Expert visual assessment strategies for equine lameness examinations in a straight line and circle: A mixed methods study using eye tracking.

BACKGROUND: A large number of lameness indicators have been suggested for the visual equine lameness assessment. However, it remains unknown which of these are commonly used by experts. METHODS: Twenty-four expert lameness assessors from 10 leading UK institutions viewed 28 video clips of sound and mildly lame horses (median score 2/10). Horses were shown at trot in a straight line (rear and front view) and circle (side view, left and right rein). Eye tracking data were collected at 60 Hz while participants evaluated each clip. A questionnaire captured contextual information. RESULTS: During assessment on the straight line, participants consistently looked mostly at the head and pelvis. On the circle, many participants consistently looked at the head, yet the subsequent choice, weighting and order of examined body regions was unsystematic between and within participants, and there was a bias towards prolonged assessment of the horse's front region. Questionnaires revealed different descriptions of lameness indicators for the same body region and different approaches to decision making under uncertainty. CONCLUSION: In contrast to reasonably high similarity on the straight line, expert veterinarians have not developed a consistent assessment approach when evaluating horses on the circle. The reliability of various lameness indicators on the circle requires a stronger evidence base for a more systematic, repeatable approach.

Robustness of five different visual assessment methods for the evaluation of hindlimb lameness based on tubera coxarum movement in horses at the trot on a straight line.

BACKGROUND: The evaluation of hindlimb lameness remains a major challenge in everyday clinical practice. In the absence of clear guidelines, veterinarians use different visual assessment methods for this task whose robustness is unknown. OBJECTIVES: Determination of the robustness of five visual hindlimb lameness assessment methods based on the comparison of left and right tuber coxae movement. STUDY DESIGN: Validated mathematical hindlimb lameness model based on experimental data from the literature. METHODS: Vertical movement of left (LTC) and right (RTC) tuber coxae was simulated for the range of common hindlimb lameness movement patterns that horses present within practice. Lameness severity ranged from sound to moderately lame (0% to 60% motion asymmetry). The scenarios of a pelvis held tilted and asymmetrical pelvic roll were included to reflect possible adaptations in pelvic rotation. Across all conditions, the outcomes for five different visual assessment methods based on comparative tubera coxarum movement were quantified, including hip hike, -drop and range of motion. The robustness of each assessment method was established through comparison to sacrum-based overall motion asymmetry as the ground truth. RESULTS: Tubera coxarum-based lameness assessment was highly sensitive to all the unique lameness patterns and changes in pelvic rotation which a lame horse may adopt. None of the five visual lameness assessment methods was 100% robust across all conditions tested. For everyday clinical practice, comparing the upward movement amplitude of the RTC before right hind foot contact and of the LTC before left hind foot contact (Hip_hike_diff) would be the most robust single tubera coxarum-based visual assessment method. MAIN LIMITATIONS: In the absence of published data regarding the frequency of different movement patterns and hip rotation adaptations in clinical practice, this study cannot indicate the proportion of assessments that would be incorrect for a given visual assessment method. CONCLUSIONS: Using a single tubera coxarum-based visual hindlimb lameness assessment method may lead to incorrect clinical judgement. Therefore, using multiple assessment methods would be beneficial to substantiate impressions.

Effect of gamified perceptual learning on visual detection and discrimination skills in equine gait assessment.

BACKGROUND: Visual assessment of equine lameness is an everyday veterinary task suffering from poor diagnostic accuracy. The aim of this study was to quantify the impact of the perceptual learning game 'LamenessTrainer' on skill development. METHODS: Thirty-six undergraduate veterinary students engaged in four game modules teaching the assessment of fore- and hindlimb lameness. Computer animations of horses in this game displayed 0% (sound) to 70% (moderately lame) vertical movement asymmetry of head and pelvis. Performance, learning effects, diagnostic accuracy, detection thresholds and survey responses were analysed. RESULTS: Following staircase learning, more than 80% of students reliably classified horses with ≥20% asymmetry for forelimb lameness, ≥40% asymmetry for simplified hindlimb lameness and ≥50% asymmetry for realistic hindlimb lameness. During random presentation, on average 82% of sound and 65% of lame horses were assessed correctly during forelimb lameness evaluation, dropping to 39% of sound and 56% of lame horses for hindlimb lameness. CONCLUSION: In less than two hours, systematic perceptual learning through deliberate practice can develop visual assessment skills to an accuracy level comparable to expert assessors scoring the same animations. Skills should be developed further to improve misclassifications of sound and mildly lame horses, especially for hindlimb lameness evaluation.

