Angular kinematics of the gait of children with Down's syndrome after intervention with hippotherapy (original) (raw)
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The use of hippotherapy in shaping the body posture and balance in children with Down syndrome
Sport i Turystyka. Środkowoeuropejskie Czasopismo Naukowe
Down syndrome (DS) is one of the most common genetic developmental disorders that is caused by a trisomy of the 21st chromosome pair. The incidence of Down syndrome in the general population is estimated at 1/732 infants. This percentage increases significantly with the increasing age of women in labour. Down syndrome manifests itself in a variety of signs and symptoms. The signs mainly refer to abnormalities in the structure of the central nervous system, internal organs, eye and skeletal system defects. Both aspects of development, i.e., physical and mental, are delayed. One of the methods that supports the treatment of patients with DS is hippotherapy. It takes various forms, including: therapy in the form of contact with a horse, psycho-pedagogical horse riding and therapeutic horse riding. The purpose of the article was to present the influence of hippotherapy on the shaping of body posture and coordination skills with particular emphasis on body balance.
Physiotherapy Theory and Practice, 2010
The purpose of this case report is to describe the impact of an 11-week hippotherapy program on the gross motor functions of two children (respectively 28 and 37 months old) diagnosed with Down syndrome. Hippotherapy is a strategy that uses the horse's motion to stimulate and enhance muscle contraction and postural control. The children were assessed by the Gross Motor Function Measure (GMFM) and accelerometry. The results indicate that both children improved on many dimensions of the GMFM. Power spectral analysis of the acceleration signals showed improvement in postural control of either the head or trunk, because the children adopted two different adaptative strategies to perturbation induced by the moving horse.
The effects of low arched feet on foot rotation during gait in children with Down syndrome
Journal of Intellectual Disability Research, 2013
Background In children with Down syndrome (DS) hypotonia and ligament laxity are characteristic features which cause a number of orthopaedic issues, such as flat foot. The aim of this study was to determine if children with flat foot are characterised by an accentuated external foot rotation during walking. Method Fifty-five children with DS and 15 typically developing children recruited as control group were assessed using three-dimensional gait analysis, using an optoelectronic system, force platforms and video recording. Parameters related to foot rotation were identified and calculated and the participants' foot morphology was assessed using the arch index. Results Data obtained in this study showed that while DS children without flat foot displayed the foot position on the transverse plane globally close to controls during the whole gait cycle, the DS children with flat foot were characterised by higher extra-rotation of the foot in comparison with those without flat foot and controls. Conclusions Our results suggest that the presence of flatfoot lead the children with DS to extra-rotate their feet more than the children without flat foot. From a clinical point of view, these results could enhance the rehabilitative programmes in DS.
Joint stiffness and gait pattern evaluation in children with Down syndrome
Gait & Posture, 2008
Hypotonia, ligament laxity and motor alterations are characteristic for patients with Down syndrome (DS). The purpose of this study was the evaluation of typical gait pattern of subjects with Down syndrome and the quantification of their joint stiffness, connected with ligament laxity and hypotonia, as a possible compensation. 98 children with DS (mean age: 11.7 years; range: 6-15 years) and 30 healthy children (control group (CG); mean age: 11 years; range: 5-13 years) underwent full 3D gait analysis at self-selected speed.
Effect of hippotherapy in the global motor coordination in individuals with Down Syndrome
Fisioterapia em Movimento
Introduction: Down syndrome (DS) of all genetic syndromes is the most common. In Hippotherapy, three-dimensional movements, provided by horse walking, awaken in the body of children with DS a large amount of sensory and neuromuscular stimuli, which directly interfere with overall development and the acquisition of motor skills. Objective: To analyze the effects of an Hippotherapy program on global motor coordination variables in individuals with DS of both genders and to compare individuals with the same syndrome who do not practice Hippotherapy. Methods: 41 individuals participated in the study, 20 of them practicing Hippotherapy (EG) and 21 who did not practice Hippotherapy (CG). The Körperkoordinations test für Kinder (KTK) test was used, consisting of four tasks: Balance on beams, Single-lever jump, Side-jump and Transfer on platform for analysis of motor coordination for individuals. Results: Comparing the groups, a significant difference (p < 0.01) was observed for the Late...
