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Öztürk S, Aydoğdu O, Sari Z. Efficacy of hippotherapy simulator exercise program in patients with stroke: a randomized single-blind clinical trial. Top Stroke Rehabil 2024; 31:576-584. [PMID: 38351871 DOI: 10.1080/10749357.2024.2310425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/20/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES The aim of this study was to investigate the effect of hippotherapy simulator on balance, postural control, mobility, functional capacity and independence level in people with stroke. METHODS This study involved 26 people with stroke aged 18-65, who were randomly assigned to a Hippotherapy Simulator Group (HSG; n = 13) and a Conventional Exercise Group (CEG; n = 13). Patients underwent assessments using the Berg Balance Scale (BBS), Postural Assessment Scale for Stroke (PAS-S), Timed Up and Go Test (TUG), Rivermead Mobility Index (RMI), 2-Minute Walking Test (2-MWT), and Barthel Daily Living Activity Index (BI) to evaluate balance, postural control, mobility, functional capacity, and independence before and after treatment. In the HSG, participants received 30 sessions of conventional exercises and hippotherapy simulator - a mechanical and robotic equipment with a dynamic saddle simulating horse movement - exercises over 6 weeks. Meanwhile, the CEG underwent 30 sessions of conventional exercises alone for 6 weeks. RESULTS In the post-therapy evaluation between groups, BBS (p = 0.004) and 2-MWT (p < 0.001) scores were higher in HSG compared to CEG. However, no statistically significant difference was found between the two groups in terms of PAS-S, RMI, TUG and BI scores (p > 0.05). Statistically significant differences were found between BBS, PAS-S, RMI, TUG, BI and 2-MWT scores before and after treatment in both groups (p < 0.05). CONCLUSIONS Hippotherapy simulator can be added to conventional exercises to improve balance and functional capacity in people with stroke.
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Affiliation(s)
- Sergen Öztürk
- Acıbadem University, Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul, Türkiye
- Marmara University, Institute of Health Sciences, Istanbul, Türkiye
| | - Onur Aydoğdu
- Marmara University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Türkiye
| | - Zübeyir Sari
- Marmara University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Türkiye
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Wu M, Kim J, Gaebler-Spira D. Improving trunk posture control in children with CP through a cable-driven robotic hippotherapy: A randomized controlled feasibility study. Gait Posture 2024; 113:209-214. [PMID: 38943825 PMCID: PMC11381160 DOI: 10.1016/j.gaitpost.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 05/30/2024] [Accepted: 06/19/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Many children with cerebral palsy (CP) show impairments in trunk posture control, one crucial factor contributing to impairments in gait and arm manipulation. RESEARCH QUESTION The goal of this study was to test the feasibility of the cable-driven hippotherapy system on improving trunk posture control and walking function in children with CP. METHOD Ten children were recruited in this study with average age 6.4 ± 3.0 years old, and were randomly assigned to the robotic group and the conventional balance training group. A custom designed cable-driven robotic hippotherapy system was used to deliver controlled pelvis perturbations while children were sitting astride. Participants from both groups underwent intensive robotic hippotherapy training or conventional balance training, depending on their group assignment, for 6 weeks (3 time/week). Outcome measures were assessed pre and post 6 weeks of robotic or conventional balance training, and 8 weeks after the end of training (follow-up test). The primary outcome measure was trunk control, which was measured using the Trunk Control Measurement Scale (TCMS). In addition, the Gross Motor Function Measure (GMFM-66), self-selected overground walking speed, and 6-minute walking distance were also assessed. RESULTS The change in TCMS score from baseline to the post intervention was significantly greater for the robotic group than that for the conventional group (i.e., 6 ± 3 vs. -1 ± 5, p = 0.048, Mann-Whitney test). GMFM scores, self-selected overground walking speed, and 6-minute walking distance showed no significant improvement after robotic hippotherapy and after conventional balance training (p > 0.05). SIGNIFICANCE Results from this study indicated that it was feasible to improve trunk posture control in children with CP using a cable-driven robotic hippotherapy system. Knowledge obtained from this study may provide an insight for the development of new perturbation-based intervention approaches for improving trunk posture control in children with CP.
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Affiliation(s)
- Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
| | - Janis Kim
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Deborah Gaebler-Spira
- Legs and Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
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Gözaçan Karabulut D, Numanoğlu Akbaş A. The effect of horse riding simulator on upper extremity skills, trunk control and functionality in cerebral palsy: a randomized controlled trial. Disabil Rehabil 2024:1-8. [PMID: 39022889 DOI: 10.1080/09638288.2024.2380785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE The aim of this study was to investigate the effect of horse riding simulator on upper extremity skills, trunk control and functionality in cerebral palsy (CP). MATERIALS AND METHODS This randomized controlled trial included total 32 CP, 16 in horse riding simulator group (HRSG) and 16 in control group (CG). ABILHAND-Kids, Jebsen-Taylor Hand Function Test (JTHFT), Gross Motor Function Measurement-sitting dimension (GMFM-B), Trunk Control Measurement Scale (TCMS), Pediatric Evaluation of Disability Inventory (PEDI) were evaluated before and after procedure. RESULTS It was observed that there were improvements in both groups for ABILHAND-Kids scores after intervention, but the change in HRSG was significantly higher (p < 0.001). For all parameters of JTHFT (except writing dominant, non-dominant, turning cards-dominant), there was a significant difference between groups in favor of HRSG (p < 0.001-0.002). There was no change in GMFM-B values with intervention for both groups (p > 0.05). There were significant changes in favor of HRSG group in terms TCMS-Total (p = 0.003). There were significant changes in HRSG compared to CG for PEDI (pPEDI-Self-care<0.001, pPEDI-Mobility<0.001, pPEDI-Social function=0.016, respectively). CONCLUSIONS It has been found that HRS in addition to conventional physiotherapy have positive effects on upper extremity skills, trunk control and functional abilities in daily life in the rehabilitation process of CP.The study protocol is registered on ClinicalTrials.gov (Identifier: NCT05518370).
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Affiliation(s)
- Demet Gözaçan Karabulut
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gaziantep Islam Science and Technology University, Gaziantep, Turkey
| | - Ayşe Numanoğlu Akbaş
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas, Turkey
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Balıkesir University, Balıkesir, Turkey
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Çoban O, Mutluay F. The effects of mechanical hippotherapy riding on postural control, balance, and quality of life (QoL) in patients with stroke. Disabil Rehabil 2024; 46:2338-2347. [PMID: 37303153 DOI: 10.1080/09638288.2023.2221458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/21/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023]
Abstract
PURPOSED This study aimed to investigate the effects of exercises by mechanical hippotherapy devices on postural control, balance, mobility, and Quality of Life in patients with stroke. MATERIAL AND METHODS This was a randomized controlled clinical trial with a total of 30 which were randomly divided into two groups. The participants in the mechanical hippotherapy group (MHG) (n = 15) were given exercises with a mechanical hippotherapy device for 15 min in addition to intensive conventional treatments (45 min), while the control group (CG) (n = 15) received additional 15 min of postural control and balance exercises for five days per week for four consecutive weeks. The primary outcome was The Berg Balance Scale (BBS). Secondary outcomes were the Fugl-Meyer (FM) Rating Scale, Biodex Balance Measurement (BBM), Trunk Impairment Scale (TIS), the Timed Up and Go Test (TUG) and quality of Life Short Form (SF-36). RESULTS In the MHG, FM-Lower extremity score (-6.4, p = 0.024), FM-Upper extremity score (-12.87, p = 0.013), TIS (-5.87, p = 0.04) and TUG (5.73, p = 0.027) improved statistically significant compared to CG. CONCLUSION Exercises using mechanical hippotherapy devices could improve postural control, functional mobility and balance in patients with stroke. It may also improve the quality of life. CLINICAL TRIAL REGISTRATION NUMBER NCT03528993IMPLICATIONS FOR REHABILITATIONNCT03528993It was concluded from our results that mechanical hippotherapy could be included in the treatment programs of stroke patients.
