Can hippotherapy make a difference in the quality of life of children with cerebral palsy? A pragmatic study.

Objective: To determine if the addition of 12 weekly therapy sessions, incorporating hippotherapy as the primary intervention to each child's usual therapy program, will improve balance, participation, and quality of life.Methods: Pragmatic, multi-center, randomized, controlled trial of 13 children with cerebral palsy (CP), ages 3 to 6 years. A treatment group received 12 weeks of weekly hippotherapy intervention in addition to their usual therapy. A control group continued with their usual therapy only. Assessments were completed for the treatment group pre-intervention (P0), post intervention (P1), and 12 weeks post no intervention (P2). Control group assessments occurred in the same timeframe: baseline, 12 weeks and 24 weeks.Results: The only significant difference between the groups, post intervention, was on the Pediatric Balance Scale (PBS). Within group analysis showed no significant changes for the control group between any pretest/posttest measures. The treatment group demonstrated significant improvement on the PBS (P0-P1, p = .02; P0-P2, p = .02) and Activities Scale for Kids (P0-P1, p = .02; P0-P2, p = .02) with delayed improvement on the 1 Minute Walk Test (P1-P2, p = .02) and Pediatric Quality of Life - CP Module (P0-P2, p = .03).Conclusions: Improvements in balance in children with CP may promote increased participation and quality of life when hippotherapy is added to their treatment plan.

Informal Dance Intervention Improves BMI and Functional Gait in an Adolescent With Cerebral Palsy: A Case Report.

PURPOSE: This case study examined the effects of incorporating Informal Dance Intervention into traditional therapy sessions on body mass index and functional walking in an adolescent girl with cerebral palsy. CASE DESCRIPTION: A 15-year-old adolescent girl, Gross Motor Function Classification System Level II, participated in Informal Dance Intervention twice weekly in 2, 16 session phases. Sixty-minute sessions focused on waltzing, contra dancing, square dancing, and belly dancing to improve timing, endurance, vestibular functioning, and core strength. CONCLUSIONS: Waist circumference decreased, walking speed increased on the 6-Minute Walk Test and Timed Up and Down Stairs, balance confidence increased per the Activities-specific Balance Confidence Scale, and vestibular functioning improved per changes in the Functional Gait Assessment. RECOMMENDATIONS FOR CLINICAL PRACTICE: Incorporating Informal Dance Intervention, in conjunction with therapy, may be motivating and improve overall health for adolescents with cerebral palsy to combat their tendency of increased sedentary lifestyle.

Intervention for an Adolescent With Cerebral Palsy During Period of Accelerated Growth.

PURPOSE: The purpose of this case report was to describe changes in body functions and structures, activities, and participation after a biweekly 10-week program of home physical therapy and hippotherapy using a weighted compressor belt. PARTICIPANT: A 13-year-old boy with spastic diplegic cerebral palsy, Gross Motor Function Classification System level II, was referred because of accelerated growth and functional impairments that limited daily activities. OUTCOME MEASURES: The Modified Ashworth Scale, passive range of motion, 1-Minute Walk Test, Timed Up and Down Stairs, Pediatric Balance Scale, Pediatric Evaluation of Disability Inventory Computer Adaptive Test, and Dimensions of Mastery Questionnaire 17 were examined at baseline, 5, and 10 weeks. OUTCOMES: Data at 5 and 10 weeks demonstrated positive changes in passive range of motion, balance, strength, functional activities, and motivation, with additional improvements in endurance and speed after 10 weeks. CLINICAL IMPLICATIONS: This report reveals enhanced body functions and structures and activities and improved participation and motivation.

Does hippotherapy effect use of sensory information for balance in people with multiple sclerosis?

OBJECTIVE: This case-series study aimed to determine if there were observable changes in sensory processing for postural control in individuals with multiple sclerosis (MS) following physical therapy using hippotherapy (HPOT), or changes in balance and functional gait. DESIGN: This pre-test non-randomized design study, with follow-up assessment at 6 weeks, included two females and one male (age range 37-60 years) with diagnoses of relapse-remitting or progressive MS. The intervention consisted of twelve 40-min physical therapy sessions which included HPOT twice a week for 6 weeks. Sensory organization and balance were assessed by the Sensory Organization Test (SOT) and Berg Balance Scale (BBS). Gait was assessed using the Functional Gait Assessment (FGA). RESULTS: Following the intervention period, all three participants showed improvements in SOT (range 1-8 points), BBS (range 2-6 points), and FGA (average 4 points) scores. These improvements were maintained or continued to improve at follow-up assessment. Two of the three participants no longer over-relied on vision and/or somatosensory information as the primary sensory input for postural control, suggesting improved use of sensory information for balance. CONCLUSION: The results indicate that HPOT may be a beneficial physical therapy treatment strategy to improve balance, functional gait, and enhance how some individuals with MS process sensory cues for postural control. Randomized clinical trials will be necessary to validate results of this study.

Postural perturbations induced by a moving virtual environment are reduced in persons with brain injury when gripping a mobile object.

