Cerebral Palsy
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Alemdaroğlu, E., Yanikoğlu, I., Öken, Ö., Uçan, H., Ersöz, M., Köseoğlu, B. F., & Kapicioğlu, M. I. S
Complementary Therapies in Clinical Practice, 23, 26–29. (2016)
Description
To evaluate the short-term effects of horseback riding therapy in addition to a conventional rehabilitation program in children with cerebral palsy.
Nine children receiving horseback riding therapy in addition to conventional rehabilitation (Group 1) and seven children receiving conventional rehabilitation alone (Group 2) were assessed at baseline and 5 weeks later. Assessed were: modified functional reach test (MFRT), hip abduction angle, the Ashworth Scale for hip adductor muscle spasticity, knee distance test, and the Gross Motor Function Classification System (GMFCS).
Results
The percentage change in hip adductor spasticity on the Ashworth Scale was 22% in Group 1 and 0% in Group 2 (significant difference; p = 0.016). Comparison of changes on the MFRT, GMFCS, knee distance test and hip abduction angle showed that the differences between Groups 1 and 2 were not significant.
Conclusions
In these children, horseback riding therapy in addition to conventional rehabilitation resulted in significant improvement in adductor spasticity on short-term follow-up.
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Antunes, Severo do Pinho, Kleiner, Salazar, Eltz, Alves de Oliveira Junior, Cechetti, Galli, Pagnussat
Research in Dev. Disabilities (2016)
Description
Hippotherapy is often carried out for the rehabilitation of children with Cerebral Palsy (CP), with the horse riding at a walking pace. This study aimed to explore the immediate effects of a hippotherapy protocol using a walk-trot pace on spatio-temporal gait parameters and muscle tone in children with Bilateral Spastic CP (BS-CP). Ten children diagnosed with BS-CP and 10 healthy aged-matched children (reference group) took part in this study. The children with BS-CP underwent two sessions of hippotherapy for one week of washout between them. Two protocols (lasting 30min) were applied on separate days: Protocol 1: the horse's pace was a walking pace; and Protocol 2: the horse's pace was a walk-trot pace. Children from the reference group were not subjected to treatment. A wireless inertial measurement unit measured gait spatio-temporal parameters before and after each session. The Modified Ashworth Scale was applied for muscle tone measurement of hip adductors. The participants underwent the gait assessment on a path with surface irregularities (ecological context).
Results
The comparisons between BS-CP and the reference group found differences in all spatio-temporal parameters, except for gait velocity. Within-group analysis of children with BS-CP showed that the swing phase did not change after the walk pace and after the walk-trot pace. The percentage of rolling phase and double support improved after the walk-trot. The spasticity of the hip adductors was significantly reduced as an immediate result of both protocols, but this decrease was more evident after the walk-trot.
Conclusions
The walk-trot protocol is feasible and is able to induce an immediate effect that improves the gait spatio-temporal parameters and the hip adductors spasticity.
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Benda W, McGibbon NH, Grant KL
The Journal of Alternative and Complementary Medicine (2003)
Description
To evaluate the effect of hippotherapy (physical therapy utilizing the movement of a horse) on muscle activity in children with spastic cerebral palsy.
Results
After hippotherapy, significant improvement in symmetry of muscle activity was noted in those muscle groups displaying the highest asymmetry prior to hippotherapy. No significant change was noted after sitting astride a barrel.
Conclusion
Eight minutes of hippotherapy, but not stationary sitting astride a barrel, resulted in improved symmetry in muscle activity in children with spastic cerebral palsy. These results suggest that the movement of the horse rather than passive stretching accounts for the measured improvements.
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Casady RL, Nichols-Larsen DS
Pediatric Physical Therapy (2004)
Description
The purpose of this study was to determine whether hippotherapy has an effect on the general functional development of children with cerebral palsy.
The study employed a repeated-measures design with two pre-tests and two post-tests conducted 10 weeks apart using the Pediatric Evaluation of Disability Inventory (PEDI) and the Gross Motor Function Measure (GMFM) as outcome measures. A convenience sample of 10 children with cerebral palsy participated whose ages were 2.3 to 6.8 years at baseline (mean +/- SD 4.1 +/- 1.7). Subjects received hippotherapy once weekly for 10 weeks between pre-test 2 and post-test 1. Test scores on the GMFM and PEDI were compared before and after hippotherapy.
Results
One-way analysis of variance of group mean scores with repeated measures was significant (p < 0.05) for all PEDI subscales and all GMFM dimensions except lying/rolling. Post hoc analyses with the Tukey test for honest significant differences on the PEDI and GMFM total measures as well as GMFM crawling/kneeling and PEDI social skills subtests were statistically significant between pre-test 2 and post-test 1.
Conclusions
The results of this study suggest that hippotherapy has a positive effect on the functional motor performance of children with cerebral palsy. Hippotherapy appears to be a viable treatment strategy for therapists with experience and training in this form of treatment and a means of improving functional outcomes in children with cerebral palsy, although specific functional skills were not investigated.
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Hyun JC, Kwon JY, Lee JY, Kim YH
Journal of Physical Therapy Science (2012)
Description
The aim of this study was to investigate whether hippotherapy could improve the functional performance of preschool- and school-aged children with spastic bilateral CP. We assessed whether the therapeutic effects of hippotherapy would be different according to the functional statuses of the recipients.
Results
Total GMFM scores and PBS did not change during the pre-riding control period; however, the GMFM and PBS of children with CP improved significantly after hippotherapy. Specifically, dimensions D and E of the GMFM were significantly increased after hippotherapy compared with the pre-riding period.
Conclusion
Hippotherapy can improve gross motor function and balance in pediatric CP patients without adverse effects. Therefore, it may be considered as an effective therapeutic method for rehabilitation of preschool- and school-aged children with spastic CP.
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Debuse D, Gibb C, Chandler C
Physiotherapy Theory and Practice (2009)
Description
Although there is now some evidence for specific effects of hippotherapy on people with cerebral palsy, these studies fail to provide a comprehensive picture of the effects of hippotherapy. This was the first qualitative study to explore the hippotherapy experience of people with cerebral palsy from a user perspective. The effects of hippotherapy and their context were of particular interest. Seventeen users aged from 4 to 63, with or without their parents, participated in focus groups or individual interviews in six centres in Britain and in Germany.
