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Medicina (Kaunas, Lithuania)2025; 61(10); 1811; doi: 10.3390/medicina61101811

The Effect of Hippotherapy Simulator-Assisted Therapy on Motor and Functional Outcomes in Children with Cerebral Palsy.

Abstract: : Horse riding simulators (HRS) provide rhythmic, repetitive, and multidirectional movements analogous to horseback riding, which may facilitate postural control, balance, and functional abilities in children with cerebral palsy (CP). This study aimed to investigate the effects of the HRS application on the muscle tone of the lower extremity, gross motor function, trunk postural control, balance, gait functions, and functional independence in children with CP. : A quasi-experimental study included 30 children with cerebral palsy (17 hemiparetic, 13 diparetic; mean age, 9.3 ± 3.2 years). All participants received Neurodevelopmental Therapy (NDT) for eight weeks, followed by eight weeks of HRS plus NDT, in a sequential design. Outcomes included the Modified Ashworth Scale (MAS), MyotonPRO, Gross Motor Function Measures (GMFM)-88, Pedalo Sensamove Balance Test (Pedalo SBT), Pediatric Balance Scale (PBS), Trunk Impairment Scale (TIS), gait analysis parameters, and Functional Independence Measure (WeeFIM). Assessments were made at baseline, the 8th, and the 16th week. : At week 16, after incorporating HRS, all MAS parameters demonstrated greater improvements compared to those achieved during the first eight weeks of NDT alone (ES: 0.728-0.931, < 0.05). MyotonPRO measurements showed a significant reduction in gastrocnemius stiffness (ES = 0.672, < 0.05) in hemiparetic children and decreases in hip adductor (ES: 0.649, < 0.05) and gastrocnemius-soleus (ES: 0.766-0.865, < 0.05) stiffness from week 8 to 16 in diparetic children following HRS intervention. Total scores on the GMFM-88, WeeFIM, TIS, and PBS improved significantly, with large effect sizes observed both from baseline to week 16 and from week 8 to 16 (ES: 0.771-0.886, < 0.05). Additionally, Pedalo SBT scores increased following HRS intervention from baseline to week 16 (ES = 0.599-0.602, < 0.05). : HRS integrated with conventional NDT may improve muscle tone, motor function, balance, gait, and functional independence in children with cerebral palsy, representing a valuable adjunct to standard rehabilitation. These findings provide the first evidence that simulator-assisted interventions may benefit daily activities in children with cerebral palsy.
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Publication Date: 2025-10-09 PubMed ID: 41155798PubMed Central: PMC12566273DOI: 10.3390/medicina61101811Google Scholar: Lookup
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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.

Overview

  • This study explored the effects of hippotherapy simulator-assisted therapy (HRS), combined with Neurodevelopmental Therapy (NDT), on muscle tone, motor skills, balance, gait, and functional independence in children with cerebral palsy (CP).
  • The research showed that adding HRS led to significant improvements in these areas compared to NDT alone.

Introduction and Rationale

  • Children with cerebral palsy often face challenges related to muscle tone abnormalities, poor postural control, limited balance, and impaired motor and functional abilities.
  • Hippotherapy, which involves horse riding, is known to provide rhythmic, repetitive, multidirectional movements that can improve these abilities, but actual horse riding is not always available or practical.
  • Horse riding simulators (HRS) mimic the movements of horseback riding and potentially offer an accessible way to achieve similar rehabilitative benefits.
  • The study aimed to determine if HRS combined with conventional therapy could improve motor outcomes and functional independence in children with CP.

Study Design and Participants

  • Methodology: Quasi-experimental sequential design involving 30 children with cerebral palsy, with two subtypes represented—17 with hemiparetic CP and 13 with diparetic CP.
  • Average age of participants was approximately 9.3 years.
  • First, all children received Neurodevelopmental Therapy (NDT) alone for eight weeks.
  • Then, they received combined NDT and hippotherapy simulator-assisted therapy (HRS) for an additional eight weeks.
  • Assessments of outcomes were performed at three time points: baseline, after 8 weeks of NDT, and after 16 weeks (following 8 weeks of combined therapy).

