FREE SHIPPING over $40
OVER 9000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Home / Equine Research Bank / Eur J Pediatr / Effect of hippotherapy on balance, functional mobility, and ...
European journal of pediatrics2023; 182(7); 3147-3155; doi: 10.1007/s00431-023-04959-5

Effect of hippotherapy on balance, functional mobility, and functional independence in children with Down syndrome: randomized controlled trial.

Abstract: Impaired muscle strength, proprioceptive and vestibular deficits, and orthopedic dysfunction are common disorders associated with Down syndrome (DS). Hippotherapy uses the horses' multidimensional movement to improve posture, balance, and overall function, both motor and sensory. Research evidence supports hippotherapy as an effective, medically recognized intervention for the rehabilitation of gross motor skills. The aim of this study was to determine the effect of hippotherapy on balance, functional mobility, and functional independence in children with DS. Thirty-four children with DS were randomly assigned to the experimental (hippotherapy) and control groups after the initial assessment. Both groups received physiotherapy including balance exercises, and the experimental group also received hippotherapy as an integrative therapy. Pediatric Balance Scale (PBS), Timed Up and Go Test (TUG), and Functional Independence Measure for Children (WeeFIM) were used before and after the intervention. Baseline outcome measures (PBS, TUG, WeeFIM) were statistically similar between groups (p > 0.05). After the intervention, PBS and TUG scores improved in both groups (p < 0.05). On the other hand, WeeFIM scores improved just in the hippotherapy group (p < 0.05).   Conclusion: Therefore, providing hippotherapy as an integrative therapy to physiotherapy will be more effective in improving the functional independence of children with DS.    Trial registration: NCT05297149 (March 2022, retrospectively registered). What is Known: • Hippotherapy has an improvement effect on balance and functional independence in different diseases and age groups, but the evidence is limited in DS. • There is limited evidence about the effect of hippotherapy on functional mobility in different diseases and age groups, but there is no evidence in DS. What is New: • Hippotherapy is a safe and effective approach to support improvement in functional independence in children with DS.
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Get Full Text
Publication Date: 2023-04-26 PubMed ID: 37186034PubMed Central: 4540861DOI: 10.1007/s00431-023-04959-5Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Randomized Controlled Trial
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research focused on investigating the impacts of hippotherapy, an intervention using horses’ movement, on children with Down syndrome (DS) and found that it significantly improved their balance, functional mobility, and independence.

Understanding Down Syndrome and Hippotherapy

  • Down syndrome (DS) is typically associated with deficient muscle strength, dysfunctional proprioception and vestibular systems, and orthopedic complications.
  • Hippotherapy is a therapeutic measure that utilizes the multidimensional movement of horses to enhance postural correction, balance, and overall motor and sensory function.
  • Previous scientific evidence has confirmed hippotherapy’s effectiveness in the rehabilitation of gross motor skills.

The Study

  • The study implemented a control group and experimental design, involving 34 children with DS who were equally distributed into each group after an initial assessment.
  • Both groups underwent physiotherapy comprising balance exercises, but the experimental group also received hippotherapy as part of their regimen for comparison.
  • The Pediatric Balance Scale (PBS), Timed Up and Go Test (TUG), and Functional Independence Measure for Children (WeeFIM) were used before and after the experiment to assess changes.
  • Baseline measurements obtained from the PBS, TUG, and WeeFIM tests demonstrated no significant statistical difference between the two groups, meaning both sets of children initially had similar capabilities.

Results and Conclusion

  • After the intervention, it was observed that PBS and TUG scores, which measured balance and functional mobility, improved in both physiotherapy-only and physiotherapy plus hippotherapy groups, indicating that physiotherapy was effective.
  • Significantly, only the hippotherapy group demonstrated an improvement in their WeeFIM scores, implying a greater degree of functional independence in children who received the therapeutic horse-riding sessions.
  • Consequently, the study concluded that integrating hippotherapy with physiotherapy can be more effective in promoting functional independence for children with DS.

