Use of Hippotherapy in a Pediatric Patient with Right Hemiplegia: A Case Report

Background: Hippotherapy uses horseback riding to provide specific perturbations to engage an individual’s sensory, motor, and cognitive system. It has been incorporated into plans of care by specially trained physical therapists to address gait and balance deficits primarily in children with cerebral palsy. Limited information exists for the potential benefit of using hippotherapy to treat a child in the years following a stroke. Case Description: The patient was a 9-year-old female who suffered a left middle cerebral artery (MCA) hemorrhagic stroke with resulting right-sided hemiplegia during a craniotomy at the age of two. She participated in clinic-based physical therapy for the past seven years and completed one round of hippotherapy a year prior to the outlined episode of care. Intervention: A total of six 30-minute hippotherapy sessions were conducted. Sessions were divided into three parts including: set-up, seated position and balance on the horse, and upper extremity exercises on the horse. Emphasis was placed on improving the patient’s ability to activate postural musculature to respond to anterior-posterior, lateral, and rotational perturbations. Outcome Measures: The Gainesville Riding through Equine Assisted Therapy (G.R.E.A.T.) Postural Scale, a measure used to analyze the patient’s seated posture on the horse, was assessed. A 100-meter walk/run test, progressive treadmill test, and the patient’s level of assistance needed for various activities, were also used as outcome measures. Discussion: The patient demonstrated improved seated posture as indicated by the G.R.E.A.T. Postural Scale, increased endurance on the progressive treadmill test, and improved independence with activities. Therefore, this case study suggests that hippotherapy may be an effective treatment option to improve gait and balance deficits in the pediatric chronic stroke population.