Design considerations for the ideal low vision aid: insights from de-brief interviews following a real-world recording study.

PURPOSE: Low Vision Aids (LVAs) can have a transformative impact on people living with sight loss, yet the everyday requirements for developing such devices remain poorly understood and defined. This study systematically explored LVA requirements through a structured de-brief interview following a real-world self-recording study. The purpose of this work was to define the actual needs of those living with sight loss so that low vision services can better address them in future. METHODS: Thirty-two visually impaired volunteers with varying levels of previous LVA experience participated in a de-brief interview centred around a structured questionnaire. The de-brief followed a one-week real-world study during which participants used recoding spectacles to capture and narrate all situations in which they would use a 'perfect sight aid'. Content and thematic analyses were used to analyse interviews which had the purpose of contextualising these recordings and exploring requirements around psychological, functional and design factors. RESULTS: Participants reported that 46% of tasks which they had recorded were most important to them. Of these tasks, 82% were encountered frequently. Few tasks emerged as very important across many participants, the remaining tasks reflecting individual lifestyles or circumstances. Every participant used at least one LVA in their everyday life and 72% identified further coping strategies. Current LVAs identified as consistently poor were distance LVAs, with all other devices receiving mixed or only positive feedback. Around two-thirds of participants would prefer LVA use on an ad-hoc / quick access basis rather than over long periods of time, and just over half would prefer to carry it rather than wearing it all day. Lack of consistency in these responses illustrated potentially different user clusters with divergent design needs. Two-thirds of participants emphasised the desire for a discreet LVA that does not attract attention. However, since half of all participants felt self-conscious in public or in front of other people when wearing the small recording spectacles, this may not be technically achievable. CONCLUSIONS: There is a substantial opportunity for new LVAs to address visual needs that traditional devices and coping strategies cannot support. Functional, psychological and design factors require careful consideration for future LVAs to be relevant and widely adopted.

Everyday visual demands of people with low vision: A mixed methods real-life recording study.

Research has demonstrated that low vison aids (LVAs) can have a positive impact on the functional sight of those living with sight loss. Step changes in technology are now enabling new wearable LVAs with greater potential than those available previously. For these novel devices to receive increased acceptance and therefore adoption by those with sight loss, visual task demands have to be understood more clearly in order to enable better alignment between device design and user requirements. The aim of this study was to quantify these requirements. Thirty-two participants aged 18 to 87 wore a spectacle-mounted video camera to capture and narrate all everyday situations in which they would use a "perfect" sight aid during 1 week. Captured scenes were analyzed through categorization and computational image analysis. Results showed large variation in activities and lifestyles. Participants reported no available sight aid or coping strategy for 57% of the recorded activities. Reading made up 49% of all recorded tasks, the other half comprising non-textual information. Overall, 75% of captured activities were performed ad hoc (duration of 0-5 minutes), 78% occurred indoors, 58% occurred at home, 48% were lit by natural light, 68% included the object of interest within reach, and 69% required a single focus plane only. Around half of captured objects of interest had a size of 2 degrees visual angle (2.08 logarithm of the minimum angle of resolution [logMAR]) or smaller. This study highlights the need for a sight aid that can make both textual and non-textual scenes accessible while offering flexibility to accommodate individual lifestyles.

Benefit of an electronic head-mounted low vision aid.

PURPOSE: To evaluate the efficacy of electronic head-mounted low vision aid (e-LVA) SightPlus (GiveVision, UK, givevision.net) and to determine which people with low vision would see themselves likely using an e-LVA like this. METHODS: Sixty participants with low vision aged 18 to 93 used SightPlus during an in-clinic study session based on a mixed methods design. Visual acuity (ETDRS), contrast sensitivity (Pelli-Robson) and reading performance (MNREAD) were measured binocularly at baseline (no device), with the device in 'normal' mode (zoom only), and with preferred enhanced mode (zoom and one of four digital image enhancements). At the end of the session, a short questionnaire recorded willingness to use an e-LVA like SightPlus, potential use cases, positive/negative comments and adverse effects. RESULTS: Binocular distance visual acuity improved significantly by 0.63 logMAR on average (p < 0.0001) to 0.20 logMAR. Contrast sensitivity improved significantly by 0.22 log units (p < 0.0001) to 1.21 log units with zoom only and by 0.40 log units to 1.37 log units with zoom and preferred image enhancement. Reading performance improved significantly for near visual acuity and critical print size (p < 0.015), although reading speed significantly decreased (p < 0.0001). Nearly half (47%) of the participants indicated they would use an e-LVA like SightPlus, especially for television, reading and entertainment (e.g. theatre). Multivariate logistic regression showed that proportion of lifetime affected by sight loss, baseline contrast sensitivity and use of electronic LVAs explained 41% of the variation in willingness to use. CONCLUSIONS: SightPlus improves visual function in people with low vision and would be used in its current form by one half of the people who tried it. Adverse effects were infrequent and resolved when the device was removed. Future work should focus on comparing e-LVAs through repeatable real-world tasks and impact on quality of life.