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Affiliation(s)
- Osman Çoban
- Department of Physical Therapy and Rehabilitation, Faculty of Health Science, Istanbul Uskudar University, Istanbul, Turkey
| | - Fatma Mutluay
- Department of Physical Therapy and Rehabilitation, Faculty of Health Science, Istanbul Medipol University, Istanbul, Turkey
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Qin Z, Guo Z, Wang J. Multiple Equine Therapies for the Treatment of Gross Motor Function in Children with Cerebral Palsy: A Systematic Review. J Community Health Nurs 2024; 41:82-95. [PMID: 38229243 DOI: 10.1080/07370016.2024.2304825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
PURPOSE This study aimed to evaluate the impact of three equine therapy approaches on gross motor function in children with cerebral palsy. METHODS The studies were retrieved from PubMed, Web of Science, Science Direct, and the Cochrane Library, in accordance with the style commonly found in scientific journal publications:(1) peer-reviewed articles written in English; (2) experimental or quasi-experimental; (3) three Equine Therapy Interventions as experiment's independent variable; (4) children with cerebral palsy; and (5) measurement of outcomes related to Gross Motor Function. RESULTS The study examined 596 patients with cerebral palsy, whose average age was 8.03 years. The three types of horse therapy interventions had a significant impact on gross motor function in children with cerebral palsy (SMD = 0.19, 95% CI 0.02-0.36, p = 0.031). Additionally, the interventions positively affected dimensions C (SMD = 0.31, 95% CI 0.00-0.62, p = 0.05), D (SMD = 0.30, 95% CI 0.06-0.56, p = 0.017), and B (SMD = 0.72, 95% CI 0.10-1.34, p = 0.023). The Gross Motor Function Measure (GMFM) consists of 88 or 66 items, which are divided into five functional dimensions: GMFM-A (lying down and rolling), GMFM-B (sitting), GMFM-C (crawling and kneeling), GMFM-D (standing), and GMFM-E (walking, running, and jumping). Each subsection of the GMFM can be used separately to evaluate motor changes in a specific dimension of interest. Subgroup analysis revealed that different horse-assisted therapy approaches, types of cerebral palsy, exercise duration, frequency, and intervention periods are important factors influencing treatment outcomes. CONCLUSION The intervention period ranged from 8 to 12 weeks, with session durations of 30 to 45 minutes, 2 to 3 times per week. Equine-assisted therapy (EAT) demonstrated significant improvements in the overall gross motor function score, Dimension B, Dimension C, and Dimension D among children with cerebral palsy. The most effective treatment is provided by Equine-Assisted Therapy, followed by Horseback Riding Simulator (HRS). Due to its economic practicality, HRS plays an irreplaceable role. CLINICAL EVIDENCE Equine-Assisted Therapy (EAT) demonstrates the most effective treatment outcomes, suggesting that hospitals and healthcare professionals can form specialized teams to provide rehabilitation guidance. 2. Within equine-assisted therapy, Horseback Riding Simulator (HRS) exhibits treatment efficacy second only to Equine-Assisted Therapy (EAT), making it a cost-effective and practical option worthy of promotion and utilization among healthcare institutions and professionals. 3. In equine-assisted therapy, Therapeutic Horseback Riding (THR) holds certain value in rehabilitation due to its engaging and practical nature.
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Affiliation(s)
- Zhikai Qin
- Institute of physical education and training, Capital University of Physical Education and Sports, Beijing, China
| | - Zizhao Guo
- Institute of physical education and training, Capital University of Physical Education and Sports, Beijing, China
| | - Junsheng Wang
- Institute of physical education and training, Capital University of Physical Education and Sports, Beijing, China
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García-Arandilla A, Gonzàlez-Gàzquez T, Morgado-Pérez A, Davalos Yerovi V, Tejero-Sánchez M, Meza-Valderrama D. [Hippotherapy versus hippotherapy simulators as a treatment option in children with cerebral palsy: A systematic review]. Rehabilitacion (Madr) 2024; 58:100816. [PMID: 37862777 DOI: 10.1016/j.rh.2023.100816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION AND OBJECTIVE Hippotherapy (HPOT) and hippotherapy simulators (SHPOT) are used in children with cerebral palsy to achieve their maximum functionality and independence. The aim is to find out if HPOT and SHPOT produce the same effects on balance, gross motor function, and postural control in children under 18 years old with cerebral palsy. MATERIALS AND METHODS The keywords used were: hippotherapy, equine-assisted therapy and cerebral palsy. The databases used were PeDro, Scopus, LILACS, ScienceDirect, Cochrane Library, Web of Science and CINAHL Complete (Ebsco). Studies were included if they were randomized clinical trials that studied the effect of HPOT and/or SHPOT on the variables mentioned in these patients. RESULTS Four studies assessed balance, 4 studied gross motor function, and 2 investigated postural control. Both HPOT and SHPOT produced benefits in all of them. CONCLUSIONS According to the studied variables both interventions produce similar improvements. Although, they increase with HPOT possibly due to greater sensory stimulation.
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Affiliation(s)
- A García-Arandilla
- Facultad de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Grupo de Investigación en Rehabilitación (RERG), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España.
| | - T Gonzàlez-Gàzquez
- Facultad de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Grupo de Investigación en Rehabilitación (RERG), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - A Morgado-Pérez
- Grupo de Investigación en Rehabilitación (RERG), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Servicio de Medicina Física y Rehabilitación, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), Barcelona, España
| | - V Davalos Yerovi
- Grupo de Investigación en Rehabilitación (RERG), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Servicio de Medicina Física y Rehabilitación, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), Barcelona, España
| | - M Tejero-Sánchez
- Grupo de Investigación en Rehabilitación (RERG), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Servicio de Medicina Física y Rehabilitación, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), Barcelona, España
| | - D Meza-Valderrama
- Grupo de Investigación en Rehabilitación (RERG), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Servicio de Medicina Física y Rehabilitación, Instituto Nacional de Medicina Física y Rehabilitación (INFRE), Panamá, Panamá
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Burr M, Buntich J, Gonzalez M, Miranda S, Vu T. Robotic animal-assisted therapy as a complementary therapy in clinical practice: Exploring animal-assisted intervention professional perspectives. Complement Ther Clin Pract 2023; 52:101767. [PMID: 37196538 DOI: 10.1016/j.ctcp.2023.101767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND and Purpose: Animal-Assisted Therapy (AAT) is a therapy that incorporates animals to improve the motor, social, behavioral, and/or cognitive functioning of participants. AAT has been shown to be a beneficial intervention for a wide range of populations. Although, researchers have suggested concerns in implementing AAT. The purpose of this study is to gain insight into the perspectives of therapists who incorporate AAT into their programs and to explore benefits and ethical considerations within the field of AAT. This study also aims to seek possible implications for robotic animal-assisted therapy (RAAT). MATERIALS AND METHODS Professionals from the Association of Animal-Assisted Intervention Professionals (AAAIP) were recruited, along with members from multiple AAT private and public Facebook groups. Participants completed an anonymous online semi-structured survey, exploring their experience with and perspectives on both AAT and RAAT. Fourteen participants' responses were analyzed using Dedoose software to identify common themes in the responses. RESULTS The results of this study provide various perspectives from professionals in different settings on the benefits of AAT, concerns about AAT, and the implication for the utilization of RAAT. The data indicated that most of the participants have not incorporated RAAT into practice. However, many of the participants believed that RAAT can be an alternative or preparatory intervention when interaction with live animals is not possible. The data collected further contributes to an emerging niche setting.
