HIPPOTHERAPY IN CEREBRAL PALSY - SURVEY RESEARCH.

OBJECTIVE: The aim: To assess the effects of a one-year hippotherapy programme on the physical and mental functioning of children with cerebral palsy. PATIENTS AND METHODS: Materials and methods: The study included 15 children with cerebral palsy whose mean age was 9 years. The children participated in hippotherapy ses¬sions at the Rehabilitation Centre in Rusinowice (one-year observation). The clinical presentation was dominated by manifestations of motor and postural abnormalities caused by central nervous system damage. A survey questionnaire was used in the study to collect information about problems associated with everyday life and functioning. RESULTS: Results: The results obtained in this study showed that spastic CP was the most common form of the disorder, affecting 8 out of 15 children (53%). It was followed by mixed CP (40%, 6 children). Among the respondents, 67% (10 people) were already familiar with hippotherapy whereas 33% did not know this method. CONCLUSION: Conclusions: There was a strong correlation between being familiar with effects of hippotherapy and the level of education of the parent/guardian. This result had a moderate influence on the frequency of hippotherapy sessions. Systematic hippotherapy sessions helped improve physical fitness and everyday functioning in children with cerebral palsy.

Equine-Assisted Therapy in Post-Traumatic-Stress Disorder: A Systematic Review and Meta-Analysis.

Alternative treatments for Post-traumatic-Stress Disorder (PTSD) have attracted attention, especially Equine-Assisted Services (EAS) including psychotherapy and occupational therapy involving horses. In this work, we measured the effectiveness of EAS in PTSD through a meta-analysis. An intensive bibliography search focusing in EAS and PTSD was conducted following the PRISMA recommendations. The search was not restricted by date. For the quantitative analyses, 5 works were selected. They were chosen based on the instrument utilized for the assessment of PTSD symptoms: the PTSD Checklist for DSM-5 (PCL-5). A random effects model was carried out, showing significant results in the reduction of PTSD symptoms. In the qualitative synthesis, 10 studies were included which showed interesting results in the improvement of PTSD symptoms and other variables. In conclusion, EAS are beneficial for post-traumatic symptoms in the short term follow-up period. However, EAS require further research and major standardization.

Effect of hippotherapy on balance, functional mobility, and functional independence in children with Down syndrome: randomized controlled trial.

Impaired muscle strength, proprioceptive and vestibular deficits, and orthopedic dysfunction are common disorders associated with Down syndrome (DS). Hippotherapy uses the horses' multidimensional movement to improve posture, balance, and overall function, both motor and sensory. Research evidence supports hippotherapy as an effective, medically recognized intervention for the rehabilitation of gross motor skills. The aim of this study was to determine the effect of hippotherapy on balance, functional mobility, and functional independence in children with DS. Thirty-four children with DS were randomly assigned to the experimental (hippotherapy) and control groups after the initial assessment. Both groups received physiotherapy including balance exercises, and the experimental group also received hippotherapy as an integrative therapy. Pediatric Balance Scale (PBS), Timed Up and Go Test (TUG), and Functional Independence Measure for Children (WeeFIM) were used before and after the intervention. Baseline outcome measures (PBS, TUG, WeeFIM) were statistically similar between groups (p > 0.05). After the intervention, PBS and TUG scores improved in both groups (p < 0.05). On the other hand, WeeFIM scores improved just in the hippotherapy group (p < 0.05).   Conclusion: Therefore, providing hippotherapy as an integrative therapy to physiotherapy will be more effective in improving the functional independence of children with DS.    Trial registration: NCT05297149 (March 2022, retrospectively registered). What is Known: • Hippotherapy has an improvement effect on balance and functional independence in different diseases and age groups, but the evidence is limited in DS. • There is limited evidence about the effect of hippotherapy on functional mobility in different diseases and age groups, but there is no evidence in DS. What is New: • Hippotherapy is a safe and effective approach to support improvement in functional independence in children with DS.

Effects of Hippotherapy on Postural Control in Children With Cerebral Palsy: A Systematic Review.

