Neurorehabilitation through Hippotherapy on Neurofunctional Sequels of Stroke: Effect on Patients' Functional Independence, Sensorimotor/Cognitive Capacities and Quality of Life, and the Quality of Life of Their Caregivers-A Study Protocol

Hélène Viruega, Carole Imbernon, Nicolas Chausson, Tony Altarcha, Manvel Aghasaryan, Djibril Soumah, Edwige Lescieux, Constance Flamand-Roze, Olivier Simon, Arnaud Bedin, Didier Smadja, Manuel Gaviria, Hélène Viruega, Carole Imbernon, Nicolas Chausson, Tony Altarcha, Manvel Aghasaryan, Djibril Soumah, Edwige Lescieux, Constance Flamand-Roze, Olivier Simon, Arnaud Bedin, Didier Smadja, Manuel Gaviria

Abstract

Background: Stroke is a high burden illness and the second leading cause of worldwide disability with generally poor recovery rates. Robust benefits of hippotherapy, a novel neurorehabilitation approach, in functional recovery following various severe neurological disabling conditions has been shown. In the present study, we will analyze the effect of a hippotherapy program on the outcome of post-stroke patients in the first year post-stroke.

Method: A randomized controlled clinical trial on the effectiveness of hippotherapy (4 weeks/18 weeks hippotherapy/conventional neurorehabilitation) versus conventional neurorehabilitation alone (22 weeks) will be conducted over 48 weeks. In the treated group, one-hour daily hippotherapy sessions will be exclusively conducted during the hippotherapy's cycles, alternated with periods of conventional neurorehabilitation. A test battery will measure both the functional and psychological outcomes. The primary endpoint will be the patient's functional independence. The secondary endpoints will measure the sensorimotor function, autonomy, and quality of life, as well as the caregivers' quality of life.

Results and conclusion: Individual brain connectome, life history and personality construct influence the brain's functional connectivity and are central to developing optimal tailored neurorehabilitation strategies. According to our current practice, hippotherapy allows the enhancement of substantial neuroplastic changes in the injured brain with significant neurological recovery. The protocol aims to confirm those issues. Trial registration in ClinicalTrials.gov NCT04759326 accessed on 19 February 2021.

Keywords: autonomy; cerebrovascular accident; functional deficit; hippotherapy; neuroplasticity; neurorehabilitation; quality of life; silent neurofunctional barriers.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Protocol’s scheme.

References

    1. Johnson W., Onuma O., Owolabi M., Sachdev S. Stroke: A global response is needed. Bull. WHO. 2016;94:634. doi: 10.2471/BLT.16.181636.
    1. Hankey G.J. Stroke. Lancet. 2017;389:641–654. doi: 10.1016/S0140-6736(16)30962-X.
    1. Luengo-Fernandez R., Paul N.L., Gray A.M., Pendlebury S.T., Bull L.M., Welch S.J., Cuthbertson F.C., Rothwell P.M., Oxford Vascular Study Population-based study of disability and institutionalization after transient ischemic attack and stroke: 10-year results of the Oxford Vascular Study. Stroke. 2013;44:2854–2861. doi: 10.1161/STROKEAHA.113.001584.
    1. Rice D., Janzen S., McIntyre A., Vermeer J., Britt E., Teasell R. Comprehensive Outpatient Rehabilitation Program: Hospital-Based Stroke Outpatient Rehabilitation. J. Stroke Cerebrovasc. Dis. 2016;25:1158–1164. doi: 10.1016/j.jstrokecerebrovasdis.2016.02.007.
    1. Wissel J., Olver J., Sunnerhagen K.S. Navigating the poststroke continuum of care. J. Stroke Cerebrovasc. Dis. 2013;22:1–8. doi: 10.1016/j.jstrokecerebrovasdis.2011.05.021.
    1. Demain S., Wiles R., Roberts L., McPherson K. Recovery plateau following stroke: Fact or fiction? Disabil. Rehabil. 2006;28:815–821. doi: 10.1080/09638280500534796.
    1. Bernhardt J., Borschmann K., Boyd L., Carmichael S.T., Corbett D., Cramer S.C., Hoffmann T., Kwakkel G., Savitz S., Saposnik G., et al. Moving Rehabilitation Research Forward: Developing Consensus Statements for Rehabilitation and Recovery Research. Neurorehabil. Neural Repair. 2017;31:694–698. doi: 10.1177/1545968317724290.
