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Epilepsy & behavior reports2024; 28; 100707; doi: 10.1016/j.ebr.2024.100707

Equine-assisted therapy in quality of life and functioning of people with active epilepsy: A feasibility study.

Abstract: People with active epilepsy, which is often associated with specific neurological conditions, endure significant impairments in quality of life (QoL) and functioning, particularly those in middle-income countries. Physical intervention plays an essential role in addressing these challenges. This study investigated the impact of equine-assisted therapy (EAT) on QoL, functional independence, sleep quality, antiseizure medications, and frequency of seizures among people with epilepsy (PWE), with or without additional neurological conditions. Fourteen participants aged 4-34 years old diagnosed with focal epilepsy participated in a structured EAT program. The EAT program consisted of 36 sessions, each lasting 30 min and conducted weekly. Data were collected at four different times: baseline (T1), after 12 sessions (T2), after 24 sessions (T3), and after 36 sessions (T4). The assessments included the Quality of Life in Epilepsy (QOLIE-31), Functional Independence Measure (FIM), Pittsburgh Sleep Quality Index (PSQI), and Liverpool Adverse Event Profile (LAEP) scores. Seizure frequency was monitored continuously. Horse welfare was evaluated using the Horse Welfare Assessment Protocol (HWAP). After the EAT intervention, significant improvements were observed in the QoL scores (from 62.18 [57.88 - 70.25] to 80.18 [65.30 - 86.78]) and in FIM values (from 70.00 [36.50 - 97.75] to 70.00 [51.75 - 116.75]), particularly in the self-care and social cognition domains. Additionally, there was also a decrease in seizure frequency, adverse effects of antiseizure medications, and sleep quality. The HWAP indicated satisfactory welfare conditions for the horses. These findings indicate that EAT holds promise as a therapeutic intervention for improving the QoL and functioning of PWE. Tailored interventions are essential to address the diverse challenges faced by PWE, emphasizing the need for further research on effective therapeutic approaches.
Publication Date: 2024-08-22 PubMed ID: 39281302PubMed Central: PMC11399807DOI: 10.1016/j.ebr.2024.100707Google Scholar: Lookup
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  • 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.

Equine-assisted therapy (EAT) significantly improves quality of life, functional independence, and reduces seizure frequency and medication side effects in people with active epilepsy. This feasibility study highlights EAT as a promising therapeutic approach to support individuals with epilepsy, particularly in middle-income countries.

Study Background

  • People with active epilepsy often experience impairments in quality of life (QoL) and physical functioning.
  • These challenges are more pronounced in middle-income countries due to limited healthcare resources and support.
  • Physical interventions, such as equine-assisted therapy (EAT), have potential to address these challenges holistically.
  • EAT involves interaction with horses, which may provide physical, emotional, and cognitive benefits.

Study Objective and Design

  • To investigate the impact of EAT on:
    • Quality of life (QoL)
    • Functional independence
    • Sleep quality
    • Antiseizure medication side effects
    • Seizure frequency
  • Study participants: 14 individuals aged 4-34 years, all diagnosed with focal epilepsy, some with additional neurological conditions.
  • EAT program structure:
    • 36 sessions total
    • Each session lasted 30 minutes
    • Sessions conducted weekly
  • Data collection points:
    • Baseline (T1)
    • After 12 sessions (T2)
    • After 24 sessions (T3)
    • After 36 sessions (T4)

Assessment Tools Used

  • Quality of Life in Epilepsy (QOLIE-31) – measures QoL specifically for epilepsy patients.
  • Functional Independence Measure (FIM) – assesses level of functional independence, including self-care and social cognition.
  • Pittsburgh Sleep Quality Index (PSQI) – evaluates sleep quality.
  • Liverpool Adverse Event Profile (LAEP) – assesses side effects from antiseizure medications.
  • Seizure frequency – monitored continuously throughout the study.
  • Horse Welfare Assessment Protocol (HWAP) – ensured humane treatment and welfare of horses involved in therapy.

Key Findings

  • Quality of Life (QoL): Significant improvement from median score 62.18 to 80.18 after the intervention, indicating enhanced well-being.
  • Functional Independence: Increase in FIM scores, particularly:
    • Self-care abilities improved
    • Social cognition enhanced
  • Seizure Frequency: Observed decrease in seizure occurrences during and after therapy.
  • Medication Side Effects: Reported adverse effects of antiseizure medications reduced.
  • Sleep Quality: Though improvement was noted, it was less robust compared to other measures.
  • Horse Welfare: HWAP assessments showed horses were well cared for, validating the ethics of the intervention.

