HEAD SHAKING QUESTIONNAIRE

PLEASE COPY AND PASTE THIS QUESTIONNAIRE . ANSWERS MAY BE SHORT OR DETAILED. E-MAIL RESPONSE TO   ahernvet@hotmail.com

DATE       [                     ]


                                 HEAD SHAKING QUESTIONNAIRE


Your Name and contact details.         [               ]


Name of horse    [                      ]


Age of horse        [         ]


Sex         [          ]


Breed         [           ]


Discipline           [         ]


Age at onset of head shaking    [              ]


Year of onset               [              ]


Seasonal ( spring summer only)


Year round or other   [               ]  If ‘other’ please give times. [            ]


Any treatments  [                    ]


Responses to treatment [                                      ]


Describe your horses symptoms of ‘head shaking’   

     [                                        ]


PRIOR TRAUMA


Is there any history of a fall or traumatic accident?     [                                    ]


When     [             ]


Any noticeable changes since accident   


(i)  physical ( change in gait, health....etc  [                     ]


or      (ii) behavioural   [                    ]


Any treatment       [                         ]



LAMENESS


Has your horse ever been diagnosed with Laminitis, Pedal osteitis, navicular disease.   [                            ]


Which leg or legs   [                              ]



Is your horse reluctant to trot?    [                       ]


Rushes on landing after a jump           [                            ]


Stiff & short when cold but warms out of this.      [                      ]

        

Gait - short  gait & stumbles occasionally  in front [             ] behind  [     ]


Chronic lameness -  I ‘hoof pain’ or idiopathic ( of unknown origin)

             [                   ]        other    [                  ]


Is the  lameness worse at shows ‘ events or when excited?


Shortened gait in front        [               ]

                         behind             [             ]


WHEN RIDDEN -


Stiff to the left   [                     ] right  [            ]

Reluctance to ‘collect’ or ‘round up’    [                 ]


any other comments when ridden    [              ]


SHOEING -

Difficult to shoe 

in front ( sensitive when nails driven in.. or lame after shoeing for a few days.)


behind. - resistant to having leg stretched out behind.


FEET -

          - Healthy ( good growth & strength)        [                 ]

            Poor - ( poor nail holding / crumbling / poor growth)  [              ]

            Poor heal growth or excessive wear -     [                    ]

            Other comments        [                               ]


         - Normal pulse and temp       [                   ]

         - Increased pulse                   [                   ]

         - cold feet ( at coronet)           [                   ]

         - hot feet ( at coronet)             [                  ]


SWEATING -


sweats normally              [                   ]

sweats profusely             [                    ]

sweats mostly neck & shoulders only   [                    ]

doesn’t sweat (non sweating syndrome.)                  [                     ]


Coat

how would you grade your horses coat ?

Excellent - rich colour and shine ( oily)    [                  ]

Good to fair - nearly above   [                     ] 

Poor - dry and poor colour      [                     ]

other    [              ]


If less than excellent are there areas of good (rump) and poor ( chest or neck) etc.?


BEHAVIOUR :-


Would you describe your horse as a little ‘Jeckyl & Hyde’ .i.e. soft and cuddly under an often unpredictable exterior  [                    ]

explain      [            ]


Head or bridle shy!    [             ]


Oversensitive to flys [                   ]


Resents grooming?   [                      ]


Resents mane pulling [                     ]


Girthy or ‘girth sensitive’  [                  ]


Cold backed / sensitive under saddle  [                    ]


Resents narrow spaces . e.g. rushes through doors, difficult to load onto trailer   [                  ]


Bucks early when ridden  [                   ]


BEHAVIOURAL SELF MUTILATION


Biting at tendons joints flanks...     [                       ]


kicking or striking at muzzle or belly     [                       ]


ANTISOCIAL-

keeps away from other horses, aggressive towards other horses, doesn’t mix in the herd ( stays on perimeter of herd).  [                      ]


TRAVELLING - Van , Trailer, float,


good traveller           [                ]


poor traveller   Describe - e.g.  Rocks /  scrambles / ‘sweats up’

    [                ]


TEMPERATURE SENSITIVE


always keeping out of sun  [               ]


putting muzzle in drinking water  [           ]



CHIROPRACTIC  Acupuncture, touch therapies, massage , homeopathy .western medicine..... etc.    Has your horse had any form of treatment for any of the above anomalies ?               [               ]

Which type of therapy   [                ]


results of treatment [                    ]

results were , permanent [                  ] Temporary [                   ]

If temporary for how long [                       ]


ANY OTHER COMMENTS

   [                                           ]