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Home / Equine Research Bank / BMC Pediatr / Effects of equine-assisted activities on attention and quali...
BMC pediatrics2021; 21(1); 135; doi: 10.1186/s12887-021-02597-0

Effects of equine-assisted activities on attention and quality of life in children with cerebral palsy in a randomized trial: examining the comorbidity with attention-deficit/hyperactivity disorder.

Abstract: Attention problems and decreased quality of life are frequently accompanied in Cerebral Palsy (CP), which can negatively affect rehabilitation of physical disability. However, the majority of affected children remain untreated in the aspects of attention or psychosocial factors. Equine-Assisted Activities and Therapies (EAAT) use horse as a therapeutic modality including grooming as well as mounted riding activities in which patients exercise and experience mounted stimulation. It is known to help improve attention in children with ADHD, so that it can be an exercise therapy that is expected to improvement of attention as well as rehabilitating effects in CP patients. EAA may be a promising strategy to address the unmet need for CP patients. This study aims to investigate the efficacy of EAA for children with CP, those with both CP and ADHD and confirm the comorbidity between CP and ADHD. Forty-six children with cerebral palsy participated in this study. For the exercise group, they participated in a 40-min session twice a week for a 16-week period, while the control group engaged in daily life without any special treatments. Each children individually were assessed on attention and psychological wellbeing at baseline and post-treatment. Comorbidity were identified based on the Diagnostic and Statistical Manual of Mental Disorder 5th edition (DSM-5) and confirmed by Korean Kiddie-Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL). Perseveration rated using the Conner's Performance Test (CPT) showed a significant decrease only in the exercise group (p < .024). However, no significant improvement in children's quality of life was observed after EAA program compared with control group. Among the total participants, fifteen children (31.91%) were diagnosed with ADHD. When conducting an additional analysis with the subsample of CP patients diagnosed with ADHD, the d', commission error and perseveration showed a significant decrease only in the exercise group. Children with CP and ADHD reported an improvement in quality of life both in exercise and control group, but only in the exercise group social functioning exhibited a significant difference. The positive effects of the EAA on attention and quality of life were confirmed. Children with CP in the exercise group were more capable to sustain their attention longer. Those with CP and ADHD showed an increase in attention and perceived to have better social skills after receiving 16 weeks of EAA compared to those in the control group. Considering high comorbidity of CP and ADHD, it seems that the EAA program could be the better alternative treatment for CP with attentional problem. The results of this study will contribute to growing evidence for the efficacy of EAA in children especially with CP and ADHD. This trial was registered on ClinicalTrials.gov ( NCT03870893 ). Registered 26 July 2017.
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Publication Date: 2021-03-19 PubMed ID: 33740922PubMed Central: PMC7976699DOI: 10.1186/s12887-021-02597-0Google Scholar: Lookup
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  • Journal Article
  • Randomized Controlled Trial
  • Research Support
  • Non-U.S. Gov't

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.

The research paper reviews the efficacy of Equine-Assisted Activities (EAA) on the attention span and quality of life for children diagnosed with Cerebral Palsy (CP) and comorbid Attention Deficit Hyperactivity Disorder (ADHD). The study reports that EAA improves attention span and social functioning in children suffering from both CP and ADHD.

Overview of the Research

  • The research investigates the impact of EAA on children diagnosed with CP, a neurological condition affecting movement and coordination. These children often face attention problems and a reduced quality of life, hindering their rehabilitation and daily life coping strategies.
  • The study also focuses on the children diagnosed with both CP and ADHD. ADHD is a behavioral disorder characterized by persistent patterns of inattention or hyperactivity, often leading to difficulties in social and academic abilities.
  • In this study, the researchers used the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) and Korean Kiddie-Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL) to confirm the comorbidity between CP and ADHD.

