Do the type of walking surface and the horse speed during hippotherapy modify the dynamics of sitting postural control in children with cerebral palsy?


      • Horse's movements can be manipulated in hippotherapy sessions.
      • Manipulations enhance demand for postural control in children with cerebral palsy.
      • Increases in horse's walk speed changes center of pressure parameters.
      • Different types of walking surfaces do not change all center of pressure parameters.



      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.


      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.


      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.


      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.


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        • Antunes F.N.
        • Pinho A.S.
        • Kleiner A.F.R.
        • Salazar A.P.
        • Eltz G.D.
        • Junior A.A.O.
        • et al.
        Different horse's paces during hippotherapy on spatio-temporal parameters of gait in children with bilateral spastic cerebral palsy: a feasibility study.
        Res. Dev. Disabil. 2016; 59: 65-72
        • Ballinger G.A.
        Using generalized estimating equations for longitudinal data analysis.
        Organ. Res. Methods. 2004; 7: 127-150
        • Bigongiari A.
        • Souza F.A.
        • Franciulli P.M.
        • Neto S.R.
        • Araujo R.C.
        • Mochizuki L.
        Anticipatory and compensatory postural adjustments in sitting in children with cerebral palsy.
        Hum. Mov. Sci. 2011; 30: 988-997
        • Brogren E.
        • Hadders-Algra M.
        • Forssberg H.
        Postural control in sitting in children with cerebral palsy.
        Neurosci. Biobehav. Rev. 1998; 22: 591-596
        • Clayton H.M.
        • Kaiser L.J.
        • Pue B.
        • Kaiser L.
        Center-of-pressure movements during equine-assisted activities. Brief report.
        Am. J. Occup. Ther. 2011; 65: 211-216
        • Dewar R.
        • Love S.
        • Johnston L.M.
        Exercise interventions improve postural control in children with cerebral palsy: a systematic review.
        Dev. Med. Child Neurol. 2015; 57: 504-520
        • Espindula A.P.
        • Simões M.
        • Assis I.S.A.
        • Fernandes M.
        • Ferreira A.A.
        • Ferraz P.F.
        • et al.
        Electromyographic analysis during hippotherapy sessions in practitioners with cerebral palsy.
        ConScientiae Saúde. 2012; 11: 668-676
        • Fernández-Gutiérrez C.
        • Apolo-Arenas M.D.
        • Martinez-Garcia Y.
        • Cana-Pinto A.
        Efectos de la hipoterapia en la estabilidad postural en parálisis cerebral infantil: a propósito de un caso clínico.
        Fisioterapia. 2015; 37: 135-139
        • Flores F.M.
        • Dagnese F.
        • Mota C.B.
        • Copetti F.
        Parameters of the center of pressure displacement on the saddle during hippotherapy on different surfaces.
        Braz. J. Phys. Ther. 2015; 19: 211-217
        • Garner A.B.
        • Rigby B.R.
        Human pelvis motions when walking and when riding a therapeutic horse.
        Hum. Mov. Sci. 2015; 39: 121-137
        • Guimarães L.S.P.
        • Hirakata V.N.
        Use of the generalized estimating equation model in longitudinal data analysis.
        Clin Biomed Res. 2012; 32: 503-511
        • Ioris M.N.
        • Macedo L.B.
        Análise da mobilidade pélvica do cavaleiro provocada pela andadura ao passo do cavalo em terrenos variados.
        Arquivos Brasileiros de Paralisia Cerebral. 2006; 2: 26-30
        • Janura M.
        • Peham C.
        • Dvořáková T.
        • Elfmark M.
        An assessment of the pressure distribution exerted by a rider on the back of a horse during hippotherapy.
        Hum. Mov. Sci. 2009; 28: 387-393
        • Kang H.
        • Jung J.
        • YU J.
        Effects of hippotherapy on the sitting balance of children with cerebral palsy: a randomized control trial.
        J. Phys. Ther. Sci. 2012; 24: 833-836
        • Liang K.-Y.
        • Zeger S.L.
        Longitudinal data analysis using generalized linear models.
        Biometrika. 1986; 73: 13-22
        • Matusiak-Wieczorek E.
        • Małachowska-Sobieska M.
        • Synder M.
        Influence of hippotherapy on body balance in the sitting position among children with cerebral palsy.
        Ortop. Traumatol. Rehabil. 2016; 18: 165-175
        • Moraes A.G.
        • Copetti F.
        • Angelo V.R.
        • Chiavoloni L.L.
        • David A.C.
        The effects of hippotherapy on postural balance and functional ability in children with cerebral palsy.
        J. Phys. Ther. Sci. 2016; 28: 2220-2226
        • Moraes A.G.
        • Copetti F.
        • Angelo V.R.
        • Chiavoloni L.L.
        • David A.C.
        Hippotherapy on postural balance in the sitting position of children with cerebral palsy – longitudinal study.
        Physiother. Theory Pract. 2018; 11: 1-8
        • Oskoui M.
        • Coutinho F.
        • Dykeman J.
        • Jette N.
        • Pringsheim T.
        An update on the prevalence of cerebral palsy: a systematic review and meta-analysis.
        Dev. Med. Child Neurol. 2013; 55: 509-519
        • Pavão S.L.
        • Santos A.N.
        • Woollacott M.H.
        • Rocha N.A.C.F.
        Assessment of postural control in children with cerebral palsy: a review.
        Res. Dev. Disabil. 2013; 34: 1367-1375
        • Pollock A.S.
        • Durward B.R.
        • Rowe P.J.
        • Paul J.P.
        What is balance?.
        Clin. Rehabil. 2000; 14: 402-406
      1. Shumway-Cook, A., & Woollacott, M.H. (2003). Controle Motor: Teoria e Aplicações Práticas. (2th ed.). São Paulo: Manole, pg 153–156.

        • Silkwood-Sherer D.
        • Killian C.B.
        • Long T.M.
        • Martin K.S.
        Hippotherapy—an intervention to habilitate balance deficits in children with movement disorders: a clinical trial.
        Phys. Ther. 2012; 92: 707-717