Hippotherapy and life habits with children with motor deficit and neurodevelopmental impairment: A pilot survey of parents

Abstract

PURPOSE:

Hippotherapy is used by rehabilitation professionals to assist children with various diagnoses. Despite parents’ pivotal decision-making role regarding their children’s life and treatment, little is known about their perceptions of hippotherapy’s utility. This pilot study explored parents’ opinions regarding hippotherapy’s impact on their child’s life habits, as guided by the Disability Creation Process model.

METHODS:

A survey was conducted in September/October 2017 with the parents of children with varied diagnoses receiving hippotherapy in Quebec. The survey asked parents to priority rank life habit categories and then grade hippotherapy’s service characteristics and impact on children’s life habits. Descriptive analysis and proportion tests were used to analyze the data.

RESULTS:

The parents of 26 children completed the survey. These children were on average seven years old with multiple diagnoses (e.g., autism spectra, developmental delay). A positive impact was perceived for 10 of 12 life habit categories, with a statistically significant association found with Mobility and Interpersonal relationships. It was not possible to calculate the association between the profession involved and hippotherapy effects due to the small sample size.

CONCLUSION:

This investigation provides some promising results regarding the benefits of hippotherapy for children’s life habits.

Keywords

Life habits social participation hippotherapy pediatric survey

1. Introduction

Hippotherapy, the use of equine movement to reach functional goals, is an intervention strategy used by occupational therapists (OT), physiotherapists (PT) and speech-language pathologists (SLP) in various countries and with children with various diagnoses [1]. The horse’s movement is transmitted to the rider, providing sensory, neuromotor and cognitive stimulations as well as providing a walking simulation, as the three-dimensional movement of the horse’s walk is similar to that of humans [1]. These stimulations, which are transmitted by the use of a dynamic seat, may be more readily provided compared to other approaches used in rehabilitation [1]. The use of hippotherapy must be supported by an evaluation that reveals the child’s level of function and challenges performing some movements or tasks that can be addressed by the use of the horse. The professional then chooses a horse whose characteristics must be consistent with the profile of the child and the therapeutic objectives. Intervention often consists of mounting, activities on horse (variation of movement, position of the child on horse, etc.) and dismounting. Hippotherapy requires the involvement of a trained therapist, a handler following the therapist’s instructions to guide the horse, and a side walker who assists the therapist during activities.

Most of the available studies concerning the effects of hippotherapy address motor function, including variables such as balance or spasticity [2, 3, 4, 5, 6]. These investigations have mostly been conducted with individuals with cerebral palsy and autism spectrum disorder [7, 8]. In contrast, limited investigation has been conducted regarding the effects of hippotherapy on the realization of life habits [9], as described in Fougeyrollas et al.’s [10] Disability Creation Process (DCP) model. According to this model, individuals can experience social participation in the 12 categories of life habits when the interaction of personal and environmental factors permit the full realization of these life habits. Social participation is defined as the successful accomplishment of life habits resulting from the interaction between the personal and environmental factors. Life habit categories include the following: Communication, Community and spiritual life, Education, Employment, Housing, Interpersonal relationships, Mobility, Nutrition, Personal care and Health, Physical fitness and psychological well-being, Recreation and Responsibility. As noted by Levasseur et al. [11], the clarity of the elements of the DCP model provide support for its use. The DCP model is also relevant to hippotherapy in that this model can fully describe this modality. In summary, the global understanding provided by the DCP model of the interactions affecting participation and life habits supports its utility for research regarding hippotherapy.

Positive effects of hippotherapy have been demonstrated for certain life habit categories: Communication [12, 13, 14, 15, 16, 17], Interpersonal relationships [12, 13, 15, 17, 18, 19] and Mobility [12, 13, 14, 17, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29]. However, several life habit categories have not been considered, for example, Community and spiritual life, and Responsibility. In addition, there has been limited investigation of parents’ perceptions [30, 31], which is surprising given their expertise about their children’s daily functioning and their pivotal role in making decisions about their treatment.

