Alkema, A. (Anne) (2013) Therapeutisch paardrijden als interventie bij kinderen met cerebrale parese. Een pilot studie naar de inhoud en effecten van Horseback Riding Therapy. thesis, Medicine.
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Abstract
Introduction: Cerebral palsy (CP) is a group of motor disorders caused by lesion of the developing brain resulting in motor dysfunction and impaired postural control. Children with CP have difficulties adapting postural muscle activity to different situations; they show a stereotyped top-down recruitment order, implying primary activation of neck-muscles. Recruitment order of typically developing children is characterized by variation. Children with CP sometimes receive horseback riding therapy (HRT). The three-dimensional, smooth reciprocal movements of the horse are believed to improve, gross motor function and postural control. However, evidence on effectiveness is limited. This pilot study aims to explore possibilities for a randomized controlled trial (RCT) on the effects and working mechanisms of HRT. We addressed the following questions: What are the main elements in the content of HRT? What are the effects of six weeks of HRT on gross motor function and postural control of children with CP? And: what is the connection between certain elements of HRT and changes in gross motor function and postural control in children with CP? Methods: Six children aged 6-12 years with bilateral spastic CP and Gross Motor Function Classification System level III were included. An AB-design was used with a 6-week baseline period (T0-T1), followed by a 6-week period in which children received HRT twice a week (T1-T2). HRT was video recorded early (V1) and late (V2) during the intervention. For quantification of the contents of HRT, software programme Observer was used, providing frequencies and percentages of different HRT elements. Gross Motor Function Measurement (GMFM) was conducted at T0, T1 and T2. Postural control was assessed at T1 and T2 by surface electromyogram (EMG) of postural- and arm-muscles during >10 reaching movements (range 11-16). Postural EMG-analysis focused on frequency of trials with top-down recruitment. In statistical analyses with Wilcoxon’s test, p<0.05 was considered statistically significant. Results: Most time of HRT was spent on ‘stepping’ (median V1: 74%; V2: 67%). Part of the time postural challenges were practiced: video-analysis showed a significant increase in postural challenges from 3% at V1 to 15% at V2 (p=0,046). The median GMFM scores changed from 64.4 (T0) to 66.7 (T1; p=0.075) and from 66.7 (T1) to 73.2 (T2; p=0.028). Five out of six children showed a decrease in top-down recruitment between T1 and T2 (p=0.173). The exceptional child showed hyperactivity and attention problems, whereas the others did not. Exclusion of the outlier resulted in the following change in median values of top-down recruitment: from 42% (T1) to 14% (T2; p=0.043). Conclusion: This pilot study suggests that postural challenges during HRT might be of therapeutic relevance. Furthermore, this study indicated that in children with CP, six weeks of HRT was associated with improved gross motor function. The data suggest that improved postural control, reflected by less top-down recruitment, may be a mediating factor in the enhanced gross motor development. These suggestions need to be corroborated in an adequately powered RCT on HRT.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Hadders-Algra, prof. dr. M. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:55 |
| Last Modified: | 25 Jun 2020 10:55 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1587 |
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