Interpretation and Significance

  • EAT appears to contribute positively to multiple dimensions of health and daily functioning in people with epilepsy.
  • The findings suggest that physical interaction with horses can promote physical, cognitive, and psychosocial benefits.
  • Improvements in self-care and social cognition indicate that EAT could help enhance independence and social integration.
  • Reduction in seizure frequency and medication side effects suggests potential complementary effects alongside conventional treatments.
  • Sleep quality improvements hint at broader benefits but require further study to confirm significance.

Study Limitations and Future Directions

  • Small sample size (14 participants) limits generalizability.
  • Study design did not include a control group, so causality cannot be firmly established.
  • Participants’ diverse age range and neurological conditions introduce heterogeneity.
  • Further research with larger, controlled trials is needed to:
    • Confirm effectiveness of EAT for epilepsy
    • Determine optimal session frequency and duration
    • Explore long-term effects and sustainability
    • Develop tailored interventions addressing specific needs of individuals with epilepsy

Conclusion

  • This feasibility study demonstrates that equine-assisted therapy holds promise as a supportive intervention to improve quality of life and functioning in people with active epilepsy.
  • It highlights the therapeutic value of multidisciplinary physical interventions, particularly in settings where epilepsy’s burden is high.
  • The study advocates for more extensive research to establish EAT’s role in epilepsy management and to inform clinical practice guidelines.

Cite This Article

APA
de Andrade Santos FO, Souza-Santos C, Passos AA, Nunes de Santana Campos R, Martins-Filho PR, Arida RM, Teixeira-Machado L. (2024). Equine-assisted therapy in quality of life and functioning of people with active epilepsy: A feasibility study. Epilepsy Behav Rep, 28, 100707. https://doi.org/10.1016/j.ebr.2024.100707

Publication

ISSN: 2589-9864
NlmUniqueID: 101750909
Country: United States
Language: English
Volume: 28
Pages: 100707
PII: 100707

Researcher Affiliations

de Andrade Santos, Franciely Oliveira
  • Applied in Health Sciences Graduate Program, Federal University of Sergipe, Lagarto, Sergipe, Brazil.
Souza-Santos, Caroline
  • Applied in Health Sciences Graduate Program, Federal University of Sergipe, Lagarto, Sergipe, Brazil.
Passos, Adrielle Andrade
  • Psychology Graduate Program, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
Nunes de Santana Campos, Roseane
  • Applied in Health Sciences Graduate Program, Federal University of Sergipe, Lagarto, Sergipe, Brazil.
Martins-Filho, Paulo Ricardo
  • Investigative Pathology Laboratory, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
Arida, Ricardo Mario
  • Department of Physiology, Federal University of São Paulo, São Paulo, Brazil.
Teixeira-Machado, Lavínia
  • Applied in Health Sciences Graduate Program, Federal University of Sergipe, Lagarto, Sergipe, Brazil.
  • Psychology Graduate Program, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.