PURPOSE: To summarize and update the current knowledge on the effectiveness of hippotherapy on postural control in children with cerebral palsy. METHODS: Using a systematic review methodology, the electronic databases PubMed, Virtual Health Library, PEDro, Scielo, Embase, and Web of Science were searched for eligible articles from 2011 up to September 2021. Quality assessment of eligible studies was performed using the PEDro scale. RESULTS: There were 239 identified studies. Eight clinical trials were selected. The total sample consisted of 264 individuals, with 134 allocated to the experimental group (hippotherapy) and 130 individuals to the control group (conventional therapy). Most studies had moderate to high methodological quality. CONCLUSIONS: Hippotherapy can be an effective intervention to improve several aspects related to postural control, such as static balance (especially in the sitting posture), dynamic balance, and alignment (body posture) in children aged 3 to 16 years, particularly with spastic hemiplegia or diplegia. WHAT THIS ADDS TO THE EVIDENCE: This review summarizes studies that explore potential effects of hippotherapy on postural control in children with cerebral palsy.

A qualitative study of equine-assisted therapy for Israeli military and police veterans with PTSD-impact on self-regulation, bonding and hope.

Equine-assisted therapy (EAT) is an increasingly popular form of treatment for people suffering from post-traumatic stress disorder (PTSD) who, for one reason or another, find psychotherapy and other traditional treatment approaches unsuitable or unhelpful. However, the concomitant growth of research in the field is yet to engage with key factors relating to EAT; specifically, there are few studies considering the phenomenological perspective of patients, and the embodied knowledge deriving from the lived experience of PTSD patients who participated in EAT-based intervention programmes. Based on a qualitative-phenomenological study, interviews were conducted with 12 PTSD patients who had completed an EAT-based intervention programme. From these, three main themes characterising the meanings they gave to participation in an EAT-based treatment programme were identified: the ability to relax (self-regulation); establishing a relationship (bonding) and transformation and hope for the future. The findings of this study point to a process whereby participation in an EAT-based treatment programme facilitates the ability to cope with PTSD symptoms in a way that bridges the patient's emotional, social and spiritual-existential dimensions. The findings suggest that EAT can contribute to the healing process of veterans suffering from PTSD.

Analysis of Trunk Neuromuscular Activation During Equine-Assisted Therapy in Older Adults.

The three-dimensional movement of the horse in physical therapy is a valuable kinesio-therapeutic phenomenon that simultaneously affects several body systems, including particularly the neuromuscular system. However, the effects of equine-assisted services (EAS) on neuromuscular activation patterns in older adults have not been thoroughly investigated. In this study, we evaluated the impact of a 10-weeks EAS program on trunk muscles in older adults who used a saddle and placed their feet in stirrups for the first 15 minutes and out of stirrups for the remaining 15 minutes of 30-minute EAS sessions. We gathered electromyographic (EMG) data of the trunk muscles five times each on the first, fifth, and 10th sessions: pre-EAS and post-EAS on a stationary horse and at 1-minute, 15-minutes, and 30-minutes on a horse in motion. Participants were 20 adults, aged 60-79 years. We analyzed normalized EMG data with 5 (session time) by 3 (session number) analyses of variance (ANOVAs) with repeated measures and with Bonferroni's testing (p ≤ .05). There was a significant difference over the number of interventions for the right thoracic paravertebral muscle (p = .025) and session time effect for the left trapezius (p = .042), right thoracic paravertebral (p < .001), right and left multifidus (p < .001), and right and left rectus abdominis muscles (p < .001). Thus, trunk muscles in older adults showed complex neuromuscular activation synchronized with the horse's movement, which was influenced by session time and number of interventions. The practical implication of these findings is that EAS can reduce fall risk among elderly adults of both sexes.

Mental health benefits of mounted equine-assisted therapies: A scoping review.

Across mental health professionals, there is growing interest in the field of Equine-Assisted Therapy (EAT). Preliminary evidence suggests EAT is beneficial for a wide spectrum of client populations. EAT programs may be based on groundwork alone, where participants interact with the horses from the ground only, or they may incorporate mounted activities. It remains unclear whether mounted activities add therapeutic benefits to the EAT experience for participants. This scoping review explored whether mounted activities, specifically where the client rides the horse, contribute to distinct therapeutic benefits. Nine databases were searched for studies of EAT programs that included horse riding as a central component of the therapeutic intervention and 36 studies were included in the analysis. The results of these studies suggest that mounted activities positively contribute to a variety of issues experienced by different client groups. However, further quality research is needed to carefully examine riding activities as an independent phenomenon, in order to establish what contribution-mounted activities, over and above groundwork, make to any therapeutic benefit of the EAT experience.

