1. Effect of Equine-Assisted Therapy (Hippotherapy) on Gross Motor Functioning, Postural Control and Performance Outcome of Children with Cognitive & Developmental Disabilities (CDDs)
Paule Nguendang
Research Sponsor: Michelle Neuman MA, MSN, RN, PPCNP-BC
DePaul University School of Nursing
BACKGROUND
RESULTS
NURSING IMPLICATIONS
The database searches yielded fifty identified studies, only nine met the inclusion criteria.. The articles were subdivided in categories; five articles investigated the effect of hippotherapy in children with cerebral palsy, two on autism spectrum disorder, one on intellectual disability and the other on ADHD. The result of these articles revealed that after weeks of intervention, there were no significant differences in both the control and the treatment group, but the hippotherapy group had a significantly greater improvement in some dimension than the control group (p < 0.05).
The practice of hippotherapy is mostly used by occupational, physical and speech-language pathology professionals. However, Nurses can also partner with horse centers to address a patient’s physical, cognitive and emotional needs. Nurses can also gain knowledge in the benefit of this therapy and share this information with patient or family, so they may know what the available options are to improve executive functioning, gross motor, postural and social performance to achieve the highest level of functioning. Additionally, this may also help nurses to make clinical judgements to safely and effectively discuss this subject with any member of the healthcare team in order to provide an outermost care to the patient. Equine-assisted therapy has multiple positive benefit not only for children with CDDs but for everyone; and nurses should be aware of those positive outcomes on health and social development provided by this therapy on treatment and rehabilitation process.
Hippotherapy which is a subset of “Equine-assisted therapy (EAT)” is defined as a use of horses as therapeutic intervention for treatment of physical and psychosocial rehabilitation in children with development, cognitive and intellectual disabilities. This therapy has been used for many years to access or evaluate the treatment benefit horses have on children and adult with similar disabilities.
STATE OF THE LITERATURE
OBJECTIVE
Effect of Equine-assisted therapy on children with ID
To explore existing literature focusing on the effectiveness of equine-assisted therapy (EAT or hippotherapy) on gross motor, postural control and performance outcomes in children with cognitive and developmental disabilities.
FUTURE RESEARCH
METHODS
With regards to implications for future research, study with a larger randomized controlled sample with conceptual framework are needed to compare between races, genders and ages and to provide patient-centered care. The effect of hippotherapy on children with Down Syndrome should also be evaluated; as well as the potential differences due to short and prolonged exposure time during hippotherapy. Another future research can be on the use of hippotherapy to target sensory and motor difficulties in children with ASD (Borgi et al., 2016). A study could also determining the effect of hippotherapy on the pediatric evaluation of disabilities inventory (PEDI), since Park, Rha, Shin, Kim and Jung (2014) did not control the extraneous therapeutic intervention.
An integrative literature review was conducted using the Whittemore & Knafl, (2005) framework the conceptual framework of Dorothy Johnson’s Behavioral System Model.. Nine articles were selected and critically assessed with analysis. The state of the literature from these articles was generated and information was placed in a data matrix.
Effect of Equine-assisted therapy on children with ASD
In evaluating the total state of the literature, representativeness was ranked low in all studied articles because of the smaller sample size. Two studies ranked low in methodological quality due to the lack of inclusion/ exclusion criteria and no reliability or validity established (Ribeiro et al., 2017; Yoo et al., 2016). Four studies ranked low on Theoretical rigor for lack of conceptual framework and no reliable tools for data gathering (Ribeiro et al., 2017; Anderson & Meints, 2016; Borgi et al., 2016; Yoo et al., 2016). Finally, two studies was ranked low on relevance and informational value because there wasn’t any guidance for future studies (Bae et al., 2016; Herrero et al., 2012, 2010).
CONCEPTUAL FRAMEWORK
The theoretical framework adapted for this literature review followed Dorothy Johnson’s Behavioral Model. “Johnson’s theory focuses on the “fostering of efficient and effective behavioral functioning in the patient to prevent illness” (Health Behavioral Theory, 2016, para, 1). Her theory explores the behavioral aspect of an individual as a whole, in which she states that “human beings strive to make continual adjustments to achieve, maintain, or regain balance to the steady-state that is adaptation” (McEwen and Wills, 2017, p. 199).
LIMITATIONS
This integrative literature review highlights four different limitation.
First, under the state of the literature, all the nine articles received a low score of one for representative. This score relates to the fact that the selected articles have small sample sizes and this sample size does not represent the general population. Also, research was only done in certain areas of the world such as in Thailand and in South America, and Spain. Therefore, there is no ethnicity and geographical variation within each study. Second, not all children with CDDs were evaluated, as not all of their disease processes work the same way. However, none of the articles included children with Down Syndrome. Third, none of the articles presented with a conceptual framework. Fourth, the studies may have some biases as not all of the effects on the body, especially at the cellular level, were evaluated. Therefore, the difficulty is in trusting solely on the results, without understanding the processes involved in this therapy. All of these limitations lead to insufficient information for a later replication of the studies in a larger scale.
Effect of Equine-assisted therapy on children with CP
CONCLUSION
Although the use of hippotherapy was proven to be effective, further studies are warranted for better, reliable and generalized data. The nine articles addressed the population with different range of disabilities. In the population with Cerebral Palsy, improvement was mostly perceived in sitting balance and motor control; those with Autism Spectrum Disorder showed an improvement in their social functioning and those with intellectual disabilities showed an improvement in the gait and during walking. Overall, a clear understanding of how this therapy works and how it helps during these movements is not well understood. But this intervention shows promise as an innovative response to non-therapeutic therapy in clinical rehabilitation.