Implications and New Knowledge

  • Although it was already known that hippotherapy could enhance balance and functional independence in various diseases and age groups, evidence was lacking for DS.
  • This study thus provides new evidence that hippotherapy can be a safe and effective method to improve functional independence in children with DS, further underlining its potential therapeutic utility in this specific population.

Cite This Article

APA
Kaya Y, Saka S, Tuncer D. (2023). Effect of hippotherapy on balance, functional mobility, and functional independence in children with Down syndrome: randomized controlled trial. Eur J Pediatr, 182(7), 3147-3155. https://doi.org/10.1007/s00431-023-04959-5

Publication

European journal of pediatrics
ISSN: 1432-1076
NlmUniqueID: 7603873
Country: Germany
Language: English
Volume: 182
Issue: 7
Pages: 3147-3155

Researcher Affiliations

Kaya, Yelda
  • Physiotherapy Rehabilitation Department, Institute for Graduate Studies, Haliç University, Istanbul, Turkey.
Saka, Seda
  • Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Haliç University, Istanbul, Turkey. fztsedasaka@gmail.com.
Tuncer, Deniz
  • Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey.

MeSH Terms

  • Child
  • Humans
  • Animals
  • Horses
  • Functional Status
  • Down Syndrome / complications
  • Down Syndrome / therapy
  • Cerebral Palsy
  • Equine-Assisted Therapy / methods
  • Postural Balance / physiology
  • Time and Motion Studies