Conclusion
Hippotherapy constitutes a unique opportunity for motor learning: Users’ reports clearly indicate that hippotherapy facilitates true motor learning/carryover of motor ability to motor activities off the horse, not just a training effect, Users and parents experience hippotherapy to be more effective than conventional physio- therapy, The psychological effects of hippotherapy are integral to its overall effects; they enhance its physical effects, Hippotherapy benefits people with cerebral palsy at impairment, activity, and participation level, irrespective of their age, Improved function following hippotherapy clearly boosts users’ self-esteem and self-efficacy, Both physical and psychological effects of hippotherapy enhance the quality of life of people with cerebral palsy.
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Dewar R, Love S, Johnston LM
Dev Med Child Neurol (2014)
Description
The aim of this study was to evaluate the efficacy and effectiveness of exercise interventions that may improve postural control in children with cerebral palsy (CP).
A systematic review was performed using American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Six databases were searched using the following keywords: ('cerebral palsy' OR 'brain injury'); AND ('postur*' OR 'balance' OR 'postural balance' [MeSH]); AND ('intervention' OR 'therapy' OR 'exercise' OR 'treatment'). Articles were evaluated based on their level of evidence and conduct.
Results
Searches yielded 45 studies reporting 13 exercise interventions with postural control outcomes for children with CP. Five interventions were supported by a moderate level of evidence: gross motor task training, hippotherapy, treadmill training with no body weight support (no-BWS), trunk-targeted training, and reactive balance training. Six of the interventions had weak or conflicting evidence: functional electrical stimulation (FES), hippotherapy simulators, neurodevelopmental therapy (NDT), treadmill training with body weight support, virtual reality, and visual biofeedback. Progressive resistance exercise was an ineffective intervention, and upper limb interventions lacked high-level evidence.
Conclusion
The use of exercise-based treatments to improve postural control in children with CP has increased significantly in the last decade. Improved study design provides more clarity regarding broad treatment efficacy. Research is required to establish links between postural control impairments, treatment options, and outcome measures. Low-burden, low-cost, child-engaging, and mainstream interventions also need to be explored.
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Dewar R, Love S, Johnston LM
Dev Med Child Neurol (2014)
Description
The aim of this study was to evaluate the efficacy and effectiveness of exercise interventions that may improve postural control in children with cerebral palsy (CP).
A systematic review was performed using American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Six databases were searched using the following keywords: ('cerebral palsy' OR 'brain injury'); AND ('postur*' OR 'balance' OR 'postural balance' [MeSH]); AND ('intervention' OR 'therapy' OR 'exercise' OR 'treatment'). Articles were evaluated based on their level of evidence and conduct.
Results
Searches yielded 45 studies reporting 13 exercise interventions with postural control outcomes for children with CP. Five interventions were supported by a moderate level of evidence: gross motor task training, hippotherapy, treadmill training with no body weight support (no-BWS), trunk-targeted training, and reactive balance training. Six of the interventions had weak or conflicting evidence: functional electrical stimulation (FES), hippotherapy simulators, neurodevelopmental therapy (NDT), treadmill training with body weight support, virtual reality, and visual biofeedback. Progressive resistance exercise was an ineffective intervention, and upper limb interventions lacked high-level evidence.
Conclusion
The use of exercise-based treatments to improve postural control in children with CP has increased significantly in the last decade. Improved study design provides more clarity regarding broad treatment efficacy. Research is required to establish links between postural control impairments, treatment options, and outcome measures. Low-burden, low-cost, child-engaging, and mainstream interventions also need to be explored.
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Dirienzo LN, Dirienzo LT, Baceski DA
Pediatric Phys Therapy (2007)
Description
The study was designed to document the heart rate response to therapeutic riding in children with cerebral palsy having mild-to-severe disability.
Methods: Participants consisted of eight youth riders with cerebral palsy, divided into two groups: ambulatory and wheelchair dependent. The riders received continuous digital heart rate monitoring during 10 weekly 20-minute therapeutic horseback riding sessions.
Results
The averaged resting, median, and peak heart rate values, as well as the peak percentage heart rate reserve values, were significantly higher in the wheelchair-dependent group.
Conclusion
The youth with severe disability (The Gross Motor Function Classification System level IV) who were wheelchair dependent demonstrated higher heart rate values during therapeutic riding than their ambulatory counterparts. In view of these higher heart rate values, further studies are needed to address the role of monitoring heart rate response during therapeutic riding.
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El-Meniawy, G & Thabet N
Egytpian Journal of Medical Huan Genetics (2012)
Description
Controlled hippotherapy environment provides a foundation for improved neurologic function and sensory processing. This foundation can be generalized to a wide range of daily activities, making the horse a valuable therapeutic tool for rehabilitation. The purpose of this study was to examine the effects of a once weekly, twelve-week hippotherapy program on back geometry in children with spastic diplegic cerebral palsy.
Thirty spastic diplegic children from both sexes, ranging in age from six to eight years represented the sample of this study. The degree of spasticity ranged from 1 to 1+ according to the modified Ashworth scale. They were divided randomly into two groups of equal number A (control) and B (Study).
Evaluation of back geometry parameters was conducted for each child of the two groups before and after three months of treatment via using Formetric instrument system. Group A received a designed exercise program, while group B received hippotherapy training in addition to the same exercise program given to group A.
Results
No significant difference was noticed when comparing the pre-treatment results of the two groups, while significant improvement was observed in all the measuring variables of the two groups when comparing their pre and post-treatment mean values. Significant difference was also observed when comparing the post-treatment results of the two groups in favor of group B
Conclusion
Hippotherapy using the multidimensional movement of the horse may be used in conjunction with therapeutic exercise program for the improvement of back geometry in children with spastic diplegia.
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Fizkova V, Kreji E, Svoboda Z, Elfmark M, & Janura M
Acta. Univ. Palacki Olomuc.. Gymn. (2013)
Description
To evaluate the effects of hippotherapy on temporospatial parameters and pelvic and hip kinematics of gait in children with bilateral spastic cerebral palsy.
Results
Hippotherapy significantly improved walking speed, stride length, and pelvic kinematics (average pelvic anterior tilt, pelvic anterior tilt at initial contact, pelvic anterior tilt at terminal stance). Scores for dimension E of the GMFM, GMFM-66 and PBS also increased.
