Effectiveness of Mechanical Horse-Riding Simulators on Postural Balance in Neurological Rehabilitation: Systematic Review and Meta-Analysis

Mechanical horse-riding simulators consist of a device that mimics the movement of a real horse, generating between 50 and 100 three-dimensional physical movements (forward and back, left and right, up and down). The main objective of this study is to analyze the effectiveness of mechanical horse-riding simulators to improve postural balance in subjects with neurological disorders. The search was conducted during January-March 2019 in PubMed, Physiotherapy Evidence Database (PEDro), Cochrane, Web of Science, CINAHL, and Scopus. The methodological quality of the studies was evaluated through the PEDro scale. A total of seven articles were included in this systematic review, of which four contributed information to the meta-analysis. Statistical analysis showed favorable results for balance in stroke patients, measured by the Berg Balance Scale (standardized mean difference (SMD) = 3.24; 95%; confidence interval (CI): 1.66-4.83). Not conclusive results were found in sitting postural balance, measured using the Gross Motor Function Measure-66 (GMFM-66) Sitting Dimension, in patients with cerebral palsy. Most studies have shown beneficial effects on postural balance compared with conventional physical therapy. However, due to the limited number of articles and their low methodological quality, no solid conclusions can be drawn about the effectiveness of this therapy

The Effects of an Equine Riding Simulator as an Objective Feedback Modality on Learning Outcomes for Rider Competency on Performance Skills in Equestrian Riding Fundamentals

This study examined the effects of different feedback modalities provided during simulated-based practice on performance and perceptions. In addition, the research also addressed the relationship between participants\u27 feedback literacy, perceptions, and improvement scores. The purpose of this research was motivated by the emerging equine simulation technology that provides feedback on movement and coordination during complex motor skill acquisition. Selecting an effective feedback approach for simulation-based practice in motor skill learning is contingent on the complexity of the performance skill and the learner\u27s experience. However, the learner\u27s feedback literacy can result in contradictory performance and perceptions despite the feedback approach experienced. Feedback literacy is a concept that identifies a learner\u27s ability to uptake feedback. This mixed-methods study used the conceptual framework of Carless\u27s 3P Model of the Learner Experience of Feedback. Seventy-five participants completed the study, consisting of three 10-minute practice sessions with a pre/posttest and an exit survey at the end of their third session. The study demonstrated that the combination of instructor- and simulator-mediated feedback had the most significant impact on improvement scores by the completion of three practice sessions. Regardless of feedback modality, the novice participants had the most significant improvement score impact by the completion of three practice sessions. When an instructor provided feedback, participants had more positive perceptions of the practice experience. The study supported that the higher the participant\u27s feedback literacy, the more they engaged in practice, appreciated feedback, and improved on performance scores, regardless of feedback received. The lower a participant\u27s feedback literacy, the more negative they were about the experience and their perceived improvement, and the higher likelihood of disengaging during practice, regardless of feedback received. The results indicate that a multi-modality approach to feedback in simulation-based motor skill practice is effective. The findings also support that feedback literacy influences a learner\u27s engagement during practice, and instructor feedback can mitigate the negative influences of low feedback literacy. Conclusions from this research suggest that using a horseback riding simulator has the potential to improve riding seat skills and supports an equine welfare-minded approach to learning in equestrian sports

Study of the therapeutic effects of an advanced hippotherapy simulator in children with cerebral palsy: a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods/Design</p> <p>The study is a randomised controlled trial. It will be carried out with a sample of 37 children with cerebral palsy divided into two treatment groups. Eligible participants will be randomly allocated to receive either (a) Treatment Group with hippotherapy simulator, maintaining sitting posture, with legs in abduction and rhythmic movement of the simulator or (b) Treatment Group maintaining sitting posture, with legs in abduction and without rhythmic movement of the simulator. Data collection and analysis: all measurements will be carried out by a specially trained blind assessor. To ensure standardization quality of the assessors, an inter-examiner agreement will be worked out at the start of the study. The trial is funded by the Department of Research, Innovation and Development of the Regional Government of Aragon (Official Bulletin of Aragon 23 July 2007), project number PM059/2007.</p> <p>Discussion</p> <p>Interest in this project is due to the following factors: Clinical originality (there are no previous studies analysing the effect of simulators on the population group of children with CP, nor any studies using as many variables as this project); 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).</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN03663478.</p