Study Design and Participants

  • 46 children with Cerebral Palsy were included in this study. They were divided into two groups – an exercise group participating in EAA and a control group not receiving any special treatment.
  • The exercise group underwent a 40-minute EAA session twice a week for a period of 16 weeks. The therapy included grooming and mounted riding activities for physical and psychological rehabilitation.
  • Each child’s attention and psychological well-being were assessed at the start and end of the study. The assessments indicated that 15 children (31.91%) were additionally diagnosed with ADHD.

Results and Findings

  • Following the EAA program, the exercise group showed a significant improvement in attention levels compared to the control group.
  • Children with CP and ADHD displayed an improvement in quality of life and showed marked improvements in social functioning after participating in EAA.
  • However, the study reported no broad improvement in quality of life after EAA for the children, contrary to the initial hypothesis.
  • The results indicate that EAA can be a promising therapeutic approach to address attention problems and improve social skills, particularly in patients suffering from both CP and ADHD.

Implications and Conclusions

  • The research provides evidence supporting the efficacy of EAA as a therapeutic strategy in children, especially those diagnosed with both CP and ADHD.
  • Given the high comorbidity between CP and ADHD, the study suggests that EAA could serve as an alternative treatment to improve attention and social skills.
  • The researchers optimistically conclude that their findings will contribute to the growing evidence towards the efficacy of EAA for children, particularly those suffering from CP and ADHD.

Cite This Article

APA
Ahn B, Joung YS, Kwon JY, Lee DI, Oh S, Kim BU, Cha JY, Kim JH, Lee JY, Shin HY, Seo YS. (2021). Effects of equine-assisted activities on attention and quality of life in children with cerebral palsy in a randomized trial: examining the comorbidity with attention-deficit/hyperactivity disorder. BMC Pediatr, 21(1), 135. https://doi.org/10.1186/s12887-021-02597-0

Publication

BMC pediatrics
ISSN: 1471-2431
NlmUniqueID: 100967804
Country: England
Language: English
Volume: 21
Issue: 1
Pages: 135
PII: 135

Researcher Affiliations

Ahn, Bomi
  • Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 115 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Joung, Yoo-Sook
  • Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 115 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea. yschoung@skku.edu.
Kwon, Jeong-Yi
  • Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Lee, Dong Ik
  • Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 115 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Oh, Soohwan
  • Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 115 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Kim, Byoung-Uk
  • Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 115 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Cha, Jung Yoon
  • Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 115 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Kim, Ji-Hae
  • Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 115 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Lee, Ji Young
  • Samsung Equestrian Team, Bugok dong, Gunposi, Gyeonggido, Republic of Korea.
Shin, Hye Yeon
  • Samsung Equestrian Team, Bugok dong, Gunposi, Gyeonggido, Republic of Korea.
Seo, Yun Sik
  • Samsung Equestrian Team, Bugok dong, Gunposi, Gyeonggido, Republic of Korea.

MeSH Terms

  • Animals
  • Attention
  • Attention Deficit Disorder with Hyperactivity / epidemiology
  • Attention Deficit Disorder with Hyperactivity / therapy
  • Cerebral Palsy
  • Child
  • Comorbidity
  • Horses
  • Humans
  • Quality of Life

Grant Funding

  • 2017R1A2B4004615 / National Research Foundation of Korea

Conflict of Interest Statement

The authors declare that they have no competing interests.

