Recreation or Therapy?

Participating in selected sports is recognized as a meaningful and constructive activity for all persons, including persons with a disability. This is true of children with disabilities due to cerebral palsy. It is well recognized that sport activity can improve overall body fitness and have a positive effect on mental well-being. But, does participation have any specific effect on the disability resulting from developmental brain damage (i.e. cerebral palsy)?

Horseback riding is one of several sports in which children with cerebral palsy participate; examples of others include swimming, wheelchair basketball, wheeling, rowing and exercises such as aerobics and tai chi. However, when does a sport become a therapy? Dr. John A. Sterba and his colleagues explore horseback riding as a therapy hippotherapy¹.

Nine females and eight males at an average age of 9 years 10 months were evaluated before, during and after 6 weeks of a structured horseback riding program. The children were diagnosed as having cerebral palsy with either spastic diplegia (spastic lower extremities), spastic quadriplegia (spastic upper and lower extremities) or spastic hemiplegia (spastic extremity on one side of the body). Five of the 17 children were not ambulatory. The Gross Motor Function Classification Measure was used as the evaluation instrument for changes in gross motor function and the Childrens Functional Independence Measure was used to measure the childs level of independence in self care. All children continued their already established programs of physio-therapy and occupational therapy. The only change was the introduction of an 18 week structured program of horseback riding: 1 hour/week, 6 weeks per session, for 3 consecutive sessions. According to the type of disability, the structured program was done in either the sitting position or lying prone on the horses back.

It has been speculated that the warmth of the horse plus its rhythmatical movements improves circulation, reduces abnormally high muscle tone and promote relaxation. In addition, it is believed that the sensation of rhythmic movement in conjunction with therapy techniques done on the horse can facilitate and improve co-contraction (of muscles), joint stability, weight shift and postural and equilibrium responses.

In this study, for the group as a whole, the gross motor score improved 8.7% after 12 weeks (a significant change), 8.5% after 18 weeks (still a significant change) and remained elevated at 1.8% six weeks following the horseback riding program. However, there were wide differences in the results in different children.

Comment:

This small, but well done study indicates that a structured program of horseback riding may be of value to some children as a specific therapy (as differentiated from the general beneficial effects associated with participating in a sport). As the author points out, it was a relatively small study with a few children in each category of disability. However, the results were of enough interest to demonstrate the need for a larger study which would provide the details required to make a judgment about whether horseback riding is recreation and if the latter, for whom.

¹ Sterba, J.A. et al. (2002). Horseback Riding in Children with Cerebral Palsy. DMCN 44:301-208