The effect of therapeutic horseback riding on balance, spasticity and general well being on patients after stroke / non-congenital brain injuries

Therapeutic horseback-riding is used as a form of physical therapy. During the
therapy a patient is positioned astride a horse and passively interacts with
and responds to the three-dimensional movements of the horse. The dynamic gait
of the horse stimulates vestibular, motor, proprioceptive and tactile systems
(Meregillano, 2004; McGibbon et al., 1998). The position of the subject, in
hipflexion, -abduction and external rotation, and the three-dimensional
movements are assumed to contribute to an unique therapeutic effect on balance,
posture and spasticity (Bertoti, 1991; Sterba et al., 2002; Meregillano, 2004;
Lechner et al., 2004). Interaction with a horse may also have positive effects
on cognition, social behavior and emotion (Meregillano, 2004; Hammer et al.,
2005).
The literature on the effect of therapeutic horse-riding is scarce and besides
that limited in its methodological quality. The quality of the studies is
moderate because of a number of factors. Firstly, the studies describe mainly
subjective outcome measures to quantify the effects of therapeutic horse riding
(see e.g. Lechner et al., 2004) without covering the relevant aspects of the
ICF domains. Secondly, the studies are usually performed with a small
population which hinders the interpretation and generalisation of the findings
(Sterba, 2007). Finally, the effect of therapeutic horse riding is only
evaluated by comparing simply pre- and post measurements, wthout controlgroups.
Understanding the mechanism of the therapy is therefore difficult and the
lasting effects of the therapy remain unknown.

This project has been defined to investigate the effect of therapeutic horse
riding on balance, spasticity and general wellbeing in 30 adults in the age of
18-80 with physical impairments following a stroke or non-congenital brain
injury.

The study is designed as an interrupted time series trial with an additional
untreated control group.
The population is divided in 3 groups, of which 2 receive the intervention. All
3 groups undergo a general observation in week 1 (baseline), 6, 11 and 16. The
intervention is applied to the first group in week 2, 3, 4 and 5. Before and
after the intervention a short measurement is done. The second group recieves
the intervention and measurements at week 7, 8, 9 and 10. The controlgroup will
only be measured in the general observation. This traject will be repeated
after 16 weeks with a entirely new group of patients.

Four therapeutic horseback riding sessions of at least 20 minutes and maximal
30 minutes each are provided.
Prior to the intervention, subjects will be shown a video of the therapy to
reduce adverse effects. After the laboratory tests, the subject is placed on
the back of the horse using a lift. The horse steps in one direction in a quit
pace and is guided by a qualified worker, who ensures a good position of the
subject and takes care of the safety of the patient. A therapist will be in the
vicinity for help when needed. The area will be reserved only for the study
during the sessions.

Subject load is estimated acceptable since:
- Required measurement time is limited and rest is possible
- Measurement is restricted physically and mentally demanding
- There is limited health risk involved in participating in the study compared
to other
daily activities

Subject risk is estimated acceptable since professional workers of the riding
school are involved in the intervention with years of experience with
therapeutic horse back riding