Abstract
Background: Cerebral palsy (CP) is a permanent motor disorder that occurs at birth or during early infancy. Despite advances in fetal and maternal medicine, the incidence of CP remains high. Hippotherapy has gradually been recognized as an excellent rehabilitation tool for children with CP. However, a scientific basis for how it achieves long-term functional improvements or provides additional benefits to patients' caregivers remains unknown.Objectives: We performed a prospective trial to determine how hippotherapy affects the gross motor and gait functions in children with CP and how it may also impact the quality of life (QOL) of patients' caregivers.Methods: In total, 24 children with CP (11 boys, 13 girls; age: 4–14 years; Gross Motor Function Classification System [GMFCS] II-III) underwent a program (30 min/day, once a week) of hippotherapy or day-care recreation (control) over a 1-year intervention and a 3-month follow-up period. Assessment measures used for the children were gait parameters for a 5-m walk test, Gross Motor Function Measure (GMFM)-66, and GMFM dimension-E (GMFM-E). The QOL of the caregivers was estimated using a brief version of the World Health Organization Quality Of Life (WHOQOL-BREF) self-assessment questionnaire.Results: In addition to better GMFM-66 and GMFM-E scores, hippotherapy was associated with increased cadence, step length, and mean acceleration; stabilized horizontal/vertical displacement of patients; and better relationship between the psychological status and QOL of the caregivers than those seen in the control group (p < 0.05). Additionally, the initially improved children's step length and their caregivers' psychological QOL domain (particularly in the “positive feeling” facet) tended to be preserved up to the 3-month follow-up.Conclusion: These data suggest that compared with common day-care recreational activities, a 1-year program of once-weekly hippotherapy can improve not only the walking ability of children with CP but also the psychological health and QOL of their caregivers.Clinical Trial Registration:: www.umin.ac.jp/ctr/, identifier: UMIN000022986
Highlights
Cerebral palsy (CP) is a permanent motor disorder caused by non-progressive encephalopathies of varied etiologies at birth or during early infancy, which are strongly associated with public health issues [1]
Recent meta-analyses and systematic reviews show that there is still insufficient evidence to support the long-term benefits of hippotherapy for the total Gross Motor Function Measure (GMFM) or quality of life (QOL) parameters [7,8,9,10], some improvements in postural alignment and balance of the head and trunk and lower limb muscle activity have been found after short-term hippotherapy [3, 11,12,13,14,15,16,17]
The present results indicate that hippotherapy may have important ancillary effects to improve the psychological QOL of their primary caregivers
Summary
Cerebral palsy (CP) is a permanent motor disorder caused by non-progressive encephalopathies of varied etiologies at birth or during early infancy, which are strongly associated with public health issues [1]. Despite advances in fetal and maternal medicine, the incidence of CP is still at 2–2.5/1,000 live births [2]. Recent meta-analyses and systematic reviews show that there is still insufficient evidence to support the long-term benefits of hippotherapy for the total Gross Motor Function Measure (GMFM) or quality of life (QOL) parameters [7,8,9,10], some improvements in postural alignment and balance of the head and trunk and lower limb muscle activity have been found after short-term hippotherapy (typically involving 20–30-min treatments once or twice a week for up to 25 consecutive weeks) [3, 11,12,13,14,15,16,17]. A scientific basis for how it achieves long-term functional improvements or provides additional benefits to patients’ caregivers remains unknown
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