Hippotherapy Improves Gross Motor Function in Children with Cerebral Palsy: Evidence from a Systematic Review.

Overview

• This systematic review examines the impact of hippotherapy (therapeutic horse riding) on gross motor function in children with cerebral palsy (CP), finding that hippotherapy leads to significant improvements in motor skills, especially in standing and mobility activities.
• While the study also aimed to evaluate effects in children with autism spectrum disorder (ASD), no eligible studies for ASD were found, indicating a gap in research.

Background

• Hippotherapy uses the movement of horses to enhance physical and psychosocial rehabilitation.
• It is potentially beneficial for children with CP, a condition characterized by motor impairment.
• Standardized tools—Activity Scale for Kids-Performance (ASK), Gross Motor Function Classification System (GMFCS), and Gross Motor Function Measure (GMFM)—are used to assess changes in motor function objectively.

Objectives

• To systematically review and synthesize available scientific evidence on how hippotherapy affects gross motor functions in children diagnosed with CP.
• Although the initial search included autism spectrum disorder (ASD), the review did not identify studies meeting criteria for ASD, highlighting absence of evidence there.

Methods

• Followed PRISMA guidelines ensuring rigorous and transparent review methodology.
• Conducted comprehensive literature searches across six databases: PubMed, EMBASE, Web of Science, SCOPUS, Cochrane, and SciELO.
• Targeted studies published in English, Portuguese, or Spanish that utilized the ASK, GMFCS, or GMFM assessments.
• Two independent reviewers screened studies, extracted data, and evaluated risk of bias to enhance reliability.

Results

• Included 25 studies with a total of 602 children (mean age 7.1 years, age range 3-14).
• All eligible studies focused on cerebral palsy; none on ASD.
• Interventions typically ranged from 8 to 24 weeks, with 1 to 3 sessions per week.
• ASK outcomes from two studies showed moderate but statistically significant improvement in motor function (effect sizes Hedges g = 0.48 to 0.62).
• The GMFM was utilized in 22 studies; out of these, 20 reported clinically meaningful improvements, especially in dimensions D (standing) and E (walking, running, jumping), which relate to postural control and dynamic mobility.
• Only one study used GMFCS and reported no change in classification, suggesting this tool may be less sensitive to short-term changes or might require longer periods to detect shifts in gross motor function classification.
• Methodological quality was rated as moderate; common limitations included:
  • Relatively small sample sizes affecting statistical power.
  • Lack of blinding which could introduce bias.

Conclusions

• Hippotherapy appears to be an effective intervention to improve gross motor skills in children with cerebral palsy, as supported primarily by GMFM scores.
• No evidence was found to support or refute the use of hippotherapy in children with ASD, thus indicating a notable gap for future research.
• Wider use of ASK and GMFCS assessments in clinical trials could provide a more complete understanding of hippotherapy’s benefits across various neurodevelopmental disorders.