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Neuropediatrics 2018; 49(03): 185-192
DOI: 10.1055/s-0038-1635121
Original Article
Georg Thieme Verlag KG Stuttgart · New York

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

Ute Deutz   *
1   Division of Pediatric Neurology and Social Pediatrics, Department of Pediatrics, University Hospital RWTH Aachen, Aachen, Germany
,
Nicole Heussen   *
2   Department of Medical Statistics, University Hospital RWTH Aachen, Aachen, Germany
3   Center of Biostatistics and Epidemiology, Sigmund Freud Private University, Vienna, Austria
,
Katharina Weigt-Usinger
4   Department of Neuropaediatrics, University Children's Hospital, Ruhr University, Bochum, Germany
,
Steffen Leiz
5   Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, Kliniken Dritter Orden GmbH, München, Germany
,
Christa Raabe
6   Department of Paediatric Neurology and Developmental Medicine, University Children's Hospital Tübingen, Tübingen, Germany
,
Tilman Polster
7   Pediatric Epilepsy Department, Bethel Epilepsy Centre, Bielefeld, Germany
,
Steinbüchel Daniela
8   Kinderneurologisches Zentrum KiNZ, LVR-Klinik, Bonn, Germany
,
Christine Moll   §
1   Division of Pediatric Neurology and Social Pediatrics, Department of Pediatrics, University Hospital RWTH Aachen, Aachen, Germany
,
Thomas Lücke
4   Department of Neuropaediatrics, University Children's Hospital, Ruhr University, Bochum, Germany
,
Ingeborg Krägeloh-Mann
6   Department of Paediatric Neurology and Developmental Medicine, University Children's Hospital Tübingen, Tübingen, Germany
,
Helmut Hollmann
8   Kinderneurologisches Zentrum KiNZ, LVR-Klinik, Bonn, Germany
,
Martin Häusler
1   Division of Pediatric Neurology and Social Pediatrics, Department of Pediatrics, University Hospital RWTH Aachen, Aachen, Germany
› Author Affiliations
Further Information

Publication History

25 August 2017

26 December 2017

Publication Date:
27 February 2018 (online)

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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 (n = 35) or late (n = 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.

Keywords

hippotherapy - gross motor function - cerebral palsy - quality of life - physiotherapy

* Authors who have contributed equally


§ Mrs. Moll contributed to this publication in the course of her thesis.


Supplementary Material

 

