Abstract
Background It is debatable whether adaptive riding (AR) in children with cerebral palsy (CP) improves postural control and gross motor development.
Objective The study aim was to explore the feasibility of an extensive assessment protocol for a randomized controlled trial of therapist-designed adaptive riding (TDAR) in children with CP, with the goals of assessing the effect on child outcomes and evaluating working mechanisms of sitting postural control.
Design A pretest-posttest group design with 2 baseline measurements was used.
Methods Six children (1 girl, 5 boys; age range=6–12 years, median age=8 years 9 months) with bilateral spastic CP (Gross Motor Function Classification System level III) participated. Outcomes were evaluated 3 times (T0, T1, and T2) at 6-week intervals. T0 and T1 were baseline measurements; between T1 and T2, a TDAR intervention including an integrated program of postural challenge exercises (2 times per week for 1 hour) was applied. The complex protocol included the 88-item Gross Motor Function Measure (GMFM-88) and electromyographic (EMG) recording of postural muscle activity during reaching while sitting (EMG recording at T1 and T2 only).
Results The protocol was feasible. Median GMFM-88 scores changed from 64.4 at T0 to 66.7 at T1 and from 66.7 at T1 to 73.2 at T2. The change scores for all children exceeded the minimal clinically important difference of the GMFM-88. Five of 6 children showed a decrease in stereotyped top-down recruitment between T1 and T2.
Limitations Study limitations included the lack of a control group, small sample size, and potential assessor bias for all but the EMG parameters.
Conclusions The feasibility of the complex protocol was established. The data suggested that a 6-week TDAR intervention may improve gross motor function and may reduce stereotyped postural adjustments in children with CP. The limited results warrant replication in a well-powered randomized controlled trial.
Footnotes
Mrs Angsupaisal, Dr Maathuis, Dr Reinders-Messelink, and Dr Hadders-Algra provided concept/idea/research design. Mrs Angsupaisal, Mrs Visser, Dr Reinders-Messelink, and Dr Hadders-Algra provided writing and project management. Mrs Angsupaisal and Mrs Visser provided data collection. Mrs Angsupaisal, Mrs Visser, Ms Alkema, and Dr Hadders-Algra provided data analysis. Dr Hadders-Algra and Dr Reinders-Messelink provided fund procurement. Dr Meinsma-van der Tuin provided participants and facilities/equipment. Dr Meinsma-van der Tuin and Dr Hadders-Algra provided institutional liaisons. Mrs Angsupaisal provided administrative support. Mrs Angsupaisal, Dr Meinsma-van der Tuin, and Dr Maathuis provided consultation (including review of manuscript before submission).
The authors acknowledge the skillful collaboration of the team at the Riding Center Onder de Linde; the support of Tineke Dirks, PT, in the development of the video protocol for the classification of activities and assistance during equine movement; the assistance of the students who filmed the therapist-assisted adaptive riding sessions; and the encouragement and support of Stichting ZorgPKs, Federatie Paardrijden Gehandicapten, and the parent organization, BOSK.
This study was approved by the Medical Ethical Committee of the University Medical Center Groningen.
The Stichting Beatrixoord Noord-Nederland and Stichting Groningen-Almelo funded the study.
- Received April 4, 2014.
- Accepted April 13, 2015.
- © 2015 American Physical Therapy Association
Issue highlights
