Hippotherapy for the Pediatric Population

Candace Lovell Shelton, SPT

Background

Prior to starting physical therapy school, I worked as a physical therapy technician and a horseback riding instructor. Once I was accepted into UNC, one of the physical therapists I worked with asked me what area I was most interested in and I immediately said pediatrics. Throughout the program I have had a strong passion for all of the pediatric topics and have grown more motivated to become a pediatric physical therapist. When developing a capstone project, I wanted to combine my love of working with children and horses with my new passion of pediatric physical therapy.

I shadowed at the North Carolina Therapeutic Riding Center prior to physical therapy school and loved the experience. I was always curious as to the theory behind this specific method of physical therapy. I investigated a specific case from my second clinical rotation for my critically appraised topic in the EBP-II course to see if evidence supported hippotherapy for children with cerebral palsy, specifically regarding improvement in adductor spasticity. This evolved into what is now my capstone project.

 

Overview/Purpose

Hippotherapy is a highly specialized intervention that utilizes an equine’s movement to achieve various rehabilitative goals in a patient’s plan of care, working as an adjunct to other traditional therapies.¹ The available research suggests that hippotherapy intervention may improve gross motor skills and postural stability for a variety of pediatric diagnoses when used in conjunction with convention physical therapy.^2-12 Transmission of movement patterns from the horse to the rider provides a unique opportunity to alter and normalize movement patterns for children who display abnormal or inefficient gait. The associated improvements in body structure and function improves a child’s ability to participate in recreation, leisure, and play activities with peers.

 

Statement of Need

UNC’s pediatric elective course has VoiceThreads for students to broaden their knowledge regarding the available treatment methods for the pediatric population. Throughout the curriculum in the DPT program, there is minimal information related to the use of hippotherapy as a form of physical therapy for children or adults.

Following conversations with Dr. Dana McCarty, my capstone advisor, we determined that an overview of hippotherapy for a VoiceThread including the mechanics behind how it works, the pediatric populations it benefits based on literature, and referral options within North Carolina would be a useful tool for the pediatric elective course.

 

Products

Two products were produced as part of this Capstone Project. The first was a literature review consisting of the available evidence for the use of hippotherapy as physical therapy treatment. The evidence included studies evaluating the biomechanics of hippotherapy for the horse and rider, intervention strategies used in hippotherapy, and pediatric conditions studied within hippotherapy practice. This information along with a wealth of knowledge provided by Margie Muenzer, PT, who is a physical therapist at the North Carolina Therapeutic Riding Center (NCTRC) was incorporated into a VoiceThread for the pediatric elective course. This presentation aims to explain the theory behind hippotherapy, the research supporting it with specific pediatric populations, provide video examples of the changes that can occur from hippotherapy sessions, educate regarding important precautions and contraindications, and provide information regarding referral in NC.

 

Evaluation

Throughout the development of my literature review and script for my VoiceThread, I implemented feedback from all of my committee member to improve my products. I used the resources for health literacy and creating presentations through our Capstone course to ensure my presentation was learner-friendly and aesthetically pleasing. I also incorporated feedback from a different presentation I gave as a TA for PHYT 701 to improve my Capstone VoiceThread based on comments. Here is an evaluation form that could be used for the VoiceThread that will provide feedback regarding the presentation material and its relevance to the pediatric elective course.

 

Self-Reflection

This project has allowed me to broaden my knowledge of both pediatric and adult diagnoses that may benefit from hippotherapy intervention. I was also able to truly understand the biomechanics behind why hippotherapy may help improve gross motor function for the patients that participate in this unique form of physical therapy. After looking at my original objectives for myself, I feel that I have improved in my ability to synthesize literature on a specific topic, I have a clear understanding of indications and contraindications/precautions for hippotherapy treatment, and I understand why hippotherapy could be beneficial to specific pediatric populations.

This experience has taught me so much and has made me more passionate about pediatric physical therapy. It has been a wonderful learning experience and has pushed me to be more diligent regarding synthesizing available literature on a less common form of treatment.

