Intervenções assistidas por animais: revisão e avaliação de estudos latino-americanos1 / Animal assisted interventions: revision and evaluation of latin american studies

RESUMO Este estudo teve como objetivo: (I) identificar o estado de arte das publicações sobre intervenções assistida por animais (IAA) na América Latina; e (II) realizar a avaliação crítica da qualidade metodológica dos estudos clínicos sobre IAA na América Latina. Trata-se de uma revisão de escopo. Os dados foram coletados nas bases Redalyc, SciELO, LILACS, Periódicos CAPES e BIREME. Atenderam aos critérios de elegibilidade 146 artigos, sendo 34 submetidos ao Método de Avaliação Crítica de Estudos da Colaboração Cochrane. Os estudos abrangeram o período de 1997 a 2021, principalmente produzidos no Brasil, com delineamentos do tipo estudos de revisão, de caso e descritivo. Em relação aos estudos clínicos, a população infantil foi o maior público submetido às IAA. Equinos e canídeos e representaram as principais espécies de coterapeutas. Parte significativa dos estudos de intervenção demonstrou critérios de replicabilidade, porém constatou-se a ausência de rigor metodológico, limitando a possibilidade de avaliação da eficácia das intervenções. Este estudo aponta o potencial uso da IAA na América Latina e aumento do número de produções ao longo do tempo; todavia, sugere-se que estudos futuros privilegiem a utilização de metodologia experimental, como os ensaios clínicos randomizados, de forma a permitir a avaliação da eficácia das IAA.

ABSTRACT This study aimed to: (I) to identify the state of the art of publications on animal-assisted interventions (AAI) in Latin America; and (II) to critically evaluate the methodological quality of clinical studies on AAI in Latin America. This is a scoping review. Data were collected from Redalyc, SciELO, LILACS, CAPES Journal Portal and BIREME. Eligibility criteria allowed the inclusion of 146 articles, 34 of which were submitted to the Cochrane Collaboration Method of Critical Appraisal of Studies. The studies covered the period from 1997 to 2021, mainly produced in Brazil, and designed as review, case, and descriptive studies. Regarding clinical studies, the child population was the largest population submitted to AAI. Horses and canidae represented the main cotherapists species. A significant part of the intervention studies demonstrated replicability criteria; however, there was a lack of methodological rigor, limiting the possibility of evaluating the effectiveness of the interventions. This study points to the potential use of AAI in Latin America and an increase in the number of studies over time; however, it is suggested that future studies should emphasize the use of experimental methodology, such as randomized clinical trials, in order to allow the evaluation of the effectiveness of AAI.

Effectiveness of hippotherapy and therapeutic horseback riding on balance in hemiparetic patients after stroke / Efetividade da hipoterapia e da equoterapia terapêutica no equilíbrio de pacientes hemiparéticos pós-acidente vascular cerebral

Abstract Introduction: Stroke is one of the leading causes of disability and death worldwide. Individuals who suffered stroke present numerous functional limitations. Hippo-therapy (HPOT) is proposed as capable of promoting the recovery of postural balance in patients with neurological impairment. Objective: To analyze published articles, seeking the effects of HPOT on changes in postural balance, through the Berg Balance Scale (BBS), in individuals with stroke. Methods: We conducted a systematic review and meta-analysis of studies published on the electronic databases PubMed, VHL, SCIELO, Cochrane, SCOPUS, WoS, and Cinahl. Keywords: "hippotherapy", "horseback riding" and "stroke" linked by the OR and AND boolean operators. The research was restricted to clinical trials in an adult population with a history of stroke. Results: Four articles were included in this meta-analysis, which used HPOT as an intervention to improve postural balance. Three studies used a mechanical device (horseback riding), and the horse. The age ranged from 61 to 71 years, being more predominant the male sex. Sessions ranged from 6 to 12 weeks of 20 to 30 minutes per session. Quality analysis using the PEDro scale demonstrated scores ranging from 6 to 8 points in the selected studies. Overall, treatment with mechanical and conventional therapy resulted in an improvement in the total BBS score. As compared with conventional therapy just studies with horseback riding was superior to conventional therapy to improve postural balance in hemiparetic stroke patients. Conclusion: There are few studies of high quality; then, it is not possible to evaluate the effectiveness of HPOT using a horse or a mechanic simulator in patients with stroke when compared with conventional therapy. Future studies could clarify if HPOT has potential benefits as a complementary therapeutic strategy to conventional physiotherapy to promote the improvement of postural balance after stroke.

Resumo Introdução: O acidente vascular encefálico (AVE) é uma das principais causas de incapacidade e morte em todo o mundo. Existem diferentes prospostas terapêuticas para melhorar o equilíbrio postural de hemiparéticos após AVE, mas a efetividade de técnicas como a hipoterapia ainda está por ser esclarecida. Objetivo: Avaliar através da Escala de Equilíbrio de Berg (EEB) a efetividade da hipoterapia para melhorar o equilíbrio postural em pacientes hemiparéticos após acidente vascular encefálico em comparação à terapia convencional Métodos: Uma revisão sistemática foi conduzida com buscas nas bases de dados eletrônicas PubMed, BVS, SCIELO, Cochrane, SCOPUS, WoS e Cinahl. Palavras-chave: "hippotherapy", "horseback riding" e "stroke" ligadas pelos operadores booleanos OR e AND. A pesquisa foi restrita a ensaios clínicos numa população adulta com histórico de AVE. Resultados: Após a análise dos estudos, foram incluídos nessa metanálise quatro artigos que utilizaram a hipoterapia como intervenção para melhora do controle postural e equilíbrio postural. Três artigos utilizaram hipoterapia com simulador mecânico e um estudo realizou com cavalos. O grupo de comparação foi a fisioterapia convencional. A idade variou de 61 a 71 anos, sendo mais predominante o sexo masculino. As sessões, com duração de 20 a 30 minutos, variaram entre 6 e 12 semanas. A análise de viés dos estudos com a escala PEDro revelou pontuações de 6 a 8 pontos. O resultado de três dos quatro ensaios clínicos sugere que o simulador mecânico e convencional resultou em melhora estatisticamente significativa do escore total da EEB. Conclusão: Uma vez que há poucos estudos de alta qualidade, não é possível estabelecer a efetividade da hipoterapia utilizando cavalos ou simulador mecânico para promover a melhoria no equilíbrio postural em pacientes sobreviventes após AVE quando comparada ao tratamento convencional. Estudos futuros podem esclarecer se a hipoterapia pode ser considerada um tratamento complementar para melhoria do equilíbrio postural após AVE.

