Impact of Therapeutic Riding on Gait and Posture Regulation

Background: Hippotherapy has become an important therapeutic option in patients suffering from motoric dysfunction. The physiologic basis of this approach is the three-dimensional transmission of the horse's motion onto the patients body. These motion stimuli are believed to exert possitve effects on the patients's postural control systems. Aim: To test the hypothesis that hippotherapy has both positive short- and lang-term effects on gait and posture control of persons suffering from motoric disabilities. Methods: Twenty-two children and adolescents aged 9.69 +/- 4.01 years (range: 9.69 +/- 4.01 years) with motoric dysfunctions were included in a prospective matched control study. In each participant, gait and posture control were investigated on four different occasions (O1 - O4) using the Interactive balance system (IBS; Tetrax Inc., Ramat Gan, Israel) and the portable gait analysis sytem RehaWatch (Hasomed, Magdeburg, Germany). The dates of gait and posture analysis were defined as follows: O1: immediately prior to first therapeutic riding session (TRS); O2: immediately after first TRS; O3: after the last day of an eight weeks period of daily TRS; O4: seven weeks later after a TRS free interval. Results: The following parameters were slightly improved (adjusted significance level of p < 0.003) after eight weeks of therapeutic riding: (O1 vs. O3): (1) walking distance (p=0.009, eta(2)=0.339); (2) pace frequency (p = 0.007, eta(2) = 0.358); (3) walking speed (p = 0.006, eta(2) = 0.367), and (4) time of attachment (p=0.007, eta(2) = 0.360). The only short-term effect observed was a significant decrease of the attachment phase (p = 0.002, eta(2) = 0.387). Interestingly, gait symmetry remained unaffected. Posturography (adjusted significance level of p<0.01) at O1 versus O2 (short-term) showed a significant decrease of the performance of both the visual-nigrostriatal subsystem (p<0.001) and the somato-sensory subsystem (p=0.001). At O1 versus O3 (long-term), the following parameters were sharply decreased: (1) postural stability (p=0.011), and (2) somatosensory performance (p=0.011). Conclusions: In the individuals investigated, an eight weeks series of therapeutic riding did not improve posture control and had only a small positive effect on gait performance. The reasons for these rather disappointing results could have been the low number of therapeutic riding sessions (0.5 sessions per week), and the relatively short duration (30 min) of each session. It remains to be seen, whether a higher density and longer duration of therapeutic riding sessions yields better results.