ISSN 1392-2130. VETERINARIJA IR ZOOTECHNIKA (Vet Med Zoot). T. 76 (98) Supplement.

2018

INFLUENCE ON FUNCTIONAL MOBILITY AND MOTIVATION OF HIPPOTHERAPY

Department of Animal Breeding and Nutrition, Lithuanian University of Health Sciences

Corresponding author: Aida Grockiene

Abstract. The purpose of this study was to investigate the influence on functional mobility and motivation of
hippotherapy for people with special needs. Twelve people with disabilities (autism, Down's syndrome and cerebral palsy)
were divided in two groups: adults with disabilities (T-1) and children with disabilities (T-2). They participated in 8 times
(30 min each) hippotherapy sessions. Functional mobility was measured pre and post hippotherapy by Time Up and Go
Test (TUG). The motivation was evaluated for every person during each hippotherapy session. Assessing the change of
functional mobility before and after the hippotherapy sessions, it can be assumed that the hippotherapy activities have
contributed to an improvement. The motivation results show that there is a statistically significant difference from the
third hippotherapy session – the intension to participate in the hippotherapy sessions is increasing.
Keywords: Hippotherapy; horse; disability; autism; Down's syndrome; cerebral palsy.

Introduction. Hippotherapy (from ancient Greek word connection with the horse encourages the person to open,
hippos – horse) is a therapeutic use of horses. Healing gives the courage to speak, relax, calm and comfort.
powers of horses have been mentioned in the works of Experienced fears are gradually encouraged to turn into a
Hippocrates thousands years ago. sense of security and self-control, self-esteem to self-
The therapeutic effect of horse on the physical confidence, the lack of emotional connection to the search
condition on disabled people is undoubted: it strengthens for a new relationship, from trauma to recovery. Riding and
muscles, improves balance and coordination, as the rider communicating with a horse helps to remove or reduce
has to balance sitting on a horse. Riding may improve gait, stress. The activities with the horse require constant
increase head and trunk control, all the muscle groups of attention, concentration, while stimulating the
the patient function while being on a horse (Wollenweber development of memory, activating mental processes
et al., 2016). The principle of hippotherapy is that the (Chavatte-Palmer et al., 2017).
horse’s gait provides a precise, smooth, rhythmic, and The aim of this study was to assess the influence of
repetitive pattern of movement to the rider that is similar to hippotherapy – the aim of the paper is to investigate the
the mechanics of human gait. Muscle spasticity decreases influence on functional mobility and motivation of
and tone reduction is facilitated because of warmth of the hippotherapy for people with special needs.
horse's body. Three-dimensional horse movements force Material and methods
the rider to stretch postural muscles, which is hard to get The study was divided into several stages:
by other forms of physiotherapy (Straubergaitė, 2008). hippotherapy sessions took place from 1st May 2017 to
During hippotherapy the patient experiences human September 15th in X stud in Jonava district. Hippotherapy
walking movements as horse movement is very similar to sessions took place with the participation of a team of
the human pelvis during walking. A variety of horse riding specialists. The team consisted of: a participant with a
speed is one of the essential principles of the hippotherapy disability; therapist – physiotherapist; horse expert;
procedure (Crossman et al., 2015). sidewalker; a horse. Hippotherapy required safety
Increasingly, horse therapy is used for people with precautions, wearing a helmet on the rider and running
psychological problems or mental disabilities. During boots. Sessions consisted of 30 minutes of hippotherapy for
therapeutic exercises with a horse, a person can better each participant individually, 8 lessons in total. Another
understand himself, deepen the horse and his own stage of the study was the evaluation of the subjects by test
behavior, the current biopsychosocial state. Research and evaluation of motivation. Before and after the
shows that horses are like an impulse for social hippotherapy sessions functional mobility was assessed
intervention, facilitating the work of the therapist, and and measured by Time Up and Go Test (TUG). The
interacting with each other. The presence of a horse diagnosis of the disease was taken into account when
awakens people's confidence, self-assurance, self-esteem selecting the participants (three disabilities were selected:
and reduces stress (Parish-Plass, 2008). Sokolof (2010) autism, Down's syndrome (selected people did not have
delves the field where equine assisted therapy is used for spinal pathologies that could influence contraindications
people who have experienced abuse (psychological, for hippotherapy) and cerebral palsy). The total study
physical and/or sexual). Such people need all kind of involved 12 people: 4 having autism spectrum disorders, 5
biopsychosocial support. When communicating with a Down's syndrome and 3 cerebral palsy. Two institutions
horse, they can relax and overcome their fears. Positive were selected for the study: the Adult Center for the