[Equine Assisted Group Therapy. The Effect on the Quality of Life in Elderly with Dementia]. / Groepstherapie met assistentie van een pony. Het effect op de kwaliteit van leven van ouderen met dementie.

As people worldwide generally live longer, the number of people with dementia is also increasing, a condition for which there is no cure yet. Therefore, there is a growing focus on enhancing the quality of life of people with dementia, as well as a growing need for (new) psychosocial interventions that enhance quality of life. An example of this is Animal assisted therapy (AAT), a goal oriented, planned and structured therapeutic intervention directed and/or delivered by professionals. Equine assisted therapy (EAT) is a specific form of AAT which uses horses or other equines. In our research, the effect of EAT as group therapy was compared to the effect of group therapy without the assistance of animals. Over a period of six weeks, weekly group therapy sessions were conducted by a professional, who is psychologist and equine assisted therapist. In both groups, quality of life was measured before and after the therapy program with the Qualidem and the Quality of Life in Alzheimer's Disease questionnaires. Compared to the group that only participated in group therapy sessions, participation in the EAT program with assistance of a pony led to better results.

Equine-Assisted Therapy for Posttraumatic Stress Disorder Among Military Veterans: An Open Trial.

Objective: As veterans have high rates of posttraumatic stress disorder (PTSD) and historically poor treatment outcomes and high attrition, alternative treatments have gained much popularity despite lack of rigorous research. In this study, a recently developed and manualized 8-session group Equine-Assisted Therapy for PTSD (EAT-PTSD) was tested in an open trial to assess its preliminary feasibility, acceptability, and outcomes for military veterans.Methods: The study was conducted from July 2016 to July 2019. Sixty-three treatment-seeking veterans with PTSD enrolled. PTSD diagnosis was ascertained using the Structured Clinical Interview for DSM-5, Research Version (SCID-5-RV) and confirmed using the Clinician-Administered PTSD Scale (CAPS-5). Mean age was 50 years, and 23 patients (37%) were women. Clinician and self-report measures of PTSD and depression were assessed at pretreatment, midtreatment, and posttreatment and at a 3-month follow-up. An intent-to-treat analysis and a secondary analysis of those who completed all 4 clinical assessments were utilized.Results: Only 5 patients (8%) withdrew from treatment, 4 before midtreatment and 1 afterward. Posttreatment assessment revealed marked reductions in both clinician-rated and self-reported PTSD and depression symptoms, which persisted at 3-month follow-up. Specifically, mean (SD) CAPS-5 scores fell from 38.6 (8.1) to 26.9 (12.4) at termination. Thirty-two patients (50.8%) showed clinically significant change (≥ 30% decrease in CAPS-5 score) at posttreatment and 34 (54.0%) at follow-up.Conclusions: Manualized EAT-PTSD shows promise as a potential new intervention for veterans with PTSD. It appears safe, feasible, and clinically viable. These preliminary results encourage examination of EAT-PTSD in larger, randomized controlled trials.Trial Registration: ClinicalTrials.gov identifier: NCT03068325.

Effects of horse riding simulator on sitting motor function in children with spastic cerebral palsy.

BACKGROUND: Horse riding simulator (HRS) is an electronic horse, working under the principles of hippotherapy. It is one of the advanced therapeutic methods to improve postural control and balance in sitting, which could be recommended in the rehabilitation of cerebral palsy if real horses are unavailable. OBJECTIVE: To investigate the therapeutic effects of HRS on sitting motor function in children with spastic diplegia and evaluate the changes in sitting motor function at different periods of time (4, 8 and 12 weeks). METHODS: This study is a randomized controlled trial conducted over a period of 12 weeks. Thirty children with spastic diplegia age between 2 and 4 years with Gross Motor Function Classification System (GMFCS) Level I-III were included and divided into two groups. The control group received the conventional physiotherapy while the experimental group received HRS along with conventional physiotherapy. Sitting motor function was assessed by Gross Motor Function Measure (GMFM)-88 (sitting dimension B) at baseline, 4, 8 and 12 weeks. Pre- and post-intervention scores were measured and analysed. RESULTS: The baseline characteristics were similar in both groups before the intervention with p > .01. The observed mean value of GMFM in both groups improved over a period of 12 weeks. The results denote that the sitting motor function gradually improved over a period of time in both groups and the experimental group showed significant improvement (p < .01) than the control group in all the weeks. CONCLUSION: The study results confirmed that gradual improvement in sitting motor function was observed in both groups. Children exposed to HRS show better improvement than the children in the control group. It was concluded that HRS is effective in improving the sitting motor function in children with spastic diplegia and the continuous provision of HRS in longer duration provide more benefits than the shorter duration.

