Effectiveness of Equine-Assisted Therapy in Enhancing Gross Motor Function and Balance in Individuals with Cerebral Palsy – A literature review
Keywords:
Equine-assisted therapy, Cerebral palsy, motor functioning, balance, horseback ridingAbstract
Background: Cerebral palsy (CP) is a non-progressive neurological disorder characterized by central motor dysfunction, impairing movement, posture, and muscle tone. It manifests as abnormal gait, muscle imbalances, and coordination deficits. Classified by limb involvement, CP affects 2-3 per 1,000 live births, with symptom variability and potential functional improvement due to neural maturation. Aim: This literature review aims to evaluate the current literature on equine-assisted therapy interventions for Cerebral palsy, focusing on studies published between 2015 and 2025. The review seeks to identify the effectiveness of equine-assisted therapy approaches that enhance motor function and improve balance in individuals with CP. Methods: A comprehensive literature search was conducted using databases such as Google Scholar, Research Gate, PubMed, and Medline. Keywords included "Cerebral palsy," "Equina-assisted therapy”, "horseback riding," "balance," and "motor functions." Articles published in English and meeting the inclusion criteria were considered for review. Selection Criteria: Inclusion criteria encompassed peer-reviewed research articles, systematic reviews, clinical trials, observational studies, and case studies focusing on equine-assisted therapy for CP. Articles had to involve human participants diagnosed with CP across any stage or age group. Exclusion criteria included non-research articles, non-English publications, and articles published before 2015. Results: 7 of the 46 initially found articles met the inclusion criteria for detailed examination. These studies employed Equine-assisted therapies (EAT) to notably improve gross motor function, balance, and postural control in people with cerebral palsy. Studies show sustained GMFM and GMPM improvements, with increased muscle mass and stability. However, spasticity effects remain discrepant, and quality-of-life benefits require further research. Conclusion: Individuals with cerebral palsy benefit greatly from equine-assisted therapies (EAT) regarding improved balance, postural control, and gross motor function. Although improvements in motor function are well-established and lasting, the effects on spasticity are still erratic and require more research. To improve the clinical use of EAT in rehabilitation, future studies should concentrate on streamlining treatment plans and evaluating long-term functional results.
References
La Porta F, Caselli S, Susassi S, Cavallini P, Tennant A, Franceschini M. Is the Berg Balance Scale an internally valid and reliable measure of balance across different etiologies in neurorehabilitation? A revisited Rasch analysis study. Archives of physical medicine and rehabilitation. 2012 Jul 1;93(7):1209-16.
Chen CL, Shen IH, Chen CY, Wu CY, Liu WY, Chung CY. Validity, responsiveness, minimal detectable change, and minimal clinically important change of Pediatric Balance Scale in children with cerebral palsy. Research in developmental disabilities. 2013 Mar 1;34(3):916-22.
Huijing PA, Bénard MR, Harlaar J, Jaspers RT, Becher JG. Movement within foot and ankle joint in children with spastic cerebral palsy: a 3-dimensional ultrasound analysis of medial gastrocnemius length with correction for effects of foot deformation. BMC musculoskeletal disorders. 2013 Dec;14:1-2.
Stergiou ΑN, Varvarousis DN, Tzoufi M, Markozannes G, Plyta P, Vasileiadis G, Beris A, Ploumis A. Equine-assisted intervention in children with spastic quadriplegia: The effect on function and balance A prospective study. Archives of Hellenic Medicine/Arheia Ellenikes Iatrikes. 2024 Mar 1;41(2).
Paul S, Nahar A, Bhagawati M, Kunwar AJ. A review on recent advances of cerebral palsy. Oxidative medicine and cellular longevity. 2022;2022(1):2622310.
Cans C. Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Developmental Medicine & Child Neurology. 2000 Dec;42(12):816-24.
7: Chang HJ, Jung YG, Park YS, O SH, Kim DH, Kim CW. Virtual reality-incorporated horse riding simulator to improve motor function and balance in children with cerebral palsy: a pilot study. Sensors. 2021 Sep 24;21(19):6394.
