Gait kinematics
A pre-post study (Kwon et al, 2011) investigated the effects of hippotherapy on high functioning children with cerebral palsy (GMFCS I or II) and demonstrated that hippotherapy significantly improved walking speed (p=0.004), stride length (p<0.001).
A pre-post study (McGee, 2009) demonstrated no statistically significant differences (p < 0.05) noted in the post-ride temporal and spatial gait parameter values when compared with the pre-ride values in a sample of children with cerebral palsy.
Conclusion: There is conflicting (level 4) evidence regarding the effectiveness of hippotherapy on gait parameters in children with cerebral palsy.
Muscle geometry
A single high level RCT (McGibbon et al, 2009) examined the effects of hippotherapy compared to barrel-sitting on adductor muscle symmetry in a sample of 47 children with spastic cerebral palsy. It was found that hippotherapy significantly improved adductor muscle asymmetry (P<.001), and effects of barrel sitting were not significant (P<.05).
A pre-post study (Kwon et al, 2011) investigated the effects of hippotherapy on high functioning children with cerebral palsy (GMFCS I or II) and demonstrated a significant positive effect on pelvic kinematics after treatment (p<0.05).
A pre-post study (El-Meniawy et al, 2012) examined the effects of a hippotherapy program in conjunction to an exercise program compared to the exercise program alone on the effect of back geometry in a sample of children with spastic diplegia. It was found that a significant improvement was observed in all the measuring variables of the two groups when comparing their pre and post-treatment mean values. However, a significant difference was also observed when comparing the post-treatment results of the two groups in favor of the group receiving hippotherapy in addition to the exercise program.
A pre-post study (Shurteff et al, 2010) examined the effect of hippotherapy on head and trunk stability. Following hippotherapy, children with CP demonstrated a significant decrease in head rotation and AP translation at C7 (p = .02), Cyclops eye (p = .03), and the vertex (p = .005) measurement points. After the intervention, children with CP reduced their AP head rotation and translation (p < .05), suggesting that they had increased stability of the head and trunk in response to perturbations at the pelvis.
A literature review (Snider et al, 2007) concluded that there is limited evidence regarding the positive effects of hippotherapy on trunk and pelvic muscle symmetry.
Conclusion: There is moderate evidence (level 1b) from one high quality RCT that hippotherapy positively affects muscle geometry in children with cerebral palsy.
Sitting balance
One high quality RCT (Kang et al, 2013) evaluated the effects of hippotherapy on sitting balance in children with cerebral palsy. Sway pathway and velocity significantly decreased for the hippotherapy group (p<0.05) and resulted in the greatest increase of sitting balance.A systematic review (Zadnikar et al, 2011) aimed to provide an overview of the effects of hippotherapy or therapeutic horseback riding on postural control or balance in children with cerebral palsy. Therapy was found to be effective in 76 out of 84 children with CP included in the intervention groups. The comparison groups comprised 89 children: 50 non-disabled and 39 with CP. A positive effect was shown in 21 of the children with CP in the comparison group regardless of the activity undertaken (i.e. physiotherapy, occupational therapy, sitting on a barrel or in an artificial saddle). The pooled effect size estimate was positive (O.R.=25.41, 95% CI: 4.35, 148.53), demonstrating a statistically significant effectiveness of hippotherapy or therapeutic horseback riding in children with CP (p<0.001).
Conclusion: There is moderate evidence (level 1b) from one high quality RCT that hippotherapy improves sitting balance in children with cerebral palsy.
