Hippotherapy for Neuromotor Impairment

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of Montana

Disqualifiers: Fear of horses, Weight over 200lbs, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 19

Duration: 8 weeks

24 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Physical Therapy Using Hippotherapy and the Equine Environment for neuromotor impairment?

Research shows that hippotherapy, which uses horse movement in therapy, can improve muscle activity, motor function, and balance in children with cerebral palsy and other neuromuscular conditions. It has also been found helpful in improving walking ability in people recovering from a stroke. ^{1 2 3 4 5}

Is hippotherapy safe for humans?

Hippotherapy is generally considered safe and well-tolerated, with low rates of safety incidents requiring basic first aid (0.05% of sessions) or off-site care (0.01% of sessions). Recommended safety practices are widely adopted to manage the inherent risks of using horses in therapy. ^{3 6 7 8 9}

How is the treatment 'Physical Therapy Using Hippotherapy and the Equine Environment' different from other treatments for neuromotor impairment?

This treatment is unique because it uses the movement of a horse to help improve motor function and sensory processing in patients with neuromotor impairments. The horse's movement provides a three-dimensional motion that can positively affect posture and control systems, making it a novel approach compared to traditional physical therapy methods. ^{2 3 10 11 12}

What is the purpose of this trial?

The goal of this pilot clinical trial is to determine if physical therapy incorporating horses can improve the motor skills of the arms in children 6-17 years old with neuromotor disorders (such as cerebral palsy, spinal muscular atrophy, or spina bifida) compared to standard play-based physical therapy. The main questions it aims to answer are: 1. Is the study protocol feasible and acceptable for participants, that investigators could apply them to a larger trial? 2. Do participants make improvements toward their goals for motor function, arm use, and participation in life situations following treatment, and is it different between the experimental and comparative intervention groups? 3. What are the physiological, behavioral, and emotional responses of children receiving physical therapy incorporating horses, versus those receiving standard physical therapy? Researchers will compare the experimental group who receive physical therapy incorporating horses to the comparative intervention group who receive standard play-based physical therapy to see if there is a difference in outcomes. Participants will complete a pre- and post-intervention assessment of their motor function and participation in life situations. Participants will receive physical therapy twice a week for 8 weeks for the intervention. In both groups, physiological, behavioral, and emotional responses to the interventions will be measured in 4 total sessions, 1 each at weeks 2, 4, 6, and 8.

Eligibility Criteria

This trial is for children aged 6-17 with neuromotor disorders like cerebral palsy, spinal muscular atrophy, or spina bifida. They should be able to participate in physical therapy sessions twice a week for 8 weeks and complete assessments of their motor functions.

Inclusion Criteria

I can sit on a horse for 30 minutes without a break.

I meet the standards for horseback riding activities set by PATH Intl.

I am between 6 and 17 years old.

Exclusion Criteria

Caregivers unable to speak and read English

I cannot control my head movement on my own.

Fear of or aversion to horses

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Treatment

Participants receive physical therapy incorporating horses or standard play-based physical therapy, 2 sessions per week for 8 weeks

8 weeks

16 visits (in-person)

Assessment

Pre- and post-intervention assessments of motor function and participation in life situations

1 week

2 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Physical Therapy Using Hippotherapy and the Equine Environment

Trial Overview The study compares two types of physical therapy: one using horses (hippotherapy) and the standard play-based approach. It checks if hippotherapy can better improve arm motor skills and participation in life situations than the conventional method.

Participant Groups

Group I: Physical Therapy Using Hippotherapy and the Equine Environment Experimental Treatment 1 Intervention

Participants in the intervention group will receive 8 weeks of PT using hippotherapy and the equine environment, 2 x 1-hour sessions per week (16 hours total). Treatment will be provided by a licensed PT with the recommended training to incorporate hippotherapy and the equine environment into treatment (American Hippotherapy Association (AHA) Inc. Hippotherapy Treatment Principles Part I and II). Each therapist will work with an equine professional with PATH Intl. Therapeutic Riding Instructor Certification, to ensure that therapists adhere to industry standards for safety and handling of the equines.

