A possible mechanism of horseback riding on dynamic trunk alignment

Analysis of strength and electromyographic activity of lower limbs of individuals with down syndrome assisted in physiotherapy and hippotherapy

INTRODUCTION

one of the characteristics of Down Syndrome (DS) is muscle hypotonia. Different therapeutic approaches have a positive influence, between them Physiotherapy applications with different therapeutic approaches such as Hippotherapy have a positive effect on the physical health and quality of live of individuals with DS.

OBJECTIVE

to evaluate the effects of both treatments on the strength and electromyographic activity of the lower limbs of children and adolescents with DS.

METHODS

fourteen individuals, aged between 10 and 18 years, participated in two groups: Physiotherapy group (n = 5) and Hippotherapy group (n = 9). Thirty interventions were performed for each type of therapy, once a week, lasting 30 min. Pre and post-interventions, the 30-Second Chair Stand Test (30s-CST) was used to assess the strength of the lower limbs and the surface electromyography equipment (EMG 800RF) to assess the lower limb myoelectric activity.

RESULTS

there was a reduction in the post-intervention electromyographic values for both treatments (p˂0.001), with significantly less myoelectric activity in Hippotherapy compared to Physiotherapy for all evaluated muscles (p˂0.001) and a significant increase in muscle strength for the Hippotherapy, post-intervention group (p = 0.0007).

CONCLUSION

Physiotherapy and Hippotherapy are interventions that promote positive changes in the myoelectric activities of individuals with DS. However, only hippotherapy promoted an increase in strength of the lower limbs.

Benefits of animal-Assisted interventions in preschool children: A systematic review

Animal-assisted interventions are frequently used to stimulate and improve different skills in children with and without disabilities. However, the heterogeneity of AAI studies in preschool children is large, including different health conditions, duration, outcomes, study design or therapy animals. Therefore, the current study aims to summarize all intervention procedures and provide an updated analysis of the effectiveness of AAI intervention in the early childhood. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), a systematic search was conducted in two databases: Pubmed (MedLine) and Web of Science. The risk of bias was assessed using the Evidence Project risk of bias tool. A total of 319 articles were identified and 17 were finally included in the qualitative synthesis. Due to the large heterogeneity in terms of study design, intervention, and sample characteristics, it was not possible to conduct a meta-analysis. Animal-assisted interventions might lead to a positive impact on physical, physiological, psychosocial, and language skills in preschool children. These enhancements may be observed both in healthy children and in those with different health conditions, such as intellectual disabilities, cerebral palsy, autism disorder, or Down syndrome. Results must be interpreted with caution due to the large heterogeneity and risk of bias in the included articles.

A scoping review of the different types of exercise programs proposed for the improvement of postural balance in adolescents with idiopathic scoliosis

BACKGROUND

Adolescent idiopathic scoliosis (AIS), which is the most common type of scoliosis, is a progressive disease that occurs in children aged 10-16 years. Abnormal curvature in AIS provokes spinal asymmetry of the upper body alignment and might deteriorate postural balancing and control ability.

OBJECTIVE

To evaluate the effect of exercise interventions on balance and postural stability in patients with adolescent idiopathic scoliosis.

METHODS

Embase, Scopus, Pubmed (Medline) and Web of Science databases were searched using the terms idiopathic scoliosis, physiotherapy, and balance. The articles selected were published in English in peer-reviewed journals from 2012 to July 2022.

RESULTS

Ten studies met the inclusion criteria. The PEDro scale values ranged from 2 to 6 (mean, 3.6), indicating a low level of scientific rigor. In the sample studies, spinal stabilization exercises were most often trialed (n= 3), followed by Schroth's exercise (n= 2), stretching and self-elongation exercise (n= 2), the exercise protocol of Blount and Moe, physiotherapeutic scoliosis-specific exercise, and proprioceptive neuromuscular facilitation exercise (all n= 1).

CONCLUSIONS

Physical therapists will be able to apply hippotherapy, Schroth exercise, physiotherapy scoliosis-specific exercise, trunk stabilization, proprioceptive neuromuscular facilitation exercise, spinal stabilization exercise, core stabilization exercise, and body awareness therapy to manage balance impairments in patients with adolescent idiopathic scoliosis, and further studies are needed to provide stronger evidence.