Conflict of Interest Statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

This article includes 52 references
  1. Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L. ILAE classification of the epilepsies: position paper of the ILAE commission for classification and terminology. Epilepsia 2017;58(4):512–521.
    doi: 10.1111/epi.13709pmc: PMC5386840pubmed: 28276062google scholar: lookup
  2. Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE. Operational classification of seizure types by the international league against epilepsy: position paper of the ILAE commission for classification and terminology. Epilepsia 2017;58(4):522–530.
    doi: 10.1111/epi.13670pubmed: 28276060google scholar: lookup
  3. Muche EA, Ayalew MB, Abdela OA. Assessment of quality of life of epileptic patients in Ethiopia. Int J Chronic Dis 2020;2020:8714768.
    doi: 10.1155/2020/8714768pmc: PMC6961609pubmed: 31976314google scholar: lookup
  4. Baranowski CJ. The quality of life of older adults with epilepsy: a systematic review. Seizure 2018;60:190–197.
    doi: 10.1016/j.seizure.2018.06.002pubmed: 30031296google scholar: lookup
  5. Karakis I, Boualam N, Moura LM, Howard DH. Quality of life and functional limitations in persons with epilepsy. Epilepsy Res 2023;190.
  6. Souza-Santos C, Silveira JFS, Azevedo-Santos I, Teixeira-Machado L. Dance ande equine-assisted therapy in autismo spectrum disorder: crossover romdomized clinical trial. Clin Neuropsychiatry 2018;15(5):284–290.
  7. Encheff JL, Armstrong C, Masterson M, Fox C, Gribble P. Hippotherapy effects on trunk, pelvic, and hip motion during ambulation in children with neurological impairments. Pediatr Phys Ther 2012;24(3):242–250.
    doi: 10.1097/PEP.0b013e31825c1dc3pubmed: 22735473google scholar: lookup
  8. Giagazoglou P, Arabatzi F, Kellis E, Liga M, Karra C, Amiridis I. Muscle reaction function of individuals with intellectual disabilities may be improved through therapeutic use of a horse. Res Dev Disabil 2013;34(9):2442–2448.
    doi: 10.1016/j.ridd.2013.04.015pubmed: 23747935google scholar: lookup
  9. Zadnikar M, Kastrin A. Effects of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: a meta-analysis. Dev Med Child Neurol 2011;53(8):684–691.
  10. Matusiak-Wieczorek E, Dziankowska-Zaborszczyk E, Synder M, Borowski A. The influence of hippotherapy on the body posture in a sitting position among children with cerebral palsy. Int J Environ Res Public Health 2020;17(18):6846.
    doi: 10.3390/ijerph17186846pmc: PMC7558765pubmed: 32961681google scholar: lookup
  11. Granados AC, Agís IF. Why children with special needs feel better with hippotherapy sessions: a conceptual review. J Altern Complement Med 2011;17(3):191–197.
    doi: 10.1089/acm.2009.0229pubmed: 21385087google scholar: lookup
  12. Gianfredi V, Buffoli M, Rebecchi A, Croci R, Oradini-Alacreu A, Stirparo G. Association between urban greenspace and health: a systematic review of literature. Int J Environ Res Public Health 2021;18(10):5137.
    doi: 10.3390/ijerph18105137pmc: PMC8150317pubmed: 34066187google scholar: lookup
  13. Menor-Rodríguez MJ, Sevilla Martín M, Sánchez-García JC, 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(12):2589.
    doi: 10.3390/jcm10122589pmc: PMC8230898pubmed: 34208206google scholar: lookup
  14. Pérez-Gómez J, Amigo-Gamero H, Collado-Mateo D, Barrios-Fernandez S, Muñoz-Bermejo L, Garcia-Gordillo MÁ. Equine-assisted activities and therapies in children with attention-deficit/hyperactivity disorder: a systematic review. J Psychiatr Ment Health Nurs 2021;28(6):1079–1091.
    doi: 10.1111/jpm.12710pubmed: 33171006google scholar: lookup
  15. 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;44(26):8161–8175.
    doi: 10.1080/09638288.2021.2012847pubmed: 35043743google scholar: lookup
  16. Prieto A, Martins Almeida Ayupe K, Nemetala Gomes L, Saúde AC, Gutierres FP. Effects of equine-assisted therapy on the functionality of individuals with disabilities: systematic review and meta-analysis. Physiother Theory Pract 2022;38(9):1091–1106.
    doi: 10.1080/09593985.2020.1836694pubmed: 33084452google scholar: lookup