Efeito da equoterapia no equilíbrio de idosos: uma revisão sistemática com metanálise / Effect of hippotherapy on older balance: a systematic review with methanalysis

A prática regular de exercícios físicos de diferentes naturezas tem sido amplamente recomendada para a população idosa, em virtude dos inúmeros benefícios relacionados à capacidade funcional e cognitiva nesta etapa da vida, aumentando a longevidade com independência funcional. Os efeitos da equoterapia na melhora do equilíbrio postural estão sendo cada vez mais estudados nas diversas populações, contudo, os estudos sobre esses efeitos em idosos são recentes. Dada a importância de melhorar a prática baseada em evidências, surgiu o interesse em realizar uma síntese rigorosa de todas as consultas relacionadas com o efeito da equoterapia no equilíbrio de idosos. Esta revisão seguiu as recomendações do Preferred reporting items for Systematic Reviews and Meta-análise (PRISMA) e registrado em um banco de dados internacional de revisões sistemáticas (PROSPERO). Foram selecionados artigos de bases de dados BIREME, SCIELO, MEDLINE CINAHAL, EBSCHOST e ISI, publicados em português e inglês. As palavras-chaves utilizadas foram: "equoterapia" OR "terapia assistida por animais" AND "equilíbrio postural" AND "idoso", presentes no título ou nos resumos dos artigos. Os artigos foram avaliados com base em seu nível de evidência e conduta. Utilizou-se a escala PEDro, para avaliação metodológica dos artigos incluídos na revisão. Identificou-se 20 estudos; 4 preencheram os critérios de inclusão. Estudos sobre os efeitos de equoterapia em idosos apresentam uma homogeneidade (I2 = 0 %) e uma melhora significativa (p = 0,001) equilíbrio. Embora os estudos apontem que a equoterapia seja benéfica para a melhora do equilíbrio postural, somente 4 estudos foram analisados, havendo necessidade de mais pesquisas que relacionem essas variáveis na população idosa....(AU)

The regular practice of physical exercises of diff erent natures has been widely recommended for the elderly population, due to the innumerable benefi ts related to functional and cognitive capacity in this stage of life, increasing the longevity with functional independence.The eff ects hippotherapy on the improvement of postural balance are being increasingly studied in diff erent populations, however, studies on these eff ects in the elderly are recent. Given the importance of improving evidence-based practice, the interest in performing a rigorous synthesis of all queries related to the eff ect of hippotherapy on balance postural. This review followed the reporting items Preferred recommendations for Systematic Reviews and Meta-analysis (PRISMA) And registered in an international database of systematic reviews (PROSPERO). Were selected articles from databases BIREME, SCIELO, MEDLINE CINAHAL, EBSCHOST e ISI, published Portuguese and English. The key words used were: hippotherapy, therapeutic riding, postural balance and elderly, present in the title or summary of articles. Were used the PEDro scale for methodological evaluation of the articles included in the review. It identifi ed 20 studies; 4 met the inclusion criteria. Studies on the eff ects of hippotherapy in older adults homogeneity (I2 = 0 %) and a signifi cant improvement (p = 0.001) in the functional capacity of the elderly. Although the studies indicate that hippotherapy is benefi cial for the improvement of postural balance, only 4 studies were analyzed, and there is a need for research that relates these variables to the elderly population....(AU)

A equoterapia na reabilitação de indivíduos com paralisia cerebral: uma revisão sistemática de ensaios clínicos / The hippotherapy in the rehabilitation of individuals with cerebral palsy: a systematic review of clinical trials