Conclusion
Hippotherapy provided by licensed health professionals using the multidimensional movement of the horse may be used in conjunction with standard physical therapy for improvement of gait and balance in children with bilateral spastic cerebral palsy.
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Flores F, Dagnese F, & Copetti F
Clinical biomechanics (2019)
Description
The purpose of this study was to assess if dynamic sitting postural control in children with cerebral palsy in hippotherapy is modified when surfaces (sand or asphalt) and horse's walking speed (slow or faster) are changed.
Sixteen children participated in this crossover study. Eight bilateral spastic cerebral palsy children, age range (6-12 years), with Gross Motor Function Classification System levels III to IV, practicing hippotherapy and eight children with typical development (reference group), matched for age and sex. All children were evaluated during riding a horse on sand and asphalt surfaces and at slow (self-selected) and faster (30%) horse's walking speed. Center of pressure parameters were determined by a portable pressure measurement system positioned on the saddle.
Results
Mediolateral displacement amplitude of the center of pressure was larger when the horse was on sand. Mediolateral and anteroposterior displacements amplitude and velocities of the center of pressure increased at horse's faster walking speed.
Conclusion
In order to increase the demand for sitting postural control in children with cerebral palsy during horse riding, faster horse speed or riding on sand should be used.
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Frank A, McCloskey S, Dole RL
Pediatric Physical Therapy (2011)
Description
This case report highlights changes in self-competence and social acceptance, along with changes in functional skills, after an 8-week program of hippotherapy. A 6-year-old girl with mild ataxic cerebral palsy, level I Gross Motor Functional Classification System, exhibited typical impairments in body systems and functions that affected her participation in age-appropriate functional and leisure activities.
Results
Data at 8 weeks demonstrated positive changes in all areas, with improvements continuing for 2 months after the program's completion.
Conclusion
Hippotherapy not only may be an effective intervention to improve functional gross motor development but also may affect perceived self-competence and social acceptance, which may lead to increases in participation for children with mild cerebral palsy.
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Haehl, V., Giuliani, C., Lewis, C
Pediatric Physical Therapy (1999)
Description
Therapists use hippotherapy to improve postural control in children with neuromotor dysfunction. Understanding the influence of the horse's movement on the child may clarify mechanisms, which influence posture during hippotherapy. This study was conducted in two phases. First measures of the kinematic relationship between the rider and the horse were developed. A kinematic analysis of the rider's trunk and the horse's back was used to describe postural orientation, postural stability, and temporal phase relations of a novice and an experienced rider.
Results
Both riders exhibited a biphasic movement pattern in response to the horse's movement. The experienced rider had a more vertical orientation of the trunk and delayed postural response to the movement of the horse. Next we examined the influence of 12 weekly hippotherapy sessions on the postural control, coordination, and function of two children with cerebral palsy. Both children with cerebral palsy approximated the biphasic movement patterns exhibited by the two children developing typically. Both also demonstrated improved coordination between the upper and lower trunk, and between the lower trunk and the back of the horse.
Conclusion
One child's functional mobility improved. Additional research should investigate the kinematic relationship between the client and horse and the efficacy of hippotherapy.
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Hamill D, Washington K, White OR.
Physical & Occupational Therapy in Pediatrics (2007)
Description
The purpose of this single subject research study was to examine the effects of a once weekly, 10-week hippotherapy program for three children, ages 27–54 months, with cerebral palsy. Participants were rated as Level V on the Gross Motor Function Classification System.
Conclusion
None of the children made gains on the standardized outcome measures, but parents reported improved ROM and head control.
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Herrero, Asensio, García, Marco, Oliván, Ibarz, Gómez-Trullén, E., and Casas
BMC Musculoskeletal Disord. (2010)
Description
Although hippotherapy treatment has been demonstrated to have therapeutic effects on children with cerebral palsy, the samples used in research studies have been very small. In the case of hippotherapy simulators, there are no studies that either recommend or advise against their use in the treatment of children with cerebral palsy. The aim of this randomised clinical study is to analyse the therapeutic effects or the contraindications of the use of a commercial hippotherapy simulator on several important factors relating to children with cerebral palsy such as their motor development, balance control in the sitting posture, hip abduction range of motion and electromyographic activity of adductor musculature.
Conclusion
Interest in this project is due to the following factors: Clinical originality; Clinical impact (infantile cerebral palsy is a chronic multisystemic condition that affects not only the patient but also the patient's family and their close circle of friends); Practical benefits (the development of an effective treatment is very important for introducing this element into the rehabilitation of these children).
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Honkavaara M, Rintala P
European Journal of Adapted Physical Activity (2010)
Description
The purpose of this study was to investigate the effects of short term hippotherapy on functional gait changes in children with cerebral palsy (CP). Participants were two boys (ages 12 and 13) with spastic diplegia and a girl (14 yrs) with athetoid CP.
Results
The two boys demonstrated improvement in stride length and gait velocity without sustained improvement in cadence. There was increase in stride length and cadence, but most noticeable improvements in velocity for the girl.
Conclusion
The results indicated that it is possible that short-term hippotherapy may improve functional gait in children with cerebral palsy.
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Hsieh YL, Yang CC, Sun SH, Chan SY, Wang TH, Luo HJ
Disability and rehabilitation (2017)
Description
To evaluate the effects of hippotherapy on body functions, activities, and participation in children with CP of various functional levels by using the International Classification of Functioning, Disability and Health-Children and Youth (ICF-CY) checklist.
Fourteen children with cerebral palsy (CP) (3-8 years of age) were recruited for a 36-week study composed of baseline, intervention, and withdrawal phases (12 weeks for each phase, ABA design). Hippotherapy was implemented for 30 min once weekly for 12 consecutive weeks during the intervention phase. Body Functions (b) and Activities and Participation (d) components of the ICF-CY checklist were used as outcome measures at the initial interview and at the end of each phase.
Results
Over the 12 weeks of hippotherapy, significant improvements in ICF-CY qualifiers were found in neuromusculoskeletal and movement-related functions (b7), mobility (d4) and major life areas (d8) and, in particular, mobility of joint functions (b710), muscle tone functions (b735), involuntary movement reaction functions (b755), involuntary movement functions (b765), and play (d811) (all p < 0.05) when compared with baseline.
