Innovative robotic hippotherapy improves postural muscle size and postural stability during the quiet stance and gait initiation in a child with cerebral palsy: A single case study
Restricted accessCase reportFirst published online March 12, 2018
Innovative robotic hippotherapy improves postural muscle size and postural stability during the quiet stance and gait initiation in a child with cerebral palsy: A single case study
Postural instability is an important pathomarker in children with cerebral palsy (CP), and is often implicated in gait disturbance.
OBJECTIVE:
The purpose of this study was to investigate the therapeutic effects of long-term robotic hippotherapy (HPOT) on postural muscles size and static and dynamic postural stability in a child with CP.
METHODS:
Ultrasonography was used to measure postural muscles size. We also evaluated the magnitude of the separation between the center of pressure (COP) and center of mass (COM) during quiet stance and gait initiation (GI) using an eight-camera motion capture system and two force plates. Robotic HPOT was provided as a 45-minute session once per week for 12 weeks.
RESULTS:
As transverse abdominal (12%) and lumbar multifidus (60%) muscles size improved, normalized sway area (16%) during the quiet stance decreased. Similarly, the maximal resultant COP-COM distance (12.84%) during the initial phase of GI increased.
CONCLUSIONS:
In a child with CP, robotic HPOT may be an important treatment for improving postural muscles size and postural stability in static and dynamic states.
BaekI. H., & KimB. J. (2014). The effects of horse riding simulation training on stroke patients’ balance ability and abdominal muscle thickness changes. Journal of Physical Therapy Science, 26(8), 1293–1296.
2.
BordoloiK., & SharmaN. (2012). Effectiveness of proprioceptive training over strength training in improving the balance of cerebral palsy children with impaired balance. Scientific Research Journal of India, 1.
3.
DietzV., & SinkjaerT. (2007). Spastic movement disorder: Impaired reflex function and altered muscle mechanics. The Lancet Neurology, 6(8), 725–733.
4.
EncheffJ. L., ArmstrongC., MastersonM., FoxC., & GribbleP. (2012). Hippotherapy effects on trunk, pelvic, and hip motion during ambulation in children with neurological impairmentsPediatric Physical Therapy, 24(3), 242–250.
5.
ElshafeyM. A. (2014). Hippotherapy simulator as alternative method for hippotherapy treatment in hemiplegic children. International Journal of Physiotherapy and Research, 2(2), 435–441.
6.
FerreiraP. H., FerreiraM. L., & HodgesP. W. (2004). Changes in recruitment of the abdominal muscles in people with low back pain: Ultrasound measurement of muscle activity. Spine, 29(22), 2560–2566.
7.
FrankC., KobesovaA., & KolarP. (2013). Dynamic neuromuscular stabilization & sports rehabilitation. International Journal of Sports Physical Therapy, 8(1), 62.
8.
HassC. J., WaddellD. E., FlemingR. P., JuncosJ. L., & GregorR. J. (2005). Gait initiation and dynamic balance control in Parkinson’s disease. Archives of Physical Medicine and Rehabilitation, 86(11), 2172–2176.
9.
HesariA. F., MahdaviS., & AbadiM. R. (2012). Comparisons of berg balance scale following core stabilization training in women elderly. Annals of Biological Research, 3(3), 1499–1504.
10.
HsueB. J., MillerF., & SuF. C. (2009). The dynamic balance of the children with cerebral palsy and typical developing during gait. Part I: Spatial relationship between COM and COP trajectories. Gait & Posture, 29(3), 465–470.
11.
HubbleR. P., NaughtonG. A., SilburnP. A., & ColeM. H. (2014). Trunk muscle exercises as a means of improving postural stability in people with Parkinson’s disease: A protocol for a randomised controlled trial. BMJ Open, 4(12), e006095.
12.
JensenR. K. (1986). Body segment mass, radius and radius of gyration proportions of children. Journal of Biomechanics, 19(5), 359–368.