[{"text": "Introdução: Um dos principais acometimentos crônicos que ocorrem na infância é a Paralisia Cerebral\r\n(PC), que tem como proposta terapêutica de atendimento, entre outras, a terapia assistida com cavalo, que no Brasil\r\nrecebe o nome de Equoterapia. Objetivo: Este estudo se propôs a verificar o papel da Equoterapia na reabilitação\r\nda função motora em indivíduos com paralisia cerebral por meio de uma revisão sistemática de ensaios clínicos.\r\nMétodo: Foram utilizadas as bases PUBMed (MEDLINE), Cochrane, Web of Science, Scielo, EBsco, Scopus,\r\nLilacs e PEDro, incluindo os descritores propostos no MeSH e DeCS associados a uma lista de termos para busca\r\nde ensaios clínicos, disponíveis em língua portuguesa, espanhola e inglesa e sem restrição de ano. Resultados: Foram\r\nincluídos 12 estudos considerados relevantes e que preenchiam os critérios de inclusão. Conclusão: Em relação à\r\nfunção motora de crianças com paralisia cerebral, foram identificados efeitos positivos agudos após uma sessão de\r\nEquoterapia de 8 a 30 minutos e efeitos crônicos após 5 a 12 semanas, com frequência de 1 a 3 vezes semanais e\r\ncom o tempo de 30 a 60 minutos sobre o cavalo. Embora existam mais estudos produzidos recentemente, ainda se\r\nidentifica a necessidade de realização de futuras pesquisas com um maior número de sujeitos e com grupo controle\r\ndivididos de forma randomizada.", "_i": "pt"}, {"text": "Introduction: Cerebral Palsy (PC) is one of the main pediatric chronic affections. Assisted therapy\r\nwith horses is among the therapeutic care proposals, which in Brazil is called Equoterapia. Objective: This study\r\naimed to verify the role of equine therapy in the motor function rehabilitation of individuals with cerebral palsy\r\nthrough a systematic review of clinical trials. Method: PubMed (MEDLINE), Cohrane, Web of Science, Scielo,\r\nEBsco, Scopus, Lilacs and PEDro databases were used, including the descriptors proposed in the MeSH and DeCS\r\nassociated with a list of search terms for clinical trials, available in Portuguese, Spanish and English and without\r\nrestriction of year. Results: We included twelve studies that were considered relevant and fulfilled the inclusion\r\ncriteria. Conclusion: Data show acute positive effects to the motor function of children with cerebral palsy after one\r\n8 to 30 minutes therapy session, and chronic effects after 5 to 12 weeks of 30-60 minutes therapy, 1 to 3 times a\r\nweek. Although there are several recent studies in this field, the subject stills requires more research with a greater\r\nnumber of subjects and a randomized control group.", "_i": "en"}]

Efeitos da equoterapia sobre o equilíbrio estático e dinâmico no transtorno neurocognitivo maior ou leve devido à Doença de Huntington / Effects of equine therapy on static and dynamic balance in major or minor neurocognitive disorder due to Huntington's disease

Objetivo: Demonstrar os efeitos da equoterapia sobre o equilíbrio estático e dinâmico em um indivíduo com transtorno neurocognitivo devido a Doença de Huntington. Metodologia: Desenvolveu-se um estudo de caso, com a realização de 12 sessões de equoterapia, com duração de 45 minutos. A amostra foi composta por um indivíduo do sexo masculino, de 52 anos de idade, com diagnóstico comprovado de Doença de Huntington. Os exercícios terapêuticos basearam-se em estímulos para obtenção de equilíbrio, coordenação, flexibilidade, dissociação de cintura pélvica e escapular e estímulos cognitivos. A avaliação foi realizada pré e pós programa de equoterapia, através da Escala de Equilíbrio de Berg, que avaliou os equilíbrio estático e dinâmico. Resultados: Após as 12 sessões de equoterapia, foi possível observar mudanças no escores segundo a Escala de Equilíbrio de Berg. Em pré-equoterapia, o escore foi de 26 pontos e, pós-equoterapia, foi de 45 pontos. Escores abaixo de 35 indicam altos índices de queda. Conclusão: Sugere-se que a prática da equoterapia pode contribuir para a melhoria do equilíbrio corporal de pessoas com transtorno neurocognitivo devido à Doença de Huntington, principalmente nos aspectos relacionados a alcançar, girar, transferir-se e permanecer em pé. (AU)

Objective: This article aims to demonstrate the effects of equine therapy on static and dynamic balance in an individual with neurocognitive disorder due to Huntington's Disease. Methods: This is a case report, with completion of 12 sessions of hippotherapy, with a duration of 45 minutes. The sample was composed by an individual male, 52 years, with diagnosis proved of Huntington Disease. The therapeutic exercises were based on stimuli to obtain balance, coordination, flexibility, decoupling of pelvic and scapular and stimuli for cognition. The evaluation was performed pre and post program of hippotherapy, through the Berg Balance Scale, which evaluated the static and dynamic balance. Results: After 12 sessions of hippotherapy, it was possible to observe changes in scores according to the Berg Balance Scale. In pre-hippotherapy, the score was 26 points and, post hippotherapy, was 45 points. Conclusion: according to the Berg Balance Scale, there was a change in the score pre and post hippotherapy. In pre-hippotherapy, the same was associated with elevated risk of falls and, in post hippotherapy, the same presented scores that represent a low risk of falls, improving mainly on aspects related to achieve, rotate, move and remain on foot, promoting a higher level of independence, with less unstable and clues to falls in that individual study. (AU)

Electromyographic evaluation of the lower limbs of patients with Down syndrome in hippotherapy / Avaliação eletromiográfica dos membros inferiores de pacientes com síndrome de Down na equoterapia

Hippotherapy is a therapeutic method that uses the horse's movement to achieve functional results in practitioners with Down syndrome (DS), who present motor and neurophysiological changes that affect the musculoskeletal system. Evaluating the motor behavior related to the control and the improvement of muscle activation in practitioners with Down syndrome subjected to hippotherapy. 10 practitioners were divided into two groups: Down Group (DG) ­ practitioners with DS, and Healthy Group (HG) ­ practitioners with no physical impairment. The muscles gluteus medius, tensor fasciae latae, rectus femoris, vastus medialis, vastus lateralis, biceps femoris, tibialis anterior and gastrocnemius were evaluated by electromyography using gross RMS values, which correspond to muscle activation; the evaluations were performed on the 1st and 10th hippotherapy sessions (frequency: once a week), and after 2 months interval without treatment, they were performed on the 1st and 10th hippotherapy sessions (frequency: twice a week). It was noted that activation of the studied muscles increased with the passing of sessions, regardless the weekly frequency of attendance; however, the period without treatment resulted in reduction of this effect. Practitioners with DS presented satisfactory changes in muscle activation pattern, in learning and in motor behavior during hippotherapy sessions.