  17. Lanning BA, Baier ME, Ivey-Hatz J, Krenek N, Tubbs JD. Effects of equine assisted activities on autism spectrum disorder. J Autism Dev Disord 2014;44(8):1897–1907.
    doi: 10.1007/s10803-014-2062-5pubmed: 24526337google scholar: lookup
  18. Earles JL, Vernon LL, Yetz JP. Equine-assisted therapy for anxiety and posttraumatic stress symptoms. J Trauma Stress 2015;28(2):149–152.
    doi: 10.1002/jts.21990pubmed: 25782709google scholar: lookup
  19. Patton MQ. Qualitative research & evaluation methods. 3rd ed. SAGE; Thousand Oaks, CA: 2002.
  20. Yin RK. Case study research: Design and methods. 6th ed. SAGE; Thousand Oaks, CA: 2018.
  21. da Silva TI, Ciconelli RM, Alonso NB, Azevedo AM, Westphal-Guitti AC, Pascalicchio TF. Validity and reliability of the Portuguese version of the quality of life in epilepsy inventory (QOLIE-31) for Brazil. Epilepsy Behav 2007;10(2):234–241.
    doi: 10.1016/j.yebeh.2006.08.022pubmed: 17292675google scholar: lookup
  22. Riberto M, Miyazaki MH, Jucá SS, Sakamoto H, Pinto PPN, Battistella LR. Validation of the Brazilian version of functional independence measure. Acta Fisiatr 2004;11(2):72–76.
  23. Martins HH, Alonso NB, Vidal-Dourado M, Carbonel TD, de Araújo Filho GM, Caboclo LO. Are adverse effects of antiepileptic drugs different in symptomatic partial and idiopathic generalized epilepsies? The Portuguese-Brazilian validation of the Liverpool Adverse Events Profile. Epilepsy Behav 2011;22(3):511–517.
    doi: 10.1016/j.yebeh.2011.08.005pubmed: 21907625google scholar: lookup
  24. Bertolazi AN, Fagondes SC, Hoff LS, Dartora EG, Miozzo IC, de Barba ME. Validation of the Brazilian Portuguese version of the pittsburgh sleep quality index. Sleep Med 2011;12(1):70–75.
    doi: 10.1016/j.sleep.2010.04.020pubmed: 21145786google scholar: lookup
  25. Hiratuka E, Matsukura TS, Pfeifer LI. Cross-cultural adaptation of the gross motor function classification system into Brazilian-Portuguese (GMFCS). Rev Bras Fisioter 2010;14(6):537–544.
  26. Silva DB, Funayama CA, Pfeifer LI. Manual ability classification system (MACS): reliability between therapists and parents in Brazil. Braz J Phys Ther 2015;19(1):26–33.
    doi: 10.1590/bjpt-rbf.2014.0065pmc: PMC4351605pubmed: 25651133google scholar: lookup
  27. American Psychiatric Association. DSM-5. Artmed Editora; 2014.
  28. Hammerschmidt J, Molentoc FM. Identificação de maus-tratos contra animais por meio de um protocolo de perícia em bem-estar animal. Revis de Ed Cont em Med Vet e Zoot do CRMV-SP 2015;13(2):89.
  29. Pervin S, Jicha GA, Bensalem-Owen M, Mathias SV. Incident epilepsy in the cognitively normal geriatric population, irrespective of seizure control, impairs quality of life. Epilepsy Behav 2022;126.
    doi: 10.1016/j.yebeh.2021.108457pmc: PMC8792889pubmed: 34883464google scholar: lookup
  30. Fisher RS, Vickrey BG, Gibson P, Hermann B, Penovich P, Scherer A. The impact of epilepsy from the patient's perspective I. Descriptions and Subjective Perceptions. Epilepsy Res 2000;41(1):39–51.
    doi: 10.1016/s0920-1211(00)00126-1pubmed: 10924867google scholar: lookup
  31. Pálsdóttir AM, Gudmundsson M, Grahn P. Equine-assisted intervention to improve perceived value of everyday occupations and quality of life in people with lifelong neurological disorders: a prospective controlled study. Int J Environ Res Public Health 2020;17(7):2431.
    doi: 10.3390/ijerph17072431pmc: PMC7177295pubmed: 32260047google scholar: lookup
  32. Nakken KO, Bjørholt PG, Johannessen SI, Løyning T, Lind E. Effect of physical training on aerobic capacity, seizure occurrence, and serum level of antiepileptic drugs in adults with epilepsy. Epilepsia 1990;31(1):88–94.
  33. McAuley JW, Long L, Heise J, Kirby T, Buckworth J, Pitt C. A prospective evaluation of the effects of a 12-week outpatient exercise program on clinical and behavioral outcomes in patients with epilepsy. Epilepsy Behav 2001;2(6):592–600.
    doi: 10.1006/ebeh.2001.0271pubmed: 12609395google scholar: lookup
  34. Nakken KO. Physical exercise in outpatients with epilepsy. Epilepsia 1999;40(5):643–651.
  35. Eriksen HR, Ellertsen B, Grønningsæter H, Nakken KO, Løyning Y, Ursin H. Physical exercise in women with intractable epilepsy. Epilepsia 1994;35:1256–1264.
