Efficacy Hippotherapy on Postural Asymmetries and Balance in Adolescents With Idiopathic Scoliosis
Condition: Idiopathic Scoliosis; Equine-assisted Therapy
MeSH terms: Scoliosis
Study type: Interventional

Summary: 
      This study showed that the addition of hippotherapy to Schroth exercises is more effective in
      improving postural asymmetry and balance ability in adolescents with idiopathic scoliosis
      compared to Schroth exercises alone. Therefore, this combination should be considered during
      designing a rehabilitation program for AIS
    

Detailed description: 
      The hippotherapy program started with a physical therapy assessment to develop specific
      corrective movements to be practiced while riding the horse based on the direction of the
      spinal curvature. Interventions were performed by a licensed physical therapist experienced
      with hippotherapy at two local therapeutic riding centers. The participants received 15
      sessions split into two phases over 10 weeks. In the first phase, during the first 5 weeks,
      they performed 30 minutes of walking and sitting trot training without a stirrup iron once a
      week. The frequency was then raised to twice a week for the rest of the treatment program.
      Before the start of the intervention, two familiarization sessions were given to clarify
      safety guidelines, riding mistakes, and create a riding rapport with the horse. The
      individuals wore protective helmets during each hippotherapy session and mounted on a moving
      horse on walk and/or trot performing different positions, namely forward astride, side
      sitting, backward astride, sometimes with transitions between positions and often while the
      horse was moving. To restore normal alignment of the spine, participants were also asked to
      ride without holding on with their hands to perform self-correction movements. Examples of
      these movements include raising both arms high to decrease the degree of thoracic kyphosis,
      bending the upper trunk towards the convex side of the curve, raising the arm on the concave
      side with scapular adduction to level both shoulders. To correct pelvic obliquity, a small
      pad was put under the hip on the side of the lumbar convexity. Under the instructions of the
      physical therapist, a leader pulled the horse reins in front to control the horse gait, gait
      velocity, and orient the horse in different directions . All these movements activate the
      patient's neuromuscular and sensory reactions.

      Both groups performed Schroth exercises that are patient-specific asymmetric exercises with
      rotational breathing methods used for three-dimensional correction. For the first 2 weeks,
      there were five 1-h long individual sessions during which the participants were trained in
      their home exercise program. This was followed by 1-h weekly visits and paired with their
      daily home exercises. These exercises aimed to provide and promote enhanced postural control
      by using asymmetrical standing postural exercises specifically designed to restore body
      balance and mobility. During ground exercises, aid pads were used to build pressure for
      costal protrusions and/or trunk asymmetry correction. Postural correction was facilitated by
      rotational breathing exercises focusing on the concave side of the thorax. During the therapy
      sessions, postural correction principles of the Schroth process, axial elongation,
      deflection, de-rotation, facilitation, stabilization, were used.
    

Intervention name(s): Hippotherapy
Intervention type(s): Other
Intervention description(s): The hippotherapy program for 10 weeks
Other intervention name(s): Schroth exercises
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A total of 52 patients (15 males and 37 females) participated in the current study, assigned to 2 groups, which were the group A who received hippotherapy combined with Schroth exercises and group B who received only Schroth exercises
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Hipptherapy; Formateric; Balance; Schroth exercises