Factors Influencing Motor Outcome of Hippotherapy in Children with Cerebral Palsy

Abstract

Objective This study was aimed to identify individual factors influencing the gross motor outcome of hippotherapy in children with cerebral palsy (CP).

Methods One hundred and forty-six children with CP (mean age: 5.78 ± 1.72 years, male: 56.2%) presenting variable function (gross motor function classification system [GMFCS], levels I–IV) participated in this study. Participants received 30 minutes of hippotherapy twice a week for 8 weeks. Clinical information including GMFCS level, age, sex, CP distribution, CP type, gross motor function measure-88 (GMFM-88), GMFM-66, and pediatric balance scale (PBS) score were collected retrospectively. We regarded the children with GMFM-66 score increased by 2.0 points as good responders to hippotherapy. Further we analyzed factors affecting good responders.

Results GMFCS level I and II compared with IV (odds ratio [OR] = 6.83) and III compared with IV (OR = 4.45) were significantly associated with a good response to hippotherapy. Higher baseline GMFM E (OR = 1.05) and lower baseline GMFM B (OR = 0.93) were also significantly associated with a good response to hippotherapy. Sex, age, CP type, and distribution were not factors influencing gross motor outcome of hippotherapy.

Conclusions The children with CP, GMFCS level I–III, with relatively poor postural control in sitting might have a greater chance to improve their GMFM-66 scores through hippotherapy. This supports the hypothesis that hippotherapy is a context-focused therapy to improve postural control in sitting.