References

This article includes 43 references
  1. Palisano RJ, Walter SD, Russell DJ, Rosenbaum PL, Gémus M, Galuppi BE, Cunningham L. Gross motor function of children with down syndrome: creation of motor growth curves.. Arch Phys Med Rehabil 2001 Apr;82(4):494-500.
    doi: 10.1053/apmr.2001.21956pubmed: 11295010google scholar: lookup
  2. Vicari S. Motor development and neuropsychological patterns in persons with Down syndrome.. Behav Genet 2006 May;36(3):355-64.
    doi: 10.1007/s10519-006-9057-8pubmed: 16505965google scholar: lookup
  3. Cabeza-Ruiz R, García-Massó X, Centeno-Prada RA, Beas-Jiménez JD, Colado JC, González LM. Time and frequency analysis of the static balance in young adults with Down syndrome.. Gait Posture 2011 Jan;33(1):23-8.
    doi: 10.1016/j.gaitpost.2010.09.014pubmed: 20980150google scholar: lookup
  4. Jain PD, Nayak A, Karnad SD, Doctor KN. Gross motor dysfunction and balance impairments in children and adolescents with Down syndrome: a systematic review.. Clin Exp Pediatr 2022 Mar;65(3):142-149.
    doi: 10.3345/cep.2021.00479pubmed: 34126707google scholar: lookup
  5. Graham HK, Harvey A, Rodda J, Nattrass GR, Pirpiris M. The Functional Mobility Scale (FMS).. J Pediatr Orthop 2004 Sep-Oct;24(5):514-20.
    doi: 10.1097/01241398-200409000-00011pubmed: 15308901google scholar: lookup
  6. Volman MJ, Visser JJ, Lensvelt-Mulders GJ. Functional status in 5 to 7-year-old children with Down syndrome in relation to motor ability and performance mental ability.. Disabil Rehabil 2007 Jan 15;29(1):25-31.
    doi: 10.1080/09638280600947617pubmed: 17364754google scholar: lookup
  7. Shields N, Plant S, Warren C, Wollersheim D, Peiris C. Do adults with Down syndrome do the same amount of physical activity as adults without disability? A proof of principle study.. J Appl Res Intellect Disabil 2018 May;31(3):459-465.
    doi: 10.1111/jar.12416pubmed: 28960662google scholar: lookup
  8. American Hippotherapy Association. Inc. statements of best practice for the use of hippotherapy by occupational therapy, Physical Therapy, and Speech-Language Pathology Professionals. .
  9. Espindula AP. Effects of hippotherapy on posture in individuals with Down syndrome. Fisioterapia em Movimento 29:497–506.
    doi: 10.1590/1980-5918.029.003.AO07google scholar: lookup
  10. Wood WH, Fields BE. Hippotherapy: a systematic mapping review of peer-reviewed research, 1980 to 2018.. Disabil Rehabil 2021 May;43(10):1463-1487.
    doi: 10.1080/09638288.2019.1653997pubmed: 31491353google scholar: lookup
  11. Potvin-Bélanger A, Vincent C, Freeman A, Flamand VH. Impact of hippotherapy on the life habits of children with disabilities: a systematic review.. Disabil Rehabil 2022 Dec;44(26):8161-8175.
    doi: 10.1080/09638288.2021.2012847pubmed: 35043743google scholar: lookup
  12. Maresca G, Portaro S, Naro A, Crisafulli R, Raffa A, Scarcella I, Aliberti B, Gemelli G, Calabrò RS. Hippotherapy in neurodevelopmental disorders: a narrative review focusing on cognitive and behavioral outcomes.. Appl Neuropsychol Child 2022 Jul-Sep;11(3):553-560.
    doi: 10.1080/21622965.2020.1852084pubmed: 33949903google scholar: lookup
  13. Portaro S, Cacciola A, Naro A, Cavallaro F, Gemelli G, Aliberti B, De Luca R, Calabrò RS, Milardi D. Can Individuals with Down Syndrome Benefit from Hippotherapy? An Exploratory Study on Gait and Balance.. Dev Neurorehabil 2020 Aug;23(6):337-342.
    doi: 10.1080/17518423.2019.1646830pubmed: 31342817google scholar: lookup
  14. Champagne D, Dugas C. Improving gross motor function and postural control with hippotherapy in children with Down syndrome: case reports.. Physiother Theory Pract 2010 Nov;26(8):564-71.
    doi: 10.3109/09593981003623659pubmed: 20673078google scholar: lookup
  15. Franjoine MR, Gunther JS, Taylor MJ. Pediatric balance scale: a modified version of the berg balance scale for the school-age child with mild to moderate motor impairment.. Pediatr Phys Ther 2003 Summer;15(2):114-28.
    doi: 10.1097/01.PEP.0000068117.48023.18pubmed: 17057441google scholar: lookup
  16. Bennie S. Measurements of balance: comparison of the Timed “Up and Go” test and Functional Reach test with the Berg Balance Scale. J Phys Ther Sci 15(2):93–97.
    doi: 10.1589/jpts.15.93google scholar: lookup
  17. Nicolini-Panisson RD, Donadio MV. Normative values for the Timed 'Up and Go' test in children and adolescents and validation for individuals with Down syndrome.. Dev Med Child Neurol 2014 May;56(5):490-7.
    doi: 10.1111/dmcn.12290pubmed: 24206424google scholar: lookup
  18. Msall ME. WeeFIM: normative sample of an instrument for tracking functional independence in children. Clin Pediatr 33(7):431–438.
    doi: 10.1177/000992289403300709google scholar: lookup
  19. Tur BS, Küçükdeveci AA, Kutlay S, Yavuzer G, Elhan AH, Tennant A. Psychometric properties of the WeeFIM in children with cerebral palsy in Turkey.. Dev Med Child Neurol 2009 Sep;51(9):732-8.
    doi: 10.1111/j.1469-8749.2008.03255.xpubmed: 19207295google scholar: lookup
  20. Maïano C, Hue O, Lepage G, Morin AJS, Tracey D, Moullec G. Do Exercise Interventions Improve Balance for Children and Adolescents With Down Syndrome? A Systematic Review.. Phys Ther 2019 May 1;99(5):507-518.
    pubmed: 31089706doi: 10.1093/ptj/pzz012google scholar: lookup
