Equine-Assisted Therapies for Children With Cerebral Palsy: A Meta-analysis

Cerebral Palsy Phenotypes in Genetic Epilepsies

BACKGROUND

Although there are established connections between genetic epilepsies and neurodevelopmental disorders like intellectual disability, the presence of cerebral palsy (CP) in genetic epilepsies is undercharacterized. We performed a retrospective chart review evaluating the motor phenotype of patients with genetic epilepsies.

METHODS

Patients were ascertained through a research exome sequencing study to identify genetic causes of epilepsy. We analyzed data from the first 100 individuals with molecular diagnoses. We determined motor phenotype by reviewing medical records for muscle tone and motor function data. We characterized patients according to CP subtypes: spastic diplegic, spastic quadriplegic, spastic hemiplegic, dyskinetic, hypotonic-ataxic.

RESULTS

Of 100 individuals with genetic epilepsies, 14% had evidence of possible CP, including 5% characterized as hypotonic-ataxic CP, 5% spastic quadriplegic CP, 3% spastic diplegic CP, and 1% hemiplegic CP. Presence of CP did not correlate with seizure onset age (P = 0.63) or seizure control (P = 0.07). CP occurred in 11% (n = 3 of 27) with focal epilepsy, 9% (n = 5 of 54) with generalized epilepsy, and 32% (n = 6 of 19) with combined focal/generalized epilepsy (P = 0.06).

CONCLUSIONS

In this retrospective analysis of patients with genetic epilepsies, we identified a substantial portion with CP phenotypes, representing an under-recognized comorbidity. These findings underscore the many neurodevelopmental features associated with neurogenetic conditions, regardless of the feature for which they were ascertained for sequencing. Detailed motor phenotyping is needed to determine the prevalence of CP and its subtypes among genetic epilepsies. These motor phenotypes require clinical management and represent important targeted outcomes in trials for patients with genetic epilepsies.

Multiple Equine Therapies for the Treatment of Gross Motor Function in Children with Cerebral Palsy: A Systematic Review

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.

Effects of Hippotherapy on Health-Related Quality of Life in Caregivers of Children with Cerebral Palsy: A Pilot Quasi-Experimental Study in Japan

BACKGROUND

Despite accumulating data regarding the beneficial effects of hippotherapy on gait and balance skills in children with cerebral palsy (CP), its effects on caregivers' quality of life (QOL) are limited, presumably due to a lack of reliable and valid measurement tools. This study aims to evaluate the impact of hippotherapy on the health-related QOL of primary caregivers using the Japanese version of the Cerebral Palsy Quality of Life for Children (CP QOL) questionnaire.

METHODS

A quasi-experimental design embedded within our existing cohort was utilized. A total of 29 children with CP (range 4-12 years) and their caregivers participated in either a weekly hippotherapy or recreation (usual care) program for 1 year. In addition to gait-related measurements (Gross Motor Function Measure [GMFM]-E) of children, CP QOL-evidenced determinants of the caregivers' health-related QOL and well-being were compared before and after the intervention.

RESULTS

In addition to improvements in children's GMFM-E scores, hippotherapy improved CP QOL domains related to participation and physical health, children's emotional well-being, and parents' overall health (p < 0.05). Linear regression analysis showed a positive relationship between the children's GMFM-E scores and their caregivers' health domains in participants who received hippotherapy (r2 = 0.404; p = 0.011).

CONCLUSIONS

Hippotherapy has a beneficial effect on the physical and mental well-being and satisfaction of Japanese parents caring for children with CP.

Effectiveness of Mechanical Horse-Riding Simulator-Based Interventions in Patients with Cerebral Palsy-A Systematic Review and Meta-Analysis

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.