Impact of Hippotherapy on Gross Motor Function and Quality of Life in Children with Bilateral Cerebral Palsy: A Randomized Open-Label Crossover Study

Abstract

This study investigated the effect of hippotherapy on gross motor function (Gross Motor Function Measure [GMFM]-66, GMFM dimension E and D) and quality of life (Child Health Questionnaire [CHQ 28], KIDSCREEN-27 parental versions) in children with bilateral spastic cerebral palsy. Seventy-three children (age: 9.1 ± 3.3 years; male = 44; GMFCS levels II = 27; III = 17; IV = 29) were randomized to an early ( = 35) or late ( = 38) treatment group. Data from 66 probands were available for further analysis. Probands received hippotherapy once to twice weekly during a period of 16 to 20 weeks (mean: 17 treatments) in a crossover approach. Whereas no significant changes were found for total GMFM scores and quality of life parameters, a significant increase in GMFM dimension E was found. Children terminating the study early showed lower mean psychosocial quality of life scores than children who completed the whole study (CHQ-28 "psychosocial dimension"; KIDSCREEN-27 "mood and emotional dimension"). Our data are in line with previous reports and suggest that hippotherapy shows distinct therapeutic strengths with regard to promoting upright stand and gait in children with cerebral palsy. Children with higher psychosocial burden of disease may need special support to get access to and benefit from intensified physiotherapy programs.

Factors Influencing Motor Outcome of Hippotherapy in Children with Cerebral Palsy

“…This result also supports the recent study which suggests that hippotherapy shows distinct therapeutic strengths with regard to promoting upright stand and gait in children with cerebral palsy. 26 We did not find any influence of CP type and distribution on the increase in GMFM-66 score after hippotherapy. Relatively fewer ataxic (5.5%) and dyskinetic (6.8%) CP cases than spastic cases were enrolled in this study.…”

“…Further several previous RCTs on EAATs or hippotherapy examined mostly body structure and function, such as muscle asymmetry, spasticity, gait, gross motor function, and balance, using various laboratory and clinical measures, such as surface electromyography, 34 modified Ashworth scale, 35 GMFM, 25,36 and PBS. 25 Only two RCTs 26,36 used the CP quality of life questionnaire for children, child health questionnaire, and the KIDSCREEN-27 that represent quality of life. When planning EAAT or hippotherapy clinical trials, we recommend standardized outcome measures that meet corresponding individual's goals based on the ICF model (body structure/function, activity, and participation).…”

The Effectiveness of Hippotherapy to Recover Gross Motor Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis

“…Blinding of the participants and therapists was not possible in most studies due to the unconcealable nature of the intervention. In addition, the concealed allocation was only possible in two studies [16,19] and the assessor blinding was carried out by four studies [5,16,17,24]. Nevertheless, the overall quality of the studies was acceptable.…”

Protocol for a systematic review and meta-analysis on the effect of hippotherapy and related equine-assisted therapies on motor capabilities in children with cerebral palsy

“…As this treatment interacts with a malfunctioning neuromuscular system and aims to improve this pathological medical condition, proof for its therapeutic efficiency is needed. In this context, an increasing number of studies have focused on this question, ranging from single case reports to controlled studies [3,4]. Outcome measures used in these studies are heterogeneous, including different tests for motor function (for example, the GMFM (Gross Motor Function Measure), pediatric balance scale, SATCo (segmental assessment of trunc control), modified Ashworth scale, quantitative gait analysis) but also electromyographic or comparable measurements [4][5][6].…”

“…In this context, an increasing number of studies have focused on this question, ranging from single case reports to controlled studies [3,4]. Outcome measures used in these studies are heterogeneous, including different tests for motor function (for example, the GMFM (Gross Motor Function Measure), pediatric balance scale, SATCo (segmental assessment of trunc control), modified Ashworth scale, quantitative gait analysis) but also electromyographic or comparable measurements [4][5][6]. A series of reviews has already addressed distinct aspects of these results, frequently only including studies with the GMFM as only outcome measure, none including artificial horses or distinguishing between hippotherapy and further equine-assisted treatments.…”