Group II: Play-Based Physical Therapy Active Control 1 Intervention

Participants in the control group will receive 8 weeks of standard play-based PT, 2 x 1-hour sessions per week, for a total of 16 hours. The sessions will be implemented by a licensed PT.

Who Is Running the Clinical Trial?

University of Montana

Lead Sponsor

Trials

29

Recruited

4,700+

National Institute of General Medical Sciences (NIGMS)

Collaborator

Trials

315

Recruited

251,000+

Findings from Research

A comparison of physical therapy with hippotherapy and physical therapy alone in 315 children and adolescents with cerebral palsy showed that both interventions had similar effects on gross motor function, including measures like gait speed and stride length.

While the group receiving hippotherapy showed slightly greater improvements, these changes were not significant enough to be considered clinically meaningful, indicating that both therapies are effective but may not differ substantially in outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical therapy with hippotherapy compared to physical therapy alone in children with cerebral palsy: systematic review and meta-analysis. Santos de Assis, G., Schlichting, T., Rodrigues Mateus, B., et al.[2022]

Hippotherapy is primarily utilized by physical and occupational therapists for pediatric clients, with significant variations in practice patterns based on geographic location.

Safety practices in hippotherapy are effective, with very low rates of incidents requiring basic first aid (0.05% of sessions) or off-site care (0.01% of sessions), indicating that risks are well managed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hippotherapy Practice and Safety Patterns in the United States: A Descriptive Survey Study. Peters, BC., Fields, BE., Erdman, EA.[2021]

Hippotherapy utilizes the movement of horses as a therapeutic tool to help clients with neuromusculoskeletal dysfunction, such as those with cerebral palsy, by improving their functional abilities through engaging and enjoyable activities.

The controlled environment of hippotherapy allows therapists to adjust the horse's movements and sensory inputs, which can enhance neurological function and sensory processing, benefiting clients in their daily activities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hippotherapy. Meregillano, G.[2020]

References

1. United States pubmed.ncbi.nlm.nih.gov

Improvements in muscle symmetry in children with cerebral palsy after equine-assisted therapy (hippotherapy). [2004]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Hippotherapy: Remuneration issues impair the offering of this therapeutic strategy at Southern California rehabilitation centers. [2018]

3. Germany pubmed.ncbi.nlm.nih.gov

Use of hippotherapy in gait training for hemiparetic post-stroke. [2019]

4. England pubmed.ncbi.nlm.nih.gov

Physical therapy with hippotherapy compared to physical therapy alone in children with cerebral palsy: systematic review and meta-analysis. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Study of the therapeutic effects of a hippotherapy simulator in children with cerebral palsy: a stratified single-blind randomized controlled trial. [2014]

6. Turkey pubmed.ncbi.nlm.nih.gov

What is hippotherapy? The indications and effectiveness of hippotherapy. [2020]

7. England pubmed.ncbi.nlm.nih.gov

Hippotherapy in adults with acquired brain injury: A systematic review. [2020]

8. United States pubmed.ncbi.nlm.nih.gov

Hippotherapy Practice and Safety Patterns in the United States: A Descriptive Survey Study. [2021]

9. United States pubmed.ncbi.nlm.nih.gov

Analysis of the electromiographic activity of lower limb and motor function in hippotherapy practitioners with cerebral palsy. [2019]

10. Germany pubmed.ncbi.nlm.nih.gov

[Impact of therapeutic riding on gait and posture regulation]. [2009]

11. United States pubmed.ncbi.nlm.nih.gov

Hippotherapy. [2020]

12. England pubmed.ncbi.nlm.nih.gov

The short-term effect of hippotherapy on spasticity in patients with spinal cord injury. [2011]