    1. Bernhardt J., Hayward K.S., Kwakkel G., Ward N.S., Wolf S.L., Borschmann K., Krakauer J.W., Boyd L.A., Carmichael S.T., Corbett D., et al. Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce. Int. J. Stroke. 2017;12:444–450. doi: 10.1177/1747493017711816.
    1. Corbett D., Jeffers M., Nguemeni C., Gomez-Smith M., Livingston-Thomas J. Lost in translation: Rethinking approaches to stroke recovery. Prog. Brain Res. 2015;218:413–434. doi: 10.1016/bs.pbr.2014.12.002.
    1. Malá H., Rasmussen C.P. The effect of combined therapies on recovery after acquired brain injury: Systematic review of preclinical studies combining enriched environment, exercise, or task-specific training with other therapies. Restor. Neurol. Neurosci. 2017;35:25–64. doi: 10.3233/RNN-160682.
    1. Viruega H., Gaillard I., Briatte L., Gaviria M. Inter-Day Reliability and Changes of Surface Electromyography on Two Postural Muscles Throughout 12 Weeks of Hippotherapy on Patients with Cerebral Palsy: A Pilot Study. Brain Sci. 2020;10:281. doi: 10.3390/brainsci10050281.
    1. Viruega H., Gaillard I., Carr J., Greenwood B., Gaviria M. 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. Brain Sci. 2019;9:261. doi: 10.3390/brainsci9100261.
    1. Galeote A., Bastien L., Viruega H., Gaviria M. Neurological rehabilitation after severe traumatic brain injury, new tools new hopes: The hippotherapy approach. J. Neurol. Neurophysiol. 2014;5:231. doi: 10.4172/2155-9562.1000231.
    1. Sterba J.A. Does horseback riding therapy or therapist-directed hippotherapy rehabilitate children with cerebral palsy? Dev. Med. Child Neurol. 2007;49:68–73. doi: 10.1017/S0012162207000175.x.
    1. Bronson C., Brewerton K., Ong J., Palanca C., Sullivan S.J. Does hippotherapy improve balance in persons with multiple sclerosis: A systematic review. Eur. J. Phys. Rehabil. Med. 2010;46:347–353.
    1. Gabriels R.L., Pan Z., Dechant B., Agnew J.A., Brim N., Mesibov G. Randomized Controlled Trial of Therapeutic Horseback Riding in Children and Adolescents with Autism Spectrum Disorder. J. Am. Acad. Child Adolesc. Psychiatry. 2015;54:541–549. doi: 10.1016/j.jaac.2015.04.007.
    1. Han J.Y., Kim J.M., Kim S.K., Chung J.S., Lee H.C., Lim J.K., Lee J., Park K.Y. Therapeutic effects of mechanical horseback riding on gait and balance ability in stroke patients. Ann. Rehabil. Med. 2012;36:762–769. doi: 10.5535/arm.2012.36.6.762.
    1. McGibbon N.H., Benda W., Duncan B.R., Silkwood-Sherer D. Immediate and long-term effects of hippotherapy on symmetry of adductor muscle activity and functional ability in children with spastic cerebral palsy. Arch. Phys. Med. Rehabil. 2009;90:966–974. doi: 10.1016/j.apmr.2009.01.011.
    1. Shurtleff T.L., Standeven J.W., Engsberg J.R. Changes in dynamic trunk/head stability and functional reach after hippotherapy. Arch. Phys. Med. Rehabil. 2009;90:1185–1195. doi: 10.1016/j.apmr.2009.01.026.
    1. Kwon J.Y., Chang H.J., Lee J.Y., Ha Y., Lee P.K., Kim Y.H. Effects of hippotherapy on gait parameters in children with bilateral spastic cerebral palsy. Arch. Phys. Med. Rehabil. 2011;92:774–779. doi: 10.1016/j.apmr.2010.11.031.
    1. Silkwood-Sherer D.J., Killian C.B., Long T.M., Martin K.S. Hippotherapy—An intervention to habilitate balance deficits in children with movement disorders: A clinical trial. Phys. Ther. 2012;92:707–717. doi: 10.2522/ptj.20110081.
    1. Uchiyama H., Ohtani N., Ohta M. Three-dimensional analysis of horse and human gaits in therapeutic riding. Appl. Animal Behav. Sci. 2011;135:271–276. doi: 10.1016/j.applanim.2011.10.024.