Estudio de los efectos terapéuticos de un simulador de movimiento equino en niños con parálisis cerebral infantil

Objetivo: Investigar si la hipoterapia (aplicada mediante simulador) sirve para mejorar el control postural y la función motriz en niños con parálisis cerebral infantil y si los efectos terapéuticos son diferentes en dependencia de los niveles de función motriz de los niños. Material y métodos: Ensayo clínico aleatorizado a simple ciego con un evaluador independiente. La aleatorización fue oculta y realizada según los niveles de la escala Gross Motor Function Classification System (GMFCS). Los niños fueron asignados de forma aleatoria al grupo intervención (simulador encendido) o control (simulador apagado) después de obtener el consentimiento informado. Los niños desarrollaron diferentes actividades adaptadas a sus capacidades motrices mientras permanecían sentados en el simulador. El tratamiento consistió en una sesión semanal de 15 minutos de duración durante un periodo de 10 semanas. Las variables de estudio fueron medidas con las escalas estandarizadas Gross Motor Function Measure (Dimensión B de la escala para el control postural en sedestación, y puntuación total en la escala para la función motriz general) y la Sitting Assessment Scale, al inicio del estudio (de forma previa a la aleatorización), al final del periodo de tratamiento y 12 semanas después de completar el tratamiento. Resultados: 38 niños con parálisis cerebral infantil participaron. No se encontraron diferencias estadísticamente significativas entre los grupos al inicio del estudio. El control postural en sedestación (medido con la dimensión B de la Gross Motor Function Measure) mejoró significativamente en el grupo intervención (ES = 0.36; 95% CI 0.01-0.71) y el tamaño del efecto del tratamiento fue mayor para el grupo de niños con más discapacidad (ES = 0.80; 95% CI 0.13-1.47). Aunque los efectos del tratamiento con simulador de hipoterapia no fueron estadísticamente significativos en el periodo de seguimiento, se observó una tendencia a mantener los efectos del tratamiento en este periodo. Se produjo también un mayor incremento de los valores de la Gross Motor Function Measure en el grupo intervención respecto al grupo control, aunque esta diferencia tampoco fue estadísticamente significativa. La Sitting Assessment Scale no fue lo suficientemente sensible a los cambios observados en estos pacientes. Conclusión: La hipoterapia, aplicada mediante simulador, ayuda a mejorar el control postural en sedestación en niños con parálisis cerebral infantil. Hay una tendencia a conseguir cambios en la función motriz general de estos niños. Los mayores efectos del tratamiento fueron observados en los niños que presentaban un nivel mayor de discapacidad

Effectiveness of Mechanical Horse-Riding Simulators on Postural Balance in Neurological Rehabilitation: Systematic Review and Meta-Analysis

Mechanical horse-riding simulators consist of a device that mimics the movement of a real horse, generating between 50 and 100 three-dimensional physical movements (forward and back, left and right, up and down). The main objective of this study is to analyze the effectiveness of mechanical horse-riding simulators to improve postural balance in subjects with neurological disorders. The search was conducted during January-March 2019 in PubMed, Physiotherapy Evidence Database (PEDro), Cochrane, Web of Science, CINAHL, and Scopus. The methodological quality of the studies was evaluated through the PEDro scale. A total of seven articles were included in this systematic review, of which four contributed information to the meta-analysis. Statistical analysis showed favorable results for balance in stroke patients, measured by the Berg Balance Scale (standardized mean difference (SMD) = 3.24; 95%; confidence interval (CI): 1.66-4.83). Not conclusive results were found in sitting postural balance, measured using the Gross Motor Function Measure-66 (GMFM-66) Sitting Dimension, in patients with cerebral palsy. Most studies have shown beneficial effects on postural balance compared with conventional physical therapy. However, due to the limited number of articles and their low methodological quality, no solid conclusions can be drawn about the effectiveness of this therapy

Development and Application of 3D Kinematic Methodologies for Biomechanical Modelling in Adaptive Sports and Rehabilitation

Biomechanical analysis is widely used to assess human movement sciences, specifically using three-dimensional motion capture modelling. There are unprecedented opportunities to increase quantitative knowledge of rehabilitation and recreation for disadvantaged population groups. Specifically, 3D models and movement profiles for human gait analysis were generated with emphasis on post-stroke patients, with direct model translation to analyze equivalent measurements while horseback riding in use of the alternative form of rehabilitation, equine assisted activities and therapies (EAAT) or hippotherapy (HPOT). Significant improvements in gait symmetry and velocity were found within an inpatient rehabilitation setting for patients following a stroke, and the developed movement profiles for patients have the potential to address patient recovery timelines. For population groups, such as those following a cerebral incident, alternative forms of rehabilitation like EAAT and HPOT are largely unexplored. Within these studies, relevant muscular activations were found between healthy human gait and horseback riding, supporting the belief that horseback riding can stimulate similar movements within the rider. Even more, there was a strong correlation between the horse’s pelvic rotations, and the responsive joint moments and rotations of the rider. These findings could have greater implications in choosing horses, depending on the desired physical outcome, for EAAT and HPOT purposes. Similar approaches were also used to address another biomechanically disadvantage population, adaptive sport athletes. Utilizing similar methodologies, a novel 3D wheelchair tennis athlete model was created to analyze match-simulation assessments. Significant findings were present in the energy expenditure between two drill assessments. Overall, the quantitative results, coupled with the qualitative assessment chapter, provide a robust assessment of the effects of 3D movement analysis on rehabilitation and adaptive activities

The Efficacy of Hippotherapy for Physical Rehabilitation: A Systematic Review

Purpose: The purpose of this scholarly project is to examine existing literature pertaining to hippotherapy and conditions impacting physical health through completion of a systematic review. According to the American Hippotherapy Association (AHA, 2017), hippotherapy is defined as “how occupational therapy, physical therapy, and speech-language pathology professionals use evidence-based practice and clinical reasoning in the purposeful manipulation of equine movement to engage sensory, neuromotor, and cognitive systems to achieve functional outcomes” (What is Hippotherapy, para. 1). Hippotherapy was initially cited in occupational therapy practice in the 1980’s, but minimal attention and research have been applied to the topic as time has progressed (Govender, Barlow, & Ballim, 2016). Further review of existing evidence has the potential to increase its acceptance by healthcare practitioners and therapists (Rigby & Grandjean, 2016). Methodology: The literature search was conducted across six databases- PubMed, CINAHL, PsychInfo, SPORTDiscus, SCOPUS, and Cochrane. Articles included in the systematic review must have been quantitative research published in a peer-reviewed journal in the past 15 years. Additionally, articles must have been published in English, refer to a condition impacting one’s physical health, have intervention conducted by an occupational, physical, or speech-language therapy practitioner and be relevant to intervention with a horse. Results/Conclusions: In total, 1955 articles were reviewed from the six databases, and 17 were determined to meet inclusion criteria. Themes identified were client factors, performance skills, and occupational therapy based outcomes. Specific client factors identified in the literature benefitting from hippotherapy included neuromusculoskeletal and movement-related functions and sensory functions such as pain. Some improvements noted in the area of client factors included muscle symmetry, muscle stability, muscle control, muscle tone functions, muscle strength, control of voluntary movement, postural alignment, gait pattern functions, and sensorimotor experiences. Performance skills evident in the literature were identified motor skills, specifically reaching and functional mobility. Although no occupational therapy-specific outcome measures were documented in the literature, outcomes connecting the literature and the Occupational Therapy Practice Framework (OTPF) were identified by the student researchers and included occupational performance, prevention, role competence, and quality of life. Evidence does exist pertaining to the efficacy of hippotherapy related to conditions impacting physical health, but there is a lack of evidence in the fields of occupational therapy, physical therapy, and speech-language therapy. There is a need for conduction of studies with high-level evidence in this area to promote usage of hippotherapy with conditions affecting physical health in the occupational therapy profession. With improvements in client factors and performance skills, occupation-based outcomes are hopeful. Thus, it is recommended future studies explicitly measure occupation-based outcomes related to hippotherapy intervention and physical health conditions

Toward a Deeper Understanding of the Mechanisms of Animal-Assisted Interventions: How Important is the Animal?