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

INTRODUCCIÓN: La parálisis cerebral es producida por una lesión no progresiva en el cerebro durante su desarrollo. Esta lesión da lugar a una afectación motora y a disfunciones del área perceptiva, del habla, comunicativa, de cognición y de competencia. La fisioterapia es una parte muy importante del tratamiento de esta patología, donde podemos incluir la hipoterapia, que utiliza el movimiento equino para estimular los sistemas sensoriales, neuromotores y cognitivos con el fin de promover resultados funcionales. METODOLOGÍA: Se llevó a cabo una búsqueda bibliográfica utilizando diferentes bases de datos y las palabras claves: «cerebral palsy» (parálisis cerebral), «children» (niños), «treatment» (tratamiento) y «physiotherapy» (fisioterapia). Tras la aplicación de los criterios de inclusión y exclusión, la eliminación de los artículos duplicados y la lectura crítica, se seleccionaron 22 artículos. CONCLUSIÓN: La hipoterapia es utilizada en el ámbito de la fisioterapia para el tratamiento de la parálisis cerebral infantil, mediante la manipulación intencionada del movimiento equino para estimular los sistemas sensitivos, neuromotores y cognitivo con el fin de promover resultados funcionales. Entre las intervenciones usadas, la más recomendada por los autores es la alineación postural, aunque no existe un protocolo único de actuación, sino que el tratamiento se adapta de forma individual a las necesidades de cada paciente con parálisis cerebral

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

[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.

Parental Perspectives of Occupational Therapy in an Equine Environment for Children with Autism Spectrum Disorder.

This paper reports on the qualitative phase of a mixed methods study of occupational therapy in an equine environment for children with autism spectrum disorder (ASD). The study's quantitative phase found that this intervention improved the occupational performance, social motivation, social communication, and self-regulation of some children with ASD. The study's qualitative phase, reported herein, subsequently aimed to describe parental perspectives on children's experiences of the intervention and its influences on everyday life. Using a qualitative descriptive research approach, five parents participated in two rounds of semi-structured interviews. Interview data were analyzed using theoretical thematic analysis. Although parents expressed some concerns about the intervention, overall they found the intervention to be appropriate and acceptable. Next research steps include creation of a manual for the intervention and assessment of feasibility across a broader range of practice sites, occupational therapists, children with ASD, and their parents.

Pilot Study: Occupational Therapy in an Equine Environment for Youth With Autism.

Despite growing prevalence, research investigating occupational therapy incorporating horses for youth with autism is limited. This study aimed to (a) pilot a screening, evaluation, and intervention protocol of occupational therapy in an equine environment and (b) assess preliminary effects on occupational performance goals, behavior, and social functioning of youth with autism. A multiple baseline single-case experimental design was used. Six youth with autism participated in a no-treatment baseline phase and 10 weeks of intervention. Therapists implemented the intervention with 95% fidelity. Per parent report, participants improved in occupational performance goals, social motivation, and communication; four demonstrated decreased irritability and hyperactivity. This research operationalizes a screening, evaluation, and intervention protocol for occupational therapy in an equine environment, and demonstrates it may improve occupational, behavioral, and social outcomes for youth with autism. Next steps include manualizing the intervention, refining feasibility measures, and implementing a randomized controlled efficacy study.

Complementary horse-assisted therapy for substance use disorders: a randomized controlled trial.