    1. Fisher P.W., Lazarov A., Lowell A., Arnon S., Turner J.B., Bergman M., Ryba M., Such S., Marohasy C., Zhu X., et al. Equine-Assisted Therapy for Posttraumatic Stress Disorder Among Military Veterans: An Open Trial. J. Clin. Psychiatry. 2021;82:271–276. doi: 10.4088/JCP.21m14005.
    1. Menor-Rodríguez M.J., Sevilla Martín M., Sánchez-García J.C., Montiel-Troya M., Cortés-Martín J., Rodríguez-Blanque R. Role and Effects of Hippotherapy in the Treatment of Children with Cerebral Palsy: A Systematic Review of the Literature. J. Clin. Med. 2021;10:2589. doi: 10.3390/jcm10122589.
    1. Maresca G., Portaro S., Naro A., Crisafulli R., Raffa A., Scarcella I., Aliberti B., Gemelli G., Calabrò R.S. Hippotherapy in neurodevelopmental disorders: A narrative review focusing on cognitive and behavioral outcomes. Appl. Neuropsychol. Child. 2020:1–8. doi: 10.1080/21622965.2020.1852084.
    1. Moraes A.G., Neri S.G.R., Motl R.W., Tauil C.B., von Glehn F., Corrêa É.C., de David A.C. Effects of hippotherapy on postural balance, functional mobility, self-perceived fatigue, and quality of life in people with relapsing-remitting multiple sclerosis: Secondary results of an exploratory clinical trial. Mult. Scler. Relat. Disord. 2021;52:102948. doi: 10.1016/j.msard.2021.102948.
    1. Lee N., Park S., Kim J. Hippotherapy and neurofeedback training effect on the brain function and serum brain-derived neurotrophic factor level changes in children with attention-deficit or/and hyperactivity disorder. J. Exerc. Nutr. Biochem. 2017;21:35–42. doi: 10.20463/jenb.2017.0018.
    1. Bunketorp-Käll L., Lundgren-Nilsson Å., Samuelsson H., Pekny T., Blomvé K., Pekna M., Pekny M., Blomstrand C., Nilsson M. Long-Term Improvements After Multimodal Rehabilitation in Late Phase After Stroke: A Randomized Controlled Trial. Stroke. 2017;48:1916–1924. doi: 10.1161/STROKEAHA.116.016433.
    1. Bunketorp-Käll L., Pekna M., Pekny M., Blomstrand C., Nilsson M. Effects of horse-riding therapy and rhythm and music-based therapy on functional mobility in late phase after stroke. NeuroRehabilitation. 2019;45:483–492. doi: 10.3233/NRE-192905.
    1. Pohl P., Carlsson G., Bunketorp-Käll L., Nilsson M., Blomstrand C. A qualitative exploration of post-acute stroke participants’ experiences of a multimodal intervention incorporating horseback riding. PLoS ONE. 2018;13:e0203933. doi: 10.1371/journal.pone.0203933.
    1. Beinotti F., Correia N., Christofoletti G., Borges G. Use of hippotherapy in gait training for hemiparetic post-stroke. Arq. Neuropsiquiatr. 2010;68:908–913. doi: 10.1590/S0004-282X2010000600015.
    1. Beinotti F., Christofoletti G., Correia N., Borges G. Effects of horseback riding therapy on quality of life in patients post stroke. Top Stroke Rehabil. 2013;20:226–232. doi: 10.1310/tsr2003-226.
    1. Sung Y.H., Kim C.J., Yu B.K., Kim K.M. A hippotherapy simulator is effective to shift weight bearing toward the affected side during gait in patients with stroke. NeuroRehabilitation. 2013;33:407–412. doi: 10.3233/NRE-130971.
    1. Kim Y.N., Lee D.K. Effects of horse-riding exercise on balance, gait, and activities of daily living in stroke patients. J. Phys. Ther. Sci. 2015;27:607–609. doi: 10.1589/jpts.27.607.
    1. Gaviria M., Celeghin A., Michael-Titus A.T., Pallier P.N. Editorial: Brain Plasticity and Contribution of the Emotional Brain to Neural Remodelling After Injury. Front. Neurol. 2020;11:606271. doi: 10.3389/fneur.2020.606271.
    1. Bromberg P.M. Standing in the Spaces: Essays on Clinical Process, Trauma, and Dissociation. Analytic Press; Hillsdale, NJ, USA: 1998. p. 376.