Conclusion
This study demonstrated the beneficial effects of hippotherapy on body functions, activities, and participation in children with CP. Implications for Rehabilitation ICF-CY provides a comprehensive overview of functioning and disability and constitutes a universal language for identifying the benefits of hippotherapy in areas of functioning and disability in children with CP. In children with CP, hippotherapy encourages a more complementary approach that extends beyond their impairments and limitations in body functions, activities, and participation. The effect of hippotherapy was distinct from GMFCS levels and the majority of improvements were present in children with GMFCS levels I-III.
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Ionatamishvili NI, Tsverava DM, Loriya SH, Sheshaberidze EG, Rukhadze MM
Human Physiology (2004)
Description
Riding therapy (hippotherapy) is a novel progressive and original method for treating infantile cerebral palsy (ICP) and can be applied early in life. We examined 100 ICP patients aged from 3 to 14 years, who were divided into two equal groups, one assigned to riding therapy and the other (control) to therapeutic exercises by the Bobath method.
Conclusion
It was shown that riding therapy is advisable because it maximally mobilizes the reserve possibilities of children for integrating perceptive and behavioral skills. We developed a protocol of therapeutic riding and scales for assessing its effect and demonstrated the efficacy of therapeutic riding.
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Chul Hwan Jang, Min Cheol Joo, Se Eung Noh, Sang Yeol Lee, Dae Bo Lee, Sung Ho Lee, Ho Kyun Kim, Hyo In Park
Ann Rehabil Med (2016)
Description
To investigate the effects of hippotherapy on psychosocial and emotional parameters in children with cerebral palsy (CP) and their caregivers.
Results
Significant improvements on the GMFM, dimension E in the GMFM, and the PBS were observed after hippotherapy compared with the baseline assessment (p<0.05). However, no improvements were detected in the psychosocial or emotional parameters in children with CP or their caregivers. None of the participants showed any adverse effects or accidents during the 10 weeks hippotherapy program.
Conclusion
Hippotherapy was safe and effectively improved gross motor and balance domains in children with CP. However, no improvements were observed in psychosocial or emotional parameters.
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Kang, Jung, Yu
Journal of Physical Therapy Science (2012)
Description
This study aimed to verify the effect of hippotherapy on the sitting balance of children with severe cerebral palsy (CP) by comparing hippotherapy, physical therapy, and a control. [Subjects] In this study, 45 children with CP were randomly divided into the hippotherapy group (HTG, n = 15), physical therapy group (PTG, n = 15), and control group (CON, n = 15). [Methods] Two expert physical therapists provided the HTG and PTG with traditional physical therapy comprising strengthening and stretching exercises in 30-minute sessions, semi-weekly, for 8 weeks .
Results
Sway pathway and velocity significantly decreased in HTG compared to PTG and CON. Left/right pathway, total pathway, left/right velocity, and total velocity were significantly reduced in PTG compared to that in the CON
Conclusion
Hippotherapy with traditional physical therapy improved the sitting balance of children with severe CP, who could not walk independently more than traditional physical therapy alone.
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Krejci, Janura, & Svoboda
Acta Gymica (2015)
Description
The research is based on an assumption that the hypokinesia induced by cerebral palsy (CP) leads to inhibition of some mental functions. The method we used to treat patients with CP, hippotherapy (HT), is a treatment using horses and belongs to proprioceptive-neuromuscular-facilitative methods. Objective: The aim of the research was to determine the benefit of HT on attention and memory of patients with CP.
Results
Attention improvement demonstrated in a significant decrease of an average time of “Numeric square test”. The improvement was seen in both long-term HT (15.7 seconds overall average time reduction after HT, p < .01) and short-term HT (20.8 seconds reduction, p < .01) groups. Short-term memory improvement was found in the long-term HT group, demonstrated by a higher number of memorized words (more than half of the patients memorized on average 10.5 more words after HT) (p < .05). While the short-term HT group did not show significant improvement of attention or short-term memory, the average number of memorized words after a diversion of attention and a 30 minute delay increased by 4.1, showing an improvement (p < .05) of long-term memory.
Conclusion
Our results suggest that hippotherapy as a part of comprehensive therapy in patients with CP leads to improvement of memory and attention skill.
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Kwon JY, Chang HJ, Yi SH, Lee JY, Shin HY, Kim YH
J Altern Complement Med (2015)
Description
To examine whether hippotherapy has a clinically significant effect on gross motor function in children with cerebral palsy (CP).
Results
Pre- and post-treatment measures were completed by 91 children (45 in the intervention group and 46 in the control group). Differences in improvement on all three measures significantly differed between groups after the 8-week study period. Dimensions of GMFM-88 improved significantly after hippotherapy varied by GMFCS level: dimension E in level I, dimensions D and E in level II, dimensions C and D in level III, and dimensions B and C in level IV.
Conclusion
Pre- and post-treatment measures were completed by 91 children (45 in the intervention group and 46 in the control group). Differences in improvement on all three measures significantly differed between groups after the 8-week study period. Dimensions of GMFM-88 improved significantly after hippotherapy varied by GMFCS level: dimension E in level I, dimensions D and E in level II, dimensions C and D in level III, and dimensions B and C in level IV.
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Kwon, Chang, Lee, Ha, Lee, Kim
Journal of Physical Therapy Science (2012)
Description
To evaluate the effects of hippotherapy on temporospatial parameters and pelvic and hip kinematics of gait in children with bilateral spastic cerebral palsy.
Results
Hippotherapy significantly improved walking speed, stride length, and pelvic kinematics (average pelvic anterior tilt, pelvic anterior tilt at initial contact, pelvic anterior tilt at terminal stance). Scores for dimension E of the GMFM, GMFM-66 and PBS also increased.
Conclusion
Hippotherapy significantly improved walking speed, stride length, and pelvic kinematics (average pelvic anterior tilt, pelvic anterior tilt at initial contact, pelvic anterior tilt at terminal stance). Scores for dimension E of the GMFM, GMFM-66 and PBS also increased.
