Hippotherapy (Greek hippos = horse) is a specialised physiotherapy treatment that makes use of the horses' unique three-dimensional movement impulses at a walk to facilitate movement responses in patients sitting on the horse's back (Strauss, 2000). Despite a substantial body of anecdotal and clinical evidence for its benefits, research evidence for hippotherapy is sparse. This questionnaire survey was the first study in a series of investigations exploring the views of physiotherapists and people with cerebral palsy who use hippotherapy. These investigations, in turn, form the basis from which the authors will recommend outcome measures for individuals with cerebral palsy in a hippotherapy environment. This study aimed to: (a) establish the pattern of hippotherapy practice in Germany and the U.K.; (b) examine the perceived main effects of hippotherapy on people with cerebral palsy in Germany and the U.K.; and (c) investigate how these effects are being measured in both countries. The results highlighted considerable differences in how hippotherapy is practised in the U.K. compared with in Germany. In spite of this, the study revealed agreement among respondents on the overall perceived effects of hippotherapy on individuals with cerebral palsy, namely, the regulation of muscle tone, improvement of postural control and psychological benefits. The results also indicate scant use of outcome measures to evaluate these effects. The impact of these findings is discussed in the light of published research, and suggestions for further research are made.

Although there is now some evidence for specific effects of hippotherapy on people with cerebral palsy, these studies fail to provide a comprehensive picture of the effects of hippotherapy. This was the first qualitative study to explore the hippotherapy experience of people with cerebral palsy from a user perspective. The effects of hippotherapy and their context were of particular interest. Seventeen users aged from 4 to 63, with or without their parents, participated in focus groups or individual interviews in six centres in Britain and in Germany. The main effects of hippotherapy, as identified by users and parents, are normalisation of muscle tone, improved trunk control, improved walking ability, carryover effects of hippotherapy to activities of daily living, and increased self-efficacy, confidence, and self-esteem. This study provided unique and new insights into the context in which hippotherapy happens, as well as its effects on impairment, activity, participation, and quality of life in people with cerebral palsy. The study's findings are integrated with the existing literature on motor learning and pedagogy to try to explain the complex effects of hippotherapy as reported by users and parents. A conceptual framework that illustrates these effects and their interactions is introduced.

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To date, a range of exercises have been used to improve the function of the lumbar multifidus (LM) and transversus abdominis (TrA) muscles in people with low back pain, but uncertainty remains as to what exactly constitutes meaningful LM and TrA training. We examined the effects of exercising with a new device which combines weight-bearing, an unstable base of support (BOS) (feet), an upright posture with a relatively stable lumbo-pelvic area, and functional lower limb movement, with the aim of exploring which of these elements may be effective, in increasing LM and TrA muscle activity. Twelve non-symptomatic participants had ultrasound images taken of their LM and TrA during a range of conditions, including rest, traditional exercise approaches to LM and TrA recruitment, and exercising on the new device. Our results indicate that an unstable BOS on its own is not enough to increase LM and TrA activity, and that a combination of weight-bearing, an unstable BOS (feet), an upright posture with a relatively stable lumbo-pelvic area, and functional lower limb movement is most effective at increasing LM and TrA activity. This way of exercising appears to recruit LM more effectively than the widely used "swelling" of LM, and to cause automatic TrA and LM recruitment. Importantly, our findings also indicate LM and TrA may have slightly different roles during trunk stabilisation.

Most measures require further research to fully establish their psychometric properties. Only the Gross Motor Function Measure versions 88 and 66 and the Pediatric Evaluation of Disability Inventory were identified as potentially appropriate for this client group, but not all are valid for children of all ages and Gross Motor Function Classification System levels. The clinical application of these OMs is discussed in relation to capacity, capability, or performance; new developments are highlighted.

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Gravitational unloading leads to adaptations of the human body, including the spine and its adjacent structures, making it more vulnerable to injury and pain. The Functional Re‐adaptive Exercise Device (FRED) has been developed to activate the deep spinal muscles, lumbar multifidus (LM) and transversus abdominis (TrA), that provide inter‐segmental control and spinal protection. The FRED provides an unstable base of support and combines weight bearing in up‐right posture with side alternating, elliptical leg movements, without any resistance to movement. The present study investigated the activation of LM, TrA, obliquus externus (OE), obliquus internus (OI), abdominis, and erector spinae (ES) during FRED exercise using intramuscular fine‐wire and surface EMG. Nine healthy male volunteers (27 ± 5 years) have been recruited for the study. FRED exercise was compared with treadmill walking. It was confirmed that LM and TrA were continually active during FRED exercise. Compared with walking, FRED exercise resulted in similar mean activation of LM and TrA, less activation of OE, OI, ES, and greater variability of lumbo‐pelvic muscle activation patterns between individual FRED/gait cycles. These data suggest that FRED continuously engages LM and TrA, and therefore, has the potential as a stationary exercise device to train these muscles.

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