Efectividad de la terapia ecuestre en niños con retraso psicomotor

Pilot Study of the Influence of Equine Assisted Therapy on Physiological and Behavioral Parameters Related to Welfare of Horses and Patients

Simple Summary

Equine assisted therapy is being used successfully in patients with different psychic and motor pathologies. In the present work, different physiological and behavioral parameters have been evaluated in horses and patients with psychomotor alterations during equine assisted therapy sessions. After a first anticipatory phase in which signs of stress were observed in the behavior of the horses, with increased heart and respiratory rates as well as increased blood pressure, the horses relaxed in the phase of interaction with the patients on the ground. Later, in the phase of interaction with the patient on horseback, physical activity increased the heart and respiratory rates in the horses, but these parameters decreased after finishing the sessions (recovery phase). The patients also showed some anticipatory stress with increased heart rate in the first phase, but they relaxed during the interaction phases on the ground and on horseback. In addition, the quality of sleep improved on the days of therapy. On the other hand, the patients improved their fine and gross motor function, as well as the parameters related to the cognitive, emotional and affective-social areas. The benefits in the patients had a positive influence on the quality of life of their families.

Abstract

Different welfare indicators were studied in three patients with psychomotor alterations and in two horses throughout 9–10 equine assisted therapy sessions in each patient. In horses, heart and respiratory rates, blood pressure, temperature and behavioral signs were studied. In patients, heart rate, oxygen saturation, temperature, sleep quality, psychomotor and emotional parameters were analyzed. Data collection was recorded in the anticipatory phase (15 min before the start of the session), two interaction phases (after 30 min of horse-patient interaction on the ground and on horseback, respectively) and the recovery phase (15 min after the end of the session). During the anticipatory phase, most of physiological parameters of patients and horses and the stress behavioral signs of horses increased, followed by a relaxing phase during the horse-patient interaction on the ground. In horse-patient riding phase the heart and respiratory rates of the horses again increased. These results showed that the horses did not seem to suffer stress attributable to the therapy sessions, but only an increase in their parameters associated with activity and external stimuli. The patients improved their gross and fine motor skills, their cognitive and perceptual-sensitive parameters and it led to an improvement in the life quality of their families.

Changes in Motor Skill Proficiency After Equine-Assisted Activities and Brain-Building Tasks in Youth With Neurodevelopmental Disorders

There is a lack of current research to support the efficacy of a combination of equine-assisted activities (EAA) and brain building activities to influence motor skill competencies in youth with neurodevelopmental disorders (ND). The primary objective of this study was to quantify changes in motor skill proficiency before and after 8 weeks of EAA and brain-building activities in youth with ND. A secondary objective was to quantify changes in motor skill proficiency before and after 1 year of EAA and brain-building activities in youth with ND. Twenty-five youth completed the same 32-week protocol that was separated into 4, 8-week blocks, in the following order: (1) control; (2) EAA-only; (3) washout; (4) GaitWay block (EAA and brain building activities). Before and after each block, motor skills were assessed using the Short Form of the Bruininks-Oseretsky Test of Motor Proficiency-Version 2 (BOT-2). Seven youth continued with the GaitWay intervention for one additional year, and the BOT-2 Short Form was also administered following this intervention. A repeated-measures analysis-of-variance was performed to compare BOT-2 subtest and overall scores between interventions with a significance of 0.05. Manual dexterity was higher at Post-Washout [3.3 (2.4)] vs. Pre-Control [2.2 (2.1); p = 0.018] and Post-Control [2.6 (2.0); p = 0.024], and at Post-GaitWay vs. Pre-Control [3.2 (2.4) vs. 2.2 (2.1); p = 0.037]. Upper-limb coordination was higher at Post-GaitWay vs. Post-Control [6.0 (4.1) vs. 3.9 (3.8); p = 0.050]. When compared to Pre-Control [3.2 (3.0)], strength was higher at Post-EAA [4.9 (3.5); p = 0.028] and at Post-GaitWay [5.2 (2.9); p = 0.015]. Overall scores were higher at Post-GaitWay [39.1 (22.2)] when compared to Pre-Control [32.4 (21.6); p = 0.003] and Post-Control [32.5 (21.9); p = 0.009]. Additionally, motor skills were maintained for 1 year following the Post-GaitWay testing session among seven participants. This is the first known study to include and demonstrate the short-term and long-term effects of a combination of EAA and brain building activities with motor proficiency in youth with ND.

Clinical Trial Registration: Motor Skill Proficiency After Equine-Assisted Activities and Brain-building Tasks; www.ClinicalTrials.gov, identifier: NCT04158960.