BACKGROUND: Treatment completion is the greatest challenge for the treatment of substance use disorders (SUDs). A previous investigation showed that complementary horse-assisted therapy (cHAT) was associated with higher retention in treatment and completion than standard treatment alone. This randomized controlled trial further explored the benefits of cHAT for patients with SUDs. METHODS: Fifty patients in residential SUD treatment at the Department of Addiction Treatment, Oslo University Hospital, were randomly allocated to either cHAT (cHAT group) or treatment as usual alone (TAU-only group). The primary end-point was treatment completion. Secondary end-points were dropout, transfer to another treatment, and time in treatment. RESULTS: The multinomial logistic regression analysis found no statistically significant association between intervention (cHAT) and treatment outcome (completion, dropout, transferred) among the 37 participants who were ultimately recruited to the study. Some unforeseen challenges were encountered in the study: a high number of subjects transferred to another treatment, variable attendance at cHAT sessions, and long temporary exits. Nevertheless, 44% of participants in the cHAT group completed their treatment, compared with 32% in the TAU-only group; this observation encourages further investigation in a larger sample. CONCLUSIONS: Though no association was identified between cHAT and treatment retention or completion, our study may have been underpowered. Further work in a larger clinical population is needed; observational studies with repeated measures may also be useful for investigating whether cHAT increases retention in treatment or rates of completion, two important factors for successful SUD treatment. Trial registration The trial was registered and approved on 14 October 2011 by the Regional Committee for Medical and Health Research Ethics with registration number 2011/1642 and registered at ClinicalTrials.gov on 21 February 2013 with registration number NCT01795755.

Self-Management Intervention for Attention and Executive Functions Using Equine-Assisted Occupational Therapy Among Children Aged 6-14 Diagnosed with Attention Deficit/Hyperactivity Disorder.

Background: Attention deficit/hyperactivity disorder (ADHD), characterized by inattention, hyperactivity, and impulsivity, is currently one of the most common diagnoses given to children. Children with ADHD have a unique cognitive profile that involves difficulties in executive functions (EFs) and in the self-management system of the brain, and are at higher risk for educational failure, social and emotional difficulties, and high risk behavior. Objectives: The purpose of this study was to examine the effectiveness of self-management intervention for attention and executive functions using equine-assisted occupational therapy (STABLE-OT) for school-aged children with ADHD. Design: A pre-post design was used in the intervention. Setting/location: The study was conducted at two riding school stables is Israel. Subjects: Twenty-five 6-14-year-old children (3 girls, 22 boys, age: 7.8-12.3 years, M = 9.41 ± 1.75) diagnosed with ADHD participated in a therapeutic equestrian riding intervention. Intervention: The intervention included structured 45-min sessions for 12 weeks, while integrating child- and family-centered strategy acquisition and immediate feedback principles. Outcome measures: Their EF and occupational performance were evaluated pre- and post-intervention, using The Behavior Rating Inventory of Executive Function (BRIEF) and the Canadian Occupational Performance Measure (COPM). Results: Results showed a significant improvement in EF, as reflected by statistically significant decreases in the Global Executive Composite (GEC; t = 2.801; p = 0.01), metacognitive index (t = 3.873; p = 0.001), working memory (t = 2.476; p = 0.021), monitor (t = 2.359; p = 0.027), and initiation (t = 3.204; p = 0.004) subscales of the BRIEF questionnaire. A statistically (p < 0.001) and clinically significant improvement was also found in the COPM performance and satisfaction scales. Conclusions: This study provides key preliminary evidence supporting the effectiveness of an individual equine-assisted OT intervention for children with ADHD. It constitutes an initial step toward clinical implementation of such therapeutic approaches, and is expected to spark further research in this area.

Outcomes following physical therapy incorporating hippotherapy on neuromotor function and bladder control in children with Down syndrome: A case series.

Aims: The objective of this case series was to document gross motor function, gait parameter, and bladder control outcomes following physical therapy incorporating hippotherapy in children with Down syndrome (DS). Methods: Four children between three and five years of age received eight-weekly physical therapy sessions incorporating hippotherapy. Outcome measures included the Gross Motor Function Measure-88 (GMFM-88), parental perception of function during every day activities, spatiotemporal parameters of gait and bladder control. Results: Total change scores on the GMFM-88 exceeded the standardized response mean in all four children, while scores on Dimension E improved in two children. From the mothers' perspectives, all children showed at least some improvement in walking, running, and jumping; sitting, kneeling, and standing; symmetry and comfort; balance; coordination and social interactions and there were inconsistent changes in bladder control. Only one child demonstrated changes greater than 20% in any of the gait parameters. Conclusions: Physical therapy incorporating hippotherapy may be a potential treatment to assist in improving gross motor function in children with DS, but eight sessions may not be long enough to show major improvements in gait parameters or bladder control. Further research in the form of larger controlled trials is warranted to provide more support for the intervention in those with DS.

