Thoroughbred racehorses in training.* “Our 90 percent weekly median absolute differences were actually tighter than [the other study], 13.2 mm for Diff Min head and 12.4 mm for Diff Max head which is an equivalent Vector Sum of 17.3 mm; and 5.3mm for Diff Min pelvis and 7.5 mm for Diff Max pelvis. This means that 90 percent of the weekly differences were below this value,” he noted (fig. 1). He further explained, “Despite the fact that the range in this study included horses that we know did become lame, this might be a place to start if we were looking at trying to find some reasonable range as a threshold for change that requires that a horse be more closely scrutinized.”

Dr. Keegan shared some of the longitudinal data collected to date, plotting each horse’s weekly measurements for forelimb lameness (using head Vector Sum), hindlimb impact and pushoff lameness (using Diff Min Pelvis and Diff Max Pelvis respectively). “Looking at the data like this, you can quickly pick out the horses and times when a horse measured with lameness way outside the pack,” Dr. Keegan says. He shared a few examples of horses with gradually increasing lameness or a sudden change from their usual measurements.

[It is] interesting to look at the progression, or lack of progression, of lameness over time in individual horses. Some patterns of lameness measurement over time may be hints that a horse should be more closely scrutinized for potential pre-existing injury,” Dr. Keegan said. One particularly intriguing example was a horse that sometimes measured with a mild left hindlimb pushoff lameness and sometimes measured with a mild right hindlimb pushoff lameness (fig. 2). Dr. Keegan opined, “This horse might have a bilateral hindlimb lameness that may be confusing to detect subjectively over time.” He added, “It was pointed out retrospectively that a similar pattern of shifting mild hindlimb lameness was reported for Mongolian Groom.”

While it is currently unknown why certain horses exited the Ohio study, Dr. Keegan did point out one horse that suddenly measured with a left hind limb lameness and then dropped out of the study. Reviewing race records, the horse raced the day prior and its Equibase speed factor had dropped 36 points. “We are still trying to accumulate historical information about potential injuries that may have caused [a] horse to stop racing or training, how well the horse is currently racing, etc., to see if we can identify any signature lameness measurement patterns to scrutinize.” 

Considerations for Implementation at Racetracks

Dr. Keegan closed with some additional insight on using lameness measurement to monitor racing and training Thoroughbreds. 

Race day may not be the most ideal time for a Lameness Locator exam, Keegan says. Anxiety can mask lameness as the horse becomes more difficult to handle.

“The best time to evaluate a racehorse is a day after or a few days after a race,” Keegan says.

“…this allows for the creation of objective data.”

He also suggested that it may be more relevant and easier to evaluate horses under saddle, jogging on the track. He cited the weight of the jockey to bring out lameness, the ability to better control the horse, and the ease of obtaining many strides are all advantages of evaluating the horse under saddle. He noted, “Now we can determine the side of lameness [in straight line trials] using pelvic rotation.” This would eliminate the need for a right front sensor, further simplifying lameness measurement at the track.

Keegan concluded that using body-mounted inertial sensors to measure lameness is not difficult, reduces doubt and difference of opinion, and that objective data from large numbers of horses can be collected, saved and studied. “The question on [whether] measuring lameness can help minimize the incidence of catastrophic racing injury is not answered, because I do not think we really know what the association between lameness and injury is.  But if they are associated, I am convinced that measuring and studying lameness with body-mounted inertial sensors is the way to go.”

Use of Lameness Locator Abroad

The next presenter at the virtual seminar was Dr. Bronte Forbes, a veterinarian with the Singapore Turf Club. Forbes spoke on his experience with the use of the Lameness Locator on Thoroughbred racehorses and its value in screening racehorses for soundness.

“I look at this as a ladder,” Forbes explains. “I want to get this technology on board so we can contribute to the overall situation [of increasing the possibility of racing sound Thoroughbreds]. The use of this technology could alert owners and trainers that something has changed or gone wrong [with the horse’s soundness] before a more-serious injury occurs.”

Forbes agrees with Keegan that a consensus must be reached on how lame is too lame to race. He questions if each racing jurisdiction will need its own local threshold of lameness or if racing as a whole should look at a more-global threshold that should be classified as “lame.”

“We must work together and share knowledge,” Forbes stresses. “I appreciate what regulatory vets do and see, but by adding this tool, the horse will benefit. If we put the horse first, a lot of problems will go away.” Buy-in from trainers, owners, clinicians and regulators is essential if the Lameness Locator is to be used as a regulatory tool.

Trainers in Singapore trust the technology of the body-mounted sensors, Forbes explained, and some trainers will ask specifically for the modality to be used. “This technology is often used for nerve blocking and in difficult lameness,” he reported. However, he noted, the vets in Singapore did receive push back if the horses were required to have a Lameness Locator exam done every day.

Forbes recommended that veterinarians and those involved in racehorse care continue to develop quality, evidence-based assessments of equine gait symmetry and what this means in relation to lameness. He also suggested that work be ongoing to help vets understand what information the Lameness Locator collects and how it can be extrapolated. 

He concluded that the education of vets, trainers, owners and racing management benefits the industry by increasing objectivity. “Removing bias from decision making [as to if a horse is lame] is important for improving the integrity of the process,” Forbes said.


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