The effect of four user interface concepts on visual scan pattern similarity and information foraging in a complex decision making task.

User interface (UI) design can affect the quality of decision making, where decisions based on digitally presented content are commonly informed by visually sampling information through eye movements. Analysis of the resulting scan patterns - the order in which people visually attend to different regions of interest (ROIs) - gives an insight into information foraging strategies. In this study, we quantified scan pattern characteristics for participants engaging with conceptually different user interface designs. Four interfaces were modified along two dimensions relating to effort in accessing information: data presentation (either alpha-numerical data or colour blocks), and information access time (all information sources readily available or sequential revealing of information required). The aim of the study was to investigate whether a) people develop repeatable scan patterns and b) different UI concepts affect information foraging and task performance. Thirty-two participants (eight for each UI concept) were given the task to correctly classify 100 credit card transactions as normal or fraudulent based on nine transaction attributes. Attributes varied in their usefulness of predicting the correct outcome. Conventional and more recent (network analysis- and bioinformatics-based) eye tracking metrics were used to quantify visual search. Empirical findings were evaluated in context of random data and possible accuracy for theoretical decision making strategies. Results showed short repeating sequence fragments within longer scan patterns across participants and conditions, comprising a systematic and a random search component. The UI design concept showing alpha-numerical data in full view resulted in most complete data foraging, while the design concept showing colour blocks in full view resulted in the fastest task completion time. Decision accuracy was not significantly affected by UI design. Theoretical calculations showed that the difference in achievable accuracy between very complex and simple decision making strategies was small. We conclude that goal-directed search of familiar information results in repeatable scan pattern fragments (often corresponding to information sources considered particularly important), but no repeatable complete scan pattern. The underlying concept of the UI affects how visual search is performed, and a decision making strategy develops. This should be taken in consideration when designing for applied domains.

Veterinary student competence in equine lameness recognition and assessment: a mixed methods study.

The development of perceptual skills is an important aspect of veterinary education. The authors investigated veterinary student competency in lameness evaluation at two stages, before (third year) and during (fourth/fifth year) clinical rotations. Students evaluated horses in videos, where horses were presented during trot on a straight line and in circles. Eye-tracking data were recorded during assessment on the straight line to follow student gaze. On completing the task, students filled in a structured questionnaire. Results showed that the experienced students outperformed inexperienced students, although even experienced students may classify one in four horses incorrectly. Mistakes largely arose from classifying an incorrect limb as lame. The correct detection of sound horses was at chance level. While the experienced student cohort primarily looked at upper body movement (head and sacrum) during lameness assessment, the inexperienced cohort focused on limb movement. Student self-assessment of performance was realistic, and task difficulty was most commonly rated between 3 and 4 out of 5. The inexperienced students named a considerably greater number of visual lameness features than the experienced students. Future dedicated training based on the findings presented here may help students to develop more reliable lameness assessment skills.

Workflows and individual differences during visually guided routine tasks in a road traffic management control room.

Road traffic control rooms rely on human operators to monitor and interact with information presented on multiple displays. Past studies have found inconsistent use of available visual information sources in such settings across different domains. In this study, we aimed to broaden the understanding of observer behaviour in control rooms by analysing a case study in road traffic control. We conducted a field study in a live road traffic control room where five operators responded to incidents while wearing a mobile eye tracker. Using qualitative and quantitative approaches, we investigated the operators' workflow using ergonomics methods and quantified visual information sampling. We found that individuals showed differing preferences for viewing modalities and weighting of task components, with a strong coupling between eye and head movement. For the quantitative analysis of the eye tracking data, we propose a number of metrics which may prove useful to compare visual sampling behaviour across domains in future.

A universal approach to determine footfall timings from kinematics of a single foot marker in hoofed animals.

