Clinical trial NCT03548376: Hippotherapy in Children With Cerebral Palsy
Official title: Effects of Hippotherapy in Postural Control, Balance, Gross-motor Function and Quality of Life of Children With Cerebral Palsy
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Cerebral Palsy
Keywords: rehabilitation
cerebral palsy
postural control
balance
gross-motor function
quality of life
hippotherapy
Lead sponsor: Federal University of Minas Gerais
Sponsor class: OTHER
First posted: 2018-06-07
Enrollment: 31
Sex: ALL
Minimum age (years): 4
Maximum age (years): 12
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: Before-after trial (6 months of follow-up; one group with three repeated measurements)
Primary purpose: TREATMENT

Brief 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).

Eligibility criteria: Inclusion Criteria:

* Children with medical diagnosis of cerebral palsy
* Ages 4 to 12 years old

Exclusion Criteria:

• Other CP-associated diagnoses (e.g., autism)

Primary outcomes:
measure: Change in Child's Postural control and balance
timeFrame: From Pre-intervention to 3 months after intervention onset
measure: Change in Child's Postural control and balance
timeFrame: From 3 months to 6 months after intervention onset
Secondary outcomes:
measure: Change in Child's Gross Motor Function Measure (GMFM)
timeFrame: From pre-intervention to 3 months after intervention onset
measure: Change in Child's Gross Motor Function Measure (GMFM)
timeFrame: From 3 months to 6 months after intervention onset (end on intervention period)
measure: Change in Child's Quality of Life
timeFrame: From pre-intervention to 6 months after intervention onset (end on intervention period)
Other outcomes:
Locations:
Study officials:
affiliation: Federal University of Minas Gerais
name: Marisa C Mancini, PhD
role: PRINCIPAL_INVESTIGATOR
References:
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