Based upon the gait, where's the lesion? (Proceedings)


Based upon the gait, where's the lesion? (Proceedings)

Nov 01, 2009

Observation of gait is an important component of the neurological examination but often is under utilized when assessing patients with gait abnormalities, lameness, or changes in posture. Several factors may interfere with the ability of a veterinarian to properly evaluate the gait of a patient, including space constrictions, flooring that makes gait evaluation difficult, absence of an assistant and time constraints.

In order to obtain the most information from observing the gait of a patient a space large enough to allow visualization of the patient from the front, back and side is necessary. At a minimum observation of a pet walking in a straight line, turning and walking off a leash is recommended. Watching an animal navigate steps, curbs and other barriers may provide additional information and may be beneficial to further evaluate gait in patients with more subtle deficits. In a busy veterinary practice finding the space to properly evaluate a patient's gait may not be readily available inside the veterinary hospital itself. If necessary a patient can be taken outside to an area of flat, mowed lawn or a non-crowded, cool parking lot or sidewalk. Patient safety and the ability to properly restrain the pet should be kept in mind at all times during the examination both inside and outside the veterinary hospital.

Observation of gait with the patient off a leash is not recommended outside unless a secure, fenced area is available. If observing a pet inside the hospital a room which can be completely secured is also recommended, such as an examination room or large run. Small pets can be adequately observed in even small examination rooms, but for large and giant breed dogs the room should be large enough to allow the patient to move freely and take more than one or two steps. Examination tables that fold against the wall to open up the examination space are useful to allow larger pets a more open area to walk. Ideally the room should be uncluttered and free of low ledges or furniture that a pet can crawl under. This is especially important when observing the gait of feline and exotic animal species.

Animals need secure, comfortable, familiar footing in order to walk and demonstrate their gait most accurately. Many veterinary hospitals have ceramic tile or other hard, smooth surfaces. While these floors make cleaning easy they do not always provide the best footing for patients with weakness or lameness. There are several options to provide more secure footing for patients to facilitate gait observation. Several textured tile and laminate materials are available, as are several types of rubber flooring options. Rubber mats can also be used to temporarily cover areas of less secure footing during examination of gait.

An assistant is recommended to walk the patient while the veterinarian stands back at a comfortable distance. Many pet owners can assist with walking their pet but surprisingly this task is not always as easy as one might think. Ideally the pet will be walked beside the pet owner and not in front or behind them so as to obscure the view of the observer. A short, non-retractable leash should be used to provide the best control of direction and pace of the pet. Keeping short leashes in each examination keeps them readily available and can be used in lieu of the pet owner's retractable leash if necessary. If a pet owner is physically unable or has difficulty controlling their pet the use of a trained veterinary assistant is recommended. This often provides the best, most consistent way to observe the gait of patients.

Finally, in order to obtain the most out of observing a patient's gait the veterinarian has to make the task a priority and make time to evaluate the gait. Often a patient is on the examination table waiting for the veterinarian when he or she enters the examination room. Taking the pet off the exam table, closing the door and removing the leash allows the veterinarian to observe the pet while a history is obtained. Observation of the gait while on a leash should be one of the first components of the examination once a history is obtained if the primary concern is lameness or weakness.