Research in Developmental Disabilities, 2016
Hippotherapy is often carried out for the rehabilitation of children with Cerebral Palsy (CP), with the horse riding at a walking pace. This study aimed to explore the immediate effects of a hippotherapy protocol using a walk-trot pace on spatio-temporal gait parameters and muscle tone in children with Bilateral Spastic CP (BS-CP). Ten children diagnosed with BS-CP and 10 healthy aged-matched children (reference group) took part in this study. The children with BS-CP underwent two sessions of hippotherapy for one week of washout between them. Two protocols (lasting 30 min) were applied on separate days: Protocol 1: the horse's pace was a walking pace; and Protocol 2: the horse's pace was a walk-trot pace. Children from the reference group were not subjected to treatment. A wireless inertial measurement unit measured gait spatio-temporal parameters before and after each session. The Modified Ashworth Scale was applied for muscle tone measurement of hip adductors. The participants underwent the gait assessment on a path with surface irregularities (ecological context). The comparisons between BS-CP and the reference group found differences in all spatio-temporal parameters, except for gait velocity. Within-group analysis of children with BS-CP showed that the swing phase did not change after the walk pace and after the walk-trot pace. The percentage of rolling phase and double support improved after the walk-trot. The spasticity of the hip adductors was significantly reduced as an immediate result of both protocols, but this decrease was more evident after the walk-trot. The walktrot protocol is feasible and is able to induce an immediate effect that improves the gait spatio-temporal parameters and the hip adductors spasticity.
Clinical Biomechanics, 2019
Background: Hippotherapy is described as a rehabilitation method for postural control in children with cerebral palsy. Horse's movements can be manipulated during hippotherapy's sessions with horse walking on different surfaces and at different speeds. The purpose of this study was to assess if dynamic sitting postural control in children with cerebral palsy in hippotherapy is modified when surfaces (sand or asphalt) and horse's walking speed (slow or faster) are changed. Methods: Sixteen children participated in this crossover study. Eight bilateral spastic cerebral palsy children, age range (6-12 years), with Gross Motor Function Classification System levels III to IV, practicing hippotherapy and eight children with typical development (reference group), matched for age and sex. All children were evaluated during riding a horse on sand and asphalt surfaces and at slow (self-selected) and faster (30%) horse's walking speed. Center of pressure parameters were determined by a portable pressure measurement system positioned on the saddle. Findings: Mediolateral displacement amplitude of the center of pressure was larger when the horse was on sand. Mediolateral and anteroposterior displacements amplitude and velocities of the center of pressure increased at horse's faster walking speed. Interpretation: Our study test empirical procedures used in clinical practice and with a population widely reached by hippotherapy. In order to increase the demand for sitting postural control in children with cerebral palsy during horse riding, faster horse speed or riding on sand should be used.
International Journal of Environmental Research and Public Health, 2020
Background: Subjects with Down Syndrome (DS) are characterized by specific physiological alterations, including musculoskeletal abnormalities. Flat Foot (FF), caused by hypotonia and ligament laxity, represents one of the most common disabling disorders in this population. Conservative treatments promote the use of orthopaedic insoles and plantar supports. The aim of this study was to evaluate the impact of Foot Orthoses (FOs) on the gait pattern of subjects with DS, assessing the biomechanical effects associated with their use. Methods: Twenty-nine subjects were screened under two conditions—walking barefoot (WB); with shoes and insoles (WSI), during three trials for each. Assessments were performed through the 3D gait analysis, using an optoelectronic system, force platforms, and video recording. Specifically, synthetic indices of gait kinematics, i.e., gait profile score (GPS) and gait variable score (GVS) were calculated and compared with Wilcoxon signed-rank test, to evaluate b...
