Inter-Day Reliability and Changes of Surface Electromyography on Two Postural Muscles Throughout 12 Weeks of Hippotherapy on Patients with Cerebral Palsy: A Pilot Study

Abstract

Cerebral palsy (CP) is an umbrella term covering a group of permanent developmental disorders of movement and posture characterized by highly variable clinical features. The aim of this study was to assess the short-term and mid-term effects of neurorehabilitation via hippotherapy on the contractile properties of two key postural muscles during functional sitting in such patients. Thirty-minute hippotherapy sessions were conducted biweekly for 12 weeks in 18 patients (18.1 ± 5.7 years old). Surface electromyography (EMG) was implemented bilaterally in rectus abdominis and adductor magnus. We quantitatively analyzed the amplitude of EMG signals in the time domain and its spectral characteristics in the frequency domain. EMGs were recorded at the beginning and end of each session on day one and at week six and week twelve. Statistical analysis revealed a substantial inter-day reliability of the EMG signals for both muscles, validating the methodological approach. To a lesser extent, while beyond the scope of the current study, quantitative changes suggested a more selective recruitment/contractile properties’ shift of the examined muscles. Exploring postural control during functional activities would contribute to understanding the relationship between structural impairment, activity performance and patient capabilities, allowing the design of neurorehabilitation programs aimed at improving postural and functional skills according to each individual’s needs. The present study provides basic quantitative data supporting the body of scientific evidence making hippotherapy an approach of choice for CP neurorehabilitation.

After 55 Years of Neurorehabilitation, What Is the Plan?

“…Physical methods should be favored and as far as possible should be preferred to pharmacological surrogate measures. For instance, regular movement and activity can partly attenuate muscle tone disorders (e.g., spasticity), pain, or mood conditions through the modulation of neuroactive endogenous molecules [ 13 , 135 , 136 ]. Additionally, during physical neurorehabilitation, visuo-motor feedback of the body movements corresponds to the patient’s motor intention and helps the individual to recreate the sensorimotor congruence of the body, restoring its voluntary movement representations and lessening phenomena like the phantom limb syndrome or the hemineglect syndrome [ 122 , 137 ].…”

“…The abnormal body’s spatial representation hinders the exact execution of a task and interferes with vital functions necessary for the individual’s homeostasis (e.g., respiratory function, cardiovascular function, energy metabolism). It is of great importance to support and reinforce the different feedbacks of a disabled-moving body [ 13 , 135 , 136 ]. This will allow the individual to develop and perfect new strategies for tuning the function and adapt it to the external request.…”

“…Indeed, this comprehensive approach must be carried out according to specific ethical considerations (unlikelihood of suspending and/or delaying interventions or providing a “placebo procedure” in a control group), intragroup variability (heterogeneous populations with various clinical pictures and levels of disability), interdependent components and contexts, and comprehensive treatments involving organizational complexity and tailored multidisciplinary and cross-sectorial interventions. All these factors currently limit the methodological validity of the results [ 11 , 12 , 13 ].…”

Breast cancer: how hippotherapy bridges the gap between healing and recovery. A randomized controlled clinical trial.

“…Through contextualized and relevant multimodal inputs (sensory, exteroceptive, proprioceptive, interoceptive and emotional), hippotherapy has a robust action on the motor abilities of the person 10,12,78,79 . In parallel to the hippotherapy's setting into motion, the work of understanding the instantaneous needs of the patients is fundamental.…”

“…Hippotherapy can tackle this challenge by providing a self-committed, e cient, non-intrusive, custom made framework of the patient's physical, mental, emotional and spiritual spheres [8][9][10][11][12][13][14] . We have therefore developed a wholeness-through-hippotherapy program that allows patients to move beyond recovery and that warrants novel forms of adjustments in order to nurture the more standard outcomes related to the attenuation of functional de cits [15][16][17] .…”