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Effect of hippotherapy on balance, functional mobility, and functional independence in children with Down syndrome: randomized controlled trial

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Abstract

Impaired muscle strength, proprioceptive and vestibular deficits, and orthopedic dysfunction are common disorders associated with Down syndrome (DS). Hippotherapy uses the horses’ multidimensional movement to improve posture, balance, and overall function, both motor and sensory. Research evidence supports hippotherapy as an effective, medically recognized intervention for the rehabilitation of gross motor skills. The aim of this study was to determine the effect of hippotherapy on balance, functional mobility, and functional independence in children with DS. Thirty-four children with DS were randomly assigned to the experimental (hippotherapy) and control groups after the initial assessment. Both groups received physiotherapy including balance exercises, and the experimental group also received hippotherapy as an integrative therapy. Pediatric Balance Scale (PBS), Timed Up and Go Test (TUG), and Functional Independence Measure for Children (WeeFIM) were used before and after the intervention. Baseline outcome measures (PBS, TUG, WeeFIM) were statistically similar between groups (p > 0.05). After the intervention, PBS and TUG scores improved in both groups (p < 0.05). On the other hand, WeeFIM scores improved just in the hippotherapy group (p < 0.05).

   Conclusion: Therefore, providing hippotherapy as an integrative therapy to physiotherapy will be more effective in improving the functional independence of children with DS.

   Trial registration: NCT05297149 (March 2022, retrospectively registered).

What is Known:

• Hippotherapy has an improvement effect on balance and functional independence in different diseases and age groups, but the evidence is limited in DS.

• There is limited evidence about the effect of hippotherapy on functional mobility in different diseases and age groups, but there is no evidence in DS.

What is New:

• Hippotherapy is a safe and effective approach to support improvement in functional independence in children with DS.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

Abbreviations

DS:

Down syndrome

AHA:

American Hippotherapy Association

PBS:

Pediatric Balance Scale

TUG:

Timed Up and Go Test

WeeFIM:

Functional Independence Measure for Children

BMI:

Body mass index

GMFM:

Gross Motor Function Measure

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Acknowledgements

We would like to thank the children and their families who participated in the study.

Author information

Authors and Affiliations

  1. Physiotherapy Rehabilitation Department, Institute for Graduate Studies, Haliç University, Istanbul, Turkey

    Yelda Kaya

  2. Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Haliç University, Istanbul, Turkey

    Seda Saka

  3. Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey

    Deniz Tuncer

Authors
  1. Yelda Kaya
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  2. Seda Saka
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  3. Deniz Tuncer
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Y.K. and S.S. The first draft of the manuscript was written by S.S. and D.T., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Seda Saka.

Ethics declarations

Ethical approval

The study was approved by the Haliç University Non-Interventional Clinical Research Ethics Committee (139/22.10.2020). This study was performed in line with the principles of the Declaration of Helsinki.

Consent to participate

Written informed consent was obtained from the parents.

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Peter de Winter.

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Kaya, Y., Saka, S. & Tuncer, D. Effect of hippotherapy on balance, functional mobility, and functional independence in children with Down syndrome: randomized controlled trial. Eur J Pediatr 182, 3147–3155 (2023). https://doi.org/10.1007/s00431-023-04959-5

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  • DOI: https://doi.org/10.1007/s00431-023-04959-5

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