References

This article includes 39 references
  1. Whitney DG, Warschausky SA, Peterson MD. Mental health disorders and physical risk factors in children with cerebral palsy: a cross-sectional study.. Dev Med Child Neurol 2019 May;61(5):579-585.
    doi: 10.1111/dmcn.14083pmc: PMC6450728pubmed: 30362114google scholar: lookup
  2. Bjorgaas HM, Elgen I, Boe T, Hysing M. Mental health in children with cerebral palsy: does screening capture the complexity?. ScientificWorldJournal 2013;2013:468402.
    doi: 10.1155/2013/468402pmc: PMC3654290pubmed: 23690745google scholar: lookup
  3. Sigurdardottir S, Indredavik MS, Eiriksdottir A, Einarsdottir K, Gudmundsson HS, Vik T. Behavioural and emotional symptoms of preschool children with cerebral palsy: a population-based study.. Dev Med Child Neurol 2010 Nov;52(11):1056-61.
    doi: 10.1111/j.1469-8749.2010.03698.xpubmed: 20497458google scholar: lookup
  4. Gabis LV, Tsubary NM, Leon O, Ashkenasi A, Shefer S. Assessment of Abilities and Comorbidities in Children With Cerebral Palsy.. J Child Neurol 2015 Oct;30(12):1640-5.
    doi: 10.1177/0883073815576792pubmed: 25855688google scholar: lookup
  5. Bjorgaas HM, Hysing M, Elgen I. Psychiatric disorders among children with cerebral palsy at school starting age.. Res Dev Disabil 2012 Jul-Aug;33(4):1287-93.
    doi: 10.1016/j.ridd.2012.02.024pubmed: 22502856google scholar: lookup
  6. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis.. Am J Psychiatry 2007 Jun;164(6):942-8.
    doi: 10.1176/ajp.2007.164.6.942pubmed: 17541055google scholar: lookup
  7. American Psychiatric Association . Diagnostic and Statistical Manual Disorders. 4. Washington, DC: American Psychiatric Association; 2013. p. 2000.
  8. Faraone SV, Biederman J, Mennin D, Gershon J, Tsuang MT. A prospective four-year follow-up study of children at risk for ADHD: psychiatric, neuropsychological, and psychosocial outcome.. J Am Acad Child Adolesc Psychiatry 1996 Nov;35(11):1449-59.
    doi: 10.1097/00004583-199611000-00013pubmed: 8936911google scholar: lookup
  9. Jang B, Song J, Kim J, Kim S, Lee J, Shin HY, Kwon JY, Kim YH, Joung YS. Equine-Assisted Activities and Therapy for Treating Children with Attention-Deficit/Hyperactivity Disorder.. J Altern Complement Med 2015 Sep;21(9):546-53.
    pubmed: 26167851doi: 10.1089/acm.2015.0067google scholar: lookup
  10. Konicarova J, Bob P, Raboch J. Balance deficits and ADHD symptoms in medication-naïve school-aged boys.. Neuropsychiatr Dis Treat 2014;10:85-8.
    doi: 10.2147/NDT.S56017pmc: PMC3896312pubmed: 24476629google scholar: lookup
  11. Tervo RC, Azuma S, Fogas B, Fiechtner H. Children with ADHD and motor dysfunction compared with children with ADHD only.. Dev Med Child Neurol 2002 Jun;44(6):383-90.
    doi: 10.1017/s0012162201002250pubmed: 12088306google scholar: lookup
  12. McEvoy RE, Rogers SJ, Pennington BF. Executive function and social communication deficits in young autistic children.. J Child Psychol Psychiatry 1993 May;34(4):563-78.
    doi: 10.1111/j.1469-7610.1993.tb01036.xpubmed: 7685360google scholar: lookup
  13. Mayes SD, Calhoun SL. WISC-IV and WISC-III profiles in children with ADHD.. J Atten Disord 2006 Feb;9(3):486-93.
    doi: 10.1177/1087054705283616pubmed: 16481665google scholar: lookup
  14. Prior M, Sanson A, Freethy C, Geffen G. Auditory attentional abilities in hyperactive children.. J Child Psychol Psychiatry 1985 Mar;26(2):289-304.
    doi: 10.1111/j.1469-7610.1985.tb02267.xpubmed: 3980616google scholar: lookup