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Affiliation(s)
- Macy Burr
- Department of Occupational Therapy, University of St. Augustine for Health Sciences, 700 Windy Point Dr, San Marcos, CA, 92069, USA.
| | - Jordan Buntich
- Department of Occupational Therapy, Stanbridge University, 2041 Business Center Dr, Irvine, CA, 92612, USA
| | - Marissa Gonzalez
- Department of Occupational Therapy, Stanbridge University, 2041 Business Center Dr, Irvine, CA, 92612, USA
| | - Stephanie Miranda
- Department of Occupational Therapy, Stanbridge University, 2041 Business Center Dr, Irvine, CA, 92612, USA
| | - Tuyen Vu
- Department of Occupational Therapy, Stanbridge University, 2041 Business Center Dr, Irvine, CA, 92612, USA
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Abstract
PURPOSE To summarize and update the current knowledge on the effectiveness of hippotherapy on postural control in children with cerebral palsy. METHODS Using a systematic review methodology, the electronic databases PubMed, Virtual Health Library, PEDro, Scielo, Embase, and Web of Science were searched for eligible articles from 2011 up to September 2021. Quality assessment of eligible studies was performed using the PEDro scale. RESULTS There were 239 identified studies. Eight clinical trials were selected. The total sample consisted of 264 individuals, with 134 allocated to the experimental group (hippotherapy) and 130 individuals to the control group (conventional therapy). Most studies had moderate to high methodological quality. CONCLUSIONS Hippotherapy can be an effective intervention to improve several aspects related to postural control, such as static balance (especially in the sitting posture), dynamic balance, and alignment (body posture) in children aged 3 to 16 years, particularly with spastic hemiplegia or diplegia. WHAT THIS ADDS TO THE EVIDENCE This review summarizes studies that explore potential effects of hippotherapy on postural control in children with cerebral palsy.
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Lee K, Jung J, Shin H, Lee K, Lee H, Lee G. Analysis of trunk muscles activity during horseback riding machine exercise in children with spastic cerebral palsy. Medicine (Baltimore) 2022; 101:e31915. [PMID: 36595990 PMCID: PMC9803444 DOI: 10.1097/md.0000000000031915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Appropriate trunk muscle activity is needed to perform functional activities in cerebral palsy, this study analyzed the activity of trunk muscles during horseback riding machine exercise in children with spastic cerebral palsy. 10 children with spastic cerebral palsy were participated, the activity of the trunk muscles, including both sides of the rectus abdominis, external oblique, latissimus dorsi, and erector spinae in sitting posture and during horseback riding machine exercise were evaluated using a surface electromyography. The activity of bilateral rectus abdominis, external oblique, latissimus dorsi, and erector spinae increased during horseback riding machine exercise than quiet sitting posture. Moreover, there were significant differences in activities of the trunk muscles between the sitting posture and horseback riding machine exercise, with the exception of the left external oblique and the left latissimus dorsi. Horseback riding machine exercise provides more opportunities to use the trunk muscles for children with spastic cerebral palsy than general sitting posture. In future, it will be of use to investigate the effect of horseback riding machine exercise in patients with cerebral palsy.
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Affiliation(s)
- Kyeongbong Lee
- Department of Physical Therapy, Kangwon National University, Samcheok, Republic of Korea
| | - JungHee Jung
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Republic of Korea
| | - HyeonHui Shin
- Department of Occupational Therapy, Dongseo University, Busan, Republic of Korea
| | - KyungJune Lee
- Department of Broadcasting and Communication Policy, Seoul National University of Science and Technology, Seoul, Republic of Korea
| | - HyoSun Lee
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Republic of Korea
| | - GyuChang Lee
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
- * Correspondence: GyuChang Lee, Department of Physical Therapy, Kyungnam University, 7 Kyungnamdaehak-ro, Masanhappo-gu, Changwon, Gyeongsangnam-do 51767, Republic of Korea (e-mail: )
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Effectiveness of Mechanical Horse-Riding Simulator-Based Interventions in Patients with Cerebral Palsy-A Systematic Review and Meta-Analysis. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9120790. [PMID: 36550996 PMCID: PMC9774556 DOI: 10.3390/bioengineering9120790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mechanical horse-riding simulator (HRS) exercises are a type of therapy based on the use of robotic or mechanical devices that produces movement similar to a real horse with the aim of simulating hippotherapy. This review analyses the effectiveness of HRS therapies in patients with cerebral palsy (CP). METHODS A systematic review and a meta-analysis were carried out by searching studies in PubMed Medline, SCOPUS, Web of Science, CINAHL, PEDro and SciELO up until October 2022. We selected clinical trials that assessed the effectiveness of HRS therapy, compared to other interventions, in patients with CP. The main variables were gross motor function (its global score and dimensions, such as sitting ability), functional balance, spasticity, hip range of motion (ROM), posturographic balance and satisfaction. The risk of bias was assessed using the Cochrane Risk of Bias Tool. The pooled effect was calculated using Cohen's Standardized Mean Difference (SMD) for a 95% confidence interval (95% CI). RESULTS Twelve studies were included in the systematic review, and 10 were included in the meta-analysis, providing data from 343 patients with spastic diplegic CP. Our findings revealed that HRS plus physiotherapy is more effective than physiotherapy in improving the total gross motor function (SMD 0.98; 95% CI 0.35-1.62), sitting ability of the gross motor function (SMD 0.84; 95% CI 0.32-1.36) and functional balance (SMD 0.6; 95% CI 0.1-1.08), and HRS therapy is better than sham to improve pelvic abduction ROM (SMD 0.79; 95% CI 0.21-1.37). CONCLUSIONS Horse-riding simulator-based therapy is an effective therapy to improve gross motor function, functional balance and abduction pelvic ROM in children with CP, in comparison to physiotherapy or sham.
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Sacks H, Wu M, Carter C, Karamitopoulos M. Parasport: Effects on Musculoskeletal Function and Injury Patterns. J Bone Joint Surg Am 2022; 104:1760-1768. [PMID: 35975928 DOI: 10.2106/jbjs.21.01504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Sports participation can improve gait, muscle strength, and functional abilities in patients with a wide variety of disabilities. Para athletes are also at substantial risk for injury during sports participation. ➤ Ambulant athletes with cerebral palsy are at risk for soft-tissue injuries about the knee as well as foot and ankle injuries. Wheelchair athletes are at risk for osteoporotic fractures and shoulder girdle injuries. Limb-deficient athletes are prone to low back pain and overuse injuries of the contralateral extremity. ➤ Para athletes are vulnerable to abuse during sports participation, and physicians should promptly report any possible abuse or mistreatment. ➤ Orthopaedic surgeons should understand disability and sport-specific risk factors for injury in para athletes in order to initiate early management and injury prevention protocols.