The overall objective of our pilot study is to explore the association between hippotherapy and the life habit categories of children with a motor deficit or neurodevelopmental impairment, from the point of view of their parents. Our hypothesis was that parents would perceive a positive impact of hippotherapy on life habits. Specifically, three questions were posed: (1) Which life habits are positively associated with hippotherapy from the parents’ perspectives? (2) Which of these life habits are considered the most important for the parents? (3) Is there an association between types of hippotherapy (OT, PT, SLP) and the impact perceived by the parents? Consistent with the DCP model, in addressing these questions, a description was obtained of the personal factors of children who receive hippotherapy, the reasons invoked by parents for trying this therapy, and the facilitators and obstacles invoked by parents for recommending it.

2. Methods

2.1 Design

A descriptive survey design [32] was used, which was appropriate for capturing parents’ perceptions regarding hippotherapy and their children’s life habits. This research was conducted in collaboration with two organizations offering hippotherapy services to children in the province of Quebec (Canada). Currently in this province, hippotherapy is provided in privately-funded settings. Research ethics approval for this study was obtained (#2017-559) from the Scientific Evaluation Committee and Research Ethics Committee of the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale. The completion and submission of online and paper questionnaires, which included no personally identifying information, by parents was considered to be informed consent; this point was clearly stated in the questionnaire information.

2.2 Participants

The parents of children with a motor impairment or a neurodevelopmental disorder from the two hippotherapy centers were recruited, respecting the following inclusion criteria: the child had received at least 10 hippotherapy sessions between May 2015 and August 2017; s/he was between 2 and 18 years old at the time of hippotherapy; the other parent had not already completed the questionnaire; and the parent was able to read, understand and respond to written French.

A sample size calculation was conducted based on a proportion test and our hypothesis. The software G*power was used with the following parameters: power of 0.8; $\alpha=$ 0.05; and a fixed proportion of 0.7 (identified in the absence of an existing gold standard for our variable). The number of participants needed to achieve a ratio of 70% positive answers significant was 37. However, because we used a scale with negative and positive options (see Section 2.3), we subsequently realized that the use of a one-tailed test was inappropriate; the sample size calculation should have been done with a two-tailed test. Based on the recalculation to determine the real power of our pilot study, the real power is 0.69 for the same sample size result (37 parents) and the other parameters ( $\alpha=$ 0.05; fixed proportion of 0.7). Given that the two organizations provided a total of about 80 hippotherapy interventions per week to different individuals and that the participants’ children could have received hippotherapy two years prior to their participation in the study, the sample size was judged realistic.

2.3 Measures

In the absence of an existing questionnaire based on hippotherapy and social participation in the 12 life habit categories, a self-administered questionnaire was developed. This questionnaire was based on available theory about hippotherapy, life habits, the LIFE-H 4.0 (33) and the clinical experience of the first author. The questionnaire included four sections; the first of these addressed parents’ identification of the most important life habits from a list of choices to improve with their child, by selecting up to three life habit categories. Specific examples for each category, which consisted of related activities, were included to support the parents in making their choices. The second section dealt with interventions received with the hippotherapy modality. Parents were asked why they wanted to use hippotherapy, the number of sessions their child received, the start and end (if applicable) dates of the interventions, and the types of health professionals who provided the services. The number and nature of incidents (e.g., fall, bite, emergency transfer) or other events (e.g., medical condition, family event, accident) that occurred during hippotherapy sessions were also requested. Next, parents were asked to indicate the perceived impacts of hippotherapy on their child’s realization of the 12 life habit categories. To achieve this objective, each category was linked to a six-level non-neutral scale with three negative levels ( $-$ 1, $-$ 2, $-$ 3) and three positive levels ( $+$ 1, $+$ 2, $+$ 3) using the following qualifiers: slight, moderate, great. A neutral option was not included to limit misplaced answers when Not Applicable was the intended response. Three of the categories, Community and spiritual life, Employment, and Responsibility, had a seventh option named Not Applicable because of the possible age of the children (2–18 years). In addition, parents were also asked, via two open-ended questions, to indicate why they might, or might not, recommend hippotherapy to other parents. The final section collected the following sociodemographic data about the children: gender, age, highest level of education, diagnosis, orthopedic appliances/assistive devices (e.g., wheelchair, walker, augmentative communication device)/home adaptations used, other clinical services received, distance traveled to receive hippotherapy, and mean annual family income. Regarding other services, parents were offered seven possible options: none, occupational therapy, physical therapy, speech and language therapy, psycho-education services, social work services, and other (details to be provided by parents).

