Analysis of strength and electromyographic activity of lower limbs of individuals with down syndrome assisted in physiotherapy and hippotherapy.

INTRODUCTION: one of the characteristics of Down Syndrome (DS) is muscle hypotonia. Different therapeutic approaches have a positive influence, between them Physiotherapy applications with different therapeutic approaches such as Hippotherapy have a positive effect on the physical health and quality of live of individuals with DS. OBJECTIVE: to evaluate the effects of both treatments on the strength and electromyographic activity of the lower limbs of children and adolescents with DS. METHODS: fourteen individuals, aged between 10 and 18 years, participated in two groups: Physiotherapy group (n = 5) and Hippotherapy group (n = 9). Thirty interventions were performed for each type of therapy, once a week, lasting 30 min. Pre and post-interventions, the 30-Second Chair Stand Test (30s-CST) was used to assess the strength of the lower limbs and the surface electromyography equipment (EMG 800RF) to assess the lower limb myoelectric activity. RESULTS: there was a reduction in the post-intervention electromyographic values for both treatments (p˂0.001), with significantly less myoelectric activity in Hippotherapy compared to Physiotherapy for all evaluated muscles (p˂0.001) and a significant increase in muscle strength for the Hippotherapy, post-intervention group (p = 0.0007). CONCLUSION: Physiotherapy and Hippotherapy are interventions that promote positive changes in the myoelectric activities of individuals with DS. However, only hippotherapy promoted an increase in strength of the lower limbs.

Impact of equine assisted therapy on the cardiovascular parameters of the elderly / Impacto da terapia assistida por equinos nos parâmetros cardiovasculares de idosos

INTRODUCTION: Physical activity programs in the elderly aim to prevent and/or reduce the functional decline resulting from the senescence process. Several studies provide evidence that Equine Assisted Therapy (EAT) is an effective means of improving health. However, studies addressing the effects of EATon the cardiovascular system are scarce. OBJECTIVE: To evaluate the effect of Equine Assisted Therapyon the cardiovascular responses of participants divided into two groups: normotensive and hypertensive. METHODS: Twenty individuals participated, aged between 60 and 79 years, divided into three groups: Normotensive Group (n=14), Hypertensive Group (n=6) and all participants, Total Group (n=20). The Omron® HEM 742 blood pressure monitor was used to measure blood pressure and the Gerathem® portable finger oximeter to measure heart rate and blood oxygen saturation. Ten visits were made once a week, lasting 30 minutes. RESULTS: Between the first and tenth interventions, there was a reduction in blood pressure and heart rate, with statistical significance of systolic blood pressure for the Hypertensive Group (p=0.0478), the Total Group (p=0.0201) and diastolic pressure for the Total Group (p=0.0421). There was also a statistically significant difference in systolic blood pressure and heart rate during some visits. Blood oxygen saturation increased after the intervention, but without statistical significance. CONCLUSION: Equine Assisted Therapy can promote a reduction in blood pressure in the elderly, especially hypertensive individuals.

INTRODUÇÃO: Programas de atividade física em idosos visam prevenir e/ou reduzir o declínio funcional decorrente do processo de senescência. Vários estudos fornecem evidências de que a Terapia Assistida por Equinos (TAE) é um meio eficaz de melhorar a saúde. No entanto, estudos que abordam os efeitos da TAE no sistema cardiovascular são escassos. OBJETIVO: Avaliar o efeito da Terapia Assistida por Eqüinos nas respostas cardiovasculares dos participantes dividos em dois grupos: normotensos e hipertensos. MÉTODOS: Participaram 20 indivíduos, com idade entre 60 a 79 anos, distribuídos em três Grupos: Grupo Normotenso (n=14), Grupo Hipertenso (n=6) e todos os participantes, Grupo Total (n=20). Foi utilizado o monitor de pressão arterial Omron® HEM 742 para aferir a pressão arterial e o oxímetro de dedo portátil Gerathem® para medir a freqüência cardíaca e a saturação de oxigênio no sangue. Foram realizados dez atendimentos uma vez por semana, com duração de 30 minutos. RESULTADOS: Entre a primeira e décima intervenção, houve redução da pressão arterial e da frequência cardíaca, com significância estatística da pressão arterial sistólica para o Grupo Hipertenso (p=0,0478), o Grupo Total (p=0,0201) e da pressão diastólica para o Grupo Total (p=0,0421). Também houve diferença estatisticamente significante da pressão arterial sistólica e da frequência cardíaca durante alguns atendimentos. A saturação de oxigênio no sangue aumentou após a intervenção, porém sem significância estatística. CONCLUSÃO: A Terapia Assistida por Eqüinos pode promover redução da pressão arterial em idosos, principlamente de hipertensos.