The study of animal movement commonly requires the segmentation of continuous data streams into individual strides. The use of forceplates and foot-mounted accelerometers readily allows the detection of the foot-on and foot-off events that define a stride. However, when relying on optical methods such as motion capture, there is lack of validated robust, universally applicable stride event detection methods. To date, no method has been validated for movement on a circle, while algorithms are commonly specific to front/hind limbs or gait. In this study, we aimed to develop and validate kinematic stride segmentation methods applicable to movement on straight line and circle at walk and trot, which exclusively rely on a single, dorsal hoof marker. The advantage of such marker placement is the robustness to marker loss and occlusion. Eight horses walked and trotted on a straight line and in a circle over an array of multiple forceplates. Kinetic events were detected based on the vertical force profile and used as the reference values. Kinematic events were detected based on displacement, velocity or acceleration signals of the dorsal hoof marker depending on the algorithm using (i) defined thresholds associated with derived movement signals and (ii) specific events in the derived movement signals. Method comparison was performed by calculating limits of agreement, accuracy, between-horse precision and within-horse precision based on differences between kinetic and kinematic event. In addition, we examined the effect of force thresholds ranging from 50 to 150 N on the timings of kinetic events. The two approaches resulted in very good and comparable performance: of the 3,074 processed footfall events, 95% of individual foot on and foot off events differed by no more than 26 ms from the kinetic event, with average accuracy between -11 and 10 ms and average within- and between horse precision ≤8 ms. While the event-based method may be less likely to suffer from scaling effects, on soft ground the threshold-based method may prove more valuable. While we found that use of velocity thresholds for foot on detection results in biased event estimates for the foot on the inside of the circle at trot, adjusting thresholds for this condition negated the effect. For the final four algorithms, we found no noteworthy bias between conditions or between front- and hind-foot timings. Different force thresholds in the range of 50 to 150 N had the greatest systematic effect on foot-off estimates in the hind limbs (up to on average 16 ms per condition), being greater than the effect on foot-on estimates or foot-off estimates in the forelimbs (up to on average ±7 ms per condition).

Estimation of vertical tuber coxae movement in the horse from a single inertial measurement unit.

Pelvic movement is altered in hind limb lame horses. A simple method using one inertial measurement unit (IMU) attached to the sacrum, which objectively measures 'hip hike', will help detecting hind limb lameness in large scale studies. In this study, IMUs over the sacrum and the left and right tuber coxae (TC) quantified vertical movement symmetry (MS) in 10 clinically lame horses. A simple geometrical model was used to estimate TC movement from the sacrum IMU. The differences between measured and estimated MS values (mean±SD) and MS changes during different exercise conditions (straight, circle, flexion) were quantified using established MS parameters to assess the performance of the sacral IMU for estimating TC movement. Mean differences between measured and estimated MS values were variable between horses and ranged from 5 to 30 mm, SD of differences ranged from 7 to 14 mm. However, the difference between measured and estimated change in MS induced by lungeing or flexion test, was lower, with a value <1 mm for one MS measure, which assesses differences between left and right TC movement. Estimating TC movement from sacral movement does not accurately quantify the true state of TC MS since limits of agreement (LoA) overlap the decision boundaries for detecting mild lameness. The LoA of changes in vertical TC movement between exercises compared favourably with the average changes between exercise conditions. While in moderate to severe cases, changes in TC movement may be estimated from a single sensor over the sacrum, in mildly lame horses it should be measured with additional sensors.

The effect of trotting speed on the evaluation of subtle lameness in horses.

Equine lameness is a significant and challenging part of a veterinarian's workload, with subtle lameness inherently difficult to assess. This study investigated the influence of trotting speed on perceived and measured changes in movement asymmetry. Ten sound to mildly lame horses were trotted at a 'slow', 'preferred' and 'fast' speed on a hard surface, both on a straight line and in a circle on left and right reins. Video recordings of the horses were visually assessed by six experienced equine clinicians. Vertical movement of head, withers and pelvis was derived from inertial sensor data and several features calculated. On the straight line, more horses were subjectively declared sound at higher speeds, whilst different objective asymmetry measures showed only slight and inconsistent changes. On the circle, speed had no significant effect on the subjective assessment, with an increase in objectively measured asymmetry at higher speeds possibly balanced by a decrease in sensitivity of the observers for this asymmetry. Horses visually examined for subtle lameness on the straight should therefore be evaluated at a slow speed. Trotting speed should be consistent on repeated occasions, especially during objective gait analysis on the circle, to avoid the interaction of treatment effects and speed effects.