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Liptak GS
Ment Retard Dev Disabil Res Rev. (2005)
Description
This article reviews nine treatment modalities used for children who have cerebral palsy (CP), including hyperbaric oxygen, the Adeli Suit, patterning, electrical stimulation, conductive education, equine-assisted therapy, craniosacral therapy, Feldenkrais therapy, and acupuncture. Unfortunately, these modalities have different degrees of published evidence to support or refute their effectiveness. Uncontrolled and controlled trials of hippotherapy have shown beneficial effects on body structures and functioning.
Conclusion
More evidence is required before recommendations can be made. The individual with CP and his or her family have a right to full disclosure of all possible treatment options and whatever knowledge currently is available regarding these therapies
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Mark Drnach, Patricia A O'Brien, Alison Kreger
Journal of Alternative and Complementary Medicine (2010)
Description
The purpose of this study was to determine the outcome of a short-term therapeutic horseback riding intervention on the gross motor function in a child with cerebral palsy.
This study employed a repeated-measures design with a pretest, a post-test, and a post post-test conducted 5 weeks apart using the Gross Motor Function Measure (GMFM) as an outcome measure. The three sets of test scores from the GMFM were compared upon completion of the intervention.
The subject participated in a 5-week therapeutic horseback riding program consisting of 1 hour of riding per week. Each riding session consisted of stretching, strengthening, and balance activities. The child's level of motor function was tested prior to the intervention, upon completion of the intervention, and 5 weeks postintervention. The GMFM, a criterion-referenced observational measure designed to measure change in the gross motor function in children with cerebral palsy, was chosen as the assessment tool.
Results
Upon completion of the 5-week intervention, the child was observed to have improved scores on the GMFM in two of the five dimensions measured and scored for a total of eight items. The post post-test was completed 5 weeks after the final riding session and the results demonstrated successful maintenance of the improved scores in seven of eight items.
Conclusion
The result of this case study suggest that 5 weeks of therapeutic riding are sufficient to produce positive changes in the gross motor function of a child with cerebral palsy.
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Little, Nel, Ortell, Van Wyk, Badenhorst, Louw
South African Journal of Physiotherapy (2013)
Description
To critically appraise the evidence of hippotherapy to ascertain whether it is a clinically meaningful approach for children with CP.
Five computerised bibliographic databases were searched. Predetermined inclusion and exclusion criteria were set. The PEDro scale was used to assess the quality of the studies. A revised JBI Data extraction tool was used to extract data from the selected articles. Revman© Review Manager Software was used to create forest plots for comparisons of results.
Results
All studies used the GMFM as an outcome measure for gross motor function. The added benefit of hippotherapy is a minimum 1% and a maximum 7% increase on the GMFM scores. However, all 95% confidence intervals (CI) around all the mean differences were insignificant.
Conclusion
The clinical effect of hippotherapy on the GMF of children with CP is small. Larger studies are required to provide evidence of the effect of hippotherapy within this population.
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Mark Drnach, Patricia A O'Brien, Alison Kreger
Complementary Therapies in Clinical Practice (2018)
Description
The aim of the present study is to evaluate the effect of a 12 weeks hippotherapy intervention protocol on hip adductors spasticity in children with spastic cerebral palsy.
Results
There were significant differences in the MAS scores between the treatment and the control group in both adductors (left adductors: p = 0,040; right adductors: p = 0,047), after a 12-weeks hippotherapy intervention.
Conclusion
A hippotherapy based treatment in addition to conventional therapy, in children with cerebral palsy, produces statistically significant changes in hip adductors spasticity after a 12-weeks intervention. Thus, it seems to produce benefits in the short-term.
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Maćków et al
Ortop Traumatol Rehabil (2014)
Description
The aim of the study was to present the influence of neurophysiological hippotherapy on the transference of the centre of gravity (COG) among children with cerebral palsy (CP).The study involved 19 children aged 4-13 years suffering from CP who demonstrated an asymmetric (A/P) model of compensation.
Results
The mean value of the body's centre of gravity in the frontal plane (COG X) was 18.33 (mm) during the first examination, changing by 21.84 (mm) after neurophysiological hippotherapy towards deloading of the antigravity lower limb (p ≤ 0.0001). The other stabilographic parameters increased; however, only the change in average speed of antero - posterior COG oscillation was statistically significant (p = 0.0354).
Conclusion
One session of neurophysiological hippotherapy induced statistically significant changes in the position of the centre of gravity in the body in the frontal plane and the average speed of COG oscillation in the sagittal plane among CP children demonstrating an asymmetric model of compensation (A/P).
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McGee, M. & Reese, N.
Pediatric Physical Therapy (2009)
Description
The purpose of this study was to examine the immediate effects of a hippotherapy session on temporal and spatial gait parameters in children with spastic cerebral palsy (CP).
Results
No statistically significant differences (p < 0.05) were noted in the postride temporal and spatial gait parameter values when compared with the preride values.
Conclusion
This study provides baseline data for future research and useful clinical information for physical therapists using hippotherapy as a treatment modality for children with spastic CP.
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McGibbon N., Andrade C., Widener G., Cintas H.
Developmental Medicine and Child Neurology (1998)
Description
The purpose of this study was to evaluate the effects of an 8-week program of hippotherapy on energy expenditure during walking; on the gait dimensions of stride length, velocity, and cadence; and on performance on the Gross Motor Function Measure (GMFM) in five children with spastic cerebral palsy (CP).
Results
After hippotherapy, all five children showed a significant decrease (X2(r)=7.6, P<0.05) in energy expenditure during walking and a significant increase (X2(r)=7.6, P<0.05) in scores on Dimension E (Walking, Running, and Jumping) of the GMFM. A trend toward increased stride length and decreased cadence was observed.
Conclusion
This study suggests that hippotherapy may improve energy expenditure during walking and gross motor function in children with CP.
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McGibbon, Benda, Duncan, Silkwood-Sherer
Arch Phys Med Rehabil (2009)
Description
To investigate the immediate effects of 10 minutes of hippotherapy, compared with 10 minutes of barrel-sitting, on symmetry of adductor muscle activity during walking in children with cerebral palsy (CP) (phase I). To investigate the long-term effects of 12 weeks of hippotherapy on adductor activity, gross motor function, and self-concept (phase II).
Results
Phase I: hippotherapy significantly improved adductor muscle asymmetry (P<.001; d=1.32). Effects of barrel-sitting were not significant (P>.05; d=.10). Phase II: after 12 weeks of hippotherapy, testing in several functional domains showed improvements over baseline that were sustained for 12 weeks posttreatment.