Hippotherapy: a systematic mapping review of peer-reviewed research, 1980 to 2018

PURPOSE

Comprehensively and systematically map peer-reviewed studies of hippotherapy published over 30 years, from 1980 through 2018, from the perspective of a phased scientific approach to developing complex interventions as a guide to future research and practice.

METHODS

A systematic mapping review of research of hippotherapy was conducted. Searches of nine databases produced 3,528 unique records; 78 full-text, English-written studies were reviewed, the earliest of which was published in 1998. Data relevant to study aims were extracted electronically from these studies and analyzed using queries and pivot tables.

RESULTS

Children with cerebral palsy and physical therapists were most prevalent as participants and providers. Equine movement was hippotherapy's core component and mechanism. Early-phase outcomes-oriented research predominated. "Hippotherapy" was ambiguously defined as treatment strategies and comprehensive professional services, even as interventions grew more distinctive and complex. A treatment theory and proof of concept related to motor outcomes were established, and efficacy research with comparison conditions emerged.

CONCLUSIONS

Continuing research of complex interventions that integrate hippotherapy, equine movement as a therapy tool, is warranted. Attention to gaps in foundational scientific work concurrent with continued piloting and efficacy work will help to identify the most promising interventions worthy of replication, evaluation and widespread adoption.IMPLICATIONS FOR REHABILITATIONTo advance the evidence base of complex interventions that incorporate hippotherapy:•Proponents of hippotherapy need to define and represent hippotherapy to the public and in practice and research contexts as a therapy tool involving the use of the movement of horses by qualified professionals, rather than simply as a generic therapy with the help of a horse or simulated horse;•Providers of hippotherapy need to identify their professional degrees and certifications, and explicate their disciplinary perspectives that influence their selected components of intervention, related methods, and outcomes; and•Providers and researchers need to partner to develop an enablement theory of hippotherapy that links improved body functions with improved participation in everyday life and quality of life.

An Exploration of the Mechanism of Action of an Equine-Assisted Intervention

Though long alluded to, there is now an accumulation of evidence of the vital contribution that emotion makes to learning. Within this broad advance in understanding is a growing body of research emphasising the embodied nature of this emotion-based learning. The study presented here is a pilot study using a mixed-method approach (combining both physiological and experiential methodologies) to give a picture of the "emotional landscape" of people's learning through the intervention under study. This has allowed researchers to examine mediating pathways that may underlie any effects of an equine-assisted intervention. This study specifically focuses on examining the role of emotion. The intervention under study was used with young people with chronic mental health and behavioural problems for whom talk-based interventions were not working. Nine healthy participants aged 18-24 undertook the equine intervention, with an initial group having emotion-related psycho-physiological changes (skin conductance responses) measured while viewing their experience on video, and a further two participants experiencing a development of the methodology as their physiological responses were captured in real time during the intervention. The sessions were analysed by a group of five cross-disciplinary researchers to determine when significant learning episodes occurred, and the findings were that this learning was associated with powerful skin conductance responses. The qualitative element of the research entailed the participants watching themselves on video undertaking the equine intervention. They were asked to stop the video and share any changes in emotion at any point while watching. All participants experienced a positive temporal change in mood as the intervention progressed. All results supported the findings that emotional arousal occurred in relation to the participants asking the horse to perform a task. This paper will offer two novel contributions: (1) description of a new methodology for investigating the mechanism of action occurring in this type of intervention and (2) findings from the exploration of the intervention via psycho-physiological and experiential mechanisms.

Equine Assisted Interventions (EAIs): Methodological Considerations for Stress Assessment in Horses

Equine assisted interventions (EAIs) are recently facing an increasing popularity, and are characterized by a wide diversity of practices. However, information on the welfare of animals involved in this kind of activity is often lacking. Horses are highly susceptible to work stressors related to physical constraints and/or to the need to control emotions while interacting with humans. Considerations of the emotional state of horses involved in EAIs have multiple valences: for the safety of humans and animals involved, for the quality and efficacy of interventions, as well as for ethical reasons. The aim of this unsystematic narrative review is to summarize the different approaches used for the evaluation of horses' stress responses, investigate their application in the context of EAIs, and discuss some methodological considerations for researchers and practitioners involved in EAI. The sources of information are mostly based on electronic databases (i.e., Medline, Scopus and Google scholar), as well as on hand searches of the references of retrieved literature, and discussions with experts in the field. At present, a few studies have investigated horses' stress responses during EAIs, and further studies are recommended, with the final aim to derive a reliable multidimensional method for assessing a horse's reaction during therapeutic programs, ultimately helping professionals to better develop interventions by taking into consideration the animal's perspective.