Hippo Therapy

8/2/2019 Hippo Therapy

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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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Hippo Therapy

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