Hippotherapy on postural balance in the sitting position of children with cerebral palsy - Longitudinal study.

Purpose: To verify the effects of 12, 24, 36 hippotherapy sessions over time on postural balance while sitting in children with cerebral palsy as well the effects of treatment after one interruption period of 45 days. Methods: Hippotherapy program with a twice-weekly treatment with a total of 13 children aged 5-10 years old. Measurements of postural balance during sitting were performed using the AMTI AccuSway Plus platform. Results: There was a statistically significant reduction in mediolateral and anteroposterior sway after the first 12 hippotherapy sessions, and further significant sway reduction occurred as the treatment progressed. Changes in the center of pressure displacement velocity variable began to occur after 24 sessions. Conclusion: Seated postural balance improved in children with cerebral palsy, as evidenced by lower COP displacement, particularly after a greater number of sessions. After the last evaluations, when completing 36 sessions of hippotherapy, it was verified that the improvements to the postural balance continued to occur. Therefore, further studies with a longer treatment period may help to clarify if, at some point, there is stabilization in the improvement of postural balance. Furthermore, it is important to analyze the impact of hippotherapy on functional activities over time.

Hippotherapy in adults with acquired brain injury: A systematic review.

BACKGROUND: Hippotherapy is used to supplement conventional therapy in neurological conditions with evidence supporting its use in pediatric patients. However, evaluation of its merit in adults with acquired brain injury (ABI) is lacking. The aim of this study was to determine if hippotherapy can improve motor function in adults with ABI. Methods: A systematic review of all available controlled studies investigating the use of hippotherapy, in adults with ABI, was conducted. The primary outcome of interest was movement related function and secondary outcomes included impairment, quality of life, and adverse events. Results: Nine studies with 256 participants were included, of which six studies with 204 participants were included for meta-analysis. When the data were pooled, hippotherapy did not produce statistically significant improvements in balance (SMD = 0.24, 95% CI -0.05, 0.54, p = 0.1) or gait parameters (SMD = -0.04, 95% CI -0.79, 0.72 p = 0.92) when compared to control and measured immediately after the intervention. Long-term effects remain unknown due to lack of follow-up evaluation. Conclusions: This review suggests that hippotherapy is safe and well tolerated by adults with ABI. Short-term functional benefits were not associated with the use of hippotherapy. Further high-quality research is required before hippotherapy can be endorsed as a modality in adult neurological rehabilitation.

Can Individuals with Down Syndrome Benefit from Hippotherapy? An Exploratory Study on Gait and Balance.

Purpose: To evaluate whether a hippotherapy protocol may influence balance and gait in patients with Down Syndrome (DS). Methods: Fifteen male patients affected by DS underwent a 6-month hippotherapy protocol. Stabilometric, baropodometric, and gait assessments were performed at baseline (T0) and at the end of the treatment (T1). Results: At baseline, DS patients showed a low bilateral hind foot pressure percentage at the baropodometric analysis, a high center of pressure area in the closed-eye condition, a high center of pressure sway in open- and closed-eyes recordings, a high medio-lateral and antero-posterior velocity oscillations in the closed eye condition, and a reduced step-length and velocity. After the 6-month, hippotherapy protocol, DS patients had a significant bilateral higher hindfoot pressure percentage. The stabilometric analysis revealed a lower center of pressure area in the closed-eye condition, and a significantly reduced center of pressure sway in open- and closed-eyes recordings. In addition, DS patients showed lower medio-lateral and antero-posterior velocity oscillations in the closed eye condition. Finally, hippotherapy significantly improved step length and velocity. Conclusions: This pilot study demonstrates that hippotherapy determines functional improvement in gait speed, width, bilateral symmetry, and balance in DS.