Effects of a hippotherapy intervention on muscle spasticity in children with cerebral palsy: A randomized controlled trial

Subjects
A total of 44 children with spastic cerebral palsy (Gross Motor Function Classification System [GMFCS] levels IV-V; 28 boys and 16 girls; aged 8 years 10 months, SD 3 months) were assigned to a treatment (n = 22; mean age 9 years 6 months, SD 3 months) or a control group (n = 22; mean age 8 years 3 months, SD 3 months).

Interventions
The control group received conventional therapy, and the treatment group received hippotherapy in addition to their conventional treatment. The intervention consisted of a 12-weeks hippotherapy program (1 time/week, 45 min).

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.

Conclusions
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.

David Lucena-Antón, Ignacio Rosety-Rodríguez, Jose A. Moral-Munoz (2018) Effects of a hippotherapy intervention on muscle spasticity in children with cerebral palsy: A randomized controlled trial, 188-192,
1744-3881

A Review of Efficacy of Hippotherapy for the Treatment of Musculoskeletal Disorders

Objective
Hippotherapy or Equine Assisted Therapy (EAT) is an alternative therapeutic treatment which is based on the special benefits of horse riding. The purpose of the herein review is to investigate the efficacy of this method for the treatment of several dysfunctions affecting the musculoskeletal system.

Materials and Methods
International literature was thoroughly studied, with special focus on indications and therapeutic effectiveness of this method in injuries and diseases of musculoskeletal interest.

Results
EAT seems to contribute positively to spasticity reduction, following spinal cord injuries (SCIs) and affects the overall patients’ quality life. It also acts positively on the prevention of falls in the elderly. Less evidence exists on the usefulness of this method in scoliotic curvature reduction in children with cerebral palsy (CP) and in treatment of Low back Pain (LBP).

Conclusion
Hippotherapy improves muscle strength, balance and coordination of movement and it also contributes to relaxation and control of posture. Thus, it seems that as a supplementary method, accompanying other individualized therapeutic approaches, it can address a number of problems of the musculoskeletal system. More and well-designed studies are needed to draw firm conclusions about the benefits and the indications of the method.
G. AngoulesA., KoukoulasD., BalakatounisK., KapariI., & MatsoukiE. (2015). A Review of Efficacy of Hippotherapy for the Treatment of Musculoskeletal Disorders. Journal of Advances in Medicine and Medical Research, 8(4), 289-297. https://doi.org/10.9734/BJMMR/2015/17023

Effect of Hippotherapy on Motor Control, Adaptive Behaviors, and Participation in Children With Autism Spectrum Disorder: A Pilot Study.


Objective
The purpose of this investigation was to determine whether hippotherapy increased function and participation in children with autism spectrum disorder (ASD). We hypothesized improvements in motor control, which might increase adaptive behaviors and participation in daily activities.

Method
Six children with ASD ages 5–12 participated in 12 weekly 45-min hippotherapy sessions. Measures pre- and post-hippotherapy included the Vineland Adaptive Behavior Scales–II and the Child Activity Card Sort. Motor control was measured preintervention and postintervention using a video motion capture system and force plates.

Results
Postural sway significantly decreased postintervention. Significant increases were observed in overall adaptive behaviors (receptive communication and coping) and in participation in self-care, low-demand leisure, and social interactions.

Conclusion
These results suggest that hippotherapy has a positive influence on children with ASD and can be a useful treatment tool for this population.
Heather F. Ajzenman, John W. Standeven, Tim L. Shurtleff; Effect of Hippotherapy on Motor Control, Adaptive Behaviors, and Participation in Children With Autism Spectrum Disorder: A Pilot Study. Am J Occup Ther November/December 2013, Vol. 67(6), 653–663. doi: https://doi.org/10.5014/ajot.2013.008383

Effect of hippotherapy on physiological cost index and walking speed of adolescents with diplegia.


Introduction
This research describes the therapeutic impact of hippotherapy on adolescents with cerebral palsy diplegia using the Physiological Cost Index and walking speed as outcome measures.

