Postgraduate student A.S. Volokitin¹
Associate professor, Ph.D. A.A. Bruykov¹
Associate professor, Ph.D. V.V. Apokin²
Professor, Dr.Med. A.V. Gulin^1
1 Lipetsk State Pedagogical University, Lipetsk
² Surgut State Pedagogical University of KhMAR-Yugra, Surgut

Keywords: hippotherapy, cerebral palsy.

Introduction. Cerebral palsy (CP) is a group of syndromes that result from brain injury during the prenatal, perinatal and early postnatal periods. Motor development disorder caused primarily by abnormal distribution of the muscle tone and dystaxia is a characteristic feature of CP [1]. Motor disorder in case of CP is registered since birth, closely associated with perceptual disorders, and is the leading defect that has an adverse impact on the entire process of formation of nervous and mental functions of a child.  

Double hemiplegia is one of the most severe forms of CP. Spastic tetraplegia (tetraparesis), pseudobulbar syndrome, cognitive disorders and speech disorders are clinically diagnosed. Motor disorders are either equally manifested in arms and legs, or arms are affected more than legs. Early formation of contractures, body and limbs deformities are characteristic of double hemiplegia. Severe motor defect and lack of motivation for classes to correct their condition serve as an insurmountable obstacle to the restoration of defective functions of children with CP [3].

This problem is solved by means of using hippotherapy. Advantage of hippotherapy over other types of exercise therapy is that simultaneous functioning of almost all muscle groups takes place when riding a horse. It happens on the reflex level since, while sitting on a horse, moving along with it and on it, a child instinctively tries to keep the balance in order not to fall off the horse throughout the whole class. By doing so he induces the diseased muscles of the body to active work. In addition, no piece of sports equipment has the ability to give rise to such strong, diverse motivation that accompanies hippotherapy sessions [4].

Complex treatment of CP includes medications, exercise therapy, orthopedic treatment, various kinds of massage including fixative massage combined with developmental gymnastics, physiotherapeutic treatments, and reflexology tools [2]. In recent years hippotherapy has been increasingly used as a means of rehabilitation.

The purpose of the research was to study the influence of hippotherapy on the functional state of the neuromuscular system of children with CP using the technique of analysis of the motor reaction latent time (MRLT), the tapping test and dynamometry.    

Materials and methods. 26 girls and boys aged 8-11, diagnosed with CP in the form of double spastic hemiplegia, were involved in the study. The examined children were divided into 2 equal groups: a control group (group 1), the average age – 10.1±0.9 years old and an experimental group (group 2), the average age – 10.5±0.6 years. Observations were conducted during 6 months. Rehabilitation activities of children from group 1 included classical massage and exercise therapy. Children from group 2 were engaged in a specially designed program of hippotherapy. In each group (experimental and control) the children were examined twice: first – before the course of treatments (initial examination) and one more time – after the course of treatments (final examination). Two courses of massage and exercise therapy took place all in all, each of them consisted of 15 treatments. Hippotherapy sessions (40 sessions) were conducted continuously three times a week. Duration of massage and exercise therapy that followed it was 90 minutes, duration of a hippotherapy session – 45 minutes.  

Determining the motor reaction latent time (MRLT) (ms). MRLT with regards to light and sound was measured by a universal myoreflexometer. Those participating in the research were at first familiarized with the way it works. The examined person sat on a chair next to the device, his attention focused on the signal and he was trained to hold the key with the thumb and the forefinger of his right and then his left hand, and also press the button on hearing a bell or on seeing light. Five attempts were made, and the arithmetic mean of MRLT was calculated.

The maximum frequency of voluntary movements can be another criterion of the functional state of the nervous system of children with CP. It is known that the pace of movement is accounted for by the specifics of the functional state, primarily the cortical parts of the motor analyzer, and in particular by the speed of change of its inhibitory and excitatory phases. The maximum frequency of voluntary movements (tapping test) served as a criterion of the functional state of the nervous system. The examined person kept tapping on a sheet of paper with a pencil for 30 seconds at the maximum pace possible for him. The number of dots left by the right and left hands was calculated.  

