Efficacy of hippotherapy simulator exercise program in patients with stroke: a randomized single-blind clinical trial.

Overview

• This study examined the effectiveness of a hippotherapy simulator combined with conventional exercises to improve balance and functional abilities in stroke patients.
• The researchers conducted a randomized trial comparing stroke patients who received both conventional exercises and hippotherapy simulator training to those who received only conventional exercises.

Study Purpose

• To investigate the impact of hippotherapy simulator exercises on key rehabilitation outcomes in stroke patients.
• Specifically focused on balance, postural control, mobility, functional capacity, and independence level.

Participants and Design

• Included 26 stroke patients aged 18-65 years.
• Randomly divided into two groups: Hippotherapy Simulator Group (HSG; n=13) and Conventional Exercise Group (CEG; n=13).
• Single-blind, randomized clinical trial design.

Intervention Details

• HSG received 30 sessions of conventional exercises plus hippotherapy simulator training over 6 weeks.
• The hippotherapy simulator is a mechanical, robotic device with a dynamic saddle that simulates horse movement, aiming to replicate the therapeutic effects of actual hippotherapy.
• CEG received 30 sessions of conventional exercises alone during the same timeframe.

Outcome Measures

• Balance: Berg Balance Scale (BBS)
• Postural Control: Postural Assessment Scale for Stroke (PAS-S)
• Mobility: Timed Up and Go Test (TUG), Rivermead Mobility Index (RMI)
• Functional Capacity: 2-Minute Walking Test (2-MWT)
• Independence: Barthel Index (BI) of Daily Living Activity
• Assessments conducted before and after the 6-week treatment period.

Key Findings

• Post-treatment, the hippotherapy simulator group (HSG) showed statistically significantly higher scores in:
  • Berg Balance Scale (BBS) with p=0.004 indicating better balance.
  • 2-Minute Walking Test (2-MWT) with p<0.001 indicating improved functional walking capacity.
• No significant differences were observed between groups in:
  • Postural Assessment Scale for Stroke (PAS-S)
  • Rivermead Mobility Index (RMI)
  • Timed Up and Go Test (TUG)
  • Barthel Index (BI)
• Both groups showed significant improvements from baseline to post-treatment across all measures (BBS, PAS-S, RMI, TUG, BI, and 2-MWT), indicating benefits of conventional exercise in both groups.

Interpretation and Conclusion

• Adding hippotherapy simulator sessions to conventional stroke rehabilitation exercises offers additional benefits in improving balance and walking endurance/function.
• While general mobility and independence improvements were similar between groups, the dynamic input from the hippotherapy simulator specifically enhanced balance and functional capacity.
• The mechanical simulator provides a feasible, controlled alternative to traditional hippotherapy, potentially overcoming practical challenges such as access to horses.
• Clinicians could consider integrating hippotherapy simulator training into stroke rehabilitation programs to maximize certain motor recovery outcomes.