13.
KieselK. B., UhlT. L., UnderwoodF. B., RoddD. W., & NitzA. J. (2007). Measurement of lumbar multifidus muscle contraction with rehabilitative ultrasound imaging. Manual Therapy, 12(2), 161–166.
14.
KoM. S., SimY. J., KimD. H., & JeonH. S. (2016). Effects of three weeks of whole-body vibration training on joint-position sense, balance, and gait in children with cerebral palsy: A randomized controlled study. Physiotherapy Canada, 68(2), 99–105.
15.
KolarP., & KobesovaA. (2010). 2.A.2. Postural–locomotion function in the diagnosis and treatment of movement disorders. Clinical Chiropractic, 13(1), 58–68.
16.
KoppenhaverS. L., HebertJ. J., FritzJ. M., ParentE. C., TeyhenD. S., & MagelJ. S. (2009). Reliability of rehabilitative ultrasound imaging of the transversus abdominis and lumbar multifidus muscles. Archives of Physical Medicine and Rehabilitation, 90(1), 87–94.
17.
LangC. E., MacDonaldJ. R., & GnipC. (2007). Counting repetitions: An observational study of outpatient therapy for people with hemiparesis post-stroke. Journal of Neurologic Physical Therapy, 31(1), 3–10.
18.
LeeD. R., LeeN. G., ChaH. J., YouS. H., OhJ. H., & BangH. S. (2011). The effect of robo-horseback riding therapy on spinal alignment and associated muscle size in MRI for a child with neuromuscular scoliosis: An experimenter-blind study. NeuroRehabilitation, 29(1), 23–27.
19.
MartinM., ShinbergM., KuchibhatlaM., RayL., CarolloJ. J., & SchenkmanM. L. (2002). Gait initiation in community-dwelling adults with Parkinson disease: Comparison with older and younger adults without the disease. Physical Therapy, 82(6), 566–577.
20.
ParkJ. H., ShurtleffT., EngsbergJ., RaffertyS., YouJ. Y., YouI. Y., & YouS. H. (2014). Comparison between the robo-horse and real horse movements for hippotherapy. Bio-Medical Materials and Engineering, 24(6), 2603–2610.
21.
ProsserL. A., LeeS. C., VanSantA. F., BarbeM. F., & LauerR. T. (2010). Trunk and hip muscle activation patterns are different during walking in young children with and without cerebral palsyPhysical Therapy, 90(7), 986.
22.
dos SantosA. N., SerikawaS. S., & RochaN. A. C. F. (2016). Pilates improves lower limbs strength and postural control during quite standing in a child with hemiparetic cerebral palsy: A case report studyDevelopmental Neurorehabilitation, 19(4), 226–230.
23.
ShurtleffT. L., & EngsbergJ. R. (2010). Changes in trunk and head stability in children with cerebral palsy after hippotherapy: A pilot study. Physical & Occupational Therapy in Pediatrics, 30(2), 150–163.
24.
TeyhenD. S., GillN. W., WhittakerJ. L., HenryS. M., HidesJ. A., & HodgesP. (2007). Rehabilitative ultrasound imaging of the abdominal muscles. Journal of Orthopaedic & Sports Physical Therapy, 37(8), 450–466.
25.
UngerM., JelsmaJ., & StarkC. (2013). Effect of a trunk-targeted intervention using vibration on posture and gait in children with spastic type cerebral palsy: A randomized control trial. Developmental Neurorehabilitation, 16(2), 79–88.
26.
WallworkT. L., StantonW. R., FrekeM., & HidesJ. A. (2009). The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle. Manual Therapy, 14(5), 496–500.
27.
WoollacottM. H., & Shumway-CookA. (2005). Postural dysfunction during standing and walking in children with cerebral palsy: What are the underlying problems and what new therapies might improve balance?Neural Plasticity, 12(2-3), 211–219.