    1. Chumney D., Nollinger K., Shesko K., Skop K., Spencer M., Newton R.A. Ability of Functional Independence Measure to accurately predict functional outcome of stroke-specific population: Systematic review. J. Rehabil. Res. Dev. 2010;47:17–29. doi: 10.1682/JRRD.2009.08.0140.
    1. Bonita R., Beaglehole R. Recovery of motor function after stroke. Stroke. 1988;19:1497–1500. doi: 10.1161/01.STR.19.12.1497.
    1. Kasner S.E. Clinical interpretation and use of stroke scales. Lancet Neurol. 2006;5:603–612. doi: 10.1016/S1474-4422(06)70495-1.
    1. Fugl-Meyer A.R., Jääskö L., Leyman I., Olsson S., Steglind S. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand. J. Rehabil. Med. 1975;7:13–31.
    1. Berg K.O., Wood-Dauphinee S.L., Williams J.I., Maki B. Measuring balance in the elderly: Validation of an instrument. Can. J. Public Health. 1992;83((Suppl. 2)):S7–S11.
    1. Blum L., Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: A systematic review. Phys. Ther. 2008;88:559–566. doi: 10.2522/ptj.20070205.
    1. Hiengkaew V., Jitaree K., Chaiyawat P. Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed “Up & Go” Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone. Arch. Phys. Med. Rehabil. 2012;93:1201–1208. doi: 10.1016/j.apmr.2012.01.014.
    1. Ware J., Jr., Kosinski M., Keller S.D. A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Med. Care. 1996;34:220–233. doi: 10.1097/00005650-199603000-00003.
    1. Zarit S.H., Reever K.E., Bach-Peterson J. Relatives of the impaired elderly: Correlates of feelings of burden. Gerontologist. 1980;20:649–655. doi: 10.1093/geront/20.6.649.
    1. Caro C.C., Costa J.D., Da Cruz D.M.C. Burden and Quality of Life of Family Caregivers of Stroke Patients. Occup. Ther. Health Care. 2018;32:154–171. doi: 10.1080/07380577.2018.1449046.
    1. Rode G., Lacour S., Jacquin-Courtois S., Pisella L., Michel C., Revol P., Alahyane N., Luauté J., Gallagher S., Halligan P., et al. Long-term sensorimotor and therapeutical effects of a mild regime of prism adaptation in spatial neglect. A double-blind RCT essay. Ann. Phys. Rehabil. Med. 2015;58:40–53. doi: 10.1016/j.rehab.2014.10.004.
    1. Alisar D.C., Ozen S., Sozay S. Effects of Bihemispheric Transcranial Direct Current Stimulation on Upper Extremity Function in Stroke Patients: A randomized Double-Blind Sham-Controlled Study. J. Stroke Cerebrovasc. Dis. 2020;29:104454. doi: 10.1016/j.jstrokecerebrovasdis.2019.104454.
    1. Pitron V., Alsmith A., De Vignemont F. How do the body schema and the body image interact? Conscious Cogn. 2018;65:352–358. doi: 10.1016/j.concog.2018.08.007.
    1. Pollock A., Baer G., Campbell P., Choo P.L., Forster A., Morris J., Pomeroy V.M., Langhorne P. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database Syst. Rev. 2014;2014:CD001920. doi: 10.1002/14651858.CD001920.pub3.
    1. Slade A., Tennant A., Chamberlain M.A. A randomised controlled trial to determine the effect of intensity of therapy upon length of stay in a neurological rehabilitation setting. J. Rehabil. Med. 2002;34:260–266. doi: 10.1080/165019702760390347.
    1. Königs M., Beurskens E.A., Snoep L., Scherder E.J., Oosterlaan J. Effects of Timing and Intensity of Neurorehabilitation on Functional Outcome After Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Arch. Phys. Med. Rehabil. 2018;99:1149–1159.e1. doi: 10.1016/j.apmr.2018.01.013.
    1. Frasca D., Tomaszczyk J., McFadyen B.J., Green R.E. Traumatic brain injury and post-acute decline: What role does environmental enrichment play? A scoping review. Front. Hum. Neurosci. 2013;7:31. doi: 10.3389/fnhum.2013.00031.
    1. Khan F., Amatya B., Galea M.P., Gonzenbach R., Kesselring J. Neurorehabilitation: Applied neuroplasticity. J. Neurol. 2017;264:603–615. doi: 10.1007/s00415-016-8307-9.
