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

This article aims to determine if hippotherapy (therapy using a horse) improves head/trunk stability and upper extremity (UE) reaching/targeting in children with spastic diplegia cerebral palsy (SDCP). It designed as pre-postoperative follow-up with a 12-week intervention and 12-week washout period after intervention. Participants were eleven children (age 5–13y, average 8y) with SDCP, 8 children (age 5–13y, average 8y) without disabilities. Main outcome measures are video motion capture using surface markers collecting data at 60Hz, a mechanical barrel to challenge trunk and head stability, and functional reach/targeting test on static surface.

Results showed that significant changes with large effect sizes in head/ trunk stability and reaching/targeting, elapsed time, and efficiency (reach/path ratio) after 12 weeks of hippotherapy intervention. Changes were retained after a 12-week washout period. So, hippotherapy improves trunk/head stability and UE reaching/targeting. These skills form the foundation for many functional tasks. Changes are maintained after the intervention ceases providing a skill foundation for functional tasks that may also enhance occupational performance and participation.

The purpose of this investigation was to objectively evaluate the efficacy of hippotherapy in improving head/trunk stability and functional reaching in children with SDCP. We used a motorized barrel and kinematic measurements to quantify motor learning affecting dynamic stability of the head/trunk and the speed and efficiency of functional reaching that occurred in children with CP resulting from a therapist using the rhythmic movement of a horse as a treatment tool. These changes were compared with a baseline of the same movement patterns measured in an age-matched group of children without disabilities. Subjects were also tested after an additional 12 weeks to determine if changes persisted after the intervention ceased. Results indicated that children with SDCP responded to a series of weekly experiences with the rhythmic movement of the horse by increasing motor control of their trunk and head. This improved control of the trunk stabilized the proximal foundation of the UEs and may account for the improvements we measured in the functional reach test. Changes in trunk/head stability and in reaching/targeting persisted for at least 3 months after the intervention ceased. These objective improvements in dynamic stability suggest that hippotherapy can provide a valuable therapeutic tool in the practice of occupational therapy (OT) and physical therapy (PT) that may enable improved function in many activities of everyday life for children with CP. It appears that further use of this measurement model and further development of additional systematic and objective data about the results of hippotherapy intervention will further inform physicians, therapists, and third-party payers about the benefits of hippotherapy as an effective treatment strategy in the context of OT or PT for children with CP.

Link: https://www.sciencedirect.com/science/article/abs/pii/S000399930900272X

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