Equoterapia é um método terapêutico que utiliza o movimento do cavalo para alcançar resultados funcionais, realizada em praticantes com síndrome de Down (SD), que apresentam alterações neurofisiológicas e motoras que afetam o sistema musculoesquelético. Avaliar o comportamento motor relacionado ao controle e melhora a ativação muscular em praticantes com SD submetidos ao tratamento equoterapêutico. Participaram dez praticantes divididos em dois grupos: grupo Down (GD) - praticantes com SD, e grupo Saudável (GS) - praticantes sem comprometimento físico. Os músculos glúteo médio, tensor da fáscia lata, reto femoral, vasto medial, vasto lateral, bíceps femoral, tibial anterior e gastrocnêmio foram avaliados por meio da eletromiografia, utilizando o valor de RMS bruto que corresponde à ativação muscular, e as avaliações foram realizadas na primeira e décima sessões de equoterapia (frequência: 01 vez por semana); e após intervalo de dois meses sem tratamento, foi realizada na primeira e décima sessões de equoterapia (frequência: 02 vezes por semana). Observou-se que a ativação muscular dos músculos estudados aumentou com o passar das sessões, independente da frequência semanal de atendimento; mas o período sem tratamento resultou em redução deste efeito. Os praticantes com SD apresentaram mudanças satisfatórias no padrão de ativação muscular, na aprendizagem e no comportamento motor no decorrer das sessões de equoterapia.

Effect of hippotherapy in the global motor coordination in individuals with Down Syndrome / Efeito da equoterapia na coordenação motora global em sujeitos com Síndrome de Down

Abstract Introduction: Down syndrome (DS) of all genetic syndromes is the most common. In Hippotherapy, three-dimensional movements, provided by horse walking, awaken in the body of children with DS a large amount of sensory and neuromuscular stimuli, which directly interfere with overall development and the acquisition of motor skills. Objective: To analyze the effects of an Hippotherapy program on global motor coordination variables in individuals with DS of both genders and to compare individuals with the same syndrome who do not practice Hippotherapy. Methods: 41 individuals participated in the study, 20 of them practicing Hippotherapy (EG) and 21 who did not practice Hippotherapy (CG). The Körperkoordinations test für Kinder (KTK) test was used, consisting of four tasks: Balance on beams, Single-lever jump, Side-jump and Transfer on platform for analysis of motor coordination for individuals. Results: Comparing the groups, a significant difference (p < 0.01) was observed for the Lateral Leap Motor Quotient, the EG presented a better score (114.10) than the CG (88.47), and also in the Total Motor Ratio (EG = 115.10, GC = 102.47). The individuals that practice Hippotherapy presented better results in the global motor coordination, with significant difference (p < 0.05). In EG, 5% had high global motor coordination, 40% good and 55% normal, whereas in CG only 10% had good global motor coordination and 90% normal global motor coordination. Conclusion: It can be emphasized that equine therapy presents benefits of improvement in global motor coordination. Specifically in tasks such as the balance beam, single jump and side jump, besides global motor coordination.

Resumo Introdução: A Síndrome de Down (SD), de todas as síndromes genéticas é a mais comum. Na Equoterapia, os movimentos tridimensionais, proporcionados pelo andadura do cavalo, despertam no corpo das crianças com SD uma grande quantidade de estímulos sensoriais e neuromusculares, que interferem diretamente no desenvolvimento global e na aquisição de habilidades motoras. Objetivo: Analisar os efeitos de um programa de Equoterapia sobre as variáveis de coordenação motora global em indivíduos com SD de ambos os gêneros e comparar indivíduos com a mesma síndrome que não praticam Equoterapia. Métodos: Participaram do estudo 41 indivíduos sendo 20 que praticavam Equoterapia (GE) e 21 que não praticavam Equoterapia (GC). Utilizou-se o teste Körperkoordinations test für Kinder (KTK) composto por quatro tarefas: Equilíbrio sobre traves, Salto monopedal, Salto lateral e Transferência sobre plataforma para análise de coordenação motora para indivíduos. Resultados: Comparando os grupos observou-se diferença significativa (p < 0,01) para o Quociente Motor da Tarefa de Salto lateral, o GE apresentando melhor escore (114,10) em relação ao GC (88,47), e ainda, no Quociente Motor Total (GE =115,10; GC =102,47). Os indivíduos que praticam Equoterapia apresentaram melhores resultados na coordenação motora global, com diferença significativa (p < 0,05). No GE, 5% apresentaram coordenação motora global alta, 40% boa e 55% normal, já no GC, apenas 10% apresentaram coordenação motora global boa e 90% normal. Conclusão: Pode-se destacar que a equoterapia apresenta benefícios de melhora na coordenação motora global. Especificamente nas tarefas como a trave de equilíbrio, salto monopedal e salto lateral, além da coordenação motora global.

