Can Individuals with Down Syndrome Benefit from Hippotherapy? An Exploratory Study on Gait and Balance

Evaluating the efficacy of hippotherapy: a promising intervention in rheumatology, pain medicine, and geriatrics

Using animals for medical care has a long history. Animals have long been recognized for their ability to improve human health and well-being throughout nations and civilizations. Animal-assisted therapy is a concept that incorporates intentional and regulated interactions between individuals and animals to achieve therapeutic aims. Hippotherapy is an animal-assisted therapy consisting of medical procedures and practices that use horses to restore and enhance physical and mental health. The effectiveness of hippotherapy is evidenced by its ability to have a favorable influence on various domains, encompassing physical, psychosocial, and educational aspects. This multifaceted method entails the active involvement of the sensory, musculoskeletal, vestibular, and visual systems. Hippotherapy is an unconventional modality, leveraging horses' cyclic and repetitive motions to activate the postural reflex structures of individuals. Various studies have mostly focused on determining the efficacy of hippotherapy in the context of neurological conditions, neuro-rehabilitation, and psychiatric disorders. The primary objective of this study was to present the effectiveness of hippotherapy in the fields of rheumatology, pain medicine, and geriatrics. In addition, we provided a summary of the potential underlying mechanisms of hippotherapy. Finally, we conducted a comparison of hippotherapy and horse riding simulator interventions to provide their respective strengths and restrictions.

Effect of hippotherapy on balance, functional mobility, and functional independence in children with Down syndrome: randomized controlled trial

Impaired muscle strength, proprioceptive and vestibular deficits, and orthopedic dysfunction are common disorders associated with Down syndrome (DS). Hippotherapy uses the horses' multidimensional movement to improve posture, balance, and overall function, both motor and sensory. Research evidence supports hippotherapy as an effective, medically recognized intervention for the rehabilitation of gross motor skills. The aim of this study was to determine the effect of hippotherapy on balance, functional mobility, and functional independence in children with DS. Thirty-four children with DS were randomly assigned to the experimental (hippotherapy) and control groups after the initial assessment. Both groups received physiotherapy including balance exercises, and the experimental group also received hippotherapy as an integrative therapy. Pediatric Balance Scale (PBS), Timed Up and Go Test (TUG), and Functional Independence Measure for Children (WeeFIM) were used before and after the intervention. Baseline outcome measures (PBS, TUG, WeeFIM) were statistically similar between groups (p > 0.05). After the intervention, PBS and TUG scores improved in both groups (p < 0.05). On the other hand, WeeFIM scores improved just in the hippotherapy group (p < 0.05).   Conclusion: Therefore, providing hippotherapy as an integrative therapy to physiotherapy will be more effective in improving the functional independence of children with DS.    Trial registration: NCT05297149 (March 2022, retrospectively registered). What is Known: • Hippotherapy has an improvement effect on balance and functional independence in different diseases and age groups, but the evidence is limited in DS. • There is limited evidence about the effect of hippotherapy on functional mobility in different diseases and age groups, but there is no evidence in DS. What is New: • Hippotherapy is a safe and effective approach to support improvement in functional independence in children with DS.

Evaluation of stress markers in horses during hippotherapy sessions in comparison to being ridden by beginners

Hippotherapy has been used for decades and its benefits to human patients have largely been proven, whether being applied to those with physical or mental disabilities. There have been a plethora of animal welfare studies recently, pertaining especially to ridden horses. This study aimed to investigate stress markers in horses during hippotherapy sessions to address the ethical considerations raised by using horses for therapy. A ridden stress ethogram was established and validated specifically for this study via subjective observation and video recording of a ridden session involving intermediate-level riders. The experiment entailed eight healthy horses undergoing two ridden sessions on separate days, one with disabled riders and one with beginners. Several parameters associated with physiological responses to stress were evaluated at rest, such as heart rate, plasma adrenocorticotropic hormone [ACTH], serum and salivary cortisol. These parameters as well as the behavioural stress score from the ethogram scale were measured during both sessions. No significant differences were found between heart rate, plasma ACTH, and stress scores. Serum and salivary cortisol were significantly lower during the hippotherapy session than during the session with beginners. The current study found no evidence of compromised welfare when horses were used as a therapeutic aid during hippotherapy sessions compared to their usual ridden activity. Although these results indicate that hippotherapy may be ethically justified as it benefits humans without causing harm to the horses, the present study was small, and the results should be interpreted with caution.

Equine-Assisted Activities and Therapies: State-of-the-Art Review

The purpose of this paper is to explore what is known about equine-assisted activities and therapies based on Roy's adaptation model. Quality of life for vulnerable populations who engage with equine-assisted activities and therapies is considered the main concept here. This state-of-the-art review was conducted from four databases ranging from January 2019 to February 2020. Limited studies examined the effect of equine-assisted activities and therapies on cancer survivors, although preliminary data were promising. The rural context was not extensively examined. Thus, equine-assisted activities and therapies may enhance the quality of life through four adaptation modes.

Current Trends in Pediatric Physical Therapy Practice for Children With Down Syndrome

BACKGROUND

Physical therapists (PTs) have a broad range of approaches to the management of Down syndrome (DS).

PURPOSE

To examine the breadth of physical therapy practice for children with DS.

METHODS

A survey was distributed to 1000 randomly selected members of the Academy of Pediatric Physical Therapy.

DATA ANALYSIS

Responses were categorized into 13 thematic subcategories and 3 International Classification of Functioning, Disability and Health (ICF) subcategories.

RESULTS AND DISCUSSION

One hundred eight PTs participated. Joint stability and alignment were the most common physical therapy-related problem. Functional movement was the most common physical therapy intervention. Most clinicians identified and treated at the ICF level of body functions and structure. Multiple assessment tools were used and tended to include norm-referenced tests. There was diversity of interventions with varying amounts of supporting evidence.

CONCLUSIONS

PTs manage children with DS for a wide variety of needs with a variety of interventions.