  21. Champagne D, Corriveau H, Dugas C. Effect of Hippotherapy on Motor Proficiency and Function in Children with Cerebral Palsy Who Walk.. Phys Occup Ther Pediatr 2017 Feb;37(1):51-63.
    doi: 10.3109/01942638.2015.1129386pubmed: 26930110google scholar: lookup
  22. Silkwood-Sherer DJ, Killian CB, Long TM, Martin KS. Hippotherapy--an intervention to habilitate balance deficits in children with movement disorders: a clinical trial.. Phys Ther 2012 May;92(5):707-17.
    doi: 10.2522/ptj.20110081pubmed: 22247403google scholar: lookup
  23. Diniz LH, de Mello EC, Ribeiro MF, Lage JB, Bevilacqua Júnior DE, Ferreira AA, Ferraz MLDF, Rosa RC, Teixeira VPA, Espindula AP. Impact of hippotherapy for balance improvement and flexibility in elderly people.. J Bodyw Mov Ther 2020 Apr;24(2):92-97.
    doi: 10.1016/j.jbmt.2019.10.002pubmed: 32507159google scholar: lookup
  24. Giagazoglou P, Arabatzi F, Dipla K, Liga M, Kellis E. Effect of a hippotherapy intervention program on static balance and strength in adolescents with intellectual disabilities.. Res Dev Disabil 2012 Nov-Dec;33(6):2265-70.
    doi: 10.1016/j.ridd.2012.07.004pubmed: 22853887google scholar: lookup
  25. Casady RL, Nichols-Larsen DS. The effect of hippotherapy on ten children with cerebral palsy.. Pediatr Phys Ther 2004 Fall;16(3):165-72.
    doi: 10.1097/01.PEP.0000136003.15233.0Cpubmed: 17057544google scholar: lookup
  26. McGibbon NH, Benda W, Duncan BR, 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 Jun;90(6):966-74.
    doi: 10.1016/j.apmr.2009.01.011pubmed: 19480872google scholar: lookup
  27. Koca TT, Ataseven H. What is hippotherapy? The indications and effectiveness of hippotherapy.. North Clin Istanb 2015;2(3):247-252.
    pubmed: 28058377doi: 10.14744/nci.2016.71601google scholar: lookup
  28. Cho SH, Kim JW, Kim SR, Cho BJ. Effects of horseback riding exercise therapy on hormone levels in elderly persons.. J Phys Ther Sci 2015 Jul;27(7):2271-3.
    doi: 10.1589/jpts.27.2271pubmed: 26311966pmc: 4540861google scholar: lookup
  29. de Araújo TB, de Oliveira RJ, Martins WR, de Moura Pereira M, Copetti F, Safons MP. Effects of hippotherapy on mobility, strength and balance in elderly.. Arch Gerontol Geriatr 2013 May-Jun;56(3):478-81.
    doi: 10.1016/j.archger.2012.12.007pubmed: 23290005google scholar: lookup
  30. Hilgers M, Nielsen E. The efficacy of hippotherapy for physical rehabilitation: a systematic review. Dissertation, University of North Dakota .
  31. Lee CW, Kim SG, Na SS. The effects of hippotherapy and a horse riding simulator on the balance of children with cerebral palsy.. J Phys Ther Sci 2014 Mar;26(3):423-5.
    doi: 10.1589/jpts.26.423pubmed: 24707098pmc: 3976017google scholar: lookup
  32. Janura M. The variability of a horse’s movement at walk in hippotherapy. Kinesiology 44(2):148–154.
  33. Moraes AG, Copetti F, Angelo VR, Chiavoloni LL, David AC. The effects of hippotherapy on postural balance and functional ability in children with cerebral palsy.. J Phys Ther Sci 2016 Aug;28(8):2220-6.
    doi: 10.1589/jpts.28.2220pubmed: 27630401pmc: 5011565google scholar: lookup
  34. Sterba JA. Does horseback riding therapy or therapist-directed hippotherapy rehabilitate children with cerebral palsy?. Dev Med Child Neurol 2007 Jan;49(1):68-73.
    doi: 10.1017/S0012162207000175.xpubmed: 17209981google scholar: lookup
  35. Shurtleff TL, Standeven JW, Engsberg JR. Changes in dynamic trunk/head stability and functional reach after hippotherapy.. Arch Phys Med Rehabil 2009 Jul;90(7):1185-95.
    doi: 10.1016/j.apmr.2009.01.026pubmed: 19577032google scholar: lookup
  36. Tiwari D, Rao BK, Solomon J. Normative scores on Pediatric Balance Scale: a cross sectional study. Physiotherapy and Occupational Therapy 5(2):45.
  37. Beerse M, Lelko M, Wu J. Biomechanical analysis of the timed up-and-go (TUG) test in children with and without Down syndrome.. Gait Posture 2019 Feb;68:409-414.
    doi: 10.1016/j.gaitpost.2018.12.027pubmed: 30594868google scholar: lookup
  38. Pauletti Oliveira MF. Biopsychosocial factors related to postural sway during sit-to-stand movement in children and adolescents with Down syndrome: a cross-sectional study. Percept Mot Skills p. 00315125221133432.
  39. Salem EE. Hippotherapy therapeutic effect on postural balance in children with Down syndrome: systematic review. Med J Cairo Univ 90(6):1231–1237.
  40. Milbrandt TA, Johnston CE 2nd. Down syndrome and scoliosis: a review of a 50-year experience at one institution.. Spine (Phila Pa 1976) 2005 Sep 15;30(18):2051-5.
    doi: 10.1097/01.brs.0000179100.54453.72pubmed: 16166894google scholar: lookup
  41. Abdel-Aziem AA. A 10-week program of combined hippotherapy and Scroth’s exercises improves balance and postural asymmetries in adolescence idiopathic scoliosis: a randomized controlled study. Children 9(1):23.
    doi: 10.3390/children9010023google scholar: lookup
  42. Rezapour-Nasrabad R, Tayyar-Iravanlou F. Hippotherapy and its effect on behavioral and executive disorders in children with autism spectrum disorder. J Adv Pharm Res 12(3).
  43. Viruega H, Imbernon C, Chausson N, Altarcha T, Aghasaryan M, Soumah D, Lescieux E, Flamand-Roze C, Simon O, Bedin A, Smadja D, Gaviria M. 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.. Brain Sci 2022 May 9;12(5).
    doi: 10.3390/brainsci12050619pubmed: 35625006pmc: 9139443google scholar: lookup