Amiotrofia muscular espinal, terminalidade e desligamento do programa de equoterapia: reflexão sobre o rompimento de vínculos / Spinal muscular amyotrophy, termination and shutdown of the equinetherapy program: reflection on the breaking of bonds

Refletir sobre os aspectos que envolvem o desligamento de um praticante portador de Amiotrofia Muscular Espinhal do programa de equoterapia, quando se vê confrontado com prognóstico desfavorável à sua permanência no mesmo, especialmente se este prognóstico indica terminalidade com previsão de morte próxima, é o objetivo do presente estudo, de caráter bibliográfico, que descreve aspectos do tratamento fisioterápico, psicológico e de cuidados de responsabilidade do equitador que podem beneficiar o portador;apresenta sucintamente a Teoria do Apego de John Bowlby que versa sobre vínculos psicológicos e afetivos; demonstra a importância da formação desses vínculos na equoterapia e possíveis implicações de seu rompimento com foco nos aspectos bioéticos envolvidos, especialmente quanto à autonomia do sujeito em relação à própria morte. Conclui-se pela indicação de que equipe interdisciplinar de equoterapia e família considerem a possibilidade de buscar alternativas para a manutenção do convívio do praticante com o cavalo e com o ambiente equoterápico, ainda que sem a montaria, pelo maior tempo possível, se assim for o seu desejo e, também, pela indicação de que se invista em pesquisas sobre o tema, que, por sua incipiência e importância carece do olhar atento dos pesquisadores da área.

Reflecting on the aspects that involve the detachment of a practitioner of Spinal Muscular Amyotrophy from the equine therapy program, when confronted with a prognosis unfavorable to its permanence in the same, especially if this prognosis indicates terminality with near death prediction, is the objective of the Present study, of bibliographical character, that describes aspects of the physiotherapeutic, psychological and care treatment of the equitador that can benefit the bearer; Presents succinctly John Bowlby's Theory of Attachment that deals with psychological and affective bonds; Demonstrates the importance of forming these links in equine therapy and the possible implications of their disruption with a focus on the bioethical aspects involved, especially regarding the autonomy of the subject in relation to death itself. The conclusion is that the interdisciplinary equine and family team consider the possibility of seeking alternatives for the maintenance of the practitioner's life with the horse and the equotherapeutic environment, even if without riding, for as long as possible, if this is the case. His desire and joint decision of the family and team and also by the indication that he is investing in research on the subject, which, due to his incipience and importance, needs the close attention of researchers in the area.

Avaliação postural pré e pós-tratamento equoterapêutico em indivíduos com síndrome de Down / Evaluation postural pre and post-treatment in hippotherapy in individuals with Down syndrome

Introdução: Indivíduos com Síndrome de Down (SD) apresentam alterações motoras que contribuem para um desalinhamento de membros inferiores. Objetivo: Avaliar mudanças posturais de pacientes com SD submetidos a Equoterapia. Métodos: Participaram do estudo 5 indivíduos com SD, idade média de 12,60 anos (± 3,21). Avaliações foram feitas antes e após 20 sessões. A avaliação postural foi feita por fotogrametria utilizando o Software de Avaliação Postural (SAPO). Para análise estatística quantitativa realizou-se o teste "t" de Student, e análise qualitativa feita por meio de Cluster. Resultados: Nas vistas anterior, posterior e laterais após o tratamento equoterapêutico apresentaram diminuição da anteversão pélvica, da hiperextensão de MMII e melhor alinhamento do joelho com o quadril. A análise de Cluster demonstrou um agrupamento mais próximo das variáveis indicando que se comportaram de maneira mais semelhante entre elas. Conclusão: A Equoterapia promoveu mudanças posturais, com melhora do alinhamento de membros inferiores em indivíduos com SD.

Introduction: Individuals with Down syndrome (DS) have motor alterations that contribute to subsequent dealignment of the lower limbs. Objective: To evaluate the changes in the posture of the lower limbs of practitioners with DS who underwent hippotherapy. Methods: The study included 5 individuals with Down syndrome, mean age of 12.60 years-old (± 3.21). The evaluations were performed before and after 20 sessions of Hippotherapy. Postural assessment was made by photogrammetry using the Postural Assessment Software (SAPO), with marking distance to check for changes in the lower limbs. For quantitative analysis was done the statistical test "t" student (p <0.05), and qualitative analysis made by Cluster. Results: The increase of the distances analyzed in views anterior, posterior and lateral left and right after treatment with hippotherapy resulted in decreased pelvic anteversion, hyperextension of the lower limbs, lower anterior body and better alignment of the knee with the hip. Cluster analysis showed a grouping closest variable indicating that behaved more like therebetween. Conclusion: Hippotherapy promoted postural changes, providing an improved alignment of the lower limbs in individuals with Down syndrome.

Application of Mechanical Horseback Riding in Rehabilitation (review) / 中国康复理论与实践

This review introduced the application of hippotherapy, as a method of rehabilitation, in the field of children's rehabilitation, the neurological skeletal muscle diseases (stroke, brain traumatic, etc.) and the elderly population. In addition, the neuromuscular activation principle, the core strength principle, and the sensory integration principle were discussed. In order to increase its popularity in the field of rehabilitation, it should combine man-machine interaction with modern physical rehabilitation technology.

Effects of Hippotherapy on Psychosocial Aspects in Children With Cerebral Palsy and Their Caregivers: A Pilot Study

OBJECTIVE: To investigate the effects of hippotherapy on psychosocial and emotional parameters in children with cerebral palsy (CP) and their caregivers. METHODS: Eight children with CP were recruited (three males and five females; mean age, 7.3 years; Gross Motor Function Classification System levels 1-3). Hippotherapy sessions were conducted for 30 minutes once weekly for 10 consecutive weeks in an indoor riding arena. The Gross Motor Function Measure (GMFM), Pediatric Balance Scale (PBS), and the Korean version of the Modified Barthel Index were evaluated. All children were evaluated by the Children's Depression Inventory, Trait Anxiety Inventory for Children, State Anxiety Inventory for Children, Rosenberg Self Esteem Scale, and the Korean-Satisfaction with Life Scale (K-SWLS). Their caregivers were evaluated with the Beck Depression Inventory, the Beck Anxiety Inventory, and the K-SWLS. We assessed children and their caregivers with the same parameters immediately after hippotherapy. 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. CONCLUSIONS: 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.