Jackman M, Sakzewski L, Morgan C, Boyd RN, Brennan SE, Langdon K, Toovey RA, Greaves S, Thorley M, Novak I. Interventions to improve physical function for children and young people with cerebral palsy: international clinical practice guideline. Developmental Medicine & Child Neurology. 2022 May;64(5):536-49.
Cho C, Hwang W, Hwang S, Chung Y. Treadmill training with virtual reality improves gait, balance, and muscle strength in children with cerebral palsy. The Tohoku journal of experimental medicine. 2016;238(3):213-8.
Vitrikas K, Dalton H, Breish D. Cerebral palsy: an overview. American family physician. 2020 Feb 15;101(4):213-20.
Pourazar M, Firoozjah MH, Ardakani MD. Improving dynamic balance by self-controlled feedback in children with cerebral palsy. Human Movement Science. 2023 Aug 1;90:103123.
Mandrá PP, Moretti TC, Avezum LA, Kuroishi RC. Animal assisted therapy: systematic review of literature. InCodas 2019 Jun 27 (Vol. 31, p. e20180243). Sociedade Brasileira de Fonoaudiologia.
Araujo TB, Silva NA, Costa JN, Pereira MM, Safons MP. Effect of equine-assisted therapy on the postural balance of the elderly. Brazilian Journal of Physical Therapy. 2011;15:414-9.
Heussen N, Häusler M. Equine-assisted therapies for children with cerebral palsy: A meta-analysis. Pediatrics. 2022 Jul 1;150(1):e2021055229.
Lee CW, Kim SG, Na SS. The effects of hippotherapy and a horse riding simulator on the balance of children with cerebral palsy. Journal of physical therapy science. 2014;26(3):423-5.
Herrero P, Gómez-Trullén EM, Asensio Á, García E, Casas R, Monserrat E, Pandyan A. Study of the therapeutic effects of a hippotherapy simulator in children with cerebral palsy: a stratified single-blind randomized controlled trial. Clinical rehabilitation. 2012 Dec;26(12):1105-13.
PATH International (2013). Available at: http://www.pathintl.org/ (Acessed January 19, 2013).
Sterba JA. Does horseback riding therapy or therapist‐directed hippotherapy rehabilitate children with cerebral palsy?. Developmental medicine & child neurology. 2007 Jan;49(1):68-73.
Stergiou AN, Mattila-Rautiainen S, Varvarousis DN, Tzoufi M, Plyta P, Beris A, Ploumis A. The efficacy of Equine Assisted Therapy intervention in gross motor function, performance, and spasticity in children with Cerebral Palsy. Frontiers in Veterinary Science. 2023 Aug 15;10:1203481.
Lee SJ, Lee SY, Choi JH, Seok M, Song SW, Lee HJ. Impact of Equine-Assisted Activities and Therapies on Gross Motor Function in Children with Cerebral Palsy: A Prospective Case Series. The Korean Journal of Sports Medicine. 2024 Mar 1;42(1):12-22.
Lightsey P, Lee Y, Krenek N, Hur P. Physical therapy treatments incorporating equine movement: a pilot study exploring interactions between children with cerebral palsy and the horse. Journal of neuroengineering and rehabilitation. 2021 Dec;18:1-1.
Chinniah H, Natarajan M, Ramanathan R, Ambrose JW. Effects of horse riding simulator on sitting motor function in children with spastic cerebral palsy. Physiotherapy Research International. 2020 Oct;25(4):e1870
Alemdaroğlu E, Yanıkoğlu İ, Öken Ö, Uçan H, Ersöz M, Köseoğlu BF, Kapıcıoğlu Mİ. Horseback riding therapy in addition to conventional rehabilitation program decreases spasticity in children with cerebral palsy: a small sample study. Complementary therapies in clinical practice. 2016 May 1;23:26-9.
Antunes FN, do Pinho AS, Kleiner AF, Salazar AP, Eltz GD, de Oliveira Junior AA, Cechetti F, Galli M, Pagnussat AS. Different horse’s paces during hippotherapy on spatio-temporal parameters of gait in children with bilateral spastic cerebral palsy: A feasibility study. Research in developmental disabilities. 2016 Dec 1;59:65-72.
