[Physiotherapy interventions through hippotherapy in the treatment of cerebral palsy. A literature review]. / Intervenciones fisioterápicas mediante hipoterapia en el tratamiento de la parálisis cerebral infantil. Revisión bibliográfica.

INTRODUCTION: Cerebral palsy is produced by nonprogressive injury to the developing brain. This lesion produces life-long motor impairments, disturbances in perception, speech, communication, cognition and competence. Physiotherapy is an important part of treatment, and may include hippotherapy, which uses the movement of the horse to stimulate the sensorial, neuromotor and cognitive systems to obtain functional results. METHODS: We performed a literature search using distinct databases and the following Keywords: "hippotherapy"; "cerebral palsy"; "children"; "treatment" and "physiotherapy". After application of the inclusion and exclusion criteria; elimination of duplicated tests; and critical appraisal of the retrieved texts; 22 articles were finally selected for the review. CONCLUSION: Hippotherapy is used by physiotherapy in the treatment of cerebral palsy. In this therapy, the horse's movement is purposefully manipulated to stimulate the patient's sensitive, neuromotor and cognitive systems and promote functional goals. Among the interventions used, the most recommend by the authors is the postural alignment, although there is no single standard of care, but the treatment is individually-tailored to the needs of each patient with cerebral palsy.

Immediate effect of horse riding simulator on adductor spasticity in children with cerebral palsy: A randomized controlled trial.

BACKGROUND: Spastic cerebral palsy (CP) is the most common type of CP. Hip adductor spasticity leads to discomfort, stiffness, and difficulties in doing physical activities such as sitting, transfer, and walking. Management of hip adductor spasticity is still a challenge in the field of rehabilitation. Horse riding simulator (HRS) has been reported to have beneficial effects on spasticity, postural control, and motor function in children with spastic CP. OBJECTIVE: The aim of the study was to determine the immediate effect of HRS on adductor spasticity in children with CP. METHODS: Twenty-four children with CP were selected and were divided into two groups: experimental and control (12 children in each group). Experimental group was exposed to HRS and control group to the corner seat placement. Adductor tone and passive hip abduction range of motion were measured before and after the intervention. RESULTS: Post intervention scores in the group of HRS show significant reduction in adductor spasticity and improvement in hip abduction range of motion, whereas no difference have been reported in the control group. HRS has positive effects on reducing spasticity and improving range of motion in hip joint in spastic CP. CONCLUSION: It was concluded that immediate effect of HRS is successful in reducing the adductor spasticity and improving abduction range of motion in hip, which could be incorporated with regular physiotherapy intervention.

Effect of horse riding equipment in activity of trunk and lower limb muscles in equine-assisted therapy

Equine-assisted therapy uses the horse in rehabilitation and/or education of people, such as Down syndrome(SD), cerebral palsy(PC)and intellectual disability(DI). In context, the rehabilitation program and horse riding equipment should be usedaccording to the specific characteristics of each individual, becoming an ally in the quest for excellence in equine-assisted therapy programs. The aim was to evaluate the effect of riding equipment used in equine-assisted therapy on the muscular activityof trunk and lower limb of individuals with SD, PC and DI. The study included 15 individuals equally assigned to each group: SD, PC and DIwith a mean age of 16.2 (±1.10), 16 (±1.22)e 16 (±0) years,respectively. The analysis of muscle activity was performed through surface electromyography, using four variations of horse riding equipment: saddle with and without feet supported on the stirrups and blanket with and without feet supported on the stirrups. Sigma Stat 3.5®software was used for statistical analysis.The Shapiro Wilk's test was used for normality of the data, the Bartlett test for homogeneity of the variances and the Kruskal-Wallis test for repeated measures with no normal distribution.Statistically significant differences were observed forp<0.05.The SDgroup presented a greater muscular activity of trunk and lower limbs with blanket equipment without the feet supported in the stirrups (H = 15.078, p = 0.002), as in the DI group (H=8.302, p = 0.040), while inPCgroup was the saddle with feet supported in the stirrups (H=11.137,p = 0.011). The choice of riding equipment used in equine-assisted therapy interferes differently in the pattern of muscular activation of the trunk and the lower limbs, according to the pathological processes of the practitioners. It should be an important aspect to consider when planninga treatment.

Comparison between the robo-horse and real horse movements for hippotherapy.