  36. Arida RM. Physical exercise and seizure activity. Biochim Biophys Acta Mol basis Dis 2021;1867(1).
    doi: 10.1016/j.bbadis.2020.165979pubmed: 32980461google scholar: lookup
  37. Arida RM, Teixeira-Machado L. Physical exercise for children and adolescents with epilepsy: what have we learned?. Seizure 2023;111:1–8.
    doi: 10.1016/j.seizure.2023.07.005pubmed: 37480838google scholar: lookup
  38. Deutz U, Heussen N, Weigt-Usinger K, Leiz S, Raabe C, Polster T. Impact of hippotherapy on gross motor function and quality of life in children with bilateral cerebral palsy: a randomized open-label crossover study. Neuropediatrics 2018;49(3):185–192.
    doi: 10.1055/s-0038-1635121pubmed: 29486504google scholar: lookup
  39. Cordova F. Epilepsy and sport. Aust Fam Physician 1993;22(4):558–562.
    pubmed: 8481120
  40. Geier S. A comparative tele-EEG study of adolescent and adult epileptics. Epilepsia 1971;12(3):215–223.
  41. Perucca P, Gilliam FG. Adverse effects of antiepileptic drugs. Lancet Neurol 2012;11(9):792–802.
    doi: 10.1016/S1474-4422(12)70153-9pubmed: 22832500google scholar: lookup
  42. Glauser TA. Behavioral and psychiatric adverse events associated with antiepileptic drugs commonly used in pediatric patients. J Child Neurol 2004;19(Suppl1):S25–S38.
    doi: 10.1177/088307380401900104pubmed: 15526968google scholar: lookup
  43. Datta AN. The impact of anti-seizure medications on psychiatric disorders among children with epilepsy: both a challenge and an opportunity?. J Can Acad Child Adolesc Psychiatry 2023;32(3):177–184.
    pmc: PMC10393354pubmed: 37534124
  44. Van Golde EG, Gutter T, de Weerd AW. Sleep disturbances in people with epilepsy; prevalence, impact and treatment. Sleep Med Rev 2011;15(6):357–368.
    doi: 10.1016/j.smrv.2011.01.002pubmed: 21439869google scholar: lookup
  45. Lawthom C, Didelot A, Coppola A, Aledo-Serrano Á, Fazekas B, Sainz-Fuertes R. The impact of epilepsy and antiseizure medications on sleep: findings from a large European survey in adults with epilepsy and matched controls. Epilepsy Behav 2023;148.
    doi: 10.1016/j.yebeh.2023.109481pubmed: 37862873google scholar: lookup
  46. Fonseca APLM, de Azevedo CVM, Santos RMR. Sleep and health-related physical fitness in children and adolescents: a systematic review. Sleep Sci 2021;14(4):357–365.
    doi: 10.5935/1984-0063.20200125pmc: PMC8776269pubmed: 35087633google scholar: lookup
  47. Mendelson M, Borowik A, Michallet AS, Perrin C, Monneret D, Faure P. Sleep quality, sleep duration and physical activity in obese adolescents: effects of exercise training. Pediatr Obes 2016;11(1):26–32.
    doi: 10.1111/ijpo.12015pubmed: 25727885google scholar: lookup
  48. Xie Y, Liu S, Chen XJ, Yu HH, Yang Y, Wang W. Effects of exercise on sleep quality and insomnia in adults: a systematic review and meta-analysis of randomized controlled trials. Front Psych 2021;12.
    doi: 10.3389/fpsyt.2021.664499pmc: PMC8215288pubmed: 34163383google scholar: lookup
  49. Talo B, Turan GB. Effects of progressive muscle relaxation exercises on patients with epilepsy on level of depression, quality of sleep, and quality of life: a randomized controlled trial. Seizure 2023;105:29–36.
    doi: 10.1016/j.seizure.2023.01.002pubmed: 36702017google scholar: lookup
  50. Do J, Webster RJ, Longmuir PE, Ieradi S, Reddy D, Whiting S. Physically active children with epilepsy have good objective sleep duration and efficiency despite subjective reports of fatigue and sleep problems. Epilepsy Behav 2020;104(Pt A).
    doi: 10.1016/j.yebeh.2019.106853pubmed: 31958642google scholar: lookup
  51. Eriksen HR, Ellertsen B, Grønningsaeter H, Nakken KO, Løyning Y, Ursin H. Physical exercise in women with intractable epilepsy. Epilepsia 1994;35(6):1256–1264.
  52. de Lima C, Arida RM, Andersen ML, Polesel DN, de Alvarenga TAF, Vancini RL. Effects of acute physical exercise in the light phase of sleep in rats with temporal lobe epilepsy. Epilepsy Res 2017;136:54–61.

Citations

This article has been cited 1 times.
  1. Allendorfer JB. Special issue on advancing physical activity and exercise research in epilepsy and seizure disorders.. Epilepsy Behav Rep 2025 Dec;32:100827.
    doi: 10.1016/j.ebr.2025.100827pubmed: 41472752google scholar: lookup