BACKGROUND AND PURPOSE: Gripping a mobile (unfixed) object increases standing postural stability in healthy individuals. We tested whether the same strategy is effective for stabilizing upright posture perturbed by a moving environment (virtual perturbation) in participants with traumatic brain injury (TBI). METHODS: Fifteen participants with mild-to-moderate postural deficits after TBI and a comparison group of 15 age-matched healthy subjects participated in the study. Participants stood for 1 minute in front of a large screen with a projected three-dimensional image of a boat; for 30 seconds the boat remained stationary (no visual stimulation condition), and for 30 seconds the boat rocked on the water at a speed of 15°/s (visual stimulation condition). The visual stimulation was applied in pseudorandom order (during either the first or second half of the 1-minute trial). To analyze postural stability, the displacement and velocity of the center of mass in the sagittal and frontal planes were compared between groups and across 4 experimental conditions, including standing with/without visual stimulation and with/without gripping a 300-g object (short wooden stick) in the dominant hand. RESULTS: Participants with TBI showed greater instability under all experimental conditions. The visual stimulation significantly increased postural oscillations in the sagittal plane by 35% to 63% across groups. Gripping a stick significantly reduced the stimulation-induced instability in the sagittal plane by 19% to 29%, although not to the level of the no-stimulation condition in either group. CONCLUSION: The stabilizing effect of gripping an external object in participants with TBI was confirmed. A possibility of using this effect as a balance aid strategy requires further investigation.

Hippotherapy--an intervention to habilitate balance deficits in children with movement disorders: a clinical trial.

BACKGROUND: Clinical observations have suggested that hippotherapy may be an effective strategy for habilitating balance deficits in children with movement disorders. However, there is limited research to support this notion. OBJECTIVE: The purposes of this study were to assess the effectiveness of hippotherapy for the management of postural instability in children with mild to moderate balance problems and to determine whether there is a correlation between balance and function. DESIGN: A repeated-measures design for a cohort of children with documented balance deficits was used. METHODS: Sixteen children (9 boys and 7 girls) who were 5 to 16 years of age and had documented balance problems participated in this study. Intervention consisted of 45-minute hippotherapy sessions twice per week for 6 weeks. Two baseline assessments and 1 postintervention assessment of balance, as measured with the Pediatric Balance Scale (PBS), and of function, as measured with the Activities Scale for Kids-Performance (ASKp), were performed. RESULTS: With the Friedman analysis of variance, the PBS and the ASKp were found to be statistically significant across all measurements (P<.0001 for both measures). Post hoc analysis revealed a statistical difference between baseline and postintervention measures (P≤.017). This degree of difference resulted in large effect sizes for PBS (d=1.59) and ASKp (d=1.51) scores after hippotherapy. A Spearman rho correlation of .700 indicated a statistical association between PBS and ASKp postintervention scores (P=.003). There was no correlation between the change in PBS scores and the change in ASKp scores (r(s)=.13, P>.05). LIMITATIONS: Lack of a control group and the short duration between baseline assessments are study limitations. CONCLUSIONS: The findings suggest that hippotherapy may be a viable strategy for reducing balance deficits and improving the performance of daily life skills in children with mild to moderate balance problems.

Immediate and long-term effects of hippotherapy on symmetry of adductor muscle activity and functional ability in children with spastic cerebral palsy.

OBJECTIVES: To investigate the immediate effects of 10 minutes of hippotherapy, compared with 10 minutes of barrel-sitting, on symmetry of adductor muscle activity during walking in children with cerebral palsy (CP) (phase I). To investigate the long-term effects of 12 weeks of hippotherapy on adductor activity, gross motor function, and self-concept (phase II). DESIGN: Pretest/posttest randomized controlled trial plus clinical follow-up. SETTING: Outpatient therapy center. PARTICIPANTS: Children with spastic CP (phase I: n=47; phase II: n=6). INTERVENTIONS: Phase I: 10 minutes of hippotherapy or 10 minutes of barrel-sitting; phase II: 12 weekly hippotherapy sessions. MAIN OUTCOME MEASURES: Phases I and II: adductor muscle activity measured by surface electromyography. Phase II: gross motor function and self-perception profiles. RESULTS: Phase I: hippotherapy significantly improved adductor muscle asymmetry (P<.001; d=1.32). Effects of barrel-sitting were not significant (P>.05; d=.10). Phase II: after 12 weeks of hippotherapy, testing in several functional domains showed improvements over baseline that were sustained for 12 weeks posttreatment. CONCLUSIONS: Hippotherapy can improve adductor muscle symmetry during walking and can also improve other functional motor skills.

Effects of hippotherapy on postural stability, in persons with multiple sclerosis: a pilot study.

PURPOSE: The purpose of this pilot study was to examine the effectiveness of hippotherapy as an intervention for the treatment of postural instability in individuals with multiple sclerosis (MS). SUBJECTS: A sample of convenience of 15 individuals with MS (24-72 years) were recruited from support groups and assessed for balance deficits. METHODS: This study was a nonequivalent pretest-posttest comparison group design. Nine individuals (4 males, 5 females) received weekly hippotherapy intervention for 14 weeks. The other 6 individuals (2 males, 4 females) served as a comparison group. All participants were assessed with the Berg Balance Scale (BBS) and Tinetti Performance Oriented Mobility Assessment (POMA) at 0, 7, and 14 weeks. RESULTS: The group receiving hippotherapy showed statistically significant improvement from pretest (0 week) to posttest (14 week) on the BBS (mean increase 9.15 points (x (2) = 8.82, p = 0.012)) and POMA scores (mean increase 5.13 (x (2) = 10.38, p = 0.006)). The comparison group had no significant changes on the BBS (mean increase 0.73 (x (2) = 0.40, p = 0.819)) or POMA (mean decrease 0.13 (x (2) = 1.41, p = 0.494)). A statistically significant difference was also found between the groups' final BBS scores (treatment group median = 55.0, comparison group median 41.0), U = 7, r = -0.49. DISCUSSION: Hippotherapy shows promise for the treatment of balance disorders in persons with MS. Further research is needed to refine protocols and selection criteria.