The Effects of Foot Orthoses on Gait in New Walkers with Down Syndrome
Pediatric Physical Therapy, 2006
Purpose/Hypothesis: The purpose of this pilot study was to examine the effects of an intensive therapy protocol that uses the TheraSuit TM on the gross motor performance of children with cerebral palsy (CP). Number of Subjects: Participants were 20 children with CP. The mean age was 7 years with a range of 3-17. Children were classified into Gross Motor Function Classification System (GMFCS) levels. Materials/Methods: A pre and posttest design with one group was used. The children received therapy 4 hours a day, 5 days a week for 3 weeks using primary equipment of a TheraSuit TM and a universal exercise unit. The GMFM was videotaped for each child. The outcome measures were the Gross Motor Function Measure (GMFM), clinical judgment of change, and observation of postural alignment, latency of response, and duration of movement [quality of movement]. Rater reliability on the measures was determined before data collection. An investigator who was unfamiliar with the children and blinded to test order assessed the videotapes by scoring the GMFM and a clinical observation checklist that assessed quality of movement. Spearman rho correlation coefficients examined relationships among GMFM scores and participant characteristics. Paired sample t tests assessed changes in GMFM88, GMFM66, and quality of movement. A repeated measure MANOVA examined changes in pre and post GMFM88 and GMFM66 mean scores based on GMFCS levels. Results: The GMFM88 and GMFM Goal Total mean scores increased following the intervention (t ϭ-3.566, P ϭ 0.002 and t ϭ-3.094, P ϭ 0.006, respectively), but the GMFM66 mean scores and quality of movement mean totals did not. The correlation coefficients between Pediatric Physical Therapy Abstracts for the 2006 Combined Sections Meeting 73 strength training on quality of life. The purpose of this case study is to report the effect of strength training in a 17 year old female with cerebral palsy. Case Description: The subject is a 17 year old female with spastic quadriplegic CP who received Botox and Phenol injections to her bilateral lower extremities. She attended a day hospital rehabilitation program where she received 1.5 hours of physical therapy and 1 hour of occupational therapy 5 days per week. The subject participated in a 6 week therapy regimen which focused on quadriceps and gluteal strengthening 3 days per week and general balance and gait training on alternate days. Initial load for weight training was calculated as 65% of her maximal isometric knee extension and hip extension peak torque as measured on the Biodex System 3. Repetitions and/or exercise load was increased as the subject demonstrated improvement in ability to perform prescribed exercises. Isometric peak torque, TUG, the 9 minute walk run, EEI, GMFM, and the PedsQL were performed pre and post physical therapy intervention. Outcomes: Isometric peak torque for knee extension increased 92% and hip extension 57%, 9 minute walk run improved 1105 feet, EEI decreased from 4.7 to 0.99 beats/m, GMFM total increased 12% and standing domain increased 41%, TUG decreased 3.72 seconds, PedsQL decreased 9 points Discussion: Dramatic improvements were noted in gluteal and quadriceps strength following the 6 week strength training program. Although items from the GMFM were not specifically practiced, the subject showed improvement in all areas, most significantly in the domain of standing. Additionally, while endurance training was not a focus of physical therapy, significant change was made on the 9 minute walk run as well as the EEI. Most notably, the subjects EEI improved to within normal limits for healthy age-matched peers. Items of improvement on the PedsQL included attitude toward walking, participation in household chores, feeling afraid and keeping up with and fitting in with peers. Though the PedsQL has been shown as a reliable and valid measure of quality of life in pediatric populations, there have been few comments in the literature associating a physical therapist prescribed strengthening program with quality of life in children with chronic health conditions such as cerebral palsy. The dramatic improvements in strength, function, endurance, and energy expenditure seen in this subject corresponded to an improvement in quality of life as measured by the PedsQL. Further research is warranted to examine this relationship. This case supports the use of intensive strength training as a primary physical therapy intervention to achieve patient and family goals related to function and quality of life.
Effects of treadmill inclination on the gait of children with Down syndrome
Research in Developmental Disabilities, 2013
Down syndrome (DS) is an encephalopathy caused by irregular cell division process that leads, among other disorders, to cognitive impairments and delayed motor development, due to neurological, physiological and biomechanical factors (Anson, 1992; Shumway-Cook & Woollacott, 1985). Biomechanical alterations, such as hypermobility, hypotony and ligament laxity are primarily responsible for the delayed acquisition of motor development milestones (Rigoldi et al., 2012). Consequently, children with DS start the sequence of acquiring motor skills (such as rolling, sitting and crawling) at later age, starting to walk, on average, one year after normal children. This in turn restricts their opportunities to interact with the environment and hinders development in the motor, social and cognitive domains (Tudella, Pereira, Basso, & Savelsbergh, 2011; Ulrich, Ulrich, Angulo-Kinzler, & Yun, 2001). Although this pathology may not progress, there are resultant physical impairments and functional limitations that can change with development. According to the dynamic systems approach, motor skills are multidimensional and emerge from interaction between several subsystems of intrinsic properties such as genetic, biomechanical and physiological