The questionnaire was pre-tested regarding its clarity, feasibility, duration and relevance with two parents of children with disabilities, a resource person with expertise regarding the DCP, a PT, and an SLP using hippotherapy in their practice. These individuals’ feedback was used to revise the questionnaire.

2.4 Procedure

The parents were invited to undertake the questionnaire by using either an online or paper version, according to their preference. The online survey was conducted using LimeSurvey. The partner organizations sent an offer of participation via email to parents who had agreed, at the time when their child started to receive hippotherapy services, to be contacted for research purposes. The organizations also published the same offer of participation on their respective Facebook pages. Paper versions were made available at the three practice sites (one organization had two practice sites) with an explanatory leaflet about the research project and a deposit box for completed anonymized questionnaires. Two reminders of the offer of participation were sent by email and social network by the partner organizations during the two months during which the questionnaire was available.

2.5 Data analysis

The data analysis was performed using the Statistical Package for Social Sciences 24 (34) software. The sociodemographic data and the general characteristics of the hippotherapy services were analyzed with descriptive analyses (total, frequency, mean). The responses to the open-ended questions were categorized by the first author. The selections of up to three important life habit categories and the perceived impact levels were summarized using frequencies. It was then possible to determine the proportion of positive impacts ( $+$ 1, $+$ 2, $+$ 3) perceived by parents for each category. Consistent with our hypothesis and in order to determine whether the identified proportion of parents indicating a positive impact of hippotherapy on life habits was representative of the population, we performed two-tailed proportion tests using the R software with an $\alpha=$ 0.05 and a confidence interval of 95%. As well, given that there was no neutral answer option for the impact perceived, it was anticipated that parents with a neutral perception of the impacts of hippotherapy would select a slight negative or a slight positive impact ( $-$ 1, $+$ 1). Therefore, the proportion test was repeated to take into account that the real positive answers would only include the moderate ( $+$ 2) and great ( $+$ 3) positive answers.

3. Results

3.1 Personal factors of children who received hippotherapy

Twenty-six questionnaires were completed, with three of these being partially completed. Information about the personal factors of the children who received hippotherapy can be found in Table 1. Twenty-three children were receiving other services such as psychology, chiropractic, music therapy and zootherapy.

Table 1
Personal factors of children who received hippotherapy ( $n=$ 26)

	Frequency (%)
Gender
Male	15 (57)
Female	11 (43)
Age
2–4 years	10 (38)
5–11 years	12 (46)
12–18 years	4 (15)
Mean age (S.D.)	7 (6)
School level
None	3 (12)
Daycare	7 (27)
Preschool	3 (12)
Specialized/Adapted school	4 (15)
Regular school	9 (35)
Diagnosis ${}^{1}$
Attention deficit with-without hyperactivity disorder	8 (31)
Autism spectrum disorder	12 (46)
Cerebral palsy	4 (15)
Communication disorder	2 (8)
Developmental delay	12 (46)
Epilepsy	3 (12)
Genetic disease	5 (19)
Intellectual disability	5 (19)
Language disorder	7 (27)
Motor dyspraxia/developmental coordination disorder	7 (27)
Neurological disorder	1 (4)
Oppositional defiant disorder	2 (8)
Sensory modulation disorder	3 (12)
Verbal dyspraxia	4 (15)
Other	12 (46)
Users of assistive devices or home adaptations	14 (54)
Users of other services	23 (88)

${}^{1}$ Parents could report more than one diagnosis.

3.2 Hippotherapy services profile

Details about the characteristics regarding the hippotherapy interventions received can be found in Table 2. The interventions conducted by PTs [2] and SLPs [4] sometimes alternated or were carried out jointly with OTs [4].

Table 2
Characteristics regarding hippotherapy interventions received ( $n=$ 26)

Number of children currently participating in programs	23
Number of sessions per child (range)	11–225
Mean number of sessions (S.D.)	57.79 (67.94)
Professionals involved (frequency)
Occupational therapist (OT)	24
Speech and language pathologist (SLP)	4
Physiotherapist (PT)	2
Joint therapy	4
Occurrence of incidents (e.g., falls, bites from another horse, horse being afraid)	6
Occurrence of events (e.g., medication change, death of a relative, surgery)	7
Distance between home and hippotherapy in km (range)	21–30
Annual family income in $ (mode)	$>$ 100 000

3.3 Reasons invoked by parents for trying hippotherapy

The various reasons invoked by parents for trying hippotherapy for their child are listed in Table 3.