    1. Viruega H., Gaviria M. Functional Weight of Somatic and Cognitive Networks and Asymmetry of Compensatory Mechanisms: Collaboration or Divergency among Hemispheres after Cerebrovascular Accident? Life. 2021;11:495. doi: 10.3390/life11060495.
    1. Diaz Heijtz R., Kolb B., Forssberg H. Can a therapeutic dose of amphetamine during pre-adolescence modify the pattern of synaptic organization in the brain? Eur. J. Neurosci. 2003;18:3394–3399. doi: 10.1046/j.0953-816X.2003.03067.x.
    1. Horn G. Pathways of the past: The imprint of memory. Nat. Rev. Neurosci. 2004;5:108–120. doi: 10.1038/nrn1324.
    1. Kolb B., Muhammad A. Harnessing the power of neuroplasticity for intervention. Front. Hum. Neurosci. 2014;8:377. doi: 10.3389/fnhum.2014.00377.
    1. Lee C.W., Kim S.G., Yong M.S. Effects of hippotherapy on recovery of gait and balance ability in patients with stroke. J. Phys. Ther. Sci. 2014;26:309–311. doi: 10.1589/jpts.26.309.
    1. Koroleva E.S., Tolmachev I.V., Alifirova V.M., Boiko A.S., Levchuk L.A., Loonen A.J.M., Ivanova S.A. Serum BDNF’s Role as a Biomarker for Motor Training in the Context of AR-Based Rehabilitation after Ischemic Stroke. Brain Sci. 2020;10:623. doi: 10.3390/brainsci10090623.
    1. Delgado M., Ganea D. Anti-inflammatory neuropeptides: A new class of endogenous immunoregulatory agents. Brain Behav. Immun. 2008;22:1146–1151. doi: 10.1016/j.bbi.2008.06.001.
    1. Janura M., Peham C., Dvorakova T., Elfmark M. An assessment of the pressure distribution exerted by a rider on the back of a horse during hippotherapy. Hum. Mov. Sci. 2009;28:387–393. doi: 10.1016/j.humov.2009.04.001.
    1. Witte K., Schobesberger H., Peham C. Motion pattern analysis of gait in horseback riding by means of Principal Component Analysis. Hum. Mov. Sci. 2009;28:394–405. doi: 10.1016/j.humov.2009.04.002.
    1. Mayo N.E., Anderson S., Barclay R., Cameron J.I., Desrosiers J., Eng J.J., Huijbregts M., Kagan A., MacKay-Lyons M., Moriello C., et al. Getting on with the rest of your life following stroke: A randomized trial of a complex intervention aimed at enhancing life participation post stroke. Clin. Rehabil. 2015;29:1198–1211. doi: 10.1177/0269215514565396.
    1. Duncan F., Kutlubaev M.A., Dennis M.S., Greig C., Mead G.E. Fatigue after stroke: A systematic review of associations with impaired physical fitness. Int. J. Stroke. 2012;7:157–162. doi: 10.1111/j.1747-4949.2011.00741.x.
    1. Gebruers N., Vanroy C., Truijen S., Engelborghs S., De Deyn P.P. Monitoring of physical activity after stroke: A systematic review of accelerometry-based measures. Arch. Phys. Med. Rehabil. 2010;91:288–297. doi: 10.1016/j.apmr.2009.10.025.
    1. Lincoln N.B., Brinkmann N., Cunningham S., Dejaeger E., De Weerdt W., Jenni W., Mahdzir A., Putman K., Schupp W., Schuback B., et al. Anxiety and depression after stroke: A 5 year follow-up. Disabil. Rehabil. 2013;35:140–145. doi: 10.3109/09638288.2012.691939.
    1. Gadidi V., Katz-Leurer M., Carmeli E., Bornstein N.M. Long-term outcome poststroke: Predictors of activity limitation and participation restriction. Arch. Phys. Med. Rehabil. 2011;92:1802–1808. doi: 10.1016/j.apmr.2011.06.014.
    1. Chevreul K., Durand-Zaleski I., Gouépo A., Fery-Lemonnier E., Hommel M., Woimant F. Cost of stroke in France. Eur. J. Neurol. 2013;20:1094–1100. doi: 10.1111/ene.12143.
    1. Schmidt A., Heroum C., Caumette D., Le Lay K., Bénard S. Acute Ischemic Stroke (AIS) patient management in French stroke units and impact estimation of thrombolysis on care pathways and associated costs. Cerebrovasc. Dis. 2015;39:94–101. doi: 10.1159/000369525.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner