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Effects of Hippotherapy andtherapeutic horseback riding on
postural control or balance in
children with Cerebral Palsy: A
meta-analysis
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Cerebral palsy (CP)
It is a term used to describe a spectrum of
syndromes of posture and motor
impairments that results from an insult tothe developing central nervous system.
Most significant problem is defective posturalcontrol in children with CP.
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Postural control
Organized at two functional levels:
1. First is -Direction specific adjustment when the
equilibrium of the body is endangered orgeneration of direction specific patterns of
postural adjustment.
2. Second level is involved in the fine tuning of the
basic, directionspecific adjustment according
to multisensorial afferent input from the
somatosensory,visual and vestibular systems.
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Benefits of Hippotherapy
Improved coordination
Increased head and trunk control
Improved gait
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Rationale
The horses gait provides a precise, smooth,
rhythmic and repetitive pattern of
movement to the rider that is similar to themechanics of human gait.
The rhythmical movement plus warmth of
the horse is hypothesized to decrease hypertonicity and promote relaxation in spastic
CP.
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Rationale contd..
Adjusting to the horses movements also
involves use of muscles and joint
movements
Increased strength and Range of motion
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Rationale contd..
Movement of the horse provides a variety of
inputs which may be used to facilitate:
Improved contraction
Joint stability
Weight shift
Postural equilibrium responses
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Therapeutic horseback riding
The exercises are aimed primarily at
maintaining balance and proper body
posture in different positions.
development of riders sensory-motor and
perceptual motor skills
a gradual increase in the riders capacity tostretch and move while the horse moves at a
slow, steady gait.
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Physical Benefits
Improvement in
1. Balance
2. Strength
3. Coordination
4. Muscle tone5. Joint range of motion
6. Weight bearing
7. Posture
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Psychological Benefits
Improvement in:
1. Self-confidence
2. Self-esteem
3. Motivation
4. Attention span5. Spatial awareness
6. Concentration
7. Verbal skills
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Aim of the Meta-analysis
To summarize and evaluate critically the
evidence for or against the effectiveness of
hippotherapy and THR in people with CP.
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Search Stratergy
A systematic literature search of a total of
11 medical, scientific and arts bibliograhical
databases was performed.
The search dates covered a period from
inception of the databases up till May 2010.
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Including criteria
A quantitative study design
The investigation of the effect of
Hippotherapy or THR on postural control or
balance
The study group comprised children or
adults with CP.
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Assesment of study quality
Study purpose
Literature review
Study design
Sample
Outcomes Interventions
Results
Conclusion
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Data
Total of 8 studies were included
In which 84 children with CP were
included, of which 76 felt some positive
effects.
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Discussion
The pooled data from 8 studies has shown a
statistically significant effectiveness of
hippotherapy or THR among children withCP.
Postural control and balance are important
elements of motor tasks. Postural Stability is essential for the
accomplishment of increasingly complex
motor skills and coordination.
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Discussion contd..
Several sensory deficits are associated with
CP such as problems in:
Vision
Proprioception
Cutaneous perception
Which may contribute to impaired posture
and balance control.
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Discussion contd..
Hippotherapy and THR are comprehensive
strategies to improve postural control and
balance which in turn help in their dailyactivities, independence and quality of life.
Changes in the horses gait velocity
facilitate righting and equilibrium responseswhich enable development of dynamic
postural stabilization.
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Outcome measures
Different methods were used to measure
effectiveness:
Video recordingd
Surface EMG
Force plate (centre of pressure
displacement)
Photographs (passive range of movement of
pelvis)
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Discussion contd..
In 21 of 39 children with CP who continued
their Physiotherapy during the period of
study or sat on a barrel or in an artificialsaddle, a positive effect was observed.
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Limitations
Differences in effects were observed
between Mild and Moderate CP.
Sample size of children with CP inintervention group was small.
Children also differed in the type and
severity of CP.
Outcome measures were very diverse.
Duration of therapy was extremely variable
ranging from a single measurement to 6
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Conclusion
The measurement of effectiveness of
hippotherapy and THR that was done was
based on a comparison sample which weretoo small and population with CP too
diverse.
This analysis does recoomend eitherhippotherapy or THR as a form of therapyto
improve posture and balance.
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