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Conroy S1, Evans T1, Butler-Moburg D1, Beuttler R2, Robinson J1, O'Mahony E1, Grant-Beuttler M3
1Shea Center for Therapeutic Riding, San Juan Capistrano, United States, 2Independent Data Scientist, Orange, United States, 3Chapman University, Physical Therapy, Irvine, United States
Background: Hippotherapy is the purposeful manipulation of equine movement by licensed Physical Therapists, Occupational Therapists, or Speech and Language Pathologists to engage the sensory, neuromotor, and cognitive systems to achieve functional outcomes. Current evidence suggests the use of hippotherapy in a client´s integrated plan of care results in improvements in gait dynamics, postural control, and balance but there is limited data regarding general changes in the activity and participation domains of the International Classification of Functioning, Disability, and Health Model (ICF-Model) following physical therapy intervention using hippotherapy in children with a variety of movement disorders. The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT), is a norm referenced activity and participation outcome measure, which can assess improvements in daily activities, mobility, social/cognitive skills (activity domains), and responsibility (participation domain).
Purpose: The purpose of this study is to examine the effects of skilled Physical Therapy using hippotherapy on activity and participation related functional domains in children with movement disorders.
Methods: The study included 35 subjects (17 male, 18 female) with varying diagnoses, mean ages 4.8 (SD 2.5) with a range of 2-11.75 years. Subjects were included if they participated in weekly or bi-weekly Physical Therapy using hippotherapy for a 6 month period. Subjects participated in 45 minute physical therapy sessions with a minimum of 30 minutes spent using equine movement. Children completed an average of 23.5 sessions (86%, with a range of 68-100%). Parents/caregivers completed the PEDI-CAT assessment during the initial treatment session (T1), and reassessment (T2) 6 months following initial administration. A Linear Mixed Effects Model was used to analyze for significant changes in the scaled scores in each functional domain between T1 and T2. Cohen´s d effect sizes were then used to examine the magnitude of change between T1 and T2.
Results: Linear Mixed Effect Model comparison between equations with Time (T1 and T2) and those without demonstrated significant improvements on all 4 domains, Mobility (Chi-square=13.15, p .001, mean pre=58.69, mean post=60.23, Cohen´s d=.24), Social Cognitive (Chi-square=13.32, p .001, mean pre=59.09, mean post=60.57, Cohen´s d=.25), Daily Activities (Chi-square=15.22, p .001, mean pre=50.20, mean post=51.54, Cohen´s d=.28) and Responsibility (Chi-square=5.98, p=.01, mean pre=38.57, mean post=40.31, Cohen´s d=.23).
Conclusion(s): The PEDI-CAT was successfully used to monitor changes in both function and participation during ongoing physical therapy. In addition, children in our sample made positive improvements in all 4 domains measured over 6 months of intervention. Additional studies are needed to examine improvements over diagnosis, age, initial limitation level, and across different therapy disciplines using hippotherapy.
Implications: The use of hippotherapy, by Physical Therapists, as part of a client´s integrated plan of care may contribute to improvements in mobility, daily activities, social cognitive skills and responsibility as measured on the PEDI-CAT . The use of the PEDI-CAT to measure patient outcomes assists the therapist in determining treatment efficacy in improving client activity and participation without significantly impacting treatment flow, and in a cost effective manner.
Keywords: hippotherapy, activity and participation, functional movement impairments
Funding acknowledgements: Funded by The David R. Clare and Margaret C. Clare Foundation as well as The Shea Center for Therapeutic Riding.
Purpose: The purpose of this study is to examine the effects of skilled Physical Therapy using hippotherapy on activity and participation related functional domains in children with movement disorders.
Methods: The study included 35 subjects (17 male, 18 female) with varying diagnoses, mean ages 4.8 (SD 2.5) with a range of 2-11.75 years. Subjects were included if they participated in weekly or bi-weekly Physical Therapy using hippotherapy for a 6 month period. Subjects participated in 45 minute physical therapy sessions with a minimum of 30 minutes spent using equine movement. Children completed an average of 23.5 sessions (86%, with a range of 68-100%). Parents/caregivers completed the PEDI-CAT assessment during the initial treatment session (T1), and reassessment (T2) 6 months following initial administration. A Linear Mixed Effects Model was used to analyze for significant changes in the scaled scores in each functional domain between T1 and T2. Cohen´s d effect sizes were then used to examine the magnitude of change between T1 and T2.
Results: Linear Mixed Effect Model comparison between equations with Time (T1 and T2) and those without demonstrated significant improvements on all 4 domains, Mobility (Chi-square=13.15, p .001, mean pre=58.69, mean post=60.23, Cohen´s d=.24), Social Cognitive (Chi-square=13.32, p .001, mean pre=59.09, mean post=60.57, Cohen´s d=.25), Daily Activities (Chi-square=15.22, p .001, mean pre=50.20, mean post=51.54, Cohen´s d=.28) and Responsibility (Chi-square=5.98, p=.01, mean pre=38.57, mean post=40.31, Cohen´s d=.23).
Conclusion(s): The PEDI-CAT was successfully used to monitor changes in both function and participation during ongoing physical therapy. In addition, children in our sample made positive improvements in all 4 domains measured over 6 months of intervention. Additional studies are needed to examine improvements over diagnosis, age, initial limitation level, and across different therapy disciplines using hippotherapy.
Implications: The use of hippotherapy, by Physical Therapists, as part of a client´s integrated plan of care may contribute to improvements in mobility, daily activities, social cognitive skills and responsibility as measured on the PEDI-CAT . The use of the PEDI-CAT to measure patient outcomes assists the therapist in determining treatment efficacy in improving client activity and participation without significantly impacting treatment flow, and in a cost effective manner.
Keywords: hippotherapy, activity and participation, functional movement impairments
Funding acknowledgements: Funded by The David R. Clare and Margaret C. Clare Foundation as well as The Shea Center for Therapeutic Riding.
Topic: Paediatrics; Disability & rehabilitation; Outcome measurement
Ethics approval required: Yes
Institution: Chapman University
Ethics committee: Institutional Review Board
Ethics number: Chapman University IRB# 1718H023
All authors, affiliations and abstracts have been published as submitted.