Specific and Non-specific Factors of Animal-Assisted Interventions Considered in Research: A Systematic Review

Research on animal-assisted interventions (AAIs) has increased massively in the last few years. But it is still not clear how AAIs work and how important the animal is in such interventions. The aim of this systematic review was to compile the existing state of knowledge about the working mechanisms of AAIs. We searched 12 major electronic databases for previous AAI studies with active control groups. Of 2001 records identified, we included 172 studies in the systematic review. We extracted previously published hypotheses about working mechanisms and factors that have been implicitly considered specific or non-specific in AAI research by categorizing control conditions using content analysis. We analyzed the categories using descriptive statistics. We found that 84% of the included studies mentioned a hypothesis of working mechanisms, but 16% did not define specific hypotheses. By analyzing their control conditions, we found that in most controlled studies, the animal or the interaction with the animal was implicitly considered as a specific factor for the effects of the AAI. Non-specific factors such as therapeutic aspects, social interactions, or novelty have also been controlled for. We conclude that AAI research still cannot answer the question of how and why AAIs work. To address this important research gap, we suggest using component studies with innovative control conditions and results from placebo research to address both the specific and non-specific, contextual factors of AAIs to disentangle its mechanisms.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158103, identifier: CRD42020158103.

Benefits of Equine-Assisted Therapies in People with Multiple Sclerosis: A Systematic Review

This systematic review aimed to provide an up-to-date analysis of the effects of equine-assisted therapies (EAT) in people with multiple sclerosis (PwMS). The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed to conduct this systematic review. PubMed and Web of Science databases were employed in the search, which ended in February 2022. The risk of bias analysis was performed using the Evidence Project tool. After removing duplicates, thirty-nine studies were identified. However, only ten fulfilled the inclusion criteria and were included in this systematic review. Therefore, a total of 195 PwMS, aged between 40.3 and 51.3, were included in this systematic review. EAT-based interventions had a mean length of 13.6 weeks with a session´s frequency ranging from ten to once a week. All sessions involved real horses and lasted a mean of 34.4 min. Among the included articles, four were randomized controlled trials (RCT), four did not perform randomization, and two employed a prepost design without a control group. RCTs showed positive effects on quality of life, fatigue, balance, spasticity, and gait speed. Furthermore, non-RCT showed improvements in balance, spasticity, and postural control (postural control was not assessed in RCT studies). Importantly, significant effects were only observed when the comparison group was inactive or followed usual care. Therefore, EAT is a promising and effective therapy to improve quality of life, fatigue, balance, spasticity, and gait speed in PwMS. However, since comparison groups are heterogeneous, results could vary depending on the research design. Moreover, the inclusion of noncontrolled studies (in order to have a wide perspective of the state of art) could increase the risk of bias and make the results be taken with caution.

A 10-Week Program of Combined Hippotherapy and Scroth's Exercises Improves Balance and Postural Asymmetries in Adolescence Idiopathic Scoliosis: A Randomized Controlled Study

Introduction: The most frequent type of spine abnormality throughout adolescence was adolescent idiopathic scoliosis (AIS). Hippotherapy improved posture, balance and gait of different musculoskeletal conditions. Therefore, this study aims to see how hippotherapy combined with Schroth exercises affected postural asymmetry and dynamic balance in AIS compared to traditional physiotherapy (Schroth exercises) alone. Materials and methods: In this randomized controlled trial, fifty-two patients with AIS (10–18 years, 37 girls and 15 boys) participated. They were arbitrarily allocated into two groups: experimental (19 female/8 male; aged 14.74 ± 1.79 years; Cobb angle 18.59 ± 2.66 degrees) and control (18 female/7 male; aged 15.04 ± 1.81 years; Cobb angle 19.32 ± 2.69 degrees) groups. Both groups received Schroth exercises for 10 weeks, three days/week. The experimental group additionally received hippotherapy training. Pre-treatment and post-treatment assessment for the scoliotic, kyphotic angle, pelvic obliquity, pelvic torsion and vertical spinal rotation and the anteroposterior, mediolateral and overall stability indices were assessed using the formetric system 4D and Biodex Balance System, respectively. Results: After intervention, both groups illustrated significant improvements in all examined variables (p < 0.05). The experimental group illustrated significant improvements in scoliotic angle, kyphotic angle, pelvic obliquity, pelvic torsion and vertical spinal rotation and the stability indices compared to the control group (p < 0.05). Conclusion: In adolescence idiopathic scoliosis, hippotherapy training combined with Schroth exercises improves posture asymmetry and balancing ability more effectively than Schroth exercises alone.

Trunk and pelvis biomechanical responses in children with cerebral palsy and with typical development during horseback riding

BACKGROUND

Children with cerebral palsy (CP) have poor postural control. Horseback riding (HR) is an alternative treatment shown to improve postural control among children with CP. However, there is a paucity of research investigating the underlying mechanisms responsible for improving postural control during HR.

RESEARCH QUESTION

What are the three-dimensional biomechanical responses of the trunk and pelvis during HR among children with CP and with typical development (TD)?

METHODS

The participants, aged 4-12 years old, were inexperienced horseback riders, consisting of 10 children with TD and 10 children with spastic diplegia CP (SDCP) with GMFCS level III. Participants donned inertial measurement units (IMU) on their trunk and pelvis in order to measure angular displacement and velocity. An additional IMU was placed on the horse's lumbosacral joint. The mean absolute relative phase (MARP) and deviation phase (DP) were calculated from each plane of movement for the angular displacement and velocity across the gait cycle of the horse. Differences between groups were analyzed using independent t-tests.