Determining the absolute hand strength (kg). Carpal dynamometry of the right and left hands was determined using a children’s hand dynamometer. The examined person placed the dynamometer between his fingers and the palm at the base of the thumb moving the hand to the side and applying maximum force while squeezing the dynamometer. The best result of two attempts was registered.  

The parameters were measured before and after the treatments. The basic statistical parameters (М ± m) and significance of their differences were measured by the Wilcoxon nonparametric criterion, based on standard MS Excel software. The obtained results were highly reliable. 

Results and discussion. After the treatments of classical massage and exercise therapy MRLT to light decreased by 3.5% and 2.9%, respectively, among the children from group 1. Hippotherapy treatments considerably changed the duration of the latent period of motor reaction of the children. After hippotherapy MRLT to light of their right and left hands decreased by 6.2% and 5.5%, respectively (Table 1).  

When applying auditory stimuli in case of such treatments as classical massage and exercise therapy the reaction time of the right and left hands of the children decreased, but the data obtained were not statistically significant. After hippotherapy treatments MRLT to sound decreased by 6.4% for the right hand, and by 6% for the left hand (Table 1).  

Table 1. Functional performance of the neuromuscular system in children aged 8-11 with CP in the form of double spastic hemiplegia, n = 26

Notes.  Here and in Table 2: 

А – classical massage and exercise therapy; B – hippotherapy;

1 – initial state; 2 – after the treatments;

p – coefficient of significance of differences.

The maximum frequency of movements of children with CP before and after the treatments was studied in the next part of the experiment using the tapping test. The tapping test results of the children with CP are provided in Table 2. The table shows that the maximum frequency of voluntary movements affected by the treatments increased more after hippotherapy. Thus, the frequency of voluntary movements of the right and left hands increased by 12% and 10.5%, respectively, as a result of hippotherapy, and after the classical massage and exercise therapy the obtained data were not statistically significant.    

Table 2. Frequency of voluntary movements of children aged 8-11 with CP in the form of double spastic hemiplegia, n = 26

The absolute hand strength was measured before and after the rehabilitation impact. In case of children from group 2 the absolute hand strength increased by 29.6% and 24% for the right and left hands respectively, after the hippotherapy (Table 3), while in group № 1 the absolute power of the right and left hands increased by just 14.5% and 13.5% affected by the classical massage and exercise therapy.

Table 3. Absolute hand strength in children aged 8-11 with CP in the form of double spastic hemiplegia, n = 26

Note.  

А1 – initial state prior to classical massage and exercise therapy; B1 – initial state prior to hippotherapy; A2 – after classical massage and exercise therapy; B2 – after hippotherapy; p – coefficient of significance of differences.

Conclusions. The functional state of the neuromuscular system of children with cerebral palsy was proved to get better under the influence of hippotherapy and classical massage with physiotherapy. The changes are most remarkable in the case of using hippotherapy. The influence of hippotherapy on the absolute hand strength gain in comparison with classical massage and physiotherapy was more effective. Therefore, the method of hippotherapy can be regarded not only as an equivalent, but also as physiologically more effective when affecting the body of a child with cerebral palsy. This fact shows the usefulness of the active introduction of means of hippotherapy into the practice of rehabilitation activities of children with cerebral palsy.

References

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2. Bruykov, A.A. Fiziologicheskaya kharakteristika vliyaniya fiksatsionnogo massazha i ontogeneticheskoy gimnastiki na funktsional'noe sostoyanie TsNS u detey s DTsP (Physiological characteristics of the effect of fixative massage and developmental gymnastics on functional state of central nervous system in children with cerebral palsy) / A.A. Bruykov, A.V. Gulin, V.V. Apokin // Teoriya i Praktika Fizicheskoy Kul'tury. – 2010. – № 11. – P. 99–101.
3. Gross, N.A. Fizicheskaya reabilitatsiya detey s narusheniyami funktsii oporno-dvigatel’nogo apparata (Physical rehabilitation of children with musculoskeletal disorders) / N.A. Gross. – Moscow: Sovetskiy sport, 2000. – 224 с.
4. Zadnikar, M. On hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: a meta-analysis // Dev Med Child Neurol.: Epub. – 2011. – V. 53. – № 8.

Corresponding author: apokin_vv@mail.ru