Long-term Impact of Hippotherapy on Postural Balance and Functional Performance in Children with Cerebral Palsy

BACKGROUND: Although hippotherapy is considered an effective rehabilitation method for improving postural balance and mobility in children with cerebral palsy (CP), the evidence defining the dosage is still limited. AIM: To evaluate the effects of 40 hippotherapy sessions on static balance and functional mobility in children with CP. METHODS: A cohort study with 18 children with spastic CP (4-14 years), who completed forty weekly 30-minute sessions. Postural control was assessed using center of pressure (CoP) variables during sitting position with eye closed (EC) on a firm surface (FS) and foam surface (FoS), and standing position with eye open (EO) and EC on FS and FoS. Functional mobility was measured with the Modified Timed Up and Go (mTUG) and One-Minute Walk Test (1MTW). Assessments occurred at baseline (A1) and every eight weeks until post-intervention (A6). Data were analyzed using Generalized Estimating Equations with LSD post hoc. RESULTS: Functional outcomes improved, both mTUG and 1MTW at A6 vs. A1 (p = 0.001). In sitting position (EC/FS), reductions occurred in anteroposterior amplitude (ACoPap) (p = 0.021) and velocity (Vavg) (p = 0.002). In sitting position (EC/FoS), decreases were found in mediolateral amplitude (ACoPml) (p = 0.012), ACoPap (p = 0.007), Vavg (p = 0.011), and area (Area95) (p = 0.027). In standing position (EC/FoS), ACoPml decreased (p = 0.031). INTERPRETATION: Hippotherapy improved functional mobility from 8 and static balance from 16 sessions. These findings support hippotherapy as a long-term intervention to enhance postural control and functional mobility in children with CP.