Conclusion
Hippotherapy can improve adductor muscle symmetry during walking and can also improve other functional motor skills.
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Moraes, Copetti, Angelo, Chiavoloni, David
Journal of Physical Therapy Science (2016)
Description
This study evaluated the effects of hippotherapy on seated postural balance, dynamic balance, and functional performance in children with cerebral palsy and compared the effects of 12 and 24 sessions on seated postural balance.
Results
Significant differences were observed for center of pressure (COP) variables, including medio-lateral (COPml), anteroposterior displacement (COPap), and velocity of displacement (VelCOP), particularly after 24 sessions. There were also significant differences in BBS scores and PEDI score increases associated with functional skills (self-care, social function, and mobility), caregiver assistance (self-care), social function, and mobility.
Conclusion
Hippotherapy resulted in improvement in postural balance in the sitting position, dynamic balance, and functionality in children with cerebral palsy, an effect particularly significant after 24 hippotherapy sessions.
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Murphy, D., Kahn-D’Angelo, L., & Gleason, J.
Pediatric Physical Therapy (2008)
Description
The purpose of this study was to measure the effect of hippotherapy on functional outcomes using the Goal Attainment Scale (GAS) for children with physical disabilities.
Results
Three of the 4 children had a significant improvement in functional outcomes based on a standardized T-score formula from the GAS. Two of the 4 children had statistically significant results on the nonparametric binomial test following 6 months of intervention.
Conclusion
The findings from this study suggest that hippotherapy can be an effective intervention to improve functional outcomes for children.
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Mutoh, Mutoh, Tsubone, Takada, Doumura, Ihara, Shimomura, Taki, Ihara
Complementary Therapies in Clinical Practice (2017)
Description
The aim of this study was to obtain data of gait parameters on predicting long-term outcome of hippotherapy. In 20 participants (4-19 years; GMFCS levels I to III) with cerebral palsy (CP), gait and balance abilities were examined after 10-m walking test using a portable motion recorder.
Results
Hippotherapy increased stride length, walking speed, and mean acceleration and decreased horizontal/vertical displacement ratio over time (P < 0.05). Stride length and mean acceleration at 6 weeks predicted the elevation of GMFM-66 score.
Conclusion
Hippotherapy had short-term positive effects on muscle symmetry in the trunk and hip and that therapeutic horseback riding is effective for improved gross motor function when compared with regular therapy or time on a waiting list.
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Novak et al.
Developmental Medicine & ChildNeurology (2013)
Description
The aim of this study was to describe systematically the best available intervention evidence for children with cerebral palsy (CP).
Results
Overall, 166 articles met the inclusion criteria (74% systematic reviews) across 64 discrete interventions seeking 131 outcomes. Of the outcomes assessed, 16% (21 out of 131) were graded ‘do it’ (green go); 58% (76 out of 131) ‘probably do it’ (yellow measure); 20% (26 out of 131) ‘probably do not do it’ (yellow measure); and 6% (8 out of 131) ‘do not do it’ (red stop). Green interventions included anticonvulsants, bimanual training, botulinum toxin, bisphosphonates, casting, constraint-induced movement therapy, context-focused therapy, diazepam, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care, and selective dorsal rhizotomy. Most (70%) evidence for intervention was lower level (yellow) while 6% was ineffective (red).
Conclusion
HPOT has yellow level of evidence: could not demonstrate robust evidence of effectiveness when strict systematic review criteria about design quality, adequate sample size, and independent replication were used to judge the evidence.
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O’Neil ME, Fragala-Pinkham MA, Westcott SL, Martin K, Chiarello LA, Valvano J, Rose RU
Pediatric Physical Therapy (2006)
Description
The purpose of this special report is to present recommendations for the clinical management of children with cerebral palsy, spastic diplegia when increased functional mobility is the identified outcome.
Conclusion
These recommendations are suggestions for clinical management, not an all-inclusive document on physical therapy for children with cerebral palsy. These recommendations may help therapists develop systematic approaches to service delivery and documentation.
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Park ES, Rha DW, Shin JS, Kim S, Jung S
Yonsei Med J (2014)
Description
The purpose of our study was to investigate the effects of hippotherapy on gross motor function and functional performance in children with spastic cerebral palsy (CP).
Results
There were no significant differences between intervention and control groups in mean baseline total scores of GMFM-66, GMFM-88 or PEDI-FSS. After the 8-weeks intervention, mean GMFM-66 and GMFM-88 scores were significantly improved in both groups. However, the hippotherapy group had significantly greater improvement in dimension E and GMFM-66 total score than the control group. The total PEDI-FSS score and the sub-scores of its 3 domains were significantly improved in the hippotherapy group, but not in the control group.
Conclusion
The results of our study demonstrate the beneficial effects of hippotherapy on gross motor function and functional performance in children with Cerebral Palsy compared to control group. The significant improvement in PEDI- FSS scores suggests that hippotherapy may be useful to maximize the functional performance of children with Cerebral Palsy. The relatively greater improvements in PEDI scores observed suggest that hippo- therapy helps children to engage more meaningfully in the functional activities of daily life.
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Quint C & Toomey M
Physiotherapy (1998)
Description
This study investigated the influence on pelvic mobility in children with cerebral palsy of a mechanical saddle (BABS) with imitates the movement of a horse at walk. Using a matched pairs design, subjects were selected and matched into 13 pairs. Subjects sat on either the BABS or a static saddle ten times for ten minutes over four weeks. Passive pelvic movement was measured from photographs taken at end range of passive anterior and then posterior pelvic tilt, before and after the trial.
Conclusion
These results indicate that the movement of a horse at walk can facilitate pelvic movement; the BABS and conventional horse riding are valuable tools in the physiotherapy treatment of children with cerebral palsy.
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Shurtleff & Engsberg
Physical and Occupational Therapy in Pediatrics (2010)
Description
This pilot investigation objectively evaluated the efficacy of HPOT in improving head/trunk stability in children with cerebral palsy (CP). The participants were six children with spastic diplegia and six children without disability. Head and trunk stability was challenged by using a motorized barrel and measured by a video motion capture system before and after a 12-week intervention of 45 min of HPOT a week.