RESULTS

The MARP in the frontal plane was lower in the SDCP group, when compared to the TD group (p = 0.01). Additionally, no differences were found between groups for the DP along all three axes. However, the TD group demonstrated greater pelvic movement variability in relation to the horse's pelvis movement, when compared to the SDCP group.

SIGNIFICANCE

Children with SDCP demonstrated an in-phase coupling pattern with decreased variability of pelvic movement in relation to the horse's pelvis.

Effects of equine riding on static and dynamic mechanical contraction of the thighs and trunk muscles in inactive women

BACKGROUND AND OBJECTIVE

This study investigated whether equine riding affects static or dynamic mechanical contractions on the thighs and trunk muscles in inactive women.

METHODS

Participants consisted of 30 women with a mean (SD) age of 21.06 (0.44) years. They were randomly allotted as follows: equine group (EQG, n= 15) and control group (CON, n= 15). Two types of muscle contraction properties in their thighs and trunk were measured through a tensiomyography (static muscle tester) and an isokinetic device (dynamic muscle tester), respectively. Using the body weights of EQG and CON as covariates, a 2-way between-groups multivariate analysis of covariance was used to investigate group differences in the mechanical quantification of the thighs and trunk.

RESULTS

The effectiveness of 8 weeks of equine riding was hardly observed in a static muscle test, whereas in the dynamic muscle test, the dominant and non-dominant hip extensor/flexor, the dominant hip abductor/adductor, and trunk extensor in the EQG showed a significant increase, compared to no changes in the CON.

CONCLUSIONS

This study did not find any particular differences in a static muscle test in inactive women, but showed improvements in the dynamic mechanical properties of the thighs and trunk, which are major muscle groups related to spinal alignment.

Horse-riding simulators in treatment of chronic low back pain: A meta-analysis

BACKGROUND

The use of horse-riding simulators in the treatment of chronic low back pain has drawn considerable attention for its efficacy and acceptability to reduce chronic low back pain; because of the similarities in movements provided by equine-assisted therapies and the possible accessibility advantages. However, the results are conflicting. This study aimed to perform a meta-analysis of randomised controlled trials to assess the impact of treatments based on horse-riding simulators on chronic low back pain.

METHODS

A systematic literature search up to January 2021 was performed and 11 studies were detected with 543 subjects with chronic low back pain at the baseline of the study, 257 of them were using horse-riding simulators, and 255 of them were inactive control group who continued their usual care, and similar kind of physical therapy (control). They reported a comparison between horse-riding simulators and control to reduce chronic low back pain. Mean differences (MD) with 95% confidence intervals (CIs) were calculated assessing the impact of treatments based on horse-riding simulators on chronic low back pain using the continuous method with a random or fixed-effect model.

RESULTS

Significantly higher change-from-baseline pain outcomes was observed in Visual Analogue Scale (MD, -4.36; 95% CI, -6.24 to -2.30, P < .001), and Roland Morris Disability Questionnaire change-from-baseline (MD, -2.32; 95% CI, -3.52 to -1.12, P < .001) with horse-riding simulators compared with control.

CONCLUSIONS

Using horse-riding simulators may lower the risk of chronic low back pain. This relationship forces us to recommend the use of horse-riding simulators to avoid any complications that could occur with chronic low back pain.

Effects of Equine-Assisted Therapies or Horse-Riding Simulators on Chronic Pain: A Systematic Review and Meta-Analysis

Background and objectives: Chronic pain is a complex global public health problem that affects the health status, quality of life, activities of daily living, and different work-related variables. Riding a horse may lead to some benefits in chronic pain patients through the improvement of postural control and other biopsychosocial processes. Therefore, this systematic review and meta-analysis aimed to evaluate the effects of horse riding (with real or simulated horses) on chronic pain. Materials and methods: A systematic literature search was carried out in accordance with PRISMA guidelines in Web of Science (WOS) and PubMed (Medline) electronic databases. Eleven articles (seven randomized controlled trials) were selected to be included in the review. Due to some risk of bias concerns, two meta-analyses (using postintervention or change-from-baseline measures) were conducted utilizing Review Manager Software (RevMan 5.3). Results: Horse-riding simulators significantly reduced the pain levels of patients with low back pain (p = 0.03, with a SMD of -1.14 and a 95% CI from -2.16 to -0.11) using change-from-baseline measures. However, the p-value in the meta-analysis with the postintervention measures was 0.06. Regarding interventions with real horses, it was not possible to conduct a meta-analysis due to the low number of studies. Conclusion: Horse riding could be a useful exercise to reduce pain, but more studies are needed to make evidence-based recommendations and to compare the effects of horse-riding with real and simulated horses.