 

Acknowledgements

I would like to thank my committee advisor, Dr. Dana McCarty, for her constant advice and guidance throughout this project. My committee member Dr. Deborah Thorpe, PT, PhD for her ongoing support and feedback that helped me successfully develop a learner-friendly presentation. I would like to give a special thanks to my other committee member, Margie Muenzer, PT for all of her knowledge regarding hippotherapy and the instrumental resources she provided that truly made my product a success. It has been an honor to work with a committee full of knowledgeable individuals with a wide range of expertise in the pediatric population.

 

References

1. 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. Phys. Ther. 2012;24(3):242-250. doi:10.1097/PEP.0b013e31825c1dc3.
2. Lucena-Antón D, Rosety-Rodríguez I, Moral-Munoz JA. Effects of a hippotherapy intervention on muscle spasticity in children with cerebral palsy: A randomized controlled trial. Complement Ther Clin Pract 2018;31:188-192. doi:10.1016/j.ctcp.2018.02.013.
3. Kwon J-Y, Chang HJ, Yi S-H, Lee JY, Shin H-Y, Kim Y-H. Effect of hippotherapy on gross motor function in children with cerebral palsy: a randomized controlled trial. Altern. Complement. Med. 2015;21(1):15-21. doi:10.1089/acm.2014.0021.
4. McGibbon NH, Benda W, Duncan BR, Silkwood-Sherer D. Immediate and long-term effects of hippotherapy on symmetry of adductor muscle activity and functional ability in children with spastic cerebral palsy. Phys. Med. Rehabil. 2009;90(6):966-974. doi:10.1016/j.apmr.2009.01.011.
5. Moraes AG, Copetti F, Ângelo VR, Chiavoloni L, de David AC. Hippotherapy on postural balance in the sitting position of children with cerebral palsy – Longitudinal study. Physiother Theory Pract 2018:1-8. doi:10.1080/09593985.2018.1484534.
6. Mutoh T, Mutoh T, Tsubone H, et al. Impact of serial gait analyses on long-term outcome of hippotherapy in children and adolescents with cerebral palsy. Complement Ther Clin Pract 2018;30:19-23. doi:10.1016/j.ctcp.2017.11.003.
7. Copetti F, Mota CB, Graup S, Menezes KM, Venturini EB. Angular kinematics of the gait of children with Down’s syndrome after intervention with hippotherapy. Braz J Phys Ther doi:10.1590/S1413-35552007000600013.
8. Champagne D, Dugas C. Improving gross motor function and postural control with hippotherapy in children with Down syndrome: case reports. Physiother Theory Pract 2010;26(8):564-571. doi:10.3109/09593981003623659.
9. Professional Association of Therapeutic Horsemanship International Standards for Certification & Accreditation. 2018. Available at: http://www.pathintl.org/images/pdf/standards-manual/2018/2018-path-intl-standards-complete-manual.pdf. Accessed March 31, 2019.
10. Kraft KA, Weisberg J, Finch MD, Nickel A, Griffin KH, Barnes TL. Hippotherapy in rehabilitation care for children with neurological impairments and developmental delays: A case series. Phys. Ther. 2019;31(1):E14-E21. doi:10.1097/PEP.0000000000000567.
11. Ajzenman HF, Standeven JW, Shurtleff TL. Effect of hippotherapy on motor control, adaptive behaviors, and participation in children with autism spectrum disorder: a pilot study. J. Occup. Ther. 2013;67(6):653-663. doi:10.5014/ajot.2013.008383.
12. Hawkins BL, Ryan JB, Cory AL, Donaldson MC. Effects of Equine-Assisted Therapy on Gross Motor Skills of Two Children with Autism Spectrum Disorder: A Single-Subject Research Study. Therapeutic Recreation Journal
13. Image Source: https://res.cloudinary.com/hrscywv4p/image/upload/c_limit,fl_lossy,h_9000,w_1920,f_auto,q_auto/v1/777543/RJ5A4213_egxbvo.jpg