  15. Colver A, Rapp M, Eisemann N, Ehlinger V, Thyen U, Dickinson HO, Parkes J, Parkinson K, Nystrand M, Fauconnier J, Marcelli M, Michelsen SI, Arnaud C. Self-reported quality of life of adolescents with cerebral palsy: a cross-sectional and longitudinal analysis.. Lancet 2015 Feb 21;385(9969):705-16.
    pmc: PMC4606972pubmed: 25301503doi: 10.1016/s0140-6736(14)61229-0google scholar: lookup
  16. Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy.. Pediatrics 2012 Nov;130(5):e1285-312.
    doi: 10.1542/peds.2012-0924pubmed: 23045562google scholar: lookup
  17. Barkley RA, Fischer M, Smallish L, Fletcher K. The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder.. J Abnorm Psychol 2002 May;111(2):279-89.
    doi: 10.1037/0021-843X.111.2.279pubmed: 12003449google scholar: lookup
  18. Lee S, Choi JW, Kim KM, Kim JW, Kim S. The guideline of diagnosis and treatment of attention-deficit/hyperactivity disorder: developed by ADHD translational research center. J Korean Acad Child Adolesc Psychiatry 2016;27(4):236–266.
    doi: 10.5765/jkacap.2016.27.4.236google scholar: lookup
  19. Gross-Tsur V, Shalev RS, Badihi N, Manor O. Efficacy of methylphenidate in patients with cerebral palsy and attention-deficit hyperactivity disorder (ADHD).. J Child Neurol 2002 Dec;17(12):863-6.
    doi: 10.1177/08830738020170121401pubmed: 12593456google scholar: lookup
  20. Rigby BR, Grandjean PW. The Efficacy of Equine-Assisted Activities and Therapies on Improving Physical Function.. J Altern Complement Med 2016 Jan;22(1):9-24.
    doi: 10.1089/acm.2015.0171pubmed: 26654868google scholar: lookup
  21. Bizub AL, Joy A, Davidson L. "It's like being in another world": demonstrating the benefits of therapeutic horseback riding for individuals with psychiatric disability.. Psychiatr Rehabil J 2003 Spring;26(4):377-84.
    doi: 10.2975/26.2003.377.384pubmed: 12739908google scholar: lookup
  22. Tyler JJ. Equine psychotherapy: worth more than just a horse laugh. Women Ther 1994;15(3-4):139–146.
    doi: 10.1300/J015v15n03_11google scholar: lookup
  23. Oh Y, Joung YS, Jang B, Yoo JH, Song J, Kim J, Kim K, Kim S, Lee J, Shin HY, Kwon JY, Kim YH, Jeong B. Efficacy of Hippotherapy Versus Pharmacotherapy in Attention-Deficit/Hyperactivity Disorder: A Randomized Clinical Trial.. J Altern Complement Med 2018 May;24(5):463-471.
    pubmed: 29641212doi: 10.1089/acm.2017.0358google scholar: lookup
  24. Kwak KJ, Oh SW, Kim CT. Korean Wechsler intelligence children-fourth edition manual. Seoul: Hakjisa; 2011.
  25. So YK, Noh JS, Kim YS. The reliability and validity of Korean parent and teacher ADHD rating scale. J Korean Neuropsychiatr Assoc 2002;41:283–289.
  26. Jang CH. The effect of horse riding machine exercise on attention and balance in children with ADHD. Korean Acad Kinesiol 2012;14(3):63–70.
    doi: 10.15758/jkak.2012.14.3.63google scholar: lookup
  27. Brossard-Racine M, Hall N, Majnemer A, Shevell MI, Law M, Poulin C, Rosenbaum P. Behavioural problems in school age children with cerebral palsy.. Eur J Paediatr Neurol 2012 Jan;16(1):35-41.
    doi: 10.1016/j.ejpn.2011.10.001pubmed: 22036311google scholar: lookup
  28. Whitney DG, Warschausky SA, Peterson MD. Mental health disorders and physical risk factors in children with cerebral palsy: a cross-sectional study.. Dev Med Child Neurol 2019 May;61(5):579-585.
    doi: 10.1111/dmcn.14083pmc: PMC6450728pubmed: 30362114google scholar: lookup
