PT Critically Appraised Topics
 

Document Type

Critically Appraised Topic

Publication Date

2015

Clinical Scenario

A seven-year old male presents with a primary diagnosis of spastic quadriplegic cerebral palsy (CP) while attending a school for children with disabilities in the township of Gugulethu, Cape Town, South Africa. Impairments include decreased trunk and pelvic control, decreased lower extremity strength, increased lower and upper extremity tone, an uncoordinated flexed gait pattern, and a lack of independent ambulation. Prior to the introduction of hippotherapy, the patient was non-ambulatory. Medical treatment to date has involved general trunk and lower extremity strengthening exercises, wheelchair positioning, speech and occupational therapy for speech and swallowing problems, and gait training. Hippotherapy is suggested to be an effective intervention for children with cerebral palsy to assist in neuromuscular re-education of postural muscles and decreasing postural tone and is currently being implemented as a routine intervention in the care of this patient.

Clinical Question

Does physical therapy (PT) treatment involving hippotherapy lead to improved gross motor function and balance in children with cerebral palsy?

Clinical Bottom Line

Based on the results described by the authors identified in Table 2, there is low quality evidence supporting the use of hippotherapy as a gross motor function intervention for children with a primary diagnosis of cerebral palsy. Two studies were randomized-controlled trials while the other two utilized an A-B and A-B-A study design with moderate to poor internal validity. The large number of major threats to internal validity in all four articles dramatically decrease confidence in and ability to generalize findings from the study results. This suggests the need for more rigorous research with strict protocols and study design and larger, heterogeneous samples to reach a definitive decision regarding the effectiveness of hippotherapy compared to strengthening and stretching exercises for the trunk and extremities in improving GMFM score as a measure of postural control.

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