Table 3
Frequency of parents’ reasons for trying hippotherapy ( $n=$ 26)

Reasons ${}^{1}$	Frequency (%)
Postural control	11 (42)
Strength and mobility of limbs	9 (35)
Attention-concentration	8 (31)
Social skills	7 (27)
Walking and transfer autonomy	7 (27)
Coordination	5 (19)
Sensory modulation	5 (19)
Balance	4 (15)
Children’s interest in horses	4 (15)
Communication	4 (15)
Desire to try a new intervention	3 (12)
Self esteem	3 (12)
Adapted leisure	2 (8)
Recommendation from a health professional	1 (4)
Recommendation from a relative	1 (4)

${}^{1}$ The parents could choose up to three reasons.

3.4 Facilitators and obstacles invoked by parents for recommending hippotherapy

The various facilitators and obstacles identified by parents for recommending hippotherapy or not are reported in Table 4. Six parents did not respond to the question regarding obstacles.

Table 4
Frequency of different factors associated with facilitators and obstacles for using hippotherapy as reported by parents ( $n=$ 26)

Factors ${}^{1}$	Frequency (%)
Facilitators
Global benefits	15 (58)
Difference with traditional therapy	7 (27)
Relationship with equine and human therapist	7 (27)
Self esteem	5 (19)
Improvement and concrete results	4 (15)
Sensory stimulation	4 (15)
Communication	3 (12)
Effect on walking	3 (12)
Therapy that feels like leisure	3 (12)
Behavior	2 (8)
Interest of the child	2 (8)
Motivation	2 (8)
Responsibility	2 (8)
Contact with nature	1 (4)
Attracts child’s interest and attention	1 (4)
Qualified and attentive professional	1 (4)
Obstacles
None	9 (35)
Cost	5 (19)
Allergies	2 (8)
Confusion with horseback riding	1 (4)
Fear of big animals	1 (4)
Risk according to the child’s condition	1 (4)
Focuses on social abilities and emotional management	1 (4)

${}^{1}$ The parents could select as many factors as they wished to.

3.5 Life habits most positively associated by hippotherapy from the parents’ perspectives

The perceived impact of hippotherapy on life habits ranged from a moderate negative impact ( $-$ 2) to a highly positive impact ( $+$ 3). The response frequencies are reported in Table 5. However, parents reported a positive impact ( $+$ 1, $+$ 2, $+$ 3) on each life habit 80–100% of the time; see the details in Table 5. The proportion test revealed that for 10 out of 12 life habit categories (all except Employment and Community and spiritual life), the proportion of impact perceived by parents was statistically significant in favor of a positive impact ( $p<$ 0.01) (Table 5). With respect to the repeated calculation conducted in response to the hypothesis stating that parents in need of a neutral option (“slight”) would select low positive ( $+$ 1) or negative ( $-$ 1) impact, two categories remained statistically significant in favor of a positive impact: Interpersonal relationship ( $p<$ 0.01) and Mobility ( $p<$ 0.05). See details in Table 5.

Table 5
Association between hippotherapy and life habits ( $n=$ 26)

