Effectiveness of hippotherapy and therapeutic horseback riding on balance in hemiparetic patients after stroke

Silva, Stephanie Bruna Carlos Azevedo; Hruschka, Anna Carolina Corrêa Bicca; Moraes, Andrea Gomes; Leal, Josevan Cerqueira; Silva, Marianne Lucena da; Paz, Leonardo Petrus da Silva

doi:10.1590/fm.2021.34201

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REVIEW ARTICLE • Fisioter. mov. 34 • 2021 • https://doi.org/10.1590/fm.2021.34201 copy

Effectiveness of hippotherapy and therapeutic horseback riding on balance in hemiparetic patients after stroke

Efetividade da hipoterapia e da equoterapia terapêutica no equilíbrio de pacientes hemiparéticos pós-acidente vascular cerebral

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Stroke is one of the leading causes of disability and death worldwide. Individuals who suffered stroke present numerous functional limitations. Hippo-therapy (HPOT) is proposed as capable of promoting the recovery of postural balance in patients with neurological impairment.

Objective:

To analyze published articles, seeking the effects of HPOT on changes in postural balance, through the Berg Balance Scale (BBS), in individuals with stroke.

Methods:

We conducted a systematic review and meta-analysis of studies published on the electronic databases PubMed, VHL, SCIELO, Cochrane, SCOPUS, WoS, and Cinahl. Keywords: "hippotherapy", "horseback riding" and "stroke" linked by the OR and AND boolean operators. The research was restricted to clinical trials in an adult population with a history of stroke.

Results:

Four articles were included in this meta-analysis, which used HPOT as an intervention to improve postural balance. Three studies used a mechanical device (horseback riding), and the horse. The age ranged from 61 to 71 years, being more predominant the male sex. Sessions ranged from 6 to 12 weeks of 20 to 30 minutes per session. Quality analysis using the PEDro scale demonstrated scores ranging from 6 to 8 points in the selected studies. Overall, treatment with mechanical and conventional therapy resulted in an improvement in the total BBS score. As compared with conventional therapy just studies with horseback riding was superior to conventional therapy to improve postural balance in hemiparetic stroke patients.

Conclusion:

There are few studies of high quality; then, it is not possible to evaluate the effectiveness of HPOT using a horse or a mechanic simulator in patients with stroke when compared with conventional therapy. Future studies could clarify if HPOT has potential benefits as a complementary therapeutic strategy to conventional physiotherapy to promote the improvement of postural balance after stroke.

Keywords:
Mechanical horseback riding; Equine-assisted therapy; Hippotherapy; Stroke; Postural balance

Studies	Population		Intervention			Comparison	Outcome
	Participants in the EG	Participants in the CG	Training frequency*	Experimental Group	Instrument used and therapy	Control Group	Evaluation and variable	Results related to balance
Han et al., 2012²⁷27 Han JY, Kim JM, Kim SK, Chung JS, Lee HC, Lim JK, et al. Therapeutic effects of mechanical horseback riding on gait and balance ability in stroke patients. Ann Rehabil Med. 2012;36(6):762-9. DOI DOI...	19 (M13/ F6) Age: 61,1 Time post stroke: > 6 months Side of hemiparesis: NS	18 (M11/ F7) Age: 62,2 Time post stroke: > 6 months Side of hemiparesis: NS	12 weeks, 2x/week, 24 sessions, 20 minutes	Mechanical horseback riding therapy + Conventional physical therapy	Joba EU6441. A cycle is a set of movements: swing back and forth, left and right, and back to the starting position. The speed of movement varies from level 1 (0.62 Hz) to level 7 (1.21 Hz). There are three preset slope levels: basic conditioning (flat), forward tilt and backward tilt.	Conventional physical therapy	BBS; Balance	Balance parameters improved significantly in the experimental group at 12 weeks post treatment (p = 0,001). When comparing the groups, the dynamic balance category of BBS in post treatment showed significant difference (p = 0.02).
Lee et al., 2014³⁰30 Lee CW, Kim SG, Yong MS. Effects of hippotherapy on recovery of gait and balance ability in patients with stroke. J Phys Ther Sci. 2014;26(2):309-11. DOI DOI...	15 (M11/F4) Age: 63,8 Time post stroke: NS Side of hemiparesis: NS	15 (M12/F3) Age: 64,3 Time post stroke: NS Side of hemiparesis: NS	8 weeks, 3x/ week, 24 sessions, 30 minutes	Hippotherapy	During each hippotherapy session, the horse walked around a circle 30 meters in diameter 30 times clockwise and 30 counter- clockwise for 30 minutes.	Walk on the treadmill	BBS; Balance	There was no significant improvement between the groups, but there was significance between pre and post treatment in experimental group (p < 0,05)
Lee and Kim, 2015²⁸28 Lee DK, Kim EK. The influence of horseback riding training on the physical function and psychological problems of stroke patients. J Phys Ther Sci. 2015;27(9):2739-41. DOI DOI...	15 (M8/F7) Age: 68,4 Time post stroke: > 6 months Side of hemiparesis: R7/L8	15 (M8/F7) Age: 67,0 Time post stroke: > 6 months Side of hemiparesis: R6/L9	6 weeks, 5x/ week, 30 sessions, 30 minutes	Mechanical horseback riding therapy + Conventional physical therapy	Joba EU7200**	Conventional physical therapy	BBS; Balance	The balance improved significantly after treatment with mechanical horseback riding therapy (p < 0,05)
Kim and Lee, 2015²⁹29 Kim YN, Lee DK. Effects of horse-riding exercise on balance, gait, and activities of daily living in stroke patients. J Phys Ther Sci. 2015;27(3):607-9. DOI DOI...	10 (M5/F5) Idade: 71,1 Time post stroke: > 6 months Side of hemiparesis: R5/L5	10 (M5/ F5) Idade: 69,2 Time post stroke: > 6 months Side of hemiparesis: R5/L5	6 weeks, 5x/week, 30 sessions, 30 minutes	Mechanical horseback riding therapy + Conventional physical therapy	Joba EU7200. It offers 5 types of movements: twist, slide from top to bottom, slide from front to back, rotate from front to back and rotate from left to right (three- dimensional movements). Based on level, adaptability and motor ability, subjects were asked to start at level 1 and continue at level 4. The subjects were able to control their posture by holding the hand loops and maintaining the correct posture.	Conventional physioal therapy	BBS; Balance	Significant improvement in the balance of the experimental group after training with mechanical horseback riding therapy (p < 0,05). The experimental group showed significant differences in balance, gait, and ADLs compared with in the control group.

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[1] * Correspondence: leonardopaz@unb.br