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      Using the Horse Grimace Scale (HGS) to Assess Pain Associated with Acute Laminitis in Horses ( Equus caballus)

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          Abstract

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          Acute laminitis is a common equine disease characterized by intense foot pain. This work aimed to investigate whether the Horse Grimace Scale (HGS), a facial-expression-based pain coding system, can be usefully applied to assess pain associated with acute laminitis in horses at rest. Ten horses, referred as acute laminitis cases with no prior treatment, were assessed at the admission and at seven days after the initial evaluation and treatment. The authors found that the Horse Grimace Scale is a potentially effective method to assess pain associated with acute laminitis in horses at rest, as horses showing high HGS scores also exhibited higher Obel scores, and veterinarians classified them in a more severe painful state.

          Abstract

          Acute laminitis is a common equine disease characterized by intense foot pain, both acutely and chronically. The Obel grading system is the most widely accepted method for describing the severity of laminitis by equine practitioners, however this method requires movement (walk and trot) of the horse, causing further intense pain. The recently developed Horse Grimace Scale (HGS), a facial-expression-based pain coding system, may offer a more effective means of assessing the pain associated with acute laminitis. The aims of this study were: to investigate whether HGS can be usefully applied to assess pain associated with acute laminitis in horses at rest, and to examine if scoring HGS using videos produced similar results as those obtained from still images. Ten horses, referred as acute laminitis cases with no prior treatment, were included in the study. Each horse was assessed using the Obel and HGS (from images and videos) scales: at the admission (before any treatment) and at seven days after the initial evaluation and treatment. The results of this study suggest that HGS is a potentially effective method to assess pain associated with acute laminitis in horses at rest, as horses showing high HGS scores also exhibited higher Obel scores and veterinarians classified them in a more severe painful state. Furthermore, the inter-observer reliability of the HGS total score was good for both still images and video evaluation. There was no significant difference in HGS total scores between the still images and videos, suggesting that there is a possibility of applying the HGS in clinical practice, by observing the horse for a short time. However, further validation studies are needed prior to applying the HGS in a clinical setting.

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          Practical statistics for medical researched

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            Facial expression of pain: an evolutionary account.

            This paper proposes that human expression of pain in the presence or absence of caregivers, and the detection of pain by observers, arises from evolved propensities. The function of pain is to demand attention and prioritise escape, recovery, and healing; where others can help achieve these goals, effective communication of pain is required. Evidence is reviewed of a distinct and specific facial expression of pain from infancy to old age, consistent across stimuli, and recognizable as pain by observers. Voluntary control over amplitude is incomplete, and observers can better detect pain that the individual attempts to suppress rather than amplify or simulate. In many clinical and experimental settings, the facial expression of pain is incorporated with verbal and nonverbal vocal activity, posture, and movement in an overall category of pain behaviour. This is assumed by clinicians to be under operant control of social contingencies such as sympathy, caregiving, and practical help; thus, strong facial expression is presumed to constitute and attempt to manipulate these contingencies by amplification of the normal expression. Operant formulations support skepticism about the presence or extent of pain, judgments of malingering, and sometimes the withholding of caregiving and help. To the extent that pain expression is influenced by environmental contingencies, however, "amplification" could equally plausibly constitute the release of suppression according to evolved contingent propensities that guide behaviour. Pain has been largely neglected in the evolutionary literature and the literature on expression of emotion, but an evolutionary account can generate improved assessment of pain and reactions to it.
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              Automatic decoding of facial movements reveals deceptive pain expressions.

              In highly social species such as humans, faces have evolved to convey rich information for social interaction, including expressions of emotions and pain [1-3]. Two motor pathways control facial movement [4-7]: a subcortical extrapyramidal motor system drives spontaneous facial expressions of felt emotions, and a cortical pyramidal motor system controls voluntary facial expressions. The pyramidal system enables humans to simulate facial expressions of emotions not actually experienced. Their simulation is so successful that they can deceive most observers [8-11]. However, machine vision may be able to distinguish deceptive facial signals from genuine facial signals by identifying the subtle differences between pyramidally and extrapyramidally driven movements. Here, we show that human observers could not discriminate real expressions of pain from faked expressions of pain better than chance, and after training human observers, we improved accuracy to a modest 55%. However, a computer vision system that automatically measures facial movements and performs pattern recognition on those movements attained 85% accuracy. The machine system's superiority is attributable to its ability to differentiate the dynamics of genuine expressions from faked expressions. Thus, by revealing the dynamics of facial action through machine vision systems, our approach has the potential to elucidate behavioral fingerprints of neural control systems involved in emotional signaling.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Animals (Basel)
                Animals (Basel)
                animals
                Animals : an Open Access Journal from MDPI
                MDPI
                2076-2615
                03 August 2016
                August 2016
                : 6
                : 8
                : 47
                Affiliations
                [1 ]Department of Veterinary Medicine, University of Milan, Milan 20122, Italy; francesca.dai@ 123456unimi.it (F.D.); michela.minero@ 123456unimi.it (M.M.)
                [2 ]Havelland Equine Clinic, Beetzsee 14778, Germany; diana.stucke@ 123456pferdeklinik-havelland.de (D.S.); lebelt@ 123456pferdeklinik-havelland.de (D.L.)
                [3 ]School of Agriculture, Food & Rural Development, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK; Matthew.Leach@ 123456newcastle.ac.uk
                Author notes
                [* ]Correspondence: emanuela.dallacosta@ 123456unimi.it ; Tel.: +39-0250318033
                Article
                animals-06-00047
                10.3390/ani6080047
                4997272
                27527224
                be434f50-2ad3-445a-abf8-1641edf714d8
                © 2016 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 27 June 2016
                : 01 August 2016
                Categories
                Article

                horse,acute laminitis,obel,horse grimace scale,pain assessment

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