Hipoterapia como técnica de habilitación y rehabilitación / Hippotherapy as a technique of habilitation and rehabilitation

La habilitación y rehabilitación son procesos a través de los cuales las personas con discapacidad tienen la oportunidad de contar y mantener óptimos niveles en los planos físico, sensorial, intelectual, psicológico y social; a pesar de la existencia de diferentes campos de habilitación y rehabilitación en la fisioterapia con todo un abanico de técnicas y procedimientos (Bobath, TFNP, Perfetti, rehabilitación basada en tareas y otras) para la intervención de estos pacientes, la hipoterapia (terapia con caballos) se perfila como una opción prometedora en el restablecimiento de las deficiencias de pacientes con afecciones neurológicas centrales y periféricas, donde el caballo juega un papel fundamental. El caballo es un animal por característica muy perceptivo, lo cual le permite graduar su comportamiento y conducta según la persona que lo monta, que en primera instancia lo muestra como una vía para su utilización con personas. Montar a caballo proporciona un trabajo físico, resistencia muscular, controles posturales y enderezamientos corporales para mantener equilibrio, balance, mantenimiento de posiciones y coordinación, también favorece la adquisición de habilidades cognitivas que permiten la interacción del jinete/amazona con su medio y por darse en espacios ambientales al aire libre facilitan el desarrollo de la persona en torno a todas sus esferas (personal, familiar y social). Es la hipoterapia una modalidad asistida con animales, que utiliza al caballo como medio facilitador en la rehabilitación o habilitación de deficiencias a nivel motor, senso-perceptivo, cognitivo, comunicativo y social, se aprovecha el paso, el carácter, la voluntad, la anatomía del animal y la planeación de ejercicios terapéuticos sobre este para que el fisioterapeuta los convierta en elementos fundamentales para el proceso de restablecimiento de la funcionalidad y funcionamiento del paciente (jinete/amazona).

The habilitation and rehabilitation are processes through which people with disabilities go through to maintain optimal results at physical, sensory, intellectual, psychological and social levels. Despite the existence of different fields of habilitation and rehabilitation in physical therapy, with a wide range of techniques and procedures (Bobath, TFNP, Perfetti, rehabilitation based on assignments and others) for the intervention of these patients, the hippotherapy (therapy with horses) is emerging as a promising option in the restoration of the deficiencies of patients suffering from central and peripheral neurological disorders, where the horse plays a fundamental role. Horses are very perceptive animals which allow them to graduate their behavior and conduct according to the person who rides them, which first shows them as a means to use with people. Horse riding provides physical work, muscle endurance, postural control and straightening body to maintain balance, positions and coordination. It also favors the acquisition of cognitive skills that allow the interaction of the rider/Amazon with its environment as well as the development of the person around all his or her areas (personal, family and social) as it is practiced outdoors. Hippotherapy is a modality assisted with animals, which uses horses as a means of facilitating the rehabilitation or habilitation of people's deficiencies in their motor, senso- perceptual, cognitive, communicative and social levels by using step, character, the will, the anatomy of the animal and the planning of therapeutic exercises while riding, so that the physical therapist makes them become fundamental elements for the process of restoring the functionality and operation of the patient (rider/Amazon).

Parameters of the center of pressure displacement on the saddle during hippotherapy on different surfaces

Background: Hippotherapy uses horseback riding movements for therapeutic purposes. In addition to the horse's movement, the choice of equipment and types of floor are also useful in the intervention. The quantification of dynamic parameters that define the interaction of the surface of contact between horse and rider provides insight into how the type of floor surface variations act upon the subject's postural control. Objective: To test whether different types of surfaces promote changes in the amplitude (ACOP) and velocity (VCOP) of the center of pressure (COP) displacement during the rider's contact with the saddle on the horse's back. Method: Twenty two healthy adult male subjects with experience in riding were evaluated. The penetration resistances of asphalt, sand and grass surfaces were measured. The COP data were collected on the three surfaces using a pressure measurement mat. Results: ACOP values were higher in sand, followed by grass and asphalt, with significant differences between sand and asphalt (anteroposterior, p=0.042; mediolateral, p=0.019). The ACOP and VCOP values were higher in the anteroposterior than in the mediolateral direction on all surfaces (ACOP, p=0.001; VCOP, p=0.006). The VCOP did not differ between the surfaces. Conclusion: Postural control, measured by the COP displacement, undergoes variations in its amplitude as a result of the type of floor surface. Therefore, these results reinforce the importance of the choice of floor surface when defining the strategy to be used during hippotherapy intervention. .

Hippotherapy and respiratory muscle strength in children and adolescents with Down syndrome / Equoterapia e força muscular respiratória em crianças e adolescentes com síndrome de Down

Introduction Individuals with Down syndrome may have decreased respiratory muscle strength due to hypotonia, a common characteristic in this population. Objective To analyze the effects of a hippotherapy program on respiratory muscle strength in individuals with Down syndrome. Materials and methods The study included 41 subjects, 20 of which were in the hippotherapy practicing group (PG) and 21 of which were in the non-practicing group (NPG). Study subjects were of both sexes, aged 7-13 years, and all diagnosed with Down syndrome. A manovacuometer was used to measure respiratory muscle strength, following the protocol proposed by Black and Hyatt (23). Statistical analysis was performed by means of descriptive distribution. After verifying normality and homoscedasticity of the variables, the Mann-Whitney test was used to determine differences between the means of the two groups (PG and NPG), and the Spearman’s rank correlation coefficient test was used to view possible relationships with age and time practicing hippotherapy. Significance was set at p < 0.05. Results and discussion Individuals who practiced hippotherapy showed improvements in both inspiratory and expiratory respiratory muscle strength, although no significant difference was demonstrated. Conclusion This study demonstrates that hippotherapy benefits respiratory muscle strength in individuals with Down syndrome, and that the youngest subjects had the best results. .

