A Randomized Feasibility Study of Rehabilitation Targeting Upper Extremity Function and Participation Using Hippotherapy and the Equine Environment for Children with Cerebral Palsy and Autism Spectrum Disorder.

Overview

• This study evaluated the feasibility of using hippotherapy and activities in an equine environment to improve upper extremity function and participation in daily life for children with cerebral palsy and autism spectrum disorder who have neuromotor impairments.
• The researchers conducted a small randomized trial to assess whether recruitment, retention, treatment delivery, and acceptance of this therapy were adequate to proceed to a larger clinical trial.

Background and Purpose

• Children with neuromotor impairments affecting their arms and hands often experience reduced ability to participate in everyday activities.
• Hippotherapy uses the movement of horses as a treatment tool and may provide benefits in a natural, community setting.
• This environment might engage children more fully in therapy, potentially improving both physical function of the upper limbs and overall participation.
• The study aimed to test the feasibility of a rehabilitation program combining hippotherapy and equine activities for children aged 6-17 with cerebral palsy and/or autism.
• Feasibility factors studied included recruitment success, retention rates, adherence to the therapy protocol, acceptability to participants, and the appropriateness of assessment measures.

Methods

• Location and Duration: Conducted in Ohio from June to December 2021 over 6 months.
• Participants: Included children 6-17 years old with upper extremity neuromotor impairments due to cerebral palsy and/or autism, screened for eligibility.
• Randomization: Participants were randomly assigned to either immediate treatment or a waitlist control group using REDCap software.
• Intervention: Treatment consisted of 16 total hours, delivered as 4 hours per week for 4 weeks, involving hippotherapy sessions and rehabilitation in the horse environment.
• Control group underwent a 4-week waitlist period before receiving the same treatment.
• Outcomes: Non-blinded clinical assessments targeting body structures, functions, activities, and participation were done before and after control and treatment periods.
• Feasibility outcomes monitored recruitment numbers, attendance, adherence to treatment protocols (fidelity), measurement completion rates, acceptability, and adverse events.

Results

• Screening: 26 children screened, of which 20 met criteria (77%) and 14 enrolled (70% of eligible), randomized into 6 controls and 8 treatment.
• Withdrawals: Two participants withdrew after randomization and one excluded due to fear of horses.
• Completion: 5 control and 6 treatment participants completed baseline assessments.
• Retention: 80% in control and 83% in treatment completed the study; slightly below the preset 85% retention criteria for feasibility.
• Assessment completion rates varied from 77% to 100%, indicating some outcome measures may need replacement to ensure data completeness.
• Treatment fidelity and acceptability were rated moderate to high, meaning the therapy was delivered as planned and accepted well by participants.
• No adverse events were reported related to study participation.

Conclusions and Implications

• The study provides preliminary evidence that using hippotherapy and equine environmental rehabilitation for improving upper extremity function is feasible and acceptable for children with neuromotor impairments.
• Some logistical improvements are needed, such as enhancing enrollment strategies, improving retention to meet benchmarks, and selecting better outcome measures to reduce missing data.
• These adjustments would support a larger, definitive randomized clinical trial to evaluate the efficacy of this intervention more fully.
• The safe nature of the intervention without adverse events supports its continued study and potential use.

Additional Information

• ClinicalTrials.gov ID: NCT0653068
• Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Foundation for Physical Therapy Research, American Academy of Cerebral Palsy and Developmental Medicine, and Pedal With Pete Foundation.