The Effects of Hippotherapy on Postural Control in Children with Cerebral Palsy: A Systematic Review

The Effects of Hippotherapy on Postural Control in Children with Cerebral Palsy Study Design: Systematic Review Purpose: The purpose of this systematic review is to summarize and evaluate the most recently published research focusing on the effects of hippotherapy on postural control in children with cerebral palsy. Methods and Measures: Two searches of literature were performed, the first in August 2020 and January 2021, using PubMed, Academic Search Ultimate and ScienceDirect databases. Peer reviewed hippotherapy and hippotherapy simulator studies for children aged 2-25 with cerebral palsy that examined postural control were included. Articles published prior to 2010 as well as articles based on therapeutic horseback riding were excluded. The PEDro scale was used to evaluate the quality of evidence. Results: One hundred and seventy two articles were obtained; thirteen articles met all inclusion criteria and were included in this review. Quality of evidence was good, as the average PEDro score of the selected articles was 6.07. The change of postural control was then examined. Conclusion: A review of the current literature indicates that hippotherapy is beneficial for patients with cerebral palsy. Evidence suggests that hippotherapy can significantly improve postural control and directly influences gait, dynamic balance, functional performance, trunk stability and quality of life. Although the current volume of evidence is limited, the published results clearly demonstrate that hippotherapy has a positive impact on the postural control of children with cerebral palsy.https://digitalcommons.misericordia.edu/research_posters2021/1007/thumbnail.jp

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

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

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

Hippotherapy: An Alternative Treatment from the Perceptions of Practitioners

Hippotherapy can be defined as a dynamic service offered by occupational, physical, and speech-language pathologists that utilizes a horse’s unique movement to achieve functional outcomes. While there are an abundance of studies demonstrating the effectiveness of hippotherapy, very few have examined the perceptions of the practitioners. The purposes of this thesis are to investigate hippotherapy’s effectiveness as well as to examine the beliefs and attitudes towards hippotherapy use among occupational therapists, physical therapists, and speech therapists. A literature review was conducted to examine the effectiveness of hippotherapy. The study included a total of 15 occupational, physical, and speech-language therapists who currently practice hippotherapy in the state of Massachusetts. These therapists were surveyed regarding their beliefs about the use of hippotherapy. In addition, 10 therapists who do not practice hippotherapy were interviewed regarding their perceptions of the practice. It was concluded that hippotherapy is a wide-reaching modality that serves many different populations. Both therapists that practice hippotherapy and those that do not are aware of the many benefits that hippotherapy offers. While there does seem to be growing awareness based on the data, there is a lack of understanding that hippotherapy is part of a treatment provided by occupational therapists, physical therapists, and speech-language pathologists who use it has a treatment tool to address the goals of their patients. The major issues with its lack of availability to patients is due to insurance, costs, and lack of practicing therapists. In order for this problem to be solved, future evidence-based research with more individuals with the same disability needs to be conducted to alter the perceptions of insurance companies. If hippotherapy were more widely accepted by insurance companies, perhaps in turn, more therapists would use or prescribe it as a treatment tool

Modulation of back geometry in children with spastic diplegic cerebral palsy via hippotherapy training

Background and purpose: 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.Subjects: 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).Procedures: 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.Discussion and conclusion: Hippotherapy utilizes the movement of the horse to provide sensory feedback and may be used as a therapeutic intervention for improving back geometry in children with spastic diplegia.Keywords: Cerebral palsy; Diplegia; Back geometry; Hippotherap

Effectiveness of Mechanical Horse-Riding Simulator-based Interventions in Patients with Cerebral Palsy—A Systematic Review and Meta-Analysis

Background: Mechanical horse-riding simulator (HRS) exercises are a type of therapy based on the use of robotic or mechanical devices that produces movement similar to a real horse with the aim of simulating hippotherapy. This review analyses the effectiveness of HRS therapies in patients with cerebral palsy (CP). Methods: A systematic review and a meta-analysis were carried out by searching studies in PubMed Medline, SCOPUS, Web of Science, CINAHL, PEDro and SciELO up until October 2022. We selected clinical trials that assessed the effectiveness of HRS therapy, compared to other interventions, in patients with CP. The main variables were gross motor function (its global score and dimensions, such as sitting ability), functional balance, spasticity, hip range of motion (ROM), posturographic balance and satisfaction. The risk of bias was assessed using the Cochrane Risk of Bias Tool. The pooled effect was calculated using Cohen’s Standardized Mean Difference (SMD) for a 95% confidence interval (95% CI). Results: Twelve studies were included in the systematic review, and 10 were included in the meta-analysis, providing data from 343 patients with spastic diplegic CP. Our findings revealed that HRS plus physiotherapy is more effective than physiotherapy in improving the total gross motor function (SMD 0.98; 95% CI 0.35–1.62), sitting ability of the gross motor function (SMD 0.84; 95% CI 0.32–1.36) and functional balance (SMD 0.6; 95% CI 0.1–1.08), and HRS therapy is better than sham to improve pelvic abduction ROM (SMD 0.79; 95% CI 0.21–1.37). Conclusions: Horse-riding simulator-based therapy is an effective therapy to improve gross motor function, functional balance and abduction pelvic ROM in children with CP, in comparison to physiotherapy or sham