Lancellotti EM1, Aries A1, Hunter SM1
1Keele University, School of Health and Rehabilitation, Faculty of Medicine and Health Sciences, Keele, Newcastle, United Kingdom
Background: Cerebral Palsy affects a child's movement ability and persists throughout a lifespan. Therefore, it is imperative to enhance the child's motor learning ability by providing a high number of exercises whilst maintaining the child's enthusiasm. Traditional approaches are limited in doing so. Systematic review of the literature reports that, compared to regular therapy, hippotherapy significantly improves postural control, balance, gross motor function and muscle symmetry in children with Cerebral Palsy, challenged by the three-dimensional walking pattern of the horse. However, the scientific principles behind how these effects occur have not been explored or clarified, highlighting a gap within the literature which undermines the applicability of such therapy.
Purpose: By exploring the theory underpinning hippotherapy, the author aims to understand whether, from the scientific point of view, it may be considered a suitable and valuable approach to improve postural control and motor function in children with Cerebral Palsy.
Methods: A narrative review was undertaken, gaining both empirical and theoretical knowledge. MEDLINE, AMED, CINAHLPlus, SPORTDiscus, Web of Science, Cochrane, PEDro, Pubmed, Joanna Briggs Institute, Embase, EBSCO eBook Collection, MyiLibrary and Dawsonera databases were searched. Following removal of duplicates, citations were screened by title, abstract and finally by full-text against inclusion/ exclusion criteria, followed by hand-searching of reference lists. Relevant books were retrieved through Keele University Library. Conference and DVD material were included. The Critical Appraisal Skill Programme tools and the Centre for Evidence-Based Management tool were used to appraise literature. Books were appraised by the Colorado State University appraisal tool for books, and theoretical reviews appraised by utilising only the relevant dimensions of the same tool.
Results: 74 pieces of evidence were included. Eight common themes and scientific principles were identified from the resources. Hippotherapy was found to improve postural control, balance, gait and motor function. The cerebellum continuously receives feedback on the horse's gait pattern which, by moving the pelvis three-dimensionally, highly resembles that of humans. Through neuroplastic and learning processes, the rider identifies correct pelvic movement and postural adaptations necessary to remain on the horse. Gaining axial stability, reducing muscle co-contraction and increasing joint range of motion, distal limb control and functional ability are further enhanced. When comparing severely disabled to more able children, the literature suggests that the former exhibit greatest gain. It is also suggested that, to improve trunk control, hippotherapy may be more beneficial for children with diplegia than for children with quadriplegia.
Conclusion(s): This review has identified an in depth theoretical and scientific background for hippotherapy, and highlighted its potential in diminishing postural and functional limitations once standardised protocols have been established.
Implications: Exploring the scientific background behind hippotherapy has given further knowledge on its potential as a physiotherapeutic treatment for children with Cerebral Palsy. Despite potential financial constraints, once standardised protocols have been developed, hippotherapy may be recognised as a valuable, enjoyable and stimulating physiotherapy treatment for children with Cerebral Palsy.
Keywords: Hippotherapy, Cerebral Palsy, Postural control
Funding acknowledgements: Self-funded.
Purpose: By exploring the theory underpinning hippotherapy, the author aims to understand whether, from the scientific point of view, it may be considered a suitable and valuable approach to improve postural control and motor function in children with Cerebral Palsy.
Methods: A narrative review was undertaken, gaining both empirical and theoretical knowledge. MEDLINE, AMED, CINAHLPlus, SPORTDiscus, Web of Science, Cochrane, PEDro, Pubmed, Joanna Briggs Institute, Embase, EBSCO eBook Collection, MyiLibrary and Dawsonera databases were searched. Following removal of duplicates, citations were screened by title, abstract and finally by full-text against inclusion/ exclusion criteria, followed by hand-searching of reference lists. Relevant books were retrieved through Keele University Library. Conference and DVD material were included. The Critical Appraisal Skill Programme tools and the Centre for Evidence-Based Management tool were used to appraise literature. Books were appraised by the Colorado State University appraisal tool for books, and theoretical reviews appraised by utilising only the relevant dimensions of the same tool.
Results: 74 pieces of evidence were included. Eight common themes and scientific principles were identified from the resources. Hippotherapy was found to improve postural control, balance, gait and motor function. The cerebellum continuously receives feedback on the horse's gait pattern which, by moving the pelvis three-dimensionally, highly resembles that of humans. Through neuroplastic and learning processes, the rider identifies correct pelvic movement and postural adaptations necessary to remain on the horse. Gaining axial stability, reducing muscle co-contraction and increasing joint range of motion, distal limb control and functional ability are further enhanced. When comparing severely disabled to more able children, the literature suggests that the former exhibit greatest gain. It is also suggested that, to improve trunk control, hippotherapy may be more beneficial for children with diplegia than for children with quadriplegia.
Conclusion(s): This review has identified an in depth theoretical and scientific background for hippotherapy, and highlighted its potential in diminishing postural and functional limitations once standardised protocols have been established.
Implications: Exploring the scientific background behind hippotherapy has given further knowledge on its potential as a physiotherapeutic treatment for children with Cerebral Palsy. Despite potential financial constraints, once standardised protocols have been developed, hippotherapy may be recognised as a valuable, enjoyable and stimulating physiotherapy treatment for children with Cerebral Palsy.
Keywords: Hippotherapy, Cerebral Palsy, Postural control
Funding acknowledgements: Self-funded.
Topic: Paediatrics: cerebral palsy; Disability & rehabilitation
Ethics approval required: No
Institution: Keele University- School of Health and Rehabilitation
Ethics committee: School Project Ethics Committee
Reason not required: As it is a Narrative Review
All authors, affiliations and abstracts have been published as submitted.