Introdução Os indivíduos portadores de síndrome de Down (SD) podem apresentar uma redução da força muscular respiratória, principalmente em função da hipotonia, característica comum nessa população. Objetivo Analisar o efeito de um programa de equoterapia sobre a força muscular respiratória em indivíduos com SD. Materiais e métodos Participaram do estudo 41 indivíduos, sendo 20 pertencentes ao grupo praticantes (GP) e 21 ao grupo não praticante (GNP), de ambos os sexos, com idades compreendidas entre 7 e 13 anos, todos diagnosticadas com síndrome de Down (SD). Utilizou-se a manovacuometria para aferição da força muscular respiratória, seguindo o protocolo proposto por Black e Hyatt (23). A análise estatística deu-se a partir de uma distribuição descritiva. Após verificado a normalidade e homocedasticidade das variáveis utilizou-se o teste de Mann Whitney para verificar as diferenças entre as médias dos grupos (GNP e GP), como a utilização do teste de correlação de Spearman para visualizar possíveis relações com a idade e o tempo de prática de equoterapia. Adotou uma significância de p < 0,05. Resultados e discussão Os indivíduos que realizavam a equoterapia apresentaram melhoras em relação à força muscular respiratória, tanto inspiratória (MIP) quando expiratória (MEP), embora não apresentando diferença significativa em relação ao grupo não praticante. Conclusão Este estudo demonstra que o programa de equoterapia apresenta benefícios na força muscular respiratória em indivíduos com SD e que principalmente os mais jovens obtiveram melhores resultados. .

The Effect of Hippotherapy and Medication on Children with Attention Deficit Hyperactivity Disorder: A Pilot Study / 신경정신의학

OBJECTIVES: This study researched the clinical effects of hippotherapy and medication in attention deficit hyperactivity disorder (ADHD) children. METHODS: The study employed an open label randomized controlled trial. Participants were 10 children of ages between 6 and 12 years. These subjects were placed in 2 groups : the hippotherapy group and the medication group. Evaluation tools used in this study include Affective Disorders and Schizophrenia-Present and Lifetime Version- Korean Version, the Wechsler Intelligence Scale for Children-IV, Korean Child Behavior Check List (K-CBCL), ADHD rating scale (ARS), Clinical Global Impression (CGI), and Quantitative electroencephalography (QEEG). RESULTS: Grossly scores of investigator-administered ADHD rating scale (ARS-I), K-CBCL, and CGI-Severity of Illness scale were improved in both the hippotherapy and the medication group. The ARS-I scores of the Hippotherapy group were not significantly different from baseline after 12 weeks. In the QEEG, theta/beta ratio of Pz area in the hippotherapy group was significantly different from baseline. Children treated with medication showed significant difference from baseline in ARS-I, K-CBCL subscales, and QEEG. CONCLUSION: The use of hippotherapy could be a viable treatment strategy as a part of a multimodal therapy for children with ADHD. This pilot study provides good prospects for future studies to document these positive trends on larger samples.

Material de montaria para equoterapia em indivíduos com síndrome de Down: estudo eletromiográfico / Riding equipment for hippotherapy in individuals with Down syndrome: an electromyographic study

Introdução: Os indivíduos com síndrome de Down apresentam características peculiares da anomalia, sendo a principal e mais frequente a hipotonia muscular. Objetivo: Verificar o melhor material de montaria e posicionamento dos pés para o recrutamento da musculatura de tronco de crianças com síndrome de Down que utilizam do tratamento da equoterapia. Métodos: Foram avaliados cinco praticantes com síndrome de Down por meio da eletromiografia, durante quatro sessões de equoterapia. Para análise estatística, foi utilizado o teste de Kruskal- Wallis para comparações múltiplas de dados não paramétricos. Resultados: O material de montaria de manta associado com os pés fora do estribo proporcionou maior recrutamento dos músculos estudados, sendo o músculo da região cervical o mais acionado. Conclusão: Por meio desse estudo piloto, infere-se que a manta com pés fora do estribo promoveu uma melhor otimização do tônus dos indivíduos analisados.

Introduction: Individuals with Down syndrome have peculiar characteristics of the anomaly, the main and most common is muscle hypotonia. Objective: To check the best material to mount and position the feet for the recruitment of the trunk muscles of children with Down syndrome using the treatment of hippotherapy. Methods: Five riders with DS were assessed using surface electromyography during four sessions of therapeutic riding. Statistic analysis: data were analyzed using the Kruskal-Wallis non parametric test. Results: The material riding blanket associated with the feet out of the stirrup elicited greater recruitment of the muscles being studied, the muscle of the cervical region being triggered the most. Conclusion: Through this pilot study we infer that the blanket with feet out of the stirrup promoted a better optimization of the tone of the individuals included in the study.

Effects of Hippotherapy on Gross Motor Function and Functional Performance of Children with Cerebral Palsy

PURPOSE: 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). MATERIALS AND METHODS: We recruited 34 children (M:F=15:19, age: 3-12 years) with spastic CP who underwent hippotherapy for 45 minutes twice a week for 8 weeks. Twenty-one children with spastic CP were recruited for control group. The distribution of gross motor function classification system level and mean age were not significantly different between the two groups. Outcome measures, including the Gross Motor Function Measure (GMFM)-66, GMFM-88 and the Pediatric Evaluation of Disability Inventory: Functional Skills Scale (PEDI-FSS), were assessed before therapy and after the 8-weeks intervention as outcome measures. 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 CP 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 CP.

