Short- and Mid-Term Improvement of Postural Balance after a Neurorehabilitation Program via Hippotherapy in Patients with Sensorimotor Impairment after Cerebral Palsy: A Preliminary Kinetic Approach

Abstract

There is still a lack of studies focused on trunk neurorehabilitation. Accordingly, it is unclear which therapeutic modalities are the most effective in improving static/dynamic balance after brain damage. We designed a pilot study on hippotherapy to assess its short- and mid-term effect on dynamic postural balance in patients with moderate-to-severe sensorimotor impairment secondary to cerebral palsy. Five patients aged 15.4 ± 6.1 years old were recruited. All of them had moderate-to-severe alterations of the muscle tone with associated postural balance impairment. Standing and walking were also impaired. Ten minutes horse riding simulator followed by twenty minutes hippotherapy session were conducted during five session days separated by one week each. We analyzed the displacement of the Center of Pressure (COP) on the sitting surface of the simulator's saddle by means of a customized pressure pad. We measured the general behavior of the COP displacement as well as the postural adjustments when pace changed from walk to trot to walk during the sessions and among sessions. Statistical analysis revealed an improved postural control both by the end of the session and from session 1 to session 5. These results suggest that hippotherapy might support regularization of postural control in a long-term neurorehabilitation context.

Keywords: cerebral palsy; hippotherapy; horse riding simulator; neural plasticity; neurorehabilitation; postural balance.

Conflict of interest statement

Authors John Carr and Bill Greenwood were employed by the company Racewood Ltd. All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1

(a) Photograph of the equine simulator; (b) Diagram of the equine simulator used in the hippotherapeutic treatment; (c) Diagram of the pressure sensitive saddle and the analyzed biomechanical variables.

Figure 2

General evolution of the COP Average radial displacement (ARD) for sessions 1 and 5. The figure shows the different pace changes during the acquisition (first 2 minutes and last 2 minutes).

Figure 3

(a) Box and whiskers diagram of the COP path length in mm/s of the first two min. versus the last two min. of sessions 1 and 5; (b) Box and whiskers diagram of the COP Average radial displacement (ARD) in mm of the first two min. versus the last two min. of sessions 1 and 5.

Figure 4

Box and whiskers diagram corresponding to intrasession comparison of: (a) COP path length during compensatory postural adjustment (CPA) and (b) COP average radial displacement during CPA at different times within each session during the three seconds that follow each pace change; (c) COP path length during anticipatory postural adjustment (APA) and (d) COP average radial displacement during APA at different times within each session during the three seconds before each pace change. D1 corresponds to session 1 and D5 to session 5.

Figure 5

Box and whiskers diagrams corresponding to the comparisons of COP path length (a) and COP average radial displacement (b) during compensatory postural adjustments (CPA) and the comparisons of COP path length (c) and COP average radial displacement (d) during anticipatory postural adjustments (APA) between corresponding pace changes of sessions 1 and 5. D1 corresponds to session 1 and D5 to session 5. p < 0.05 (*), p < 0.001 (***).

Figure 6

Comparison of consecutive compensatory versus anticipatory postural adjustments (CPA versus APA) for the two measured variables (COP path length and COP ARD) at different times during both sessions.