Efficacy Hippotherapy on Postural Asymmetries and Balance in Adolescents With Idiopathic Scoliosis

Effects of Hippotherapy on Postural Asymmetries and Balance in Adolescents With Idiopathic Scoliosis: a Randomized Controlled Study

This study showed that the addition of hippotherapy to Schroth exercises is more effective in improving postural asymmetry and balance ability in adolescents with idiopathic scoliosis compared to Schroth exercises alone. Therefore, this combination should be considered during designing a rehabilitation program for AIS

Study Overview

• Status: Completed
• Conditions: Idiopathic Scoliosis; Equine-assisted Therapy
• Intervention / Treatment: Other: Hippotherapy

Detailed Description

The hippotherapy program started with a physical therapy assessment to develop specific corrective movements to be practiced while riding the horse based on the direction of the spinal curvature. Interventions were performed by a licensed physical therapist experienced with hippotherapy at two local therapeutic riding centers. The participants received 15 sessions split into two phases over 10 weeks. In the first phase, during the first 5 weeks, they performed 30 minutes of walking and sitting trot training without a stirrup iron once a week. The frequency was then raised to twice a week for the rest of the treatment program. Before the start of the intervention, two familiarization sessions were given to clarify safety guidelines, riding mistakes, and create a riding rapport with the horse. The individuals wore protective helmets during each hippotherapy session and mounted on a moving horse on walk and/or trot performing different positions, namely forward astride, side sitting, backward astride, sometimes with transitions between positions and often while the horse was moving. To restore normal alignment of the spine, participants were also asked to ride without holding on with their hands to perform self-correction movements. Examples of these movements include raising both arms high to decrease the degree of thoracic kyphosis, bending the upper trunk towards the convex side of the curve, raising the arm on the concave side with scapular adduction to level both shoulders. To correct pelvic obliquity, a small pad was put under the hip on the side of the lumbar convexity. Under the instructions of the physical therapist, a leader pulled the horse reins in front to control the horse gait, gait velocity, and orient the horse in different directions . All these movements activate the patient's neuromuscular and sensory reactions.

Both groups performed Schroth exercises that are patient-specific asymmetric exercises with rotational breathing methods used for three-dimensional correction. For the first 2 weeks, there were five 1-h long individual sessions during which the participants were trained in their home exercise program. This was followed by 1-h weekly visits and paired with their daily home exercises. These exercises aimed to provide and promote enhanced postural control by using asymmetrical standing postural exercises specifically designed to restore body balance and mobility. During ground exercises, aid pads were used to build pressure for costal protrusions and/or trunk asymmetry correction. Postural correction was facilitated by rotational breathing exercises focusing on the concave side of the thorax. During the therapy sessions, postural correction principles of the Schroth process, axial elongation, deflection, de-rotation, facilitation, stabilization, were used.

• Study Type: Interventional
• Enrollment (Actual): 52
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Saudi Arabia
  • Makkah
    • Jeddah, Makkah, Saudi Arabia, 21442
      • Batterjee Medical College

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 10 years to 18 years (ADULT, CHILD)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• AIS,
• all curve types,
• curves with Cobb angle ranged between 10 and 25 degrees,
• a Risser grade 0 to 5, and
• the ability to attend weekly visits.

Exclusion Criteria:

• Children with any significant history of riding horses,
• with diagnosis other than AIS,
• having other treatment which might affect scoliosis,
• having chronic diseases requiring any drug usage,
• presence of other neurologic, muscular or rheumatic diseases, and
• having non-idiopathic scoliosis.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: HEALTH_SERVICES_RESEARCH
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: DOUBLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Study group; Twenty six patients who received hippotherapy combined with Schroth exercises for ten weeks	Other: Hippotherapy; The hippotherapy program for 10 weeks; Other Names: Schroth exercises
OTHER: Control group; Twenty six patients who received only Schroth exercises for ten weeks	Other: Hippotherapy; The hippotherapy program for 10 weeks; Other Names: Schroth exercises

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Scoliotic angle un degrees	Measured by formatric 4-D system	10 weeks
Kyphotic angle in degrees	Measured by formatric 4-D system	10 weeks
Pelvic obliquity in degrees	Measured by formatric 4-D system	10 weeks
Pelvic torsion in degrees	Measured by formatric 4-D system	10 weeks
Vertical spinal rotation in degrees	Measured by formatric 4-D system	10 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall balance index	Measured by Biodex Balance System	10 weeks
Anteroposterior balance index	Measured by Biodex Balance System	10 weeks
Mediolateral balance index	Measured by Biodex Balance System	10 weeks

Collaborators and Investigators

• Sponsor: Batterjee Medical College
• Collaborators: Taif University
• Investigators: Principal Investigator: Amr A AbdelAziem, Ph.D, Tyiaf University, Saudi Arabia

Study record dates

Study Major Dates

• Study Start (ACTUAL): February 20, 2020
• Primary Completion (ACTUAL): December 18, 2020
• Study Completion (ACTUAL): March 7, 2021

Study Registration Dates

• First Submitted: May 4, 2021
• First Submitted That Met QC Criteria: May 9, 2021
• First Posted (ACTUAL): May 13, 2021

Study Record Updates

• Last Update Posted (ACTUAL): May 13, 2021
• Last Update Submitted That Met QC Criteria: May 9, 2021
• Last Verified: May 1, 2021

More Information

Terms related to this study

• Keywords: Balance; Hipptherapy; Formateric; Schroth exercises
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Spinal Diseases; Bone Diseases; Spinal Curvatures; Scoliosis
• Other Study ID Numbers: Batterjee Medical College; (TURSP-2020/82) (OTHER_GRANT: Taif University, Saudi Arabia)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Data Will Be available only for third parties

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No