Study: Horse-assisted therapy appears to improve balance in people with multiple sclerosis

reference

Bronson C, Brewerton K, Ong J, Palanca C, Sullivan SJ. Does hippotherapy improve balance in individuals with multiple sclerosis: a systematic review.Eur J Phys Rehabil Med. 2010;46:347-353.

design

Systematic literature search

Study methods: case control or case series

background

Multiple sclerosis (MS) is a chronic disease caused by progressive demyelination of axons in the central nervous system.¹Clinical symptoms include functional impairments in motor skills and strength, loss of sensitivity, and disturbances in coordination and balance. Symptoms can vary from patient to patient and the disease can be relapsing and remitting or progressive. Given the wide variety of clinical symptoms, various treatments are available, the primary goal of which is to improve balance in everyday activities. Exercise training has proven to be an effective strategy in this regard.^2.3

Hippotherapy is a systematic program of equine physical therapy under the direction of a certified hippotherapy specialist who is also a licensed physical therapist, occupational therapist or speech therapist. It uses the horse's movement to produce continuous dynamic changes in the rider's balance, posture, and proprioceptive input, resulting in instantaneous compensatory motor responses that ultimately retrain the neuromuscular system.^4.5

Hippotherapy is used as a therapeutic intervention for a number of neurological diseases, including cerebral palsy, spinal cord injury, traumatic brain injury and MS.

Hippotherapy is used as a therapeutic intervention for a number of neurological diseases, including cerebral palsy, spinal cord injury, traumatic brain injury and MS.

Materials and methods

The specific research question for this systematic review was: “Does hippotherapy as an intervention improve balance in individuals with MS?” The authors searched the databases of MDLIN, AMED, EMBASE, ERIC, Scopus, ISI Web of Science, CINAHL, PsychINFO, Science Direct and PEDro in 2009 for the terms: hippotherapy, horse, riding, riding, equitation therapy, horse movement therapy, horse-assisted therapy, therapeutic riding AND balance, postural balance, equilibrium, posture, Postural reactions, postural sway, dynamic balance AND multiple sclerosis. Due to limited access to translation facilities, only full-length articles written in or translated into English were included.

Results

Of the 13 articles generated on hippotherapy, balance and MS, 3 met the inclusion criteria and were assessed. The average time and duration of the hippotherapy intervention was 7.75 hours (range 5.0–13.5) over 11.2 weeks (range 9–14), and interventions were delivered both outdoors and indoors. Overall, all three studies reported improvements in balance, with one study suggesting the greatest improvement in patients with primary progressive MS compared to other subtypes of the disease. Limitations of the study included very small sample sizes as well as the lack of random selection of subjects, which is important due to the variable nature of MS.

discussion

Published research in the areas of animal-assisted therapy, equine-assisted therapy, and hippotherapy is relatively small but has increased exponentially over the last decade. Methods such as the randomized controlled trial are very difficult to apply because these interventions depend on constantly changing therapeutic input from a multifactorial source (the horse) to a recipient with a variant of multifactorial disability (cerebral palsy, traumatic brain injury, MS). .

Despite the broad search strategy, only three articles met the inclusion criteria.^6,7,8Nonetheless, all three indicate improvement in balance following hippotherapy sessions, and it is relevant to this discussion that there is significant observational evidence of the value of hippotherapy from therapists, patients and family members, although particularly in the area of ​​cerebral palsy and traumatic brain/spinal cord injury.

There are more than 700 therapeutic riding centers in the United States, and there are thousands more abroad. The North American Riding for the Handicapped Association (NARHA) oversees the certification of therapeutic riding centers, and the American Hippotherapy Association (AHA) ensures the certification of qualified therapists to provide hippotherapy interventions.

Effects on practice

Although therapeutic riding in general and hippotherapy in particular do not have the wealth of well-founded research results of more conventional therapies, numerous centers have been treating tens of thousands of patients for decades with very clearly positive observational results. The risk to the patient is very low and there are no documented side effects of these procedures other than occasional allergy to horses or other environmental sources such as hay. Given the lack of effective therapies and the absence of known cures, patients suffering from these severe neurological disabilities should be referred to a therapeutic riding center.