Results
Following HPOT, children with CP demonstrated significant reductions in head rotation and AP translation at C7, eye, and vertex. At post-testing, translation at C7 did not differ significantly between children with CP and children without disability. After HPOT intervention, children with CP reduced their AP head rotation and translation, suggesting that they had increased stability of the head and trunk in response to perturbations at the pelvis.
Conclusion
The findings suggest that HPOT might improve head and trunk stability in children with CP.
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Shurtleff & Engsberg
British Journal of Occupational Therapy (2012)
Description
This case study followed a 6-year-old child with cerebral palsy for an additional 24 weeks after a 12-week pilot study of hippotherapy (HPOT).
Pre-post measures were performed using a video motion capture system before and after 12 weeks, showing head/trunk control improvements.
Results
The third measure after 24 more weekly treatments showed no further improvement on the original variables. However, an unanticipated improvement in postural sway was found at the end of 9 months.
Conclusion
This suggests that additional investigations are needed with more children with cerebral palsy over longer periods to identify outcomes from extended interventions beyond the 6–12 weeks of most published HPOT studies. Such further work could support better treatment planning and inform discharge criteria considering diminishing returns. The information would provide better evidence-based criteria for referrals and funding. This may make HPOT more accessible for those with disabilities who can benefit in specific and predictable ways.
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Shurtleff, Standeven, Engsberg
Arch Phys Med Rehabil (2009)
Description
To determine if hippotherapy (therapy using a horse) improves head/trunk stability and upper extremity (UE) reaching/targeting in children with spastic diplegia cerebral palsy (SDCP).
Results
Significant changes with large effect sizes in head/trunk stability and reaching/targeting, elapsed time, and efficiency (reach/path ratio) after 12 weeks of hippotherapy intervention. Changes were retained after a 12-week washout period.
Conclusion
Hippotherapy improves trunk/head stability and UE reaching/targeting. These skills form the foundation for many functional tasks. Changes are maintained after the intervention ceases providing a skill foundation for functional tasks that may also enhance occupational performance and participation.
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Snider, L., Korner-Bitenshy, N., Kammann, C., Warner, S., & Saleh, M.
Physical & Occupational Therapy in Pediatrics (2007)
Description
A systematic review of the literature on horseback riding therapy as an intervention for children with cerebral palsy (CP) was carried out. The terms horse, riding, hippotherapy, horseback riding therapy, equine movement therapy, and cerebral palsy were searched in electronic databases and hand searched.
Conclusion
There is Level 2a evidence that hippotherapy is effective for treating muscle symmetry in the trunk and hip and that therapeutic horseback riding is effective for improved gross motor function when compared with regular therapy or time on a waiting list.
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Sterba, John A.
Developmental medicine & child neurology (2007)
Description
Quantitative (not qualitative) studies were sought investigating whether horseback riding used as therapy improves gross motor function in children with cerebral palsy (CP). Eleven published studies on instructor-directed, recreational horseback riding therapy (HBRT) and licensed-therapist-directed hippotherapy were identified, reviewed, and summarized for research design, methodological quality, therapy regimen, internal/external validity, results, and authors' conclusions.
Conclusion
The evidence suggests that HBRT and hippotherapy are individually efficacious, and are both medically indicated as therapy for gross motor rehabilitation in children with CP.
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Tseng, Chen, & Tam
Disability & Rehabilitation (2013)
Description
To evaluate the literature on the efficacy of equine assisted activities and therapies (EAAT) on gross motor outcomes representing the ICF component of body functions and activity in children with cerebral palsy (CP).
We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies of hippotherapy (HPOT) and therapeutic horseback riding (TR) for children with spastic CP. Gross motor outcomes, assessed via muscle activity and muscle tone, gait, posture and Gross Motor Function Measures (GMFM) were evaluated.
Results
Five TR studies and nine HPOT studies were included. Our meta-analysis indicated that short-term HPOT (total riding time 8-10 min) significantly reduced asymmetrical activity of the hip adductor muscles. HPOT could improve postural control in children with spastic CP, GMFCS level < 5. However, the evidence did not show a statistically significant effect on GMFM after long-term HPOT or TR (total riding time, 8-22 h) in children with spastic CP.
Conclusion
This systematic review found insufficient evidence to support the claim that long-term TR or HPOT provide a significant benefit to children with spastic CP. We found no statistically significant evidence of either therapeutic effect or maintenance effects on the gross motor activity status in CP children.
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Whalen & Case-Smith
Physical and Occupational Therapy in Pediatrics (2012)
Description
This systematic review examined the efficacy of hippotherapy or therapeutic horseback riding (THR) on motor outcomes in children with cerebral palsy (CP).
Databases were searched for clinical trials of hippotherapy or THR for children with CP.
Results
Nine articles were included in this review. Although the current level of evidence is weak, our synthesis found that children with spastic CP, Gross Motor Function Classification System (GMFCS) levels I-III, aged 4 years and above are likely to have significant improvements on gross motor function as a result of hippotherapy and THR. Evidence indicates that 45-min sessions, once weekly for 8-10 weeks, result in significant effects.
Conclusion
The current literature on hippotherapy and THR is limited. Large randomized controlled trials using specified protocols are needed to more conclusively determine the effects on children with CP. From the current evidence, it appears that hippotherapy and THR have positive effects on gross motor function in children with CP.
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Yokoyama, Kaname, Tabata, Hotta, Shimizu, Kamiya, Kamekawa, Kato, Akiyama, Ohta, Masuda
The Kitasato Medical Journal (2013)
Description
Hippotherapy (i.e., equine-assisted therapy, horseback riding) has been reported to have beneficial effects on children with spastic cerebral palsy (CP). The purpose of this study was to determine the effects of a single session of hippotherapy on hypertonia caused by the autonomic imbalance in children with spastic CP.
Results
A 1/f fluctuation was observed during hippotherapy in 17 of 22 children evaluated. The LF/ HF, pupil size, muscle activity, and MAS score significantly decreased after hippotherapy (P = 0.04, P = 0.03, P = 0.04, P < 0.001, respectively), while the HF value increased (P = 0.04). Furthermore, muscle activity correlated positively with both ΔLF/HF and Δpupil size (r = 0.65, P = 0.001; r = 0.61, P = 0.003, respectively).