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Affiliation(s)
- Hayley Sacks
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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Heussen N, Häusler M. Equine-Assisted Therapies for Children With Cerebral Palsy: A Meta-analysis. Pediatrics 2022; 150:188239. [PMID: 35656779 DOI: 10.1542/peds.2021-055229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Equine-assisted therapy in different facets aims to improve the clinical condition of children with cerebral palsy. A more comprehensive overview on the overall effects and on the differences between different treatment modalities seems desirable. OBJECTIVE We compared the effectiveness of various equine-assisted treatments on motor capabilities and quality of life of children with cerebral palsy. DATA SOURCES We conducted systematic searches of PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. STUDY SELECTION Randomized and nonrandomized controlled parallel-group or crossover studies on equine-assisted therapies in comparison with standard of care were included. DATA EXTRACTION Data on motor function assessed by different instruments were considered as the primary outcome. Secondary outcomes included global, social, physical, and emotional scores of quality of life. RESULTS Strong evidence for a positive effect of equine-assisted therapies, particularly hippotherapy, on global gross motor function and motor capabilities during walking in children with cerebral palsy was identified (SMD 0.24, 95% CI 0.05 to 0.43, P = .01, t2 = 0.00, I2 = 15%; SMD 2.68, 95% CI 1.02 to 4.34, P = .002, t2 = 0.0, I2 = 0%). No evidence for the improvement in quality of life could be shown in the global assessment, nor in any subscore. CONCLUSIONS Equine-assisted therapy, particularly hippotherapy, can be a therapeutic tool for children who are learning to walk. LIMITATION The heterogeneity of tools used in different studies and the low number of studies addressing quality of life issues limited the number of studies available for distinct analyses.
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Affiliation(s)
- Nicole Heussen
- Department of Medical Statistics, RWTH Aachen University, Aachen, Germany.,Center of Biostatistics and Epidemiology, Medical School, Sigmund Freud University, Vienna, Austria
| | - Martin Häusler
- Division of Neuropediatrics and Social Pediatrics, Department of Pediatrics, University Hospital RWTH Aachen, Aachen, Germany
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Jung YG, Chang HJ, Jo ES, Kim DH. The Effect of a Horse-Riding Simulator with Virtual Reality on Gross Motor Function and Body Composition of Children with Cerebral Palsy: Preliminary Study. SENSORS 2022; 22:s22082903. [PMID: 35458888 PMCID: PMC9029300 DOI: 10.3390/s22082903] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/30/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022]
Abstract
This study aimed to evaluate the effect of a horse-riding simulator (HRS) with virtual reality (VR) on gross motor function, balance control, and body composition in children with spastic cerebral palsy (CP). Seventeen preschool and school-aged children with spastic CP were included; 10 children in the intervention group (HRS group) received 30 min of HRS with VR training twice a week for a total of 16 sessions in addition to conventional physiotherapy. Seven children in the control group were instructed to perform home-based aerobic exercises twice a week for 8 weeks in addition to conventional physiotherapy. Gross motor function measure (GMFM) and body composition were evaluated before the first session and after the last session. Before and after the 2-month intervention, Pediatric Balance Scale and Timed Up and Go test were evaluated for the HRS group. GMFM scores and body composition changed significantly in the HRS group (p < 0.05). However, no significant differences were observed in the control group. Changes in the GMFM total scores, GMFM dimension D scores, and skeletal muscle mass significantly differed between the HRS and control groups (p < 0.05). HRS with VR may be an effective adjunctive therapeutic approach for the rehabilitation of children with CP.
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Affiliation(s)
- Yong Gi Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea;
| | - Hyun Jung Chang
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, School of Medicine, Sungkyunkwan University, Changwon 51353, Korea; (E.S.J.); (D.H.K.)
- Correspondence: ; Tel.: +82-55-233-5996
| | - Eun Sol Jo
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, School of Medicine, Sungkyunkwan University, Changwon 51353, Korea; (E.S.J.); (D.H.K.)
| | - Da Hye Kim
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, School of Medicine, Sungkyunkwan University, Changwon 51353, Korea; (E.S.J.); (D.H.K.)
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Selph SS, Skelly AC, Wasson N, Dettori JR, Brodt ED, Ensrud E, Elliot D, Dissinger KM, McDonagh M. Physical Activity and the Health of Wheelchair Users: A Systematic Review in Multiple Sclerosis, Cerebral Palsy, and Spinal Cord Injury. Arch Phys Med Rehabil 2021; 102:2464-2481.e33. [PMID: 34653376 DOI: 10.1016/j.apmr.2021.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To understand the benefits and harms of physical activity in people who may require a wheelchair with a focus on people with multiple sclerosis (MS), cerebral palsy (CP), and spinal cord injury (SCI). DATA SOURCES Searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO, Cochrane CENTRAL, and Embase (January 2008 through November 2020). STUDY SELECTION Randomized controlled trials, nonrandomized trials, and cohort studies of observed physical activity (at least 10 sessions on 10 days) in participants with MS, CP, and SCI. DATA EXTRACTION We conducted dual data abstraction, quality assessment, and strength of evidence. Measures of physical functioning are reported individually where sufficient data exist and grouped as "function" where data are scant. DATA SYNTHESIS No studies provided evidence for prevention of cardiovascular conditions, development of diabetes, or obesity. Among 168 included studies, 44% enrolled participants with MS (38% CP, 18% SCI). Studies in MS found walking ability may be improved with treadmill training and multimodal exercises; function may be improved with treadmill, balance exercises, and motion gaming; balance is likely improved with balance exercises and may be improved with aquatic exercises, robot-assisted gait training (RAGT), motion gaming, and multimodal exercises; activities of daily living (ADL), female sexual function, and spasticity may be improved with aquatic therapy; sleep may be improved with aerobic exercises and aerobic fitness with multimodal exercises. In CP, balance may be improved with hippotherapy and motion gaming; function may be improved with cycling, treadmill, and hippotherapy. In SCI, ADL may be improved with RAGT. CONCLUSIONS Depending on population and type of exercise, physical activity was associated with improvements in walking, function, balance, depression, sleep, ADL, spasticity, female sexual function, and aerobic capacity. Few harms of physical activity were reported in studies. Future studies are needed to address evidence gaps and to confirm findings.