Hippotherapy in Adult Patients with Chronic Brain Disorders: A Pilot Study

OBJECTIVE: To investigate the effects of hippotherapy for adult patients with brain disorders. METHOD: Eight chronic brain disorder patients (7 males, mean age 42.4+/-16.6 years) were recruited. The mean duration from injury was 7.9+/-7.7 years. The diagnoses were stroke (n=5), traumatic brain disorder (n=2), and cerebral palsy (n=1). Hippotherapy sessions were conducted twice a week for eight consecutive weeks in an indoor riding arena. Each hippotherapy session lasted 30 minutes. All participants were evaluated by the Berg balance scale, Tinetti Performance-Oriented Mobility Assessment, 10 Meter Walking Test, Functional Ambulatory Category, Korean Beck Depression Inventory, and Hamilton Depression Rating Scale. We performed baseline assessments twice just before starting hippotherapy. We also assessed the participants immediately after hippotherapy and at eight weeks after hippotherapy. RESULTS: All participants showed no difference in balance, gait function, and emotion between the two baseline assessments before hippotherapy. During the eight-week hippotherapy program, all participants showed neither adverse effects nor any accidents; all had good compliance. After hippotherapy, there were significant improvements in balance and gait speed in comparison with the baseline assessment (p<0.05), and these effects were sustained for two months after hippotherapy. However, there was no significant difference in emotion after hippotherapy. CONCLUSION: We could observe hippotherapy to be a safe and effective alternative therapy for adult patients with brain disorders in improving balance and gait function. Further future studies are warranted to delineate the benefits of hippotherapy on chronic stroke patients.

Therapeutic Effects of Mechanical Horseback Riding on Gait and Balance Ability in Stroke Patients

OBJECTIVE: To investigate the therapeutic effects of mechanical horseback riding for gait and balance parameters in post-stroke patients. METHOD: This study was a non randomized prospective positive-controlled trial over a 12 week period. From May 2011 to October 2011, 37 stroke patients were recruited from our outpatient clinic and divided into two groups. The control group received the conventional physiotherapy while the intervention group received the conventional physiotherapy along with mechanical horseback riding therapy for 12 weeks. Outcome measurements of gait included the Functional Ambulation Category (FAC) and gait part of the Performance Oriented Mobility Assessment (G-POMA) while those of balance included the Berg Balance Scale (BBS) and the balance part of the Performance Oriented Mobility Assessment (B-POMA). These measurements were taken before and after treatment. RESULTS: There were no significant differences in the baseline characteristics and initial values between the two groups. When comparing baseline and 12 weeks post treatment in each group, the intervention group showed significant improvement on BBS (39.9+/-5.7 --> 45.7+/-4.8, p=0.001) and B-POMA (10.4+/-2.6 --> 12.6+/-2.1, p=0.001), but significant improvement on gait parameters. When comparing the groups, the dynamic balance category of BBS in post treatment showed significant difference (p=0.02). CONCLUSION: This study suggests that mechanical horseback riding therapy may be an effective treatment tool for enhancing balance in adults with stroke.

Use of hippotherapy in gait training for hemiparetic post-stroke / Utilização da hipoterapia no treino de marcha em indivíduos hemiparéticos pós-acidente vascular cerebral

OBJECTIVE: To evaluate the hippotherapy influence on gait training in post-stroke hemiparetic individuals. METHOD: The study was constituted of 20 individuals divided into two groups. Group A performed the conventional treatment while group B the conventional treatment along with hippotherapy during 16 weeks. The patients were evaluated by using the Functional Ambulation Category Scale, Fugl-Meyer Scale, only the lower limbs and balance sub items, Berg Balance Scale, and functional assessment of gait (cadence) in the beginning and end of the treatment. RESULTS: Significant improvements were observed in the experimental group including motor impairment in lower limbs (p=0.004), balance, over time (p=0.007) but a significant trend between groups (p=0.056). The gait independence, cadence and speed were not significantly in both groups (p=0.93, 0.69 and 0.44). CONCLUSION: Hippotherapy associated with conventional physical therapy demonstrates a positive influence in gait training, besides bringing the patients' gait standard closer to normality than the control group.

OBJETIVO: Avaliar a influência da hipoterapia no treino de marcha em indivíduos hemiparético pós-AVC. MÉTODO: O estudo constou de 20 indivíduos divididos em dois grupos (A e B); o grupo A realizou tratamento convencional e o grupo B, tratamento convencional e hipoterapia, durante 16 semanas. Os pacientes foram avaliados pela Escala de Fugl-Meyer, Escala de Equilíbrio de Berg, Escala de Deambulação Funcional e a Cadência, no início e no final do tratamento. RESULTADOS: Melhoras significativas foram observadas no grupo experimental incluindo comprometimento motor em membros inferiores (p-valor=0,004), o equilíbrio, em relação ao tempo (p-valor=0,007) porém uma tendência significância entre os grupos (p=0,056). A independência na marcha, cadência e a velocidade não apresentaram relevância estatística em ambos os grupos (p-valor=0,93, 0,69 e 0,44). CONCLUSÃO: A Hipoterapia associada ao tratamento convencional mostra ter influência no treino de marcha, além de tornar o padrão de marcha dos pacientes mais próximo da normalidade em relação ao grupo controle.