Conclusion
The 1/f fluctuation induced by hippotherapy lead to improved autonomic imbalance and reduced muscle tone in children with spastic CP.
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Zadnikar & Kastrin
Developmental Medicine and Child Neurology (2011)
Description
This research review and meta-analysis presents an overview of the effects of hippotherapy and therapeutic horseback riding (THR) on postural control or balance in children with cerebral palsy (CP).
Results
From 77 identified studies, 10 met the inclusion criteria. Two were excluded because they did not include a comparison group. Therapy was found to be effective in 76 out of 84 children with CP included in the intervention groups. The comparison groups comprised 89 children: 50 non-disabled and 39 with CP. A positive effect was shown in 21 of the children with CP in the comparison group regardless of the activity undertaken (i.e. physiotherapy, occupational therapy, sitting on a barrel or in an artificial saddle). The pooled effect size estimate was positive (OR 25.41, 95% CI 4.35, 148.53), demonstrating a statistically significant effectiveness of hippotherapy or THR in children with CP (p<0.001). Meta-regression of study characteristics revealed no study-specific factors.
Conclusion
The eight studies found that postural control and balance were improved during hippotherapy and THR. Although the generalization of our findings may be restricted by the relatively small sample size, the results clearly demonstrate that riding therapy is indicated to improve postural control and balance in children with CP.
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Davis E., Davies B., Wolfe R., Raadsveld R., Heine B., Thomason P., Dobson F., Graham H.K.
Dev. Medicine and child Neurology (2009)
Description
This randomized controlled trial examined whether therapeutic horse riding has a clinically significant impact on the physical function, health and quality of life (QoL) of children with cerebral palsy (CP).
Results
On analysis of covariance, there was no statistically significant difference in GMFM, CP QoL-Child (parent report and child self-report), and CHQ scores (except family cohesion) between the intervention and control group after the 10-week study period, but there was weak evidence of a difference for KIDSCREEN (parent report).
Conclusion
This study suggests that therapeutic horse riding does not have a clinically significant impact on children with CP. However, a smaller effect cannot be ruled out and the absence of evidence might be explained by a lack of sensitivity of the instruments since the QoL and health measures have not yet been demonstrated to be sensitive to change for children with CP.
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Zadnikar & Rugelj
Journal of Novel Physiotherapies (2011)
Description
To investigate whether hippotherapy has short- and long-term effects on postural control in an adolescent with cerebral palsy (CP).
Results
The results of measurement of the short-term effect of HT on the parameters of movement of the COP on a firm surface with eyes open show that the total path length decreased by 20.94%, the path length in the mediolateral direction decreased by 24.30%, and in the anteroposterior direction by 17.91%; the area of the stabilogram decreased by 55.54% and the individual variance index (IVI) decreased by 9.95%. After completion of HT, the total path length decreased by 33.70%, the path length in the mediolateral direction decreased by 30.48%, in the anteroposterial direction by 35.06%; the stabilogram area decreased by 59.82% and IVI decreased by 15.10%.
Conclusion
The results of measurement of the short-term effect of HT on the parameters of movement of the COP on a firm surface with eyes open show that the total path length decreased by 20.94%, the path length in the mediolateral direction decreased by 24.30%, and in the anteroposterior direction by 17.91%; the area of the stabilogram decreased by 55.54% and the individual variance index (IVI) decreased by 9.95%. After completion of HT, the total path length decreased by 33.70%, the path length in the mediolateral direction decreased by 30.48%, in the anteroposterial direction by 35.06%; the stabilogram area decreased by 59.82% and IVI decreased by 15.10%.
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Kuczinsky M & Slonka K.
Gait and Posture (1999)
Description
Stability of quiet upright stance was investigated in 25 children with cerebral palsy at the beginning and the end of a 3-month period of therapy involving 20 min microprocessor-controlled saddle riding, performed twice a week. The traditional parameters of postural sway based on the centre-of-pressure analysis (range, standard deviation, mean speed and mean radius) dropped significantly over time confirming advantageous influence of this treatment. As a complementary tool, an autoregressive modelling technique was used allowing us to establish after each single ride considerable decreases in the frequency of the feet adjustments, which represent the control variable of the postural system in sagittal plane.
Results
These changes reflect diminished ankle joints stiffness resulting from a single session, and are supposedly a basic reason for substantial progress of the patients. The autoregressive approach proved to be a powerful method, which corroborates and reinforces stabilographic investigations.
Conclusion
The findings confirm that the therapy led to a noteworthy improvement in the postural performance of the CP children in sagittal as well in frontal planes. Morover, they let us to infer about biomechanical properties of joints involved in maintaining posture, thus giving more insight into the operation of the neuro-muscular system and allowing us to better understand the reason of progress in motor control of posture.
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Manikowsa F, Jozwiak M, Idzior M, Chen PJ, Tarnowski D
Ortop Traumatol Rehabil (2015)
Description
Hippotherapy has been shown to produce beneficial effects by improving the most difficult motor functions, such as sitting, running, jumping, coordination, as well as balance and muscle strength in children with motor developmental delays. The aim of this study was to analyze the effect of hippotherapy on spatiotemporal parameters of gait in cerebrally palsied children.
Results
Changes of walking speed were statistically significant. With the exception of step length, all spatiotemporal parameters improved, i.e. were closer to the respective reference ranges after the session. However, these changes were not statistically significant.
Conclusion
One session of hippotherapy may have a significant effect on the spatiotemporal parameters of gait in cerebrally palsied children.
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Champagne D
Physical and Occupational Therapy in Pediatrics (2016)
Description
To evaluate the effects of hippotherapy on physical capacities of children with cerebral palsy. Methods: Thirteen children (4–12 years old) with cerebral palsy classified in Gross Motor Function Classification System Level I or II were included in this prospective quasi-experimental ABA design study.
Results
Mean scores for dimensions D and E of the GMFM-88 Dimension scores (p = .005) and three out of the eight items of the BOT2-SF (fine motor precision (p = .013), balance (p = .025), and strength (p = .012) improved between baseline and immediately after intervention; mean scores immediately following and 10 weeks following intervention did not differ.
Conclusion
Hippotherapy provided by a trained therapist who applies an intense and graded session for 10 weeks can improve body functions and performance of gross motor and fine motor activities in children with cerebral palsy.
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