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Affiliation(s)
- Shelley S Selph
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon.
| | | | - Ngoc Wasson
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
| | | | | | - Erik Ensrud
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Diane Elliot
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Kristin M Dissinger
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Marian McDonagh
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
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Chang HJ, Jung YG, Park YS, O SH, Kim DH, Kim CW. Virtual Reality-Incorporated Horse Riding Simulator to Improve Motor Function and Balance in Children with Cerebral Palsy: A Pilot Study. SENSORS 2021; 21:s21196394. [PMID: 34640713 PMCID: PMC8512120 DOI: 10.3390/s21196394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/04/2021] [Accepted: 09/23/2021] [Indexed: 11/24/2022]
Abstract
The horse riding simulator (HRS) reportedly has a beneficial effect on motor function and balance in children with cerebral palsy (CP). However, by itself, the HRS is not a sufficient source of challenge and motivation for children. To address this issue, we combined the HRS with virtual reality (VR) to promote somatosensory stimulation and motivation. Sixteen children (ages: 5–17 years) with CP and presenting Gross Motor Function Classification System (GMFCS) levels I–IV were enrolled in the study. Using a head-mounted display and controllers, interventions were carried out over 30-min periods (two rides lasting 12 min each, along with a six-min rest period) twice a week over a period of eight weeks (16 sessions in aggregate). The Pediatric Balance Scale (PBS), Gross Motor Function measure (GMFM)-88, and GMFM-66 scores of each participant were measured before and after the interventions. Statistically significant improvements were observed in the PBS, GMFM-66, the total GMFM-88 scores, and those corresponding to dimensions D and E of GMFM-88 after the intervention (p < 0.05). This study demonstrates that VR-incorporated HRS is effective in improving motor function and balance in children with CP and that its incorporation in conventional PT programs could yield beneficial results.
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Affiliation(s)
- Hyun Jung Chang
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea; (H.J.C.); (Y.S.P.); (S.H.O.); (D.H.K.)
| | - Yong Gi Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Young Sook Park
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea; (H.J.C.); (Y.S.P.); (S.H.O.); (D.H.K.)
| | - Se Hwi O
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea; (H.J.C.); (Y.S.P.); (S.H.O.); (D.H.K.)
| | - Da Hye Kim
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea; (H.J.C.); (Y.S.P.); (S.H.O.); (D.H.K.)
| | - Chang Woo Kim
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea; (H.J.C.); (Y.S.P.); (S.H.O.); (D.H.K.)
- Correspondence: ; Tel.: +82-10-9488-1371
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Chinniah H, Natarajan M, Ramanathan R, Ambrose JWF. Effects of horse riding simulator on sitting motor function in children with spastic cerebral palsy. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1870. [PMID: 32808394 DOI: 10.1002/pri.1870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/14/2020] [Accepted: 07/05/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Horse riding simulator (HRS) is an electronic horse, working under the principles of hippotherapy. It is one of the advanced therapeutic methods to improve postural control and balance in sitting, which could be recommended in the rehabilitation of cerebral palsy if real horses are unavailable. OBJECTIVE To investigate the therapeutic effects of HRS on sitting motor function in children with spastic diplegia and evaluate the changes in sitting motor function at different periods of time (4, 8 and 12 weeks). METHODS This study is a randomized controlled trial conducted over a period of 12 weeks. Thirty children with spastic diplegia age between 2 and 4 years with Gross Motor Function Classification System (GMFCS) Level I-III were included and divided into two groups. The control group received the conventional physiotherapy while the experimental group received HRS along with conventional physiotherapy. Sitting motor function was assessed by Gross Motor Function Measure (GMFM)-88 (sitting dimension B) at baseline, 4, 8 and 12 weeks. Pre- and post-intervention scores were measured and analysed. RESULTS The baseline characteristics were similar in both groups before the intervention with p > .01. The observed mean value of GMFM in both groups improved over a period of 12 weeks. The results denote that the sitting motor function gradually improved over a period of time in both groups and the experimental group showed significant improvement (p < .01) than the control group in all the weeks. CONCLUSION The study results confirmed that gradual improvement in sitting motor function was observed in both groups. Children exposed to HRS show better improvement than the children in the control group. It was concluded that HRS is effective in improving the sitting motor function in children with spastic diplegia and the continuous provision of HRS in longer duration provide more benefits than the shorter duration.
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Affiliation(s)
- Hemachithra Chinniah
- Division of PM&R, RMMC&H, Annamalai University, Annamalai Nagar, Tamil Nadu, India
| | - Meena Natarajan
- Division of PM&R, RMMC&H, Annamalai University, Annamalai Nagar, Tamil Nadu, India
| | - Ramanathan Ramanathan
- Department of Paediatrics, RMMC&H, Annamalai University, Annamalai Nagar, Tamil Nadu, India
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Effectiveness of Mechanical Horse-Riding Simulators on Postural Balance in Neurological Rehabilitation: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010165. [PMID: 31881693 PMCID: PMC6981612 DOI: 10.3390/ijerph17010165] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/10/2019] [Accepted: 12/22/2019] [Indexed: 11/17/2022]
Abstract
Mechanical horse-riding simulators consist of a device that mimics the movement of a real horse, generating between 50 and 100 three-dimensional physical movements (forward and back, left and right, up and down). The main objective of this study is to analyze the effectiveness of mechanical horse-riding simulators to improve postural balance in subjects with neurological disorders. The search was conducted during January-March 2019 in PubMed, Physiotherapy Evidence Database (PEDro), Cochrane, Web of Science, CINAHL, and Scopus. The methodological quality of the studies was evaluated through the PEDro scale. A total of seven articles were included in this systematic review, of which four contributed information to the meta-analysis. Statistical analysis showed favorable results for balance in stroke patients, measured by the Berg Balance Scale (standardized mean difference (SMD) = 3.24; 95%; confidence interval (CI): 1.66-4.83). Not conclusive results were found in sitting postural balance, measured using the Gross Motor Function Measure-66 (GMFM-66) Sitting Dimension, in patients with cerebral palsy. Most studies have shown beneficial effects on postural balance compared with conventional physical therapy. However, due to the limited number of articles and their low methodological quality, no solid conclusions can be drawn about the effectiveness of this therapy.
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Ribeiro MF, Espindula AP, Lage JB, Bevilacqua Júnior DE, Diniz LH, Mello ECD, Ferreira AA, Ferraz MLF, Teixeira VDPA. Analysis of the electromiographic activity of lower limb and motor function in hippotherapy practitioners with cerebral palsy. J Bodyw Mov Ther 2019; 23:39-47. [DOI: 10.1016/j.jbmt.2017.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 12/01/2017] [Accepted: 12/06/2017] [Indexed: 11/30/2022]
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Martín-Valero R, Vega-Ballón J, Perez-Cabezas V. Benefits of hippotherapy in children with cerebral palsy: A narrative review. Eur J Paediatr Neurol 2018; 22:1150-1160. [PMID: 30017618 DOI: 10.1016/j.ejpn.2018.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/22/2018] [Accepted: 07/01/2018] [Indexed: 10/28/2022]
Abstract
UNLABELLED Children with cerebral palsy display disorders in pelvic movement and require effective rehabilitation. There is evidence to support the hippotherapy due to improvements in balance. The aim of this narrative review was to summarise the grades of recommendation regarding the benefits of hippotherapy in children with cerebral palsy. DATA SOURCES AND EXTRACTION We searched electronic databases, limiting the searches to studies published between 2004 and February 2017. The selected documents were classified according to the strength of recommendation provided by Duodecim (the Finnish medical society). The methodological quality of the selected studies was evaluated using the PEDro scale. RESULTS 18 studies (four graded A, eight graded B and six graded C) showed clinical changes in the outcomes of gross motor function, sitting independently, speed of walking, length of stride and postural alignment of the head in children with cerebral palsy. Study quality was poor to good (mean PEDro Score of 6 out of 10). Benefits were identified in relation to psychological factors, as well as positive effects on quality of life and the performance of daily life activities. CONCLUSIONS Gains were also observed in postural alignment and the balance of head and trunk. Moreover, there were improvements in quality of life and the activities of daily life, such as jumping, balance, strength and ascending and descending stairs.