  • References

  • 1 Temcharoensuk P, Lekskulchai R, Akamanon C, Ritruechai P, Sutcharitpongsa S. Effect of horseback riding versus a dynamic and static horse riding simulator on sitting ability of children with cerebral palsy: a randomized controlled trial. J Phys Ther Sci 2015; 27 (01) 273-277
    CrossrefPubMedGoogle Scholar
  • 2 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
    CrossrefPubMedGoogle Scholar
  • 3 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
    CrossrefPubMedGoogle Scholar
  • 4 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
    CrossrefPubMedGoogle Scholar
  • 5 McGibbon NH, Benda W, Duncan BR, Silkwood-Sherer D. Immediate and long-term effects of hippotherapy on symmetry of adductor muscle activity and functional ability in children with spastic cerebral palsy. Arch Phys Med Rehabil 2009; 90 (06) 966-974
    CrossrefPubMedGoogle Scholar
  • 6 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
    CrossrefPubMedGoogle Scholar
  • 7 Mackinnon JR, Noh S, Lariviere J, Macphail A, Allan DE, Laliberte D. A study of therapeutic effects of horseback riding for children with cerebral palsy. Phys Occup Ther Pediatr 1995; 15 (01) 17-34
    CrossrefPubMedGoogle Scholar
  • 8 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
    CrossrefPubMedGoogle Scholar
  • 9 Alemdaroğlu E, Yanıkoğlu İ, Öken Ö. , et al. Horseback riding therapy in addition to conventional rehabilitation program decreases spasticity in children with cerebral palsy: a small sample study. Complement Ther Clin Pract 2016; 23: 26-29
    CrossrefPubMedGoogle Scholar
  • 10 Baik K, Byeun JK, Baek JK. The effects of horseback riding participation on the muscle tone and range of motion for children with spastic cerebral palsy. J Exerc Rehabil 2014; 10 (05) 265-270
    CrossrefPubMedGoogle Scholar
  • 11 Cherng RJ, Liao HF, Leung HWC, Hwang AW. The effectiveness of therapeutic horseback riding in children with spastic cerebral palsy. Adapt Phys Activ Q 2004; 21: 103-121
    PubMedGoogle Scholar
  • 12 Sterba JA, Rogers BT, France AP, Vokes DA. Horseback riding in children with cerebral palsy: effect on gross motor function. Dev Med Child Neurol 2002; 44 (05) 301-308
    PubMedGoogle Scholar
  • 13 Jang CH, Joo MC, Noh SE. , et al. Effects of hippotherapy on psychosocial aspects in children with cerebral palsy and their caregivers: a pilot study. Ann Rehabil Med 2016; 40 (02) 230-236
    CrossrefPubMedGoogle Scholar
  • 14 Casady RL, Nichols-Larsen DS. The effect of hippotherapy on ten children with cerebral palsy. Pediatr Phys Ther 2004; 16 (03) 165-172
    CrossrefPubMedGoogle Scholar
  • 15 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
    PubMedGoogle Scholar
  • 16 Champagne D, Corriveau H, Dugas C. Effect of hippotherapy on motor proficiency and function in children with cerebral palsy who walk. Phys Occup Ther Pediatr 2017; 37 (01) 51-63
    CrossrefPubMedGoogle Scholar
  • 17 Russel DJ, Rosenbaum PL, Avery LM, Lane M. . GMFM und GMFCS. Messung und Klassifikation motorischer Funktionen. Bern: Hogrefe; 2006
    Google Scholar
  • 18 Europe TKG. , ed. The Kidscreen Questionnaires. Norm Data. Syntaxes for analysing KIDSCREEN scales. Lengerich, Germany: Pabst Science Publishers; 2006
    Google Scholar
  • 19 Inc H. Child Health Questionnaire (CHQ) Scoring and Interpretation Manual. In: HealthActCHQ, ed. Boston: HealthAct CHQ; 2008
    Google Scholar
  • 20 Bronson C, Brewerton K, Ong J, Palanca C, Sullivan SJ. Does hippotherapy improve balance in persons with multiple sclerosis: a systematic review. Eur J Phys Rehabil Med 2010; 46 (03) 347-353
    PubMedGoogle Scholar
  • 21 Pham C, Bitonte R. Hippotherapy: remuneration issues impair the offering of this therapeutic strategy at Southern California rehabilitation centers. NeuroRehabilitation 2016; 38 (04) 411-417
    CrossrefPubMedGoogle Scholar
  • 22 Lemke D, Rothwell E, Newcomb TM, Swoboda KJ. Perceptions of equine-assisted activities and therapies by parents and children with spinal muscular atrophy. Pediatr Phys Ther 2014; 26 (02) 237-244
    CrossrefPubMedGoogle Scholar
  • 23 Wilson K, Buultjens M, Monfries M, Karimi L. Equine-assisted psychotherapy for adolescents experiencing depression and/or anxiety: a therapist's perspective. Clin Child Psychol Psychiatry 2017; 22 (01) 16-33
    CrossrefPubMedGoogle Scholar
  • 24 Bachi K, Terkel J, Teichman M. Equine-facilitated psychotherapy for at-risk adolescents: the influence on self-image, self-control and trust. Clin Child Psychol Psychiatry 2012; 17 (02) 298-312
    CrossrefPubMedGoogle Scholar
  • 25 Rosenbaum P, Paneth N, Leviton A. , et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007; 109: 8-14
    PubMedGoogle Scholar
  • 26 García-Goñi M, Nuño-Solinís R, Orueta JF, Paolucci F. Is utilization of health services for HIV patients equal by socioeconomic status? Evidence from the Basque country. Int J Equity Health 2015; 14: 110
    CrossrefPubMedGoogle Scholar
  • 27 Bower E, Michell D, Burnett M, Campbell MJ, McLellan DL. Randomized controlled trial of physiotherapy in 56 children with cerebral palsy followed for 18 months. Dev Med Child Neurol 2001; 43 (01) 4-15
    CrossrefPubMedGoogle Scholar
  • 28 Bryant E, Pountney T, Williams H, Edelman N. Can a six-week exercise intervention improve gross motor function for non-ambulant children with cerebral palsy? A pilot randomized controlled trial. Clin Rehabil 2013; 27 (02) 150-159
    CrossrefPubMedGoogle Scholar
  • 29 Martin L, Baker R, Harvey A. A systematic review of common physiotherapy interventions in school-aged children with cerebral palsy. Phys Occup Ther Pediatr 2010; 30 (04) 294-312
    CrossrefPubMedGoogle Scholar
  • 30 Ammann-Reiffer C, Bastiaenen CH, Meyer-Heim AD, van Hedel HJ. Effectiveness of robot-assisted gait training in children with cerebral palsy: a bicenter, pragmatic, randomized, cross-over trial (PeLoGAIT). BMC Pediatr 2017; 17 (01) 64
    CrossrefPubMedGoogle Scholar
  • 31 Cho C, Hwang W, Hwang S, Chung Y. Treadmill training with virtual reality improves gait, balance, and muscle strength in children with cerebral palsy. Tohoku J Exp Med 2016; 238 (03) 213-218
    CrossrefPubMedGoogle Scholar