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 ISSN 1392-2130. VETERINARIJA IR ZOOTECHNIKA (Vet Med Zoot). T. 76 (98) Supplement. 2018

Disabled in Kaunas and the Special School for Children and use No. XI-2271 of 03-10-2012, also with the amended
with Disabilities in Kaunas. Test groups were divided by Order of State Food and Veterinary Service on Approval
age - one group were six children with disabilities under 21 for requirements for housing, care and use of animals for
years of age (T-2), the other – six adults 21 years and more experimental and other scientific research (No. B1-872 of
with disabilities (T-1). 24-09-2015).
Gross motor functions were measured by TUG test Statistical analysis
(Time Up and Go). This test is like a tool for quick, The statistical analysis of the data was performed by the
meaningful and practical assessment of functional mobility statistical program SPSS Statistics 25. After checking the
and balance for adults and children (Dhote et al., 2012). normal distribution of the data, the Kolmogorov-Smirnov
Williams et al., (2005) improved and adapted the test for test showed that the investigated symptoms normally
the people with disabilities, since the test was originally distributed, so descriptive statistics (mean, standard
designed to assess the skills of elderly people with reduced deviation and bias) were calculated for normal distribution
mobility. Description: test begins when a child or adult is data. Signs of averages were compared before and after the
seated on a chair adjusted to his height. The legs should be Student test-dependent sampling. As the samples tested
lowered to the ground, bending the clubs and knees at a 90 were small, a nonparametric analysis was acceptable.
degree angle. Then the distance of 3 meters from the chair Additionally, the median, the lowest and the highest values
is highlighted. The instructions are explicitly and without were given. The results were considered statistically
hurry to the subjects, they must wear their normal significant if p <0.05.
footwear, they can use auxiliary measures for walking, but Results and Discussion
not with the help of another person. Investigators are asked The data from the TUG test is presented in Table 1,
to stand up, go to a marked distance, turn around and return which shows that the shortest duration of the test for all
to the chair again to sit down. Timing is measured using subjects before the hippotherapy sessions was 9 s and the
the stopwatch. The test was performed before and after the maximum duration was 15 s. Results of children and adults
hippotherapy cycle for each person individually. Test was at the beginning of the test slightly differed. The shortest
carried out at school’s gym. The motivation was evaluated time in T - 2 group was 10 s, and in T - 1 group 9 s, the
during each hippotherapy session and it’s assessment used longest time in T - 2 group was 14 s and T - 1 group 15 s.
a 5-point scale system: 1 point – the participant does not Data after-hippotherapy sessions show that the time of all
want to enter the class, resists; 2 points - the participant subjects improved during the TUG test. The average
does not wish to come to the session, but does not express decreased from 11 s to 10.5 s, the shortest time during the
disapproval; 3 points - the participant reflects a desire to test was 8 s, and the longest - 13 s. The TUG indices of all
come to the session, but the activities involved passively; subjects changed statistically significantly (p <0.05),
4 points - the participant shows the desire to enter the comparing the test results before and after the hippotherapy
classroom, actively participates in the activities; 5 points - sessions. There were no statistically reliable results
the participant waits for the classes, is happy with them, between individual diagnoses, but the average of all the
actively participates in the activities. results improved: the average of people with autism - both
The experiment was carried out complying with the in children and adults - improved by 0.5 s, dawn syndrome
Law of the Republic of Lithuania on animal care, housing and cerebral palsy patients – by 2 s.
Table 1. Dynamics of Time Up and Go Test Data of the children and adults with disabilities before hippotherapy
and after

Median Maximum Minimum

15
15 15 15 13
14 12
13 13 11 14
11,5 11 12 11 12
11 10,5 11 10,5 10 10 9,5 10 11 11
9 10 9 10
8 9 8 9 8 9

0
Before After Before After Before After Before After Before After Before After
All T-2 T-1 Autism Down's Cerebral palsy
p<0,05 syndrome
*
P<0.05, T-1 adults with disabilities, T-2 children with disabilities

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 ISSN 1392-2130. VETERINARIJA IR ZOOTECHNIKA (Vet Med Zoot). T. 76 (98) Supplement. 2018