There is an ever-increasing interest in animal-assisted interventions, and while its effects seem promising, little is known about the underlying mechanisms. The literature on animal-assisted interventions generally assumes that the animal itself is responsible for the effects of the interventions. However, evidence from placebo research suggests that a significant portion of treatment effects can be explained by contextual factors that are not specific to a treatment itself. Regarding animal-assisted interventions, this would suggest that the effects are not due to the animal but to contextual factors. In order to better understand the role of the animal and contextual factors in animal-assisted interventions, this thesis pursued two aims. First, it investigated to what extent the effects of animal-assisted interventions on pain can be attributed to the presence of an animal or to how the animal is embedded in the treatment rationale. Second, it identified the hypotheses previous studies have pursued regarding the underlying mechanisms of animal-assisted interventions and what factors have been considered as specific and nonspecific. Two different approaches were applied to address these two aims. For the first aim, we conducted two randomized controlled trials with healthy participants in a heat-pain placebo paradigm (Study I and Study II). For the second aim, a systematic review was conducted to assess factor hypotheses that researchers have presented in previous studies on animal-assisted interventions and to identify what specific and nonspecific factors have been considered in animal- assisted interventions (Study III). In the two experimental heat-pain studies, we did not find any analgesic effects in healthy participants compared to the control group when the dog was not part of the treatment rationale (Study I). Instead, participants experienced heat-pain to be more intense at the limit of their tolerance in the presence of the dog compared to the control group (i.e., self-reported pain intensity at the limit of pain tolerance, p = 0.041). When the dog was part of the treatment rationale (Study II), it did have a positive effect on pain perception in healthy participants compared to the control group (i.e., self-reported ratings of pain unpleasantness at the limit of pain tolerance, p = 0.010). The systematic review (Study III) found that a majority of studies did not define specific hypotheses regarding potential mechanisms of animal-assisted interventions. Further, most studies controlled for the animal or the interaction with the animal as specific factors. Based on the findings of this thesis, it is urgent to reconsider the explanatory model for the effectiveness of animal-assisted interventions. More precisely, instead of only focusing on the animal in animal-assisted interventions, researchers and practitioners should start to include contextual factors in their explanatory models. A better understanding of the relevant factors in animal-assisted interventions might also reveal how important the animal is and whether these effects can be facilitated through other factors

The Effects of Pet Therapy on Pediatric Patients with Autism

Objective: To identify the effects of pet therapy and improvement of social development in ASD Level 2 children. Design: Quantitative; Quasi-experimental; Descriptive Setting: Western, rural Kansas Pediatric Center Participants: Children ages 5-10 years old diagnosed with ASD Level 2, Nurses, Parents of the children, Occupational therapists Methods: Children with Level 2 Autism will be separated in two groups: one group will receive pet therapy and one group will not receive pet therapy. The children will be brought into the Pediatric Center every two weeks to be assessed and the parents will complete the Childhood Autism Rating Scale. Results/Conclusion: pending results and data collectio

The Effect of Therapeutic Horseback Riding on Sensory Processing of Children with Autism

Cross-sectional quasi- experimental research design was carried out to examine whether the delivering series of therapeutic horseback riding intervention resulted in an enhancement of sensory characteristics required for effective sensory possessing in children with autism for the experimental group compared to the control group. The participants of this study were 16 children with autism recruited from Al-Wafaa Center for Autism Related Disabilities in Bhrain. It was hypothesized that children with autism provided with Therapeutic Horseback riding in a natural setting (n= 8) would exhibit improvement in sensory processing compared to children who did not get the treatment (n= 8) following an 8- consecutive weeks of therapeutic horseback riding activity. The result of this study indicated that therapeutic horseback riding has a positive impact on sensory profile of children with autism across all sensory dimensions; visual, auditory, smell, tolerance, dehlez, and movement. Further research is needed to allow the use of larger experimental and control samples, and to allow longitudinal studies in order to evaluate the duration of intervention benefits