Outcome Measures

  • Muscle tone: Assessed using the Modified Ashworth Scale (MAS) and MyotonPRO to measure muscle stiffness.
  • Gross motor function: Evaluated with the Gross Motor Function Measures (GMFM-88).
  • Balance and postural control: Measured through the Pedalo Sensamove Balance Test (Pedalo SBT), Pediatric Balance Scale (PBS), and Trunk Impairment Scale (TIS).
  • Gait analysis parameters: Specific gait aspects assessed to gauge walking function improvements.
  • Functional independence: Assessed by the Functional Independence Measure for Children (WeeFIM).

Key Findings

  • Muscle tone improvements:
    • Significant decreases in muscle spasticity (as measured by MAS) were observed after the addition of HRS compared to NDT alone.
    • MyotonPRO revealed reduced stiffness in specific muscles: gastrocnemius in hemiparetic children; hip adductors and gastrocnemius-soleus complex in diparetic children.
  • Motor function enhancements:
    • Gross Motor Function Measure (GMFM-88) scores showed substantial improvement with large effect sizes through combined therapy.
  • Balance and postural control:
    • Scores on the Trunk Impairment Scale and Pediatric Balance Scale improved significantly.
    • Balance measured by Pedalo SBT increased post-HRS intervention from baseline.
  • Functional independence:
    • WeeFIM scores, reflecting the ability to perform daily activities independently, showed significant gains after HRS was incorporated.
  • Gait improvements:
    • Observed improvements in gait parameters following the combined therapy indicate better walking capacity.
  • Effect sizes for improvements were moderate to large, indicating meaningful clinical benefits.

Conclusions and Implications

  • This study provides evidence that adding hippotherapy simulator-assisted therapy to standard Neurodevelopmental Therapy can enhance multiple functional domains in children with cerebral palsy.
  • The rhythmic and multi-directional movements of the HRS likely contributed to improved muscle tone regulation, enhanced balance and postural control, and better motor function, which translated into greater independence in daily activities.
  • Importantly, the use of a simulator allows for broader access to hippotherapy-like interventions in settings where actual horseback riding is not feasible.
  • These results support incorporating HRS as a complementary rehabilitation tool to standard therapies to optimize outcomes for children with CP.
  • Further research could explore long-term benefits and optimize protocols for different CP subtypes.

Cite This Article

APA
Günay Yazıcı C, Özden F, Çoban O, Tarakçı D, Aydoğdu O, Sarı Z. (2025). The Effect of Hippotherapy Simulator-Assisted Therapy on Motor and Functional Outcomes in Children with Cerebral Palsy. Medicina (Kaunas), 61(10), 1811. https://doi.org/10.3390/medicina61101811

Publication

Medicina (Kaunas, Lithuania)
ISSN: 1648-9144
NlmUniqueID: 9425208
Country: Switzerland
Language: English
Volume: 61
Issue: 10
PII: 1811

Researcher Affiliations

Günay Yazıcı, Canan
  • Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul 34854, Türkiye.
Özden, Fatih
  • Department of Health Care Services, Köyceğiz Vocational School of Health Services, Muğla Sıtkı Koçman University, Muğla 48800, Türkiye.
Çoban, Osman
  • Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Üsküdar University, Istanbul 34662, Türkiye.
Tarakçı, Devrim
  • Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, İstanbul Medipol University, Istanbul 34815, Türkiye.
Aydoğdu, Onur
  • Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul 34854, Türkiye.
Sarı, Zübeyir
  • Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul 34854, Türkiye.

MeSH Terms

  • Humans
  • Cerebral Palsy / therapy
  • Cerebral Palsy / physiopathology
  • Child
  • Equine-Assisted Therapy / methods
  • Equine-Assisted Therapy / standards
  • Equine-Assisted Therapy / instrumentation
  • Male
  • Female
  • Postural Balance / physiology
  • Horses
  • Treatment Outcome
  • Adolescent

Grant Funding

  • SAG-C-YLP-110117-0012 / Marmara University Scientific Research Projects Commission (BAPKO)

Conflict of Interest Statement

The authors report no conflicts of interest and certify that no funding has been received for this study and/or preparation of this manuscript.

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