Seung Mi Yeo, Ji Young Lee, Hye Yeon Shin, Yun Sik Seo, Jeong Yi Kwon
Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Samsung Equestrian Team, Bugok dong, Gunposi, Gyeonggido, Republic of Korea.
Neuropediatrics. 2019 Jun;50(3):170-177. doi: 10.1055/s-0039-1685526. Epub 2019 Apr 22.
This study was aimed to identify individual factors influencing the gross motor outcome of hippotherapy in children with cerebral palsy (CP).
One hundred and forty-six children with CP (mean age: 5.78 ± 1.72 years, male: 56.2%) presenting variable function (gross motor function classification system [GMFCS], levels I-IV) participated in this study. Participants received 30 minutes of hippotherapy twice a week for 8 weeks. Clinical information including GMFCS level, age, sex, CP distribution, CP type, gross motor function measure-88 (GMFM-88), GMFM-66, and pediatric balance scale (PBS) score were collected retrospectively. We regarded the children with GMFM-66 score increased by 2.0 points as good responders to hippotherapy. Further we analyzed factors affecting good responders.
GMFCS level I and II compared with IV (odds ratio [OR] = 6.83) and III compared with IV (OR = 4.45) were significantly associated with a good response to hippotherapy. Higher baseline GMFM E (OR = 1.05) and lower baseline GMFM B (OR = 0.93) were also significantly associated with a good response to hippotherapy. Sex, age, CP type, and distribution were not factors influencing gross motor outcome of hippotherapy.
The children with CP, GMFCS level I-III, with relatively poor postural control in sitting might have a greater chance to improve their GMFM-66 scores through hippotherapy. This supports the hypothesis that hippotherapy is a context-focused therapy to improve postural control in sitting.
本研究旨在确定影响脑瘫(CP)患儿马术疗法粗大运动结局的个体因素。
146例CP患儿(平均年龄:5.78±1.72岁,男性占56.2%),其功能各异(粗大运动功能分类系统[GMFCS],Ⅰ-Ⅳ级)参与了本研究。参与者每周接受两次30分钟的马术疗法,共8周。回顾性收集临床信息,包括GMFCS级别、年龄、性别、CP分布、CP类型、粗大运动功能测量-88(GMFM-88)、GMFM-66和小儿平衡量表(PBS)评分。我们将GMFM-66评分提高2.0分的儿童视为马术疗法的良好反应者。进一步分析影响良好反应者的因素。
GMFCSⅠ级和Ⅱ级与Ⅳ级相比(优势比[OR]=6.83)以及Ⅲ级与Ⅳ级相比(OR=4.45)与马术疗法的良好反应显著相关。较高的基线GMFM E(OR=1.05)和较低的基线GMFM B(OR=0.93)也与马术疗法的良好反应显著相关。性别、年龄、CP类型和分布不是影响马术疗法粗大运动结局的因素。
CP患儿中,GMFCSⅠ-Ⅲ级、坐位姿势控制相对较差的患儿可能有更大机会通过马术疗法提高其GMFM-66评分。这支持了马术疗法是以改善坐位姿势控制为重点的疗法这一假设。