While the novel robotic hippotherapy system has gradually gained clinical application for therapeutic intervention on postural and locomotor control in individuals with neurological or musculoskeletal impairments, the system's validity and reliability for the robotic hippotherapy system has not been well established. The objective of the current study was to investigate the validity and test-retest reliability of the robotic hippotherapy system by comparing with real horse movements. The 3-axis accelerometer sensors attached on the robotic and real horse saddles were used to collect 3-dimensional acceleration data at a preferred walking velocity. Linear regression analysis showed an excellent correlation in the time-to-peak acceleration (TPA) (R(2)=0.997), but little correlation in X-axis acceleration between the real and robotic horses (R(2)=0.177), thus confirming consistent time control and a certain degree of variability between the robotic and real horse movements. The mean resultant accelerations for a real horse and robotic horse were 3.22 m/s(2) and 0.67 m/s(2), respectively, accounting for almost five times greater acceleration in the real horse than the robotic horse.

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.

Physiological demands of therapeutic horseback riding in children with moderate to severe motor impairments: an exploratory study.

PURPOSE: To examine energy expenditure at rest and during a single therapeutic horseback riding (THR) session in children with moderate to severe motor impairments. METHODS: Heart rate (HR), oxygen uptake (.VO2), and minute ventilation (.VE) were measured continuously during a 10-minute rest period and during a typical THR session. RESULTS: Seven children (4 males, mean age 12.3 ± 3.5 years) completed the protocol. Significant increases from rest were seen for mean HR, .VO2, .VE, and energy expenditure. Based on .VO2, 43.3 ± 24.3% of the THR session consisted of sedentary, 44.4 ± 13.4% of light, and 12.3 ± 21.8% of moderate to vigorous activity intensity, with large interindividual differences. CONCLUSIONS: The physiological demands of THR in children with moderate to severe motor impairments are moderate. However, considering the short duration of maintaining moderate to vigorous exercise activity during THR in combination with the low training frequency, group data indicate that it is unlikely that THR will improve cardiopulmonary fitness in these children.

Therapeutic effects of a horse riding simulator in children with cerebral palsy.

OBJECTIVE: To evaluate the efficacy of horse ridding simulator on the sitting postural control of children with spastic diplegia. METHOD: Forty children were randomly divided in a group using the simulator (RS) and a group performing conventional physical therapy (CT). FScan/Fmat equipment was used to register maximal displacement in antero-posterior (AP) and medio-lateral (ML) directions with children in sitting position. At the pre and post intervention stage both groups were classified according to the Gross Motor Function Classification System (GMFCS) and, after intervention, by the AUQEI questionnaire (Autoquestionnaire Qualité de vie Enfant Image). RESULTS: Comparison between groups disclosed statistically significant pos-intervention improvement both in the AP (p<0.0001) as in the ML (p<0.0069) direction in the RS group. CONCLUSION: The horse ridding simulator produced significant improvement in the postural control of children in sitting position, additionally showing a higher motor functionality and a better acceptance of the therapeutic intervention.

Therapeutic effects of a horse riding simulator in children with cerebral palsy / Efeitos terapêuticos de um simulador de equitação em crianças portadoras de paralisia cerebral

OBJECTIVE: To evaluate the efficacy of horse ridding simulator on the sitting postural control of children with spastic diplegia. METHOD: Forty children were randomly divided in a group using the simulator (RS) and a group performing conventional physical therapy (CT). FScan/Fmat equipment was used to register maximal displacement in antero-posterior (AP) and medio-lateral (ML) directions with children in sitting position. At the pre and post intervention stage both groups were classified according to the Gross Motor Function Classification System (GMFCS) and, after intervention, by the AUQEI questionnaire (Autoquestionnaire Qualité de vie Enfant Image). RESULTS: Comparison between groups disclosed statistically significant pos-intervention improvement both in the AP (p<0.0001) as in the ML (p<0.0069) direction in the RS group. CONCLUSION: The horse ridding simulator produced significant improvement in the postural control of children in sitting position, additionally showing a higher motor functionality and a better acceptance of the therapeutic intervention.

OBJETIVO: Avaliar os efeitos terapêuticos de um simulador de equitação no controle postural sentado de crianças portadoras de diplegia espástica. MÉTODO: Quarenta crianças foram aleatoriamente divididas em dois grupos: 20 utilizaram o simulador (GS) e 20 realizaram fisioterapia convencional (TC). Foi efetuado o registro dos deslocamentos máximos na direção ântero-posterior (AP) e médio-lateral (ML) com a criança sentada, utilizando-se o sistema FScan/Fmat. Antes e após intervenção as crianças foram classificadas pelo Gross Motor Function Classification System (GMFCS) e, após intervenção, pelo AUQEI (Autoquestionnaire Qualité de vie Enfant Image). RESULTADOS: Melhora estatisticamente significativa dos deslocamentos máximos foi observada após intervenção tanto na direção AP (p<0,0001) quanto na ML (p<0,0069) no grupo GS quando comparado ao grupo TC. CONCLUSÃO: O simulador de equitação produziu melhora significativamente maior no controle postural da criança sentada, aliada a maior funcionalidade motora e melhor aceitação da intervenção terapêutica.