  29. Brossard-Racine M, Hall N, Majnemer A, Shevell MI, Law M, Poulin C, Rosenbaum P. Behavioural problems in school age children with cerebral palsy.. Eur J Paediatr Neurol 2012 Jan;16(1):35-41.
    doi: 10.1016/j.ejpn.2011.10.001pubmed: 22036311google scholar: lookup
  30. Pinquart M. Systematic Review: Bullying Involvement of Children With and Without Chronic Physical Illness and/or Physical/Sensory Disability-a Meta-Analytic Comparison With Healthy/Nondisabled Peers.. J Pediatr Psychol 2017 Apr 1;42(3):245-259.
    pubmed: 27784727doi: 10.1093/jpepsy/jsw081google scholar: lookup
  31. Kim EJ, Kim Y, Seo WS, Lee SH, Park EJ, Bae SM, Shin D. The revised Korean practice parameter for the attention-deficit hyperactivity disorder (I). J Korean Acad Child Adolesc Psychiatry 2017;28(2):46–57.
    doi: 10.5765/jkacap.2017.28.2.46google scholar: lookup
  32. On SG, Kim EJ. Social understanding and behavior in children with ADHD. Korean J Clin Psychol 2003;22(4):793–813.
  33. Shumway-Cook A, Woollacott W. Motor control theory and practical applications. Baltimore: Williams &Wilikins; 1995.
  34. Frank A, McCloskey S, Dole RL. Effect of hippotherapy on perceived self-competence and participation in a child with cerebral palsy.. Pediatr Phys Ther 2011 Fall;23(3):301-8.
    doi: 10.1097/PEP.0b013e318227caacpubmed: 21829130google scholar: lookup
  35. All AC, Loving GL, Crane LL. Animals, horseback riding, and implications for rehabilitation therapy. J Rehabil 1999;65:49–57.
  36. Schultz PN, Remick-Barlow GA, Robbins L. Equine-assisted psychotherapy: a mental health promotion/intervention modality for children who have experienced intra-family violence.. Health Soc Care Community 2007 May;15(3):265-71.
    doi: 10.1111/j.1365-2524.2006.00684.xpubmed: 17444990google scholar: lookup
  37. Aberson B, Shure MB, Goldstein S. Social problem-solving intervention can help children with ADHD.. J Atten Disord 2007 Jul;11(1):4-7.
    doi: 10.1177/1087054707299409pubmed: 17606767google scholar: lookup
  38. Barkley RA. The ecological validity of laboratory and analogue assessment methods of ADHD symptoms.. J Abnorm Child Psychol 1991 Apr;19(2):149-78.
    doi: 10.1007/BF00909976pubmed: 2056161google scholar: lookup
  39. McGee RA, Clark SE, Symons DK. Does the Conners' Continuous Performance Test aid in ADHD diagnosis?. J Abnorm Child Psychol 2000 Oct;28(5):415-24.
    doi: 10.1023/A:1005127504982pubmed: 11100916google scholar: lookup

Citations

This article has been cited 3 times.
  1. Li D, Li L, Zang W, Wang D, Miao C, Li C, Zhou L, Yan J. Effect of physical activity on attention in school-age children with ADHD: a systematic review and meta-analysis of randomized controlled trials.. Front Physiol 2023;14:1189443.
    doi: 10.3389/fphys.2023.1189443pubmed: 37576338google scholar: lookup
  2. Li D, Wang D, Cui W, Yan J, Zang W, Li C. Effects of different physical activity interventions on children with attention-deficit/hyperactivity disorder: A network meta-analysis of randomized controlled trials.. Front Neurosci 2023;17:1139263.
    doi: 10.3389/fnins.2023.1139263pubmed: 37021131google scholar: lookup
  3. Blasco M, García-Galant M, Berenguer-González A, Caldú X, Arqué M, Laporta-Hoyos O, Ballester-Plané J, Miralbell J, Jurado MÁ, Roser Pueyo. Interventions with an Impact on Cognitive Functions in Cerebral Palsy: a Systematic Review.. Neuropsychol Rev 2023 Jun;33(2):551-577.
    doi: 10.1007/s11065-022-09550-7pubmed: 35972712google scholar: lookup
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