Hippotherapy in Children With Cerebral Palsy
Condition: Cerebral Palsy
MeSH terms: Paralysis; Cerebral Palsy
Study type: Interventional

Summary: 
      The hippotherapy is a complementary therapeutic modality that seeks to promote changes in the
      functionality of children with cerebral palsy (CP). Knowing the domains in which this therapy
      causes both direct and indirect effects, and identify the mechanisms that produce their
      effects, contributes to broadening and deepening of the knowledge available on the
      hippotherapy. The main aim of this study was to evaluate changes in postural control and
      balance, gross motor function and quality of life (QoL) of children with CP undergoing
      hippotherapy for a period of six months.
    

Detailed description: 
      We conducted a quasi-experimental study with 31 children with cerebral palsy from both sexes,
      of various types and GMFCS levels who were followed for 6 months with three repeated
      measurements: beginning of the study (T1), 3 months (T2) and 6 months (T3) after the initial
      evaluation. Participants were measured 3 times on postural control and balance, gross-motor
      function and twice on quality of life. Children attended hippotherapy session one a week for
      30 minutes. Sessions were conducted by equestrian therapists (physiotherapists or
      occupational therapists) qualified by the National (Brazilian) Association of Hippotherapy.
      The horses were trained for hippotherapy practice, and each patient used the same animal in
      all sessions. The specific hippotherapy gear included safety straps, riding blankets,
      stirrups and saddles with and without support straps. The use of protective helmets for
      patients was mandatory in all sessions. Playful and educational toys were also used. The
      participants included the patient, the equestrian therapist, the horse handler (the
      professional who drives the horse) and, when necessary, an auxiliary helper to ensure the
      safety of the child. The hippotherapy sessions were individualized. The goals set by the
      therapist were based on the specific demands and the motor condition of each client. The
      activities proposed during each session sought to stimulate the development of the postural
      control of the child with CP. Such activities could be performed in various postures (i.e.,
      classic, inverted, lateral, dorsal decubitus, ventral decubitus and standing on the
      stirrups). They included demands for stability and balance (i.e., trunk rotation activities,
      range in various directions and bimanual tasks), active stretches and antigravitational
      exercises during riding, integrated with ludic-cognitive resources (i.e., memory games and
      identification of colors, numbers and letters). For the most part, children with mild and
      moderate impairments rode individually and were encouraged to maintain an upright posture
      throughout the session. Those with more severe impairment were encouraged to maintain control
      and postural alignment, with the minimum of support being provided. In some cases, it was
      necessary to use a double riding strategy, in which the therapist rode the horse along with
      the patient to favor and stimulate the child's postural control on the animal. Throughout the
      session, the horse varied speed, cadence and direction to the therapist's command, using
      different paths (i.e., circles, zigzags and straight lines) and different types of terrain
      (i.e., uphill, downhill, dirt, asphalt and grass). All participants were instructed to
      continue with their rehabilitation routine (i.e., physical therapy, occupational therapy and
      others). For data analysis, participants were stratified by age (04-07 years and 08-12
      years), severity (mild, moderate and severe), topography of the members involved (diplegia,
      hemiplegia, and quadriplegia) and previous time of hippotherapy (between 3-6 months and more
      than 6 months).
    

Intervention name(s): Hippotherapy
Intervention type(s): Other
Intervention description(s): Hippotherapy is a therapeutic intervention that is typically conducted by a physical or occupational therapist and is aimed at improving impaired body function. Hippotherapy has been proposed as a technique to decrease the energy requirements and improve walking in patients with cerebral palsy. It is thought that the natural swaying motion of the horse induces a pelvic movement in the rider that simulates human ambulation. In addition, variations in the horse's movements can also prompt natural equilibrium movements in the rider.
Other intervention name(s): horse therapy; equine movement therapy
Intervention model: Single Group Assignment
Intervention model description: Before-after trial (6 months of follow-up; one group with three repeated measurements)
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: rehabilitation; cerebral palsy; postural control; balance; gross-motor function; quality of life; hippotherapy