Academic journal article British Journal of Occupational Therapy

Long-Term Effects of Hippotherapy on One Child with Cerebral Palsy: A Research Case Study

Academic journal article British Journal of Occupational Therapy

Long-Term Effects of Hippotherapy on One Child with Cerebral Palsy: A Research Case Study

Article excerpt


'Hippotherapy (HPOT) is a treatment strategy within occupational, physical or speech-language therapy that utilises equine movement as part of an integrated intervention program to achieve functional outcomes' (American Hippotherapy Association 2007). 'Hippos' is the Greek word for horse. Hippotherapy, quite literally, is 'therapy using a horse' or using horse movement, performed by a licensed (registered) therapist. HPOT is commonly used for children with neuromuscular disabilities and is sometimes a preferred method to build trunk and head stability for children with cerebral palsy (CP) in the context of occupational therapy, physiotherapy or speech and language therapy During HPOT sessions, children may ride in several positions (forward and backward astride, side sit, quadruped, tall kneel), with sidewalkers ensuring safety and positioning. Mounted activities are included to challenge and integrate functional task demands with head and trunk control.

CP is defined as brain damage around the time of birth, is often of ischaemic or hypoxic aetiology and frequently occurs with premature birth (Beers and Berkow 1999). CP is characterised by loss of motor function compared with typically developing children. There are several subtypes of CP. The child in this case study has spastic diplegia, a subtype characterised by spasticity in both lower extremities, with less severe spasticity and incoordination of the upper extremities (Yamamoto 2007). At younger ages, due to greater neuroplasticity, and with therapy and practice, most children with CP can reorganise descending motor pathways to some extent, enabling functionally significant improvement in motor skills (Carr 2000). However, children with CP typically plateau in gross motor function development after the fifth to seventh year of age, regardless of initial level of impairment (Palisano et al 2000). This may suggest that significant improvements in motor control and function after this age may be attributable to intervention rather than maturation.

Increasing postural stability is an important 'opportunity for therapeutic help' for children with CP (Brogren et al 1998). The underlying premise of the HPOT intervention is similar to movable platform training, which has been shown to accelerate development of automatic postural responses even in infants too young to walk or cruise (Sveistrup and Woollacott 1997). Movable platform training has also been shown to improve standing stability over baseline of older children (7-12 years), even after training ceased (Shumway-Cook et al 2003).

Studies of HPOT with children with CP have typically followed them through a weekly 6-12 week intervention and have shown that it is an effective method to improve gross motor function (10 weeks) (Casady and Nichols-Larsen 2004), decreases energy expenditure and increases walking efficiency (8 weeks) (McGibbon et al 1998), and results in increased gait speed and gross motor performance (7 weeks) (Winchester et al 2002). Two 12-week intervention studies showed significant improvements in trunk and head stability, demonstrated that upper extremity reaching improves and persisted after an additional 12 weeks of no further intervention (Shurtleff et al 2009, Shurtleff and Engsberg 2010).

Many children participate in occupational therapy, physiotherapy or speech and language therapy using HPOT weekly, sometimes for several years. Anecdotal stories from families and promotional material from treatment centres, as well as therapists' notes, continue to claim improvement. However, no published studies have gone beyond 12 weeks of HPOT. Thus, it is unknown if children really continue to improve and at what rate, or if there is a point where benefits are no longer derived. Such dosing information is critical to inform therapists for treatment planning, physicians to refer for therapy and third party funders to approve payment. The purpose of this investigation was to quantify changes in head and trunk stability in a child with CP over 36 weeks of weekly HPOT. …

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