Effects of Hippotherapy on Physical Activities, Cardiopulmonary Fitness and Attention in Children With Cerebral Palsy
Phase: NA
Conditions: Cerebral Palsy, Physical Activity, Attention Disorder
Sponsor: Samsung Medical Center

CLINICAL TRIAL PROTOCOL 
 
 
Effects 
of 
Hippotherapy 
on 
Physical 
Fitness and Attention in Cerebral Palsy 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NCT no.: NCT03870893 
Protocol ID: 2017-0665-000 
Date of the document: July 26, 2017 
 
 

The purpose of this study 
This research analyzes whether hippotherapy improves the physical activity, 
cardiopulmonary fitness, and attention in children with cerebral palsy and whether 
this enhances their general health and quality of life. 
 
Background  
This research aims to promote hippotherapy by scientifically proving its therapeutic 
effects and mechanism to contribute to improving the health and quality of life of the 
patients1,2 as well as reducing their global burden of disease by shifting the current 
passive “therapy-oriented” paradigm to a more proactive “participation-oriented” 
paradigm3.  
Ever since physical activity and physical fitness have been reported to have an 
inverse relationship with the mortality rate, especially deaths due to cardiovascular 
disease, various efforts have been made to optimize physical activity and physical 
fitness among children with cerebral palsy4. ADHD is one of the most common 
coexisting conditions of cerebral palsy. More participation in engaging sports 
activities like therapeutic riding is anticipated to improve patient health and their 
quality of life5.  
 Hippotherapy is expected to improve clinical symptom of ADHD in children with 
cerebral palsy while preventing possible ensuing psychiatric disorders, thereby 
bringing significant improvement in their health and quality of life. 
 
PARTICIPANTS 
Forty-six children with CP (24 boys and 22 girls) participated in this study. Inclusion 
criteria were (a) diagnosis of CP, (b) classified at Gross Motor Function Classification 
System (GMFCS) level Ⅰ-Ⅲ, (c) body weight under 35kg, (d) ability to walk 
independently with or without an assistive device, (e) ability to comply with the study 
protocol and follow verbal directions. Exclusion criteria were (a) injected a botulinum 

toxin within 3 months, (b) a selective dorsal rhizotomy or orthopedic surgery within 1 
year, (c) moderate to severe intellectual disability(difficulty performing one step 
instructions), (d) uncontrolled seizures, (e) poor visual or acuity hearing impairment, 
(f) patients who weigh more than 35 kg, (g) hip dislocation, (h) scoliosis cobb angle > 
30 degrees, (i) musculoskeletal surgery within 1 year. 
 
INTERVENTION  
Children allocated in the Hippotherapy group participated the Hippotherapy program 
in indoor riding arena. 23 children participated in the Hippotherapy program for 40 
minutes per lesson twice a week for 16 weeks (total of 32 sessions). The sessions 
were conducted by three therapeutic riding instructors. One leader and two side 
walkers walked with a horse, and all participants wore helmets. Three participants 
were grouped together for each session. The Hippotherapy program sessions 
consisted of exercises to facilitate correct posture and balance, including lower 
extremity strengthening, and basic riding skills while walking and trotting. The 
intensity of the exercises and degree of assistance were individualized according to 
the participants’ ability to control their body and horse. The horse/ponies had a 
height of 110-125-cm and weight of 250-400kg; all animals were very experienced in 
the Hippotherapy settings. 
 
Statistical Analysis  
Analyses were performed with SPSS version 20.0 (SPSS Inc, Chicago, IL, USA), 
using a .05 level of significance for all statistical tests. All continuous variables were 
tested for normality using the Shapiro–Wilk descriptive test. Means and standard 
deviations are presented for each continuous variable. After certification of the 
normality by the Shapiro Wilks test, the independent t-tests or Mann Whitney U-test 
were performed to examine the differences between the groups. 
 
 

RERERENCE 
1. Kwon, J. Y., Chang, H. J., Yi, S. H., Lee, J. Y., Shin, H. Y., & Kim, Y. H. (2015). Effect of 
hippotherapy on gross motor function in children with cerebral palsy: a randomized controlled 
trial. The Journal of Alternative and Complementary Medicine, 21(1), 15-21. 
2. Kwon, J. Y., Chang, H. J., Lee, J. Y., Ha, Y., Lee, P. K., & Kim, Y. H. (2011). Effects of 
hippotherapy on gait parameters in children with bilateral spastic cerebral palsy. Archives of 
physical medicine and rehabilitation, 92(5), 774-779. 
3. King, G., Keenan, S., McDougall, C., & Oake, M. (2020). Investigating a participation-based 
friendship intervention for youth with disabilities: effects on goal attainment, social self-
efficacy, and engagement. Physical & Occupational Therapy In Pediatrics, 40(2), 152-167. 
4. Novak, I., Morgan, C., Fahey, M., Finch-Edmondson, M., Galea, C., Hines, A., ... & Shore, B. 
(2020). State of the evidence traffic lights 2019: systematic review of interventions for 
preventing and treating children with cerebral palsy. Current neurology and neuroscience 
reports, 20(2), 1-21. 
5. Gilboa, Y., & Helmer, A. (2019). Therapeutic Riding and Attention Deficit Hyperactivity 
Disorder (ADHD): Effect on Executive Function and Participation. American Journal of 
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