Citations

This article has been cited 4 times.
  1. Lei Z, Yuan K, Xu J, Miao Y, Dai Y, Wang J, Chang J. Effects of physical exercises on balance in children with down syndrome: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2025 Jul 2;17(1):165.
    doi: 10.1186/s13102-025-01222-2pubmed: 40604949google scholar: lookup
  2. Lee AW, Hirani R, Ogulnick J, Tiwari RK, Etienne M. Emerging Therapies for Neurological Disorders: A Clinical Review of MANAGED (Music, Art, Nature-Based, Animal-Assisted, Game, Essential Oil, Dance) Care. NeuroSci 2025 Jun 4;6(2).
    doi: 10.3390/neurosci6020051pubmed: 40559212google scholar: lookup
  3. Lim CT, Lim CW, Cheah PS, Ling KH. Reversing intellectual disabilities in Down syndrome: Hopes or hypes?. Indian J Med Res 2025 Mar;161(3):203-206.
    doi: 10.25259/IJMR_646_2025pubmed: 40347506google scholar: lookup
  4. Benito-Martínez E, Alonso-Cortés B, Fernández-Gorgojo M, Coto Martín R, Méndez Blanco R. Exploring the Impact of Adaptive Behaviors on Balance: A Comparative Analysis of Static and Dynamic Balance in Athletes With and Without Intellectual Disabilities. Brain Behav 2025 Feb;15(2):e70174.
    doi: 10.1002/brb3.70174pubmed: 39964336google scholar: lookup
Subscribe to our newsletter
Join 99,344 horse owners like you who receive our email updates on horse health and nutrition.