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Affiliation(s)
- R Martín-Valero
- Department of Physiotherapy, Faculty of Health Sciences, Spain.
| | - J Vega-Ballón
- Carlos Jimenez Mata Physiotherapy, Private Centre, Melilla, Spain
| | - V Perez-Cabezas
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, Spain
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Fragkou D, Gkrimas G, Pyrgeli M. Therapeutic interventions for trunk and improvement of posture in children with cerebral palsy: a review of the literature. ACTA ACUST UNITED AC 2018. [DOI: 10.15406/mojor.2018.10.00434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Moraes AG, Copetti F, Ângelo VR, Chiavoloni L, de David AC. Hippotherapy on postural balance in the sitting position of children with cerebral palsy – Longitudinal study. Physiother Theory Pract 2018; 36:259-266. [DOI: 10.1080/09593985.2018.1484534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Andréa Gomes Moraes
- Human Movement Analysis Laboratory, Faculty of Physical Education, University of Brasilia, Brasília, DF, Brazil
- Therapeutic Riding Center of Military Police of the Federal District, Brasília, DF, Brazil
| | - Fernando Copetti
- Sport and Physical Education Center, Federal, University of Santa Maria, Santa Maria, RS, Brazil
| | - Vera Regina Ângelo
- Therapeutic Riding Center of Military Police of the Federal District, Brasília, DF, Brazil
| | - Luana Chiavoloni
- Therapeutic Riding Center of Military Police of the Federal District, Brasília, DF, Brazil
| | - Ana Cristina de David
- Human Movement Analysis Laboratory, Faculty of Physical Education, University of Brasilia, Brasília, DF, Brazil
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Curtis DJ, Woollacott M, Bencke J, Lauridsen HB, Saavedra S, Bandholm T, Sonne-Holm S. The functional effect of segmental trunk and head control training in moderate-to-severe cerebral palsy: A randomized controlled trial. Dev Neurorehabil 2018; 21:91-100. [PMID: 28045553 DOI: 10.1080/17518423.2016.1265603] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine whether segmental training is more effective in improving gross motor function in children and young people with moderate-to-severe cerebral palsy than conventional physiotherapy. METHODS Twenty-eight participants were randomized to a segmental training or control group. Outcomes were Gross Motor Function Measure (GMFM), Pediatric Evaluation of Disability Inventory (PEDI), Segmental Assessment of Trunk Control (SATCo), and postural sway at baseline, at primary endpoint (6 months), and at follow-up (12 months). RESULTS There were no significant differences in either GMFM, PEDI, or SATCo scores at primary endpoint or follow-up. There were significant reductions in anterior-posterior head angular sway and trunk sway in the segmental training group at primary endpoint but not at follow-up. CONCLUSION Segmental training was not superior to usual care in improving GMFM. Improvements in head and trunk sway were greater in the segmental training group at primary endpoint but not at follow-up.
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Affiliation(s)
- Derek John Curtis
- a The Gait Analysis Laboratory, Department of Orthopedic Surgery , Hvidovre University Hospital , Copenhagen , Denmark.,b Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Copenhagen, Denmark.,c Institute for Physical and Occupational Therapy, The Faculty of Health and Technology , Metropolitan University College , Copenhagen
| | | | - Jesper Bencke
- a The Gait Analysis Laboratory, Department of Orthopedic Surgery , Hvidovre University Hospital , Copenhagen , Denmark
| | - Hanne Bloch Lauridsen
- a The Gait Analysis Laboratory, Department of Orthopedic Surgery , Hvidovre University Hospital , Copenhagen , Denmark
| | - Sandy Saavedra
- e Department of Rehabilitation Sciences College of Education , Nursing & Health Professions, University of Hartford , Hartford , CT, USA
| | - Thomas Bandholm
- b Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Copenhagen, Denmark.,f Department of Physical and Occupational Therapy , Hvidovre University Hospital , Copenhagen , Denmark.,g Clinical Research Centre, Hvidovre University Hospital , Copenhagen , Denmark
| | - Stig Sonne-Holm
- a The Gait Analysis Laboratory, Department of Orthopedic Surgery , Hvidovre University Hospital , Copenhagen , Denmark.,h Department of Orthopedic Surgery , Hvidovre University Hospital , Copenhagen , Denmark
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Abstract
BACKGROUND Cerebral palsy (CP) is a neurodevelopmental disorder resulting from an injury to the developing brain. It is the most common form of childhood disability with prevalence rates of between 1.5 and 3.8 per 1000 births reported worldwide. The primary impairments associated with CP include reduced muscle strength and reduced cardiorespiratory fitness, resulting in difficulties performing activities such as dressing, walking and negotiating stairs.Exercise is defined as a planned, structured and repetitive activity that aims to improve fitness, and it is a commonly used intervention for people with CP. Aerobic and resistance training may improve activity (i.e. the ability to execute a task) and participation (i.e. involvement in a life situation) through their impact on the primary impairments of CP. However, to date, there has been no comprehensive review of exercise interventions for people with CP. OBJECTIVES To assess the effects of exercise interventions in people with CP, primarily in terms of activity, participation and quality of life. Secondary outcomes assessed body functions and body structures. Comparators of interest were no treatment, usual care or an alternative type of exercise intervention. SEARCH METHODS In June 2016 we searched CENTRAL, MEDLINE, Embase, nine other databases and four trials registers. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs of children, adolescents and adults with CP. We included studies of aerobic exercise, resistance training, and 'mixed training' (a combination of at least two of aerobic exercise, resistance training and anaerobic training). DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and potentially relevant full-text reports for eligibility; extracted all relevant data and conducted 'Risk of bias' and GRADE assessments. MAIN RESULTS We included 29 trials (926 participants); 27 included children and adolescents up to the age of 19 years, three included adolescents and young adults (10 to 22 years), and one included adults over 20 years. Males constituted 53% of the sample. Five trials were conducted in the USA; four in Australia; two in Egypt, Korea, Saudi Arabia, Taiwan, the Netherlands, and the UK; three in Greece; and one apiece in India, Italy, Norway, and South Africa.Twenty-six trials included people with spastic CP only; three trials included children and adolescents with spastic and other types of CP. Twenty-one trials included people who were able to walk with or without assistive devices, four trials also included people who used wheeled mobility devices in most settings, and one trial included people who used wheeled mobility devices only. Three trials did not report the functional ability of participants. Only two trials reported participants' manual ability. Eight studies compared aerobic exercise to usual care, while 15 compared resistance training and 4 compared mixed training to usual care or no treatment. Two trials compared aerobic exercise to resistance training. We judged all trials to be at high risk of bias overall.We found low-quality