Electromyographic analysis of stomatognathic muscles in elderly after hippotherapy.

The aging process affects the entire human body, including the stomatognathic system, and can trigger not only occlusal but also postural imbalances involving other muscular chains. Hippotherapy has been used to promote cervical, postural, and balance control in individuals with diverse impairments. The present study used electromyography to evaluate the masseter and temporal muscles in an elderly population pre- and post-hippotherapy. Participants included 17 individuals, mean age 66,5±7 years. Electromyographic recording of the bilateral masseter and temporal muscles was performed during the postural resting condition and activities that involved the active participation of these muscles in different conditions. The practitioner performed no other type of activity or exercise during the intervention because the objective is to evaluate the effect of the three-dimensional movement provided by the horse. Raw electromyographic data were tabulated using commercially available software (IBM® SPSS® Statistics 234.0) and subjected to statistical analysis, in which p ≤ 0.05 was considered to be statistically significant. Post-hippotherapy, there was lower electromyographic activity for the masseter and temporalis muscles in all the static mandibular tasks, with significant effect for time for the right temporal muscle (p = 0.038), the left temporal muscle (p = 0.028) and in the all dynamic mandibular tasks for the left temporal muscle (p = 0.025) and the left masseter muscle (p = 0.027). Hippotherapy promotes a reduction in the myoelectric activity of the masticatory muscles of elderly individuals.

Impact of hippotherapy for balance improvement and flexibility in elderly people.

INTRODUCTION: The decrease in functional ability, strength, balance, flexibility, agility, and coordination owing to neurological and muscular changes is one of the characteristic features of the human aging process. Hippotherapy has been highlighted as a therapeutic approach with physical and psychological benefits for this section of the population. However, the effects of hippotherapy in elderly people need to be further studied by assessing their balance and flexibility. METHODS: Thirty elderly people were recruited and divided into two groups; 15 in the Hippotherapy Group (HG), and 15 in the control group (CG) (aged 66.07 ±â€¯5.80 and 68.47 ±â€¯5.85 years, respectively). The HG received ten 30-min sessions of hippotherapy once a week. Assessment included the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), the Functional Reach Test (FRT)and the Sit-and-Reach Test with the Well's box before the first and after the tenth session of hippotherapy; and the Sit-and-Reach Test before and after each session. RESULTS: The HG demonstrated a significant difference in the TUG test execution time and the FRT scores before and after the hippotherapy sessions (p = 0.036, p = 0.030, respectively), indicating an improvement in functional range. The examination of flexibility with the Wells's box also revealed a significant difference in the rates (cm) before and after 10 sessions of the hippotherapy for the HG (p = 0.033). CONCLUSIONS: The present findings showthat hippotherapy improved elderly people's functional mobility, dynamic balance, and flexibility. These results will guide professionals who treat this population.

Analysis of the electromiographic activity of lower limb and motor function in hippotherapy practitioners with cerebral palsy.

OBJECTIVE: Investigation of the effects of hippotherapy treatment on lower limb muscle activity and gross motor function in subjects with cerebral palsy (CP), comparing them to a group of subjects with adequate motor development. METHODS: Evaluation was made of seven individuals with spastic diparetic CP, average age 9.3 (±3.3) years (CP group), Gross Motor Function Classification System (GMFCS) levels I and II, and eight individuals with adequate motor development, average age 10.9 (±3.2) years (control group). The groups were submitted to 25 sessions of hippotherapy, each lasting 30 min, on a weekly basis, and the muscle activity of the lower limbs was evaluated using surface electromyography during the 1st, 10th, 20th, and 25th sessions. For the CP group, Gross Motor Function Measurement (GMFM-88) was performed before and after hippotherapy treatment. RESULTS: There was higher muscle activity in the 10th session, compared to the other sessions, with greater activity of the tibialis anterior muscles, for both groups studied. After treatment, the CP group showed significant improvement in the GMFM total score, and in the scores for dimensions D and E. CONCLUSION: Hippotherapy sessions improved the muscle responses in both groups, and improved the gross motor function of the subjects with CP.

