THE IMPACT OF NEURO DEVELOPMENTAL TREATMENT WITH HIPPOTHERAPY ON GMFM-88 SCORES OF CHILDREN AND ADOLESCENTS WITH CEREBRAL PALSY

¹CUDV Dobrna, Physiotherapy, Celje, Slovenia, ²Alma Mater Europaea ECM, Physiotherapy, Maribor, Slovenia

Background: Cerebral palsy (CP) is a permanent disorder of the posture and movement, which can result in impairments of gross motor function. The increasing demand for a patient centred approach to neurorehabilitation of persons with cerebral palsy (CP) requires a strict research protocol using vigorous design to scientifically investigate the impact of different physiotherapy (PT) interventions on their gross motor function. Over the past 20 years, hippotherapy has been successfully integrated into contemporary neurological PT of people with CP although the level of evidence regarding effectiveness of PT in combination with hippotherapy is very low. In the latest and previous systematic reviews comparing the effects of PT with hippotherapy versus PT alone on the gross motor function of children and adolescents with CP authors concluded that future studies should be done with low risk of bias.

Purpose: The purpose of double-blind, randomized clinical trial (RCT) was to investigate the short-term impact of contemporary neuro developmental treatment approach (NDT) with combination of intensive hippotherapy sessions on gross motor function of children and adolescents with cerebral palsy and other neurodevelopmental disorders.

Methods: A double-blind, randomized clinical trial (RCT) protocol with stratification (according to the Gross Motor Function Classification System; levels I-IV) was used in which 60 children and adolescents with CP were classified in the study group receiving NDT (2x 90 min per week with combination of intensive hippotherapy (6x 30 min per week) and into the control group (NDT 2 x 90 min per week). Initial measurements of gross motor function (GMFM-88) with high validity and reliability (4) were carried out at the beginning and at the end of the 6-month study. The data collected were analysed using the SPSS statistical program, version 22. The analysis followed the recommendations for data analysis in stratified randomized clinical studies.

Results: We found out that pre-test GMFM-88 scores showed no statistically significant differences between both groups, therefore groups were homogenous. Based on the analysis of post-test GMFM-88 results, we found out that statistically significant differences in all 5 dimensions: A–lying and rolling; B–sitting; C–kneeling and crawling; D–standing; and E–walking, running, and jumping were found between groups as well as in The GMFM-88 total score in favour of study group. There were statistically significant improvement in GMFM-88 scores in study group.

Conclusions: We can coclude that statistically significant improvements in GMFM-88 scores were due to accelerated motor learning based on an integrated NDT and hippotherapy, based on the concept of plasticity of the neuromuscular system and motor learning, which has significantly contributed to the improvement of the GMFM-88 total score in study group.

Implications: The existing RCT has high internal and external validity due to the use of a rigorous research protocol in order to minimize the impact of threats against validity and reliability. It contributes to evidence-based PT for supporting the claim that long-term NDT with hippotherapy provide a significant benefit to improvements of GMFM-88 scores in children with spastic CP.

Funding acknowledgements: No direct funding was received for this study.

Keywords:
Contemporary neurodevelopmental treatment approach
Hippotherapy
Cerebral palsy

Topics:
Paediatrics: cerebral palsy
Neurology
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: CUDV Dobrna

Committee: Komisija Republike Slovenije za Medicinsko Etiko

Ethics number: 0120-481/2017/5