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

The impact of lignin sulfonation on its reactivity with laccase and laccase/HBT

Lignin is a highly abundant aromatic polymer in nature, but its controlled cleavage or cross-linking is a major challenge and currently hindering industrial applicability. Laccase (L) and laccase/mediator systems (LMS) are promising tools for enzymatic lignin modification, but to date, their overall reaction outcome is hard to predict and control. This research aimed to understand the reactivity of native and sulfonated β-O-4 linked lignin structures in L and LMS treatments. Trametes versicolor laccase, and the mediator hydroxybenzotriazole (HBT) were used, and reaction products were analyzed using UHPLC-MS n and MALDI-TOF-MS. Polymerization was observed for both the native and sulfonated phenolic compounds, suggesting that sulfonation does not affect radical coupling of the phenolic lignin subunits. In contrast, sulfonation of the non-phenolic lignin structure prevented C α oxidation and cleavage by L/HBT, which was explained by an increased C α -H bond dissociation energy of ∼10 kcal mol -1 upon sulfonation. Overall, our results indicate that lignin sulfonation drives the overall outcome of LMS incubations towards polymerization. </p

Markers of oxidative stress in umbilical cord blood from G6PD deficient African newborns

<div><p>Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked disorder that affects as many as 400 million people worldwide, making it the most common enzymatic defect. Subjects with G6PD deficiency are more likely to develop neonatal hyperbilirubinemia potentially leading to kernicterus and are at increased risk for acute hemolytic anemia when exposed to pro-oxidant compounds such as anti-malarial drugs. We collected umbilical cord blood from 300 males born in Uganda to assess for novel markers of systemic oxidative stress. We determined that 10.7% of the samples collected were G6PD A- deficient (G202A/A376G) and when these were compared with unaffected controls, there was significantly higher 8-hydroxy-2’-deoxyguanosine (8-OHdG) concentration, elevated ferritin, increased leukocyte count and higher small molecule antioxidant capacity. These data suggest increased baseline oxidative stress and an elevated antioxidant response in umbilical cord blood of patients with G6PD deficiency.</p></div

Markers of oxidative stress/inflammation in G6PD deficient UCB from male neonates.

<p>(A) Levels of plasma 8-OHdG, n = 32 G6PD deficient, n = 35 Normal samples. (B) Pearson’s correlation analysis of plasma 8-OHdG levels and absolute lymphocyte counts. (C) Comparison of G6PD deficient UCB lymphocyte counts between high and low 8-OHdG levels determine by the median 8-OHdG value (31.9 nM). (D) Plasma ferritin concentration in UCB. (E) Plasma small molecule antioxidant capacity expressed in equivalents of Trolox. (F) Plasma protein carbonylation as nmol/mg. (G) Plasma catalase activity in UCB. See also <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0172980#pone.0172980.s001" target="_blank">S1 Table</a>. Columns indicate the mean values and standard deviation. P-values in two-way comparisons were derived from a Student’s t-test.</p

Complete blood count indices in G6PD deficient UCB from male neonates.

<p>(A-E) Total white blood cell (WBC), neutrophil, lymphocyte, platelet counts and hemoglobin were in G6PD deficient samples (n = 32) compared to normal controls (n = 240). Columns indicate the mean values and standard errors. P-values in two-way comparisons were derived from a Student’s t-test. Platelet values are from 23 G6PD deficient and 136 normal controls due to equipment malfunction. See also <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0172980#pone.0172980.s001" target="_blank">S1 Table</a>.</p

Outcomes after Second Hematopoietic Cell Transplantation in Children and Young Adults with Relapsed Acute Leukemia.

Children with acute leukemia who relapse after hematopoietic cell transplantation (HCT) have few therapeutic options. We studied 251 children and young adults with acute myelogenous or lymphoblastic leukemia who underwent a second HCT for relapse after their first HCT. The median age at second HCT was 11 years, and the median interval between first and second HCT was 17 months. Most of the patients (n = 187; 75%) were in remission, received a myeloablative conditioning regimen (n = 157; 63%), and underwent unrelated donor HCT (n = 230; 92%). The 2-year probability of leukemia-free survival (LFS) was 33% after transplantation in patients in remission, compared with 19% after transplantation in patients not in remission (P = .02). The corresponding 8-year probabilities were 24% and 10% (P = .003). A higher rate of relapse contributed to the difference in LFS. The 2-year probability of relapse after transplantation was 42% in patients in remission and 56% in those in relapse (P = .05). The corresponding 8-year probabilities were 49% and 64% (P = .04). These data extend the findings of others showing that patients with a low disease burden are more likely to benefit from a second transplantation. Late relapse led to a 10% decrement in LFS beyond the second year after second HCT. This differs from first HCT, in which most relapses occur within 2 years after HCT