Avaliação da flexibilidade de crianças com paralisia cerebral espástica após intervenção fisioterapêutica / Assessment of the flexibility of children with spastic cerebral palsy after physiotherapeutic intervention

Introdução: A fisioterapia favorece a flexibilidade e diminue a espasticidade de crianças com paralisia cerebral (PC). Objetivos: avaliar os benefícios da fisioterapia convencional para a flexibilidade a curto e longo prazo de crianças com PC espástica. Métodos: participaram seis pacientes com PC espástica, idade de seis a 14 anos, ambos os gêneros. Foram realizadas 16 sessões de fisioterapia convencional com alongamentos passivos. Para avaliação da flexibilidade, aplicou-se o Teste de Sentar e Alcançar utilizando o Banco de Wells antes e após cada sessão. Para a análise estatística foi utilizado o Software Sigma-Stat® versão 3.5 com significância estatística (p<0,05). Resultados: houve aumento significativo da flexibilidade da cadeia muscular posterior comparando pré e pós individualmente (p<0,05) e da média pré e pós sessões (p<0,0001). Conclusão: fisioterapia convencial por meio de exercícios de alongamentos passivos melhora a flexibilidade da cadeia muscular posterior de crianças com PC espástica a curto ou a longo prazo.

Introduction: Physiotherapy favors flexibility and reduce the spasticity of children with spastic cerebral palsy. Objectives: To evaluate the benefits of conventional physiotherapy to improve the flexibility of the posterior muscle chain in the short and long term of children with spastic cerebral palsy. Methods: participated six patients with a diagnosis of Cerebral Palsy, age of six to 14 years, both genders. There were 16 sessions of conventional physiotherapy with passive stretching. For the assessment of flexibility, the sit and reach test was applied using the Wells's box before and after each session. For statistical analysis, Sigma-Stat® Software version 3.5 was used with statistical significance (p <0.05). Results: There was a significant increase in the flexibility of the posterior muscular chain of the children when comparing pre and post individually (p <0.05) and the mean before and after the sessions (P <0.0001). Conclusion: Conventional physiotherapy through passive stretching exercises improves the flexibility of the posterior muscular chain of children with spastic Cerebral Palsy in the short or long term.

Activation of lower limb muscles with different types of mount in hippotherapy.

OBJECTIVES: To analyze muscle activation of lower limbs (LL) of subjects in hippotherapy sessions. METHODS: The study included 10 healthy subjects, five male and five female, with an average age of 24.03 (±4.06) years. Subjects underwent four hippotherapy sessions of 30 min with interval of one week, and each session was performed with a different type of mount material in the following order: 1st performed with saddle and feet in the stirrups (S1), 2nd with saddle and feet off the stirrups (S2), 3rd with blanket and feet off the stirrup (S3) and 4th with blanket and feet in the stirrups (S4). Surface electromyographies were performed at 1, 10, 20 and 30 min of session, and the electrodes were placed on muscle bellies bilaterally on the muscles rectus femoris, vastus medialis, vastus lateralis and tibialis anterior. RESULTS: The analysis of muscle activity during these four sessions showed a significant difference in muscle recruitment in LL, and sessions with blanket and feet in the stirrups provided greater muscle activation of quadriceps and tibialis anterior with the horse at step gait (p = 0.0002). CONCLUSION: The results suggest that feet positioned in the stirrups is a relevant factor for greater muscle recruitment in LL to maintain postural balance while riding, especially using a blanket as mount material for ride a horse.

