Hippotherapy as an intervention to improve postural control of children with movement disorders


Hippotherapy as an intervention to improve postural control of children with movement disorders
D SILKWOOD-SHERER HSCD
School of Rehabilitation and Medical Sciences, Central Michigan University, Mt. Pleasant, MI, USA

Background/Objectives: The purpose of this study was two-fold. The first objective was to assess the effectiveness of equine assisted therapy (hippotherapy) as an intervention for the treatment of postural instability in children with mild to moderate balance problems. The second purpose was to determine if improvements in balance correlated to improved function.
Design: This study was a repeated measures design, prospective cohort study of children with balance disorders.
Participants and Setting: Sixteen children with documented or observed balance problems were recruited. Ages ranged from 5 to 16 years (X=10.3, SD=3.3). The participants included nine males and seven females with diagnoses of cerebral palsy, Down syndrome, pervasive developmental disorder, autism, developmental coordination disorder, cerebellar hyperplasia, and visually impaired.
Materials/Methods: The pediatric balance scale (PBS), a 14 item tool, was used to assess balance. The PBS has high test-retest reliability (ICC=0.99). The Activities Scale for Kids (ASK), a 30-item self-assessment questionnaire that measures domains of personal care, locomotion, standing and transfer skills, was used to assess the children’s perception of their overall function within relevant environments. The ASK also has high test-retest reliability (ICC=0.097) and high validity of self-reported function to clinical observations (ICC=0.94). Following baseline testing, the children received 6 weeks of 45 minute bi-weekly hippotherapy sessions provided by the author. Post-assessments measurements were taken within 48 hours of the last treatment session.
Results: The group mean PBS baseline score was 43.9 (SD=13.4; 95% CI=33.5-54.2). The post-test mean was 49.3 (SD=12.3; 95% CI=39.6-59.1). The ASK baseline score was 74.1 (SD=21; 95% CI=54.7-93.6) and this improved to 86.7 (SD=16.3; 95% CI=71.5-101.8) after hippotherapy. Utilizing Friedman’s ANOVA, the PBS (P<0.0001) and ASK (P<0.0001) were statistically different across the two baseline measures and post-intervention measure. The Wilcoxon T matched pairs tests, with Bonferroni correction (α =0.0167), showed the difference to lie between the baseline scores and post intervention scores and not the baseline scores. Large effect sizes were found between pre- and post-intervention PBS and ASK scores (d=1.59 and 1.51 respectively). Additionally a Spearman rho correlation of .700 (P=0.003) was found linking a relation between the PBS and ASK post-test scores.
Conclusions/Significance: The improved PBS scores following intervention supports hippotherapy as a viable treatment option for postural control in children with mild to moderate balance problems. Additionally, the changes in the ASK scores following intervention show that the children also perceive clinically significant changes in their functional abilities. The improved post-intervention ASK scores, along with its high correlation to the PBS, suggests a strong relationship between balance and function.

 
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