evidence that aerobic exercise improves gross motor function in the short term (standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.02 to 1.04, N = 65, 3 studies) and intermediate term (mean difference (MD) 12.96%, 95% CI 0.52% to 25.40%, N = 12, 1 study). Aerobic exercise does not improve gait speed in the short term (MD 0.09 m/s, 95% CI -0.11 m/s to 0.28 m/s, N = 82, 4 studies, very low-quality evidence) or intermediate term (MD -0.17 m/s, 95% CI -0.59 m/s to 0.24 m/s, N = 12, 1 study, low-quality evidence). No trial assessed participation or quality of life following aerobic exercise.We found low-quality evidence that resistance training does not improve gross motor function (SMD 0.12, 95% CI -0.19 to 0.43, N = 164, 7 studies), gait speed (MD 0.03 m/s, 95% CI -0.02 m/s to 0.07 m/s, N = 185, 8 studies), participation (SMD 0.34, 95% CI -0.01 to 0.70, N = 127, 2 studies) or parent-reported quality of life (MD 12.70, 95% CI -5.63 to 31.03, n = 12, 1 study) in the short term. There is also low-quality evidence that resistance training does not improve gait speed (MD -0.03 m/s, 95% CI -0.17 m/s to 0.11 m/s, N = 84, 3 studies), gross motor function (SMD 0.13, 95% CI -0.30 to 0.55, N = 85, 3 studies) or participation (MD 0.37, 95% CI -6.61 to 7.35, N = 36, 1 study) in the intermediate term.We found low-quality evidence that mixed training does not improve gross motor function (SMD 0.02, 95% CI -0.29 to 0.33, N = 163, 4 studies) or gait speed (MD 0.10 m/s, -0.07 m/s to 0.27 m/s, N = 58, 1 study) but does improve participation (MD 0.40, 95% CI 0.13 to 0.67, N = 65, 1 study) in the short-term.There is no difference between resistance training and aerobic exercise in terms of the effect on gross motor function in the short term (SMD 0.02, 95% CI -0.50 to 0.55, N = 56, 2 studies, low-quality evidence).Thirteen trials did not report adverse events, seven reported no adverse events, and nine reported non-serious adverse events. AUTHORS' CONCLUSIONS The quality of evidence for all conclusions is low to very low. As included trials have small sample sizes, heterogeneity may be underestimated, resulting in considerable uncertainty relating to effect estimates. For children with CP, there is evidence that aerobic exercise may result in a small improvement in gross motor function, though it does not improve gait speed. There is evidence that resistance training does not improve gait speed, gross motor function, participation or quality of life among children with CP.Based on the evidence available, exercise appears to be safe for people with CP; only 55% of trials, however, reported adverse events or stated that they monitored adverse events. There is a need for large, high-quality, well-reported RCTs that assess the effectiveness of exercise in terms of activity and participation, before drawing any firm conclusions on the effectiveness of exercise for people with CP. Research is also required to determine if current exercise guidelines for the general population are effective and feasible for people with CP.
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Affiliation(s)
- Jennifer M Ryan
- Brunel University LondonInstitute of Environment, Health and SocietiesKingston LaneUxbridgeMiddlesexUKUB8 3PH
| | | | - Stephen G Noorduyn
- McMaster UniversityCanChild Centre for Childhood Disability Research1280 Main Street West, Rm. 2C1McMaster UniversityHamiltonONCanadaL8S 4L8
| | - Neil E O'Connell
- Brunel UniversityDepartment of Clinical Sciences/Health Economics Research Group, Institute of Environment, Health and SocietiesKingston LaneUxbridgeMiddlesexUKUB8 3PH
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Moraes AG, Copetti F, Angelo VR, Chiavoloni LL, David AC. The effects of hippotherapy on postural balance and functional ability in children with cerebral palsy. J Phys Ther Sci 2016; 28:2220-6. [PMID: 27630401 PMCID: PMC5011565 DOI: 10.1589/jpts.28.2220] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/07/2016] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED [Purpose] This study evaluated the effects of hippotherapy on seated postural balance, dynamic balance, and functional performance in children with cerebral palsy and compared the effects of 12 and 24 sessions on seated postural balance. [Subjects and Methods] This study included 15 children with cerebral palsy aged between 5 and 10 years. INTERVENTIONS A hippotherapy protocol was performed for 30 minutes, twice a week, for 12 weeks. Postural balance in a sitting position was measured using an AMTI AccuSway Plus force platform 1 week before initiating the hippotherapy program and after 12 and 24 weeks. The Berg Balance Scale (BBS) and Pediatric Evaluation of Disability Inventory (PEDI) were used before and after 24 sessions. [Results] Significant differences were observed for center of pressure (COP) variables, including medio-lateral (COPml), anteroposterior displacement (COPap), and velocity of displacement (VelCOP), particularly after 24 sessions. There were also significant differences in BBS scores and PEDI score increases associated with functional skills (self-care, social function, and mobility), caregiver assistance (self-care), social function, and mobility. [Conclusion] Hippotherapy resulted in improvement in postural balance in the sitting position, dynamic balance, and functionality in children with cerebral palsy, an effect particularly significant after 24 hippotherapy sessions.
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Affiliation(s)
- Andréa Gomes Moraes
- Human Movement Analysis Laboratory, University of Brasilia, Therapeutic Riding Center of Military Police of the Federal District, Brazil
| | - Fernando Copetti
- Center of Physical Education and Sports, Federal Univesity of Santa Maria, Brazil
| | - Vera Regina Angelo
- Therapeutic Riding Center of Military Police of the Federal District, Brazil
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Lim JH, Cho WS, Lee SJ, Park CB, Park JS. Effects of mechanical horseback riding velocity on spinal alignment in young adults. J Phys Ther Sci 2016; 28:1836-9. [PMID: 27390428 PMCID: PMC4932069 DOI: 10.1589/jpts.28.1836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/12/2016] [Indexed: 11/29/2022] Open
Abstract
[Purpose] This study aimed to determine if the velocity of mechanical horseback-riding
training can improve spinal alignment in young adults. [Subjects and Methods] Thirty-six
subjects were enrolled in this study. The subjects were randomly allocated into high-,
moderate-, and low-velocity mechanical horseback-riding training groups. All participants
completed one 20-minute session per day, 3 days per week, for 6 weeks. The evaluation was
performed before and 6 weeks after the training intervention. The spinal alignment was
measured by a Formetric III device. The measurement items were kyphotic angle, lordotic
angle, trunk inclination, pelvic torsion, pelvic rotation, and lateral deviation. The data
were analyzed using analysis of covariance to determine the statistical significance.
[Results] The kyphotic angle and trunk inclination were significantly different among the
groups. The kyphotic angles of the high- and moderate-velocity groups were significantly
lower than that of the low-velocity group after the intervention. The trunk inclination of
the high-velocity group was significantly lower than that of the low-velocity group after
intervention. [Conclusion] Higher-velocity mechanical horseback-riding training is more
effective than lower-velocity mechanical horseback-riding training for improving spinal
alignment.