In the motivation assessment, the data distributions horse. The connection between the horse and the human
(each time) of the Mann-Whitney-Wilcoxon test were gives the motivation to be interested in the environment, to
compared. The results show that there is a statistically communicate and to improve (Raskind et al., 2006).
significant difference from the third time – the intension to Gradually, after learning how to control a horse, self-
participate in the hippotherapy sessions is increasing. The confidence and trust in others increase. Also the autonomy
horses are very non-aggressive and social, they are happy and sense of responsibility of people with disabilities
to communicate with those who are friendly, which is increases, patience develops (Šapurova et al., 2013).
motivation for people who want to come closer and ride a

Table 2. Assessment of Motivation to participate in hippotherapy sessions

Table 3. Assessment of Motivation to participate in hippotherapy sessions by disabilities

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 ISSN 1392-2130. VETERINARIJA IR ZOOTECHNIKA (Vet Med Zoot). T. 76 (98) Supplement. 2018

In the picture of motivation assessment (Table 2) we Headache Reports. 2012 Aug; 16(4): p. 289-291.
can see how the data of both groups are distributed. There
4. Parish-Plass N. Animal-assisted therapy with
were no changes up to 4th hippotherapy session in the adult
children suffering from insecure attachment due to abuse
group (T - 1), and in the group of children (T - 2)
and neglect: A method to lower the risk of
motivation changes were noticed already during the second
intergenerational transmission of abuse. Clinical Child
session. It can be assumed that this is due to the fact that
Psychology and Psychiatry, 2008
children are more susceptible to innovation. Comparing the
beginning of the sessions to the end, there are significant 5. Pascale Chavatte-Palmer, Pauline Peugnet, and
motivational differences in both groups. During the first Morgane Robles Developmental programming in equine
lessons none of the participants enjoyed or actively species: relevance for the horse industry Published online
participated in the activities but at the end of the course (8th July 6, 2017
time) such participants were more than half (66.7% in
group T-1 and 83.3% in group T-2). 6. Raskind, M. H., Margalit, M., Higgins, E. L. (2006).
Paying attention to the changes in motivation according „My LD“: Children’s voices on the internet. Learning
Disability Quarterly 29: 253–268.
to the diagnosis of disability (Table 3), it is seen that
distributions are unevenly distributed. Looking at the test 7. Šapurova V., Lesinskienė S., Grikinienė J.
data we can see that the hardest part was to work with Hipoterapijos taikymo galimybës kompleksiniame vaikų
autism spectrum disorder persons from the first to the sveikatos gerinime. VU, Neurologijos seminarai 2013;
seventh time. It is scientifically proven that work with 17(56): 128–131
autistic people is very complicated due to the fact that they
do not realize the time and hard to overcome the fear of 8. Sokolof M. Treating Abuse with the Help of a
change and innovation. Therefore, improvements in any Horse. Society of Counseling Psychology, American
therapy can be expected for a long time (Marcus, 2012). Psychological Association. Section 13 of Division 17,
The greatest desire and motivation showed people with 2010; 99-11.
cerebral palsy, they actively participated in therapeutic 9. Straubergaitė L. Terapinis jojimas reabilitacijoje ir
exercises, awaited them very much. This is perfectly rekreacijoje. Šiauliai: Šiaulių kolegijos leidybos centras,
illustrated by the data in Table 3. Motivation assessment 2008. 9 – 24 p.
and results of physical test show that hippotherapy is one
of the implement when the horse helps to heal not only the 10. Vanessa Wollenweber, Marion Drache , Sabine
physical body, but also spiritual experiences, increases the Schickendantz, Andreas Gerber-Grote , Petra Schiller,
motivation of the child to engage in daily activities, which Dieter Pohlau. Study of the effectiveness of hippotherapy
also facilitates the daily routine of the whole family. on the symptoms of multiple sclerosis e Outline of a
Conclusion randomised controlled multicentre study (MS-HIPPO).
Assessing the change of functional mobility before and 2016.
after the hippotherapy sessions, it can be assumed that the 11. Williams EN, Carroll SG, Reddihough DS,
hippotherapy activities have contributed to an Phillips BA, Galea MP. Investigation of the timed ‘up &
improvement, although marginally. However, longer go’ test in children. Dev Med Child Neurol 2005; 47: 518–
research is needed. 24.
In assessing the motivation of people during each
session, the results were evident and each time the Received 18 May 2018
motivation was increasing, disabled people were more and Accepted 5 June 2018
more willing to participate in the classes. This shows that
the horse is a great motivator that can engage people with
disabilities in various activities (horse riding, horse
dressing, combing, feeding, learning different things on
horseback riding).

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