Accuracy and precision of hind limb foot contact timings of horses determined using a pelvis-mounted inertial measurement unit.

Gait analysis using small sensor units is becoming increasingly popular in the clinical context. In order to segment continuous movement from a defined point of the stride cycle, knowledge about footfall timings is essential. We evaluated the accuracy and precision of foot contact timings of a defined limb determined using an inertial sensor mounted on the pelvis of ten horses during walk and trot at different speeds and in different directions. Foot contact was estimated from vertical velocity events occurring before maximum sensor roll towards the contralateral limb. Foot contact timings matched data from a synchronised hoof mounted accelerometer well when velocity minimum was used for walk (mean (SD) difference of 15 (18)ms across horses) and velocity zero-crossing for trot (mean (SD) difference from -4 (14) to 12 (7)ms depending on the condition). The stride segmentation method also remained robust when applied to movement data of hind limb lame horses. In future, this method may find application in segmenting overground sensor data of various species.

Is the true 'wisdom of the crowd' to copy successful individuals?

Diversity of expertise at an individual level can increase intelligence at a collective level-a type of swarm intelligence (SI) popularly known as the 'wisdom of the crowd'. However, this requires independent estimates (rare in the real world owing to the availability of public information) and contradicts people's bias for copying successful individuals. To explain these inconsistencies, 429 people took part in a 'guess the number of sweets' exercise. Guesses made with no public information were diverse, resulting in highly accurate SI. Individuals with access to the previous guess, mean guess or a randomly chosen guess, tended to over-estimate the number of sweets and this undermined SI. However, when people were provided with the current best guess, this prevented very large (inaccurate) guesses, resulting in convergence of guesses towards the true value and accurate SI across a range of group sizes. Thus, contrary to previous work, we show that social influence need not undermine SI, especially where individual decisions are made sequentially and then aggregated. Furthermore, we offer an explanation for why people have a bias to recruit and follow experts in team settings: copying successful individuals can enable accuracy at both the individual and group level, even at small group sizes.

Vertical head and trunk movement adaptations of sound horses trotting in a circle on a hard surface.

Trotting a horse in circles is a standard and important part of the subjective equine lameness examination, yet objective data on this form of locomotion are sparse. The aim of this study was to investigate the effect of trotting in a circle on head and trunk movement symmetry. Vertical movements of the head, withers, os sacrum and left and right tuber coxae were measured using inertial sensors as 12 sound horses were trotted on a hard surface in a straight line and in a circle on both reins. Seven asymmetry measures and hip hike were calculated for each horse for at least nine strides of comparable stride duration across the three conditions (deviation on horse level ≤3.7% stride duration). Trotting in a circle introduced systematic changes to the movement pattern of all five body landmarks, affecting most asymmetry measures. On average the asymmetry magnitude was comparable for midline locations between reins and for the tuber coxae on opposite reins with few exceptions, although individual horses showed unsystematic differences between the two reins. The results from this study showed that the thresholds for objective discrimination between lame and non-lame horses will need adjustment on the circle due to the observed asymmetry bias.

Walk-run classification of symmetrical gaits in the horse: a multidimensional approach.

Walking and running are two mechanisms for minimizing energy expenditure during terrestrial locomotion. Duty factor, dimensionless speed, existence of an aerial phase, percentage recovery (PR) or phase shift of mechanical energy and shape of the vertical ground reaction force profile have been used to discriminate between walking and running. Although these criteria work well for the classification of most quadrupedal gaits, they result in conflicting evidence for some gaits, such as the tölt (a symmetrical, four-beat gait used by Icelandic horses). We use established pattern recognition methods to test the hypothesis that the tölt is a running gait based on an automated and optimized decision drawn from four features (dimensionless speed, duty factor, length of aerial phase and PR for over 6000 strides from four symmetrical gaits in seven Icelandic horses) simultaneously. We compare this decision with the use of each of these features in isolation. Sensitivity and specificity values were used to determine optimal thresholds for classifying tölt strides based on each feature separately. Duty factor and dimensionless speed indicate that tölt is more similar to running, while aerial phase and PR indicate that it is more similar to walking. Then, two multidimensional pattern recognition approaches, multivariate Gaussian densities and linear discriminant analysis, were used and it was shown that, in terms of stochastic multidimensional discrimination, tölt is more similar to 'running'. The approaches presented here have potential to be extended to studies on similar 'ambling' gaits in other quadrupeds.