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Affiliation(s)
- Jae-Heon Lim
- Department of Physical Therapy, Seonam University, Republic of Korea
| | - Woon-Su Cho
- Department of Physical Therapy, Nambu University, Republic of Korea
| | - Seong-Jin Lee
- Department of Rehabilitation Health Management, Songwon University, Republic of Korea
| | - Chi-Bok Park
- Department of Physical Therapy, Graduate School of Dongshin University, Republic of Korea
| | - Jang-Sung Park
- Department of Physical Therapy, Seonam University, Republic of Korea
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Alemdaroğlu E, Yanıkoğlu İ, Öken Ö, Uçan H, Ersöz M, Köseoğlu BF, Kapıcıoğlu MİS. Horseback riding therapy in addition to conventional rehabilitation program decreases spasticity in children with cerebral palsy: A small sample study. Complement Ther Clin Pract 2016; 23:26-9. [DOI: 10.1016/j.ctcp.2016.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/02/2016] [Accepted: 02/11/2016] [Indexed: 11/27/2022]
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Dewar R, Love S, Johnston LM. Exercise interventions improve postural control in children with cerebral palsy: a systematic review. Dev Med Child Neurol 2015; 57:504-20. [PMID: 25523410 DOI: 10.1111/dmcn.12660] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2014] [Indexed: 01/20/2023]
Abstract
AIM The aim of this study was to evaluate the efficacy and effectiveness of exercise interventions that may improve postural control in children with cerebral palsy (CP). METHOD A systematic review was performed using American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Six databases were searched using the following keywords: ('cerebral palsy' OR 'brain injury'); AND ('postur*' OR 'balance' OR 'postural balance' [MeSH]); AND ('intervention' OR 'therapy' OR 'exercise' OR 'treatment'). Articles were evaluated based on their level of evidence and conduct. RESULTS Searches yielded 45 studies reporting 13 exercise interventions with postural control outcomes for children with CP. Five interventions were supported by a moderate level of evidence: gross motor task training, hippotherapy, treadmill training with no body weight support (no-BWS), trunk-targeted training, and reactive balance training. Six of the interventions had weak or conflicting evidence: functional electrical stimulation (FES), hippotherapy simulators, neurodevelopmental therapy (NDT), treadmill training with body weight support, virtual reality, and visual biofeedback. Progressive resistance exercise was an ineffective intervention, and upper limb interventions lacked high-level evidence. INTERPRETATION The use of exercise-based treatments to improve postural control in children with CP has increased significantly in the last decade. Improved study design provides more clarity regarding broad treatment efficacy. Research is required to establish links between postural control impairments, treatment options, and outcome measures. Low-burden, low-cost, child-engaging, and mainstream interventions also need to be explored.
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Affiliation(s)
- Rosalee Dewar
- The University of Queensland, Brisbane, Qld, Australia
| | - Sarah Love
- Princess Margaret Hospital, Perth, WA, Australia
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Temcharoensuk P, Lekskulchai R, Akamanon C, Ritruechai P, Sutcharitpongsa S. Effect of horseback riding versus a dynamic and static horse riding simulator on sitting ability of children with cerebral palsy: a randomized controlled trial. J Phys Ther Sci 2015; 27:273-7. [PMID: 25642090 PMCID: PMC4305581 DOI: 10.1589/jpts.27.273] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/24/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] A randomized controlled trial was conducted to investigate the immediate
effects of horseback riding (HR) and a dynamic (DHS) and static (SHS) horse riding
simulator (OSIM uGallop, Taiwan) on sitting ability of children with cerebral palsy.
[Subjects and Methods] Thirty children with cerebral palsy were recruited and randomly
assigned into three groups. Children received 30 minutes of exercise according to their
assigned group. The Segmental Assessment of Trunk Control (SATCo) and Gross Motor Function
Measure-66 (GMFM-66) sitting dimension were used to assess children in all groups both
before and after the interventions. [Results] Sitting abilities were significantly
improved after all interventions. Horseback riding showed the most improvement, followed
by the dynamic and static horse riding simulator groups. Horseback riding also showed a
significant improvement in the GMFM sitting dimension. [Conclusion] Horseback riding was
the best intervention for promoting sitting ability of children with spastic cerebral
palsy. However, a dynamic horse riding simulator can be a good surrogate for horseback
riding when horseback riding is not available.
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Kim H, Her JG, Ko J. Effect of horseback riding simulation machine training on trunk balance and gait of chronic stroke patients. J Phys Ther Sci 2014; 26:29-32. [PMID: 24567670 PMCID: PMC3927036 DOI: 10.1589/jpts.26.29] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 07/22/2013] [Indexed: 12/03/2022] Open
Abstract
[Purpose] The purpose of this study was to assess the effect of horseback
riding simulation machine training on trunk balance and gait of patients with chronic
stroke. [Subjects and Methods] The subjects were 20 patients hospitalized for treatment
after being diagnosed with stroke. Horseback riding simulation training was provided for
30 minutes, 5 times a week, for 6 weeks. Trunk balance was assessed using the Trunk
Impairment Scale (TIS) and a balance measuring device (Biorescue, RM ingenierie, France),
and gait ability was measured using the Functional Gait Assessment (FGA) and a gait
analyzer (GAITRite, CIR system Inc., USA). [Results] There were significant changes in
movement area, distance and velocity of body sway as measured by the TIS and the balance
measuring device, and in gait velocity, cadence, stride length and double limb support as
measured by the FGA and gait analyzer. [Conclusion] Horseback riding simulation training
improved the trunk balance and gait of chronic stroke patients. This present study
provides preliminary objective data for future research, and useful clinical information
for physical therapists using horseback riding simulation machines as a treatment modality
for patients with chronic stroke.
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Affiliation(s)
- Hyungguen Kim
- Department of Rehabilitation Therapy, Graduate School of Hallym University, Republic of Korea
| | - Jin Gang Her
- Department of Physical Therapy, Hallym College, Republic of Korea
| | - Jooyeon Ko
- Department of Rehabilitation Medicine, CHA University, CHA Bundang Medical Center, Republic of Korea
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Han JY, Kim JM, Kim SK, Chung JS, Lee HC, Lim JK, Lee J, Park KY. Therapeutic effects of mechanical horseback riding on gait and balance ability in stroke patients. Ann Rehabil Med 2013; 36:762-9. [PMID: 23342307 PMCID: PMC3546177 DOI: 10.5535/arm.2012.36.6.762] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 08/09/2012] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate the therapeutic effects of mechanical horseback riding for gait and balance parameters in post-stroke patients. Method This study was a non randomized prospective positive-controlled trial over a 12 week period. From May 2011 to October 2011, 37 stroke patients were recruited from our outpatient clinic and divided into two groups. The control group received the conventional physiotherapy while the intervention group received the conventional physiotherapy along with mechanical horseback riding therapy for 12 weeks. Outcome measurements of gait included the Functional Ambulation Category (FAC) and gait part of the Performance Oriented Mobility Assessment (G-POMA) while those of balance included the Berg Balance Scale (BBS) and the balance part of the Performance Oriented Mobility Assessment (B-POMA). These measurements were taken before and after treatment. Results There were no significant differences in the baseline characteristics and initial values between the two groups. When comparing baseline and 12 weeks post treatment in each group, the intervention group showed significant improvement on BBS (39.9±5.7 → 45.7±4.8, p=0.001) and B-POMA (10.4±2.6 → 12.6±2.1, p=0.001), but significant improvement on gait parameters. When comparing the groups, the dynamic balance category of BBS in post treatment showed significant difference (p=0.02). Conclusion This study suggests that mechanical horseback riding therapy may be an effective treatment tool for enhancing balance in adults with stroke.
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Affiliation(s)
- Jun Young Han
- Department of Rehabilitation Medicine, School of Medicine, Konkuk University, Chungju 380-704, Korea
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