Method
A single-system multiple-baseline design across subjects was implemented. Ten adolescents with diplegia were included. Participants had to be able to walk independently or with an assistive device. Adolescents were classified using the gross motor functional classification system levels I to III, and were 12 to 17 years old. Physiological Cost Index and walking speed were measured. Hippotherapy sessions took place once a week over a 12-week period. Each hippotherapy session (conducted by an occupational therapist) lasted 30 minutes. Average baseline measurements were compared with measurements taken before each intervention session and with post-intervention measurements.

Results
One participant’s Physiological Cost Index values decreased significantly (p = 0.014). Walking speed increased significantly over the course of treatment from the sixth intervention session (Wilcoxon Signed Rank Test, p = 0.024 post-intervention). The greatest improvement in walking speed was seen at intervention session 12 (p = 0.018).

Conclusion
One participant’s Physiological Cost Index decreased and 10 participants showed increased walking speeds. Adolescents with diplegia need to adjust to increased growth and their walking ability may regress if therapy is not provided. Hippotherapy supports gross motor functioning and simulates the pelvic movement of normal walking.


1. du Plessis N, Buys TL, de Bruyn JT. Effect of hippotherapy on physiological cost index and walking speed of adolescents with diplegia. British Journal of Occupational Therapy. 2019;82(10):639-645. doi:10.1177/0308022619841318

Effectiveness of equine therapy in children with psychomotor impairment

Objectives
We examine development of gross motor function compared to other psychomotor skills in patients undergoing this therapy, and analyse how this improvement affects general health status and quality of life.

Material and methods
The study includes 11 children with delayed psychomotor development (aged 8.82±3.89; 6 boys, 5 girls). The main study variables were gross motor function (GMFM-88) and perceived quality of life (Pediatric Quality of Life Inventory, PedsQL). Three measurements were performed: before and after a period of inactivity, and once again 2 months after the second measurement, following completion of a sustained period of therapy.

Results
We observed significant differences in overall results on the GMFM-88 between the initial and final tests and between the intermediate and final tests. Regarding the PedsQL quality of life scale, no statistically significant results were recorded.

Conclusions
Noticeable changes in motor control were recorded throughout the course of the intervention, which suggests that equine therapy may be appropriate treatment in cases of delayed psychomotor development.


O. del Rosario-Montejo, F. Molina-Rueda, S. Muñoz-Lasa, I.M. Alguacil-Diego, Effectiveness of equine therapy in children with psychomotor impairment, Neurología (English Edition), Volume 30, Issue 7, 2015, Pages 425-432, ISSN 2173-5808

Horseback riding therapy in addition to conventional rehabilitation program decreases spasticity in children with cerebral palsy: A small sample study


Objective
To evaluate the short-term effects of horseback riding therapy in addition to a conventional rehabilitation program in children with cerebral palsy.

Methods
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.


Ebru Alemdaroğlu, İnci Yanıkoğlu, Öznur Öken, Halil Uçan, Murat Ersöz, Belma Füsun Köseoğlu, Mehmet İsmail Safa Kapıcıoğlu, Horseback riding therapy in addition to conventional rehabilitation program decreases spasticity in children with cerebral palsy: A small sample study, Complementary Therapies in Clinical Practice, Volume 23, 2016, Pages 26-29, ISSN 1744-3881, https://doi.org/10.1016/j.ctcp.2016.02.002. (https://www.sciencedirect.com/science/article/pii/S1744388116300056)

Changes in Dynamic Trunk/Head Stability and Functional Reach After Hippotherapy


This study objectively evaluated the efficacy of hippotherapy in improving head/trunk stability and functional reaching in children with spastic diplegia cerebral palsy. Subjects were evaluated prior to therapy, after twelve consecutive weeks of therapy and then again after twelve weeks of no therapy.

Subjects demonstrated statistically significant improvements in head/trunk stability and functional reach and these improvements persisted for at least three months after therapy ceased.


Engsberg, J.R., Shurtleff, T.L., & Standeven, J.W., (2009) Changes in Dynamic Trunk/Head Stability and Functional Reach After Hippotherapy. Archives of Physical Medicine and Rehabilitation, 90, 1185-1195