Effect of hippotherapy on perceived self-competence and participation in a child with cerebral palsy.

This case report highlights changes in self-competence and social acceptance, along with changes in functional skills, after an 8-week program of hippotherapy. A 6-year-old girl with mild ataxic cerebral palsy, level I Gross Motor Functional Classification System, exhibited typical impairments in body systems and functions that affected her participation in age-appropriate functional and leisure activities. The child's performance on the Gross Motor Function Measure-66, the Pediatric Outcomes Data Collection Instrument, and the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children were examined at baseline, after the 8-week intervention, and at a 2-month follow-up session. Data at 8 weeks demonstrated positive changes in all areas, with improvements continuing for 2 months after the program's completion. Hippotherapy not only may be an effective intervention to improve functional gross motor development but also may affect perceived self-competence and social acceptance, which may lead to increases in participation for children with mild cerebral palsy.

Effects of daily mechanical horseback riding on insulin sensitivity and resting metabolism in middle-aged type 2 diabetes mellitus patients.

The present study was conducted to investigate the effect of daily passive exercise using a horseback riding machine (Joba) on insulin sensitivity and resting metabolism in middle-aged, diabetic patients. Participants were 24 type 2 diabetes mellitus patients aged 59 +/- 8 years (mean +/- SD; range from 43 to 75 years of age). Patients were randomly divided into control (normal lifestyle) and Joba exercise groups. The latter group was instructed to perform one 30-min session of Joba riding per day, 7 times per week, for 3 months. Compared with baseline values, serum immunoreactive insulin (IRI) concentrations decreased and HOMA-IR was improved by Joba training. In addition, exercise duration per day significantly correlated (r = -0.65) with changes in serum IRI, and 3-month mechanical horseback riding significantly increased the resting metabolic rate of the patients. These results suggest that daily Joba passive exercise is potentially useful as a means to improve insulin sensitivity and resting metabolism in diabetic patients. The Joba fitness equipment can prove especially useful as an alternative exercise therapy for aged individuals incapable of performing independent exercise or for those who suffer from knee-joint disorders.

[Musculoskeletal rehabilitation and bone. Development of Simulator (Jouba) for horse riding therapy and utility for the aged].

Horseback riding therapy is popularly used as one of the physiotherapy in Europe. Dr. Kimura hit upon Horseback Riding Robot, which can precisely simulate horseback motion ; as a result, he has developed and completed the Horseback Riding Robot, which can be worked by six motors. The Horseback Riding Robot, however, is very expensive. For that reason we have decided to turn over a new leaf and have developed a home machine by realizing one motor type. We proved the muscle strength trainings by use of Horse Riding Robot and a home machine, unlike a existing monotonous and boring muscle training, to be worthwhile and effective.

Study of the therapeutic effects of an advanced hippotherapy simulator in children with cerebral palsy: a randomised controlled trial.

BACKGROUND: Although hippotherapy treatment has been demonstrated to have therapeutic effects on children with cerebral palsy, the samples used in research studies have been very small. In the case of hippotherapy simulators, there are no studies that either recommend or advise against their use in the treatment of children with cerebral palsy. The aim of this randomised clinical study is to analyse the therapeutic effects or the contraindications of the use of a commercial hippotherapy simulator on several important factors relating to children with cerebral palsy such as their motor development, balance control in the sitting posture, hip abduction range of motion and electromyographic activity of adductor musculature. METHODS/DESIGN: The study is a randomised controlled trial. It will be carried out with a sample of 37 children with cerebral palsy divided into two treatment groups. Eligible participants will be randomly allocated to receive either (a) Treatment Group with hippotherapy simulator, maintaining sitting posture, with legs in abduction and rhythmic movement of the simulator or (b) Treatment Group maintaining sitting posture, with legs in abduction and without rhythmic movement of the simulator. DATA COLLECTION AND ANALYSIS: all measurements will be carried out by a specially trained blind assessor. To ensure standardization quality of the assessors, an inter-examiner agreement will be worked out at the start of the study. The trial is funded by the Department of Research, Innovation and Development of the Regional Government of Aragon (Official Bulletin of Aragon 23 July 2007), project number PM059/2007. DISCUSSION: Interest in this project is due to the following factors: Clinical originality (there are no previous studies analysing the effect of simulators on the population group of children with CP, nor any studies using as many variables as this project); Clinical impact (infantile cerebral palsy is a chronic multisystemic condition that affects not only the patient but also the patient's family and their close circle of friends); Practical benefits (the development of an effective treatment is very important for introducing this element into the rehabilitation of these children). TRIAL REGISTRATION: Current Controlled Trials ISRCTN03663478.