Keywords

hippotherapy - gross motor function - cerebral palsy

• References

• 1 Ryan JM, Cassidy EE, Noorduyn SG, O'Connell NE. Exercise interventions for cerebral palsy. Cochrane Database Syst Rev 2017; 6: CD011660
• 2 World Health Organization. International Classification of Functioning, Disability and Health: Children & Youth Version. Geneva, Switzerland: WHO Publications; 2007
• 3 Damiano DL. Activity, activity, activity: rethinking our physical therapy approach to cerebral palsy. Phys Ther 2006; 86 (11) 1534-1540
• 4 Lee BH, Kim YM, Jeong GC. Mediating effects of the ICF domain of function and the gross motor function measure on the ICF domains of activity, and participation in children with cerebral palsy. J Phys Ther Sci 2015; 27 (10) 3059-3062
• 5 Law M, King G, King S. , et al. Patterns of participation in recreational and leisure activities among children with complex physical disabilities. Dev Med Child Neurol 2006; 48 (05) 337-342
• 6 Carlon SL, Taylor NF, Dodd KJ, Shields N. Differences in habitual physical activity levels of young people with cerebral palsy and their typically developing peers: a systematic review. Disabil Rehabil 2013; 35 (08) 647-655
• 7 Damiano DL. Rehabilitative therapies in cerebral palsy: the good, the not as good, and the possible. J Child Neurol 2009; 24 (09) 1200-1204
• 8 Bain AM. Pony riding for the disabled. Physiotherapy 1965; 51: 263-265
• 9 McGee MC, Reese NB. Immediate effects of a hippotherapy session on gait parameters in children with spastic cerebral palsy. Pediatr Phys Ther 2009; 21 (02) 212-218
• 10 Zadnikar M, Kastrin A. Effects of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: a meta-analysis. Dev Med Child Neurol 2011; 53 (08) 684-691
• 11 Lauruschkus K, Nordmark E, Hallström I. “It's fun, but …” Children with cerebral palsy and their experiences of participation in physical activities. Disabil Rehabil 2015; 37 (04) 283-289
• 12 Stergiou A, Tzoufi M, Ntzani E, Varvarousis D, Beris A, Ploumis A. Therapeutic effects of horseback riding interventions: a systematic review and meta-analysis. Am J Phys Med Rehabil 2017; 96 (10) 717-725
• 13 Kwon JY, Chang HJ, Lee JY, Ha Y, Lee PK, Kim YH. Effects of hippotherapy on gait parameters in children with bilateral spastic cerebral palsy. Arch Phys Med Rehabil 2011; 92 (05) 774-779
• 14 Park ES, Rha DW, Shin JS, Kim S, Jung S. Effects of hippotherapy on gross motor function and functional performance of children with cerebral palsy. Yonsei Med J 2014; 55 (06) 1736-1742
• 15 Whalen CN, Case-Smith J. Therapeutic effects of horseback riding therapy on gross motor function in children with cerebral palsy: a systematic review. Phys Occup Ther Pediatr 2012; 32 (03) 229-242
• 16 Tseng SH, Chen HC, Tam KW. Systematic review and meta-analysis of the effect of equine assisted activities and therapies on gross motor outcome in children with cerebral palsy. Disabil Rehabil 2013; 35 (02) 89-99
• 17 Russell DJ, Rosenbaum PL, Cadman DT, Gowland C, Hardy S, Jarvis S. The gross motor function measure: a means to evaluate the effects of physical therapy. Dev Med Child Neurol 1989; 31 (03) 341-352
• 18 Wang HY, Yang YH. Evaluating the responsiveness of 2 versions of the gross motor function measure for children with cerebral palsy. Arch Phys Med Rehabil 2006; 87 (01) 51-56
• 19 McGibbon NH, Andrade CK, Widener G, Cintas HL. Effect of an equine-movement therapy program on gait, energy expenditure, and motor function in children with spastic cerebral palsy: a pilot study. Dev Med Child Neurol 1998; 40 (11) 754-762
• 20 Chen CL, Shen IH, Chen CY, Wu CY, Liu WY, Chung CY. Validity, responsiveness, minimal detectable change, and minimal clinically important change of Pediatric Balance Scale in children with cerebral palsy. Res Dev Disabil 2013; 34 (03) 916-922
• 21 Hong BY, Jo L, Kim JS, Lim SH, Bae JM. Factors influencing the gross motor outcome of intensive therapy in children with cerebral palsy and developmental delay. J Korean Med Sci 2017; 32 (05) 873-879
• 22 Hsieh YL, Yang CC, Sun SH, Chan SY, Wang TH, Luo HJ. Effects of hippotherapy on body functions, activities and participation in children with cerebral palsy based on ICF-CY assessments. Disabil Rehabil 2017; 39 (17) 1703-1713
• 23 Rosenbaum PL, Walter SD, Hanna SE. , et al. Prognosis for gross motor function in cerebral palsy: creation of motor development curves. JAMA 2002; 288 (11) 1357-1363
• 24 Hanna SE, Rosenbaum PL, Bartlett DJ. , et al. Stability and decline in gross motor function among children and youth with cerebral palsy aged 2 to 21 years. Dev Med Child Neurol 2009; 51 (04) 295-302
• 25 Kwon JY, Chang HJ, Yi SH, Lee JY, Shin HY, Kim YH. Effect of hippotherapy on gross motor function in children with cerebral palsy: a randomized controlled trial. J Altern Complement Med 2015; 21 (01) 15-21
• 26 Deutz U, Heussen N, Weigt-Usinger K. , et al. Impact of hippotherapy on gross motor function and quality of life in children with bilateral cerebral palsy: a randomized open-label crossover study. Neuropediatrics 2018; 49 (03) 185-192
• 27 Odding E, Roebroeck ME, Stam HJ. The epidemiology of cerebral palsy: incidence, impairments and risk factors. Disabil Rehabil 2006; 28 (04) 183-191
• 28 Himmelmann K, McManus V, Hagberg G, Uvebrant P, Krägeloh-Mann I, Cans C. ; SCPE collaboration. Dyskinetic cerebral palsy in Europe: trends in prevalence and severity. Arch Dis Child 2009; 94 (12) 921-926
• 29 Howard J, Soo B, Graham HK. , et al. Cerebral palsy in Victoria: motor types, topography and gross motor function. J Paediatr Child Health 2005; 41 (9,10): 479-483
• 30 Anaby D, Law M, Teplicky R, Turner L. Focusing on the environment to improve youth participation: experiences and perspectives of occupational therapists. Int J Environ Res Public Health 2015; 12 (10) 13388-13398
• 31 Law MC, Darrah J, Pollock N. , et al. Focus on function: a cluster, randomized controlled trial comparing child- versus context-focused intervention for young children with cerebral palsy. Dev Med Child Neurol 2011; 53 (07) 621-629
• 32 Franki I, Desloovere K, De Cat J. , et al. The evidence-base for basic physical therapy techniques targeting lower limb function in children with cerebral palsy: a systematic review using the International Classification of Functioning, Disability and Health as a conceptual framework. J Rehabil Med 2012; 44 (05) 385-395
• 33 Novak I. Evidence-based diagnosis, health care, and rehabilitation for children with cerebral palsy. J Child Neurol 2014; 29 (08) 1141-1156
• 34 Benda W, McGibbon NH, Grant KL. Improvements in muscle symmetry in children with cerebral palsy after equine-assisted therapy (hippotherapy). J Altern Complement Med 2003; 9 (06) 817-825
• 35 Lucena-Antón D, Rosety-Rodríguez I, Moral-Munoz JA. Effects of a hippotherapy intervention on muscle spasticity in children with cerebral palsy: A randomized controlled trial. Complement Ther Clin Pract 2018; 31: 188-192
• 36 Davis E, Davies B, Wolfe R. , et al. A randomized controlled trial of the impact of therapeutic horse riding on the quality of life, health, and function of children with cerebral palsy. Dev Med Child Neurol 2009; 51 (02) 111-119 , discussion 88