Avaliação da modulação autonômica em indivíduos com síndrome de Down na equoterapia / Autonomic modulation of assessment in individuals with Down syndrome in hippotherapy

Introdução: A equoterapia é uma modalidade terapêutica que atende em grande parte os indivíduos com síndrome de Down, por apresentarem alterações motoras, cognitivas e sócio-afetivas. Sabe-se que as alterações na frequência cardíaca são moduladas pelo Sistema Nervoso Autônomo, entretanto, na literatura não há descrições sobre a Variabilidade de Frequência Cardíaca nestes praticantes, sobretudo na atividade relacionada à equoterapia. Objetivos: Avaliar a Variabilidade da Frequência Cardíaca de pacientes com Síndrome de Down antes, durante e após sessões de equoterapia. Métodos: Foram recrutadas 6 crianças com Síndrome de Down, idade média 12 ± 1,6 anos. A Frequência Cardíaca foi avaliada com um cardiofrequencímetro - Polar (RS800CX), antes, durante e após 5 sessões semanais. Resultados: Houve tendência a diminuição da atividade parassimpática no repouso inicial entre primeira e quinta sessão; e diminuição significativa da atividade parassimpática observada pelo índice pNN50 ao comparar a Frequência Cardíaca durante a primeira e quinta sessões. Conclusão: O tratamento equoterapêutico apresentou uma tendência à diminuição da Variabilidade da Frequência Cardíaca nas crianças estudadas.

Introduction: The hippotherapy is a therapeutic modality that serves largely individuals with Down syndrome, because they have motor, cognitive and socioemotional changes. It is known that changes in heart rate are modulated by the autonomic nervous system, however, in the literature there are no descriptions of the variability of heart rate in these practitioners, especially in the activity related to hippotherapy. Objectives: To evaluate Heart Rate Variability in practitioners of hippotherapy with Down Syndrome. Methods: Six children with Down Syndrome were recruited, age rate of 12 ± 1.6 years. The Heart Rate were evaluate using a cardiofrequencimetre ­ Polar (RS800CX), before, during and after 5 sessions of hippotherapy once weekly. Results: There were tendency of decrease in the parasympathetic activity during initial rest between first and fifth sessions, and significant decrease of the parasympathetic activity observed by the value of pNN50 compared to the Heart Rate during the first and fifth sessions. Conclusions: This study has shown that children treated with hippotherapy had tendency to have their Heart Rate Variability decreased.

Material de montaria para equoterapia em indivíduos com síndrome de Down: estudo eletromiográfico / Riding equipment for hippotherapy in individuals with Down syndrome: an electromyographic study

Introdução: Os indivíduos com síndrome de Down apresentam características peculiares da anomalia, sendo a principal e mais frequente a hipotonia muscular. Objetivo: Verificar o melhor material de montaria e posicionamento dos pés para o recrutamento da musculatura de tronco de crianças com síndrome de Down que utilizam do tratamento da equoterapia. Métodos: Foram avaliados cinco praticantes com síndrome de Down por meio da eletromiografia, durante quatro sessões de equoterapia. Para análise estatística, foi utilizado o teste de Kruskal- Wallis para comparações múltiplas de dados não paramétricos. Resultados: O material de montaria de manta associado com os pés fora do estribo proporcionou maior recrutamento dos músculos estudados, sendo o músculo da região cervical o mais acionado. Conclusão: Por meio desse estudo piloto, infere-se que a manta com pés fora do estribo promoveu uma melhor otimização do tônus dos indivíduos analisados.

Introduction: Individuals with Down syndrome have peculiar characteristics of the anomaly, the main and most common is muscle hypotonia. Objective: To check the best material to mount and position the feet for the recruitment of the trunk muscles of children with Down syndrome using the treatment of hippotherapy. Methods: Five riders with DS were assessed using surface electromyography during four sessions of therapeutic riding. Statistic analysis: data were analyzed using the Kruskal-Wallis non parametric test. Results: The material riding blanket associated with the feet out of the stirrup elicited greater recruitment of the muscles being studied, the muscle of the cervical region being triggered the most. Conclusion: Through this pilot study we infer that the blanket with feet out of the stirrup promoted a better optimization of the tone of the individuals included in the study.