	Frequency of response							Positive/total proportion			Positive/total proportion, adjusted to the absence of neutrality
Life habit categories ( $n$ )	—	–	-	+	++	+++	N/A	$P$ -value ( $p<$ 0.05)	Proportion ${}^{1}$	95% CI ${}^{3}$	$P$ -value ( $p<$ 0.05)	Proportion ${}^{2}$	95% CI ${}^{3}$
Communication ( $n=$ 25)	0	0	0	8	9	8	0	0.00	1.00	0.83–1.00	0.11	0.68	0.46–0.84
Community and spiritual life ( $n=$ 25)	0	0	1	0	3	1	20	0.37	0.80	0.30–0.99	0.37	0.80	0.30–0.99
Education ( $n=$ 25)	0	0	1	7	8	9	0	0.00	0.96	0.78–1.00	0.11	0.68	0.46–0.84
Employment ( $n=$ 25)	0	0	0	0	1	1	23	0.48	1.00	0.20–1.00	0.48	1.00	0.20–1.00
Housing ( $n=$ 24)	0	1	1	15	6	1	0	0.00	0.92	0.72–0.99	0.07	0.29	0.13–0.51
Interpersonal relationships (25)	0	0	0	4	11	10	0	0.00	1.00	0.83–1.00	0.00	0.84	0.63–0.95
Mobility ( $n=$ 25)	0	0	0	7	12	6	0	0.00	1.00	0.83–1.00	0.05	0.72	0.50–0.87
Nutrition ( $n=$ 24)	0	1	0	15	5	3	0	0.00	0.96	0.77–1.00	0.15	0.33	0.16–0.55
Personal care and health ( $n=$ 26)	0	0	1	13	9	3	0	0.00	0.96	0.78–1.00	0.84	0.46	0.27–0.66
Physical fitness and psychological	0	0	0	12	8	5	0	0.00	1.00	0.83–1.00	1.00	0.52	0.38–0.72
well-being ( $n=$ 25)
Recreation ( $n=$ 25)	0	1	0	13	6	5	0	0.00	0.96	0.78–1.00	0.69	0.44	0.25–0.65
Responsibility ( $n=$ 24)	0	0	0	5	2	4	13	0.00	1.00	0.68–1.00	1.00	0.55	0.25–0.82

${}^{1}$ Significance through proportion tests (+++, ++,+ VS -, –, —); ${}^{2}$ Significance through proportion tests adjusted to the absence of neutrality (+++, ++ VS +, -, –, —); ${}^{3}$ CI $=$ confidence interval; N/A, Not applicable.

3.6 Life habits considered the most important for the parents

The life habit categories considered the most important for parents are listed in Table 6.

Table 6
Frequency of parents’ priorities regarding their children’s life habits ( $n=$ 26)

Categories of life habits ${}^{1}$	Frequency (%)
Communication	19 (73)
Education	13 (50)
Interpersonal relationships	11 (42)
Mobility	9 (35)
Physical fitness and psychological well-being	5 (19)
Personal care and health	4 (15)
Housing	3 (12)
Nutrition	3 (12)
Responsibility	3 (12)
Community and spiritual life	1 (4)
Employment	1 (4)
Recreation	1 (4)

${}^{1}$ The parents could select up to three categories of life habits.

3.7 Association between providers of hippotherapy and the impact perceived by the parents

In this survey, hippotherapy was delivered most frequently by OTs (see Table 2). As a result of the limited involvement of the other professions (PTs and SLPs), it was impossible to meaningfully analyze the relationship between the type of professional implementing hippotherapy and the impact perceived by the parents in the 12 life habit categories.

4. Discussion

This research survey revealed that children receiving hippotherapy services have various diagnoses that are not limited to the most studied diagnoses regarding hippotherapy (e.g., cerebral palsy). As well, the investigation documented all life habits relative to the DCP model in association with hippotherapy (e.g., Personal care and Nutrition) compared to the existing literature in which the focus was more typically upon individuals’ motor functions.

The identification of the reasons that led parents to take an interest in and support hippotherapy adds new knowledge. Among other aspects, this finding demonstrates the range of elements that support the use of this relatively new modality in Quebec, versus the few inconveniences identified. Parents reported more potential benefits than risks, despite these risks being greater with hippotherapy compared to traditional approaches. In turn, as also previously noted (35), this finding reinforces the importance both of informed consent and the involvement of qualified therapists in the use of this modality. Parents must develop a realistic idea of the modality, and the implication of a trained therapist helps decrease the risks and supports informed consent.

This investigation has furthered understanding regarding the facilitators and obstacles to hippotherapy from the parents’ point of view. The main facilitator identified in this study justifying the recommendation of hippotherapy is its global benefits, considered to encompass both physical and psychosocial benefits. This finding is consistent with the results of Léveillé et al.’s [31] study in which parents reported physical, emotional and cognitive benefits as well as a positive impact on the social environment and occupations. This finding is also supported by Debuse et al.’s [30] investigation that reported the presence of both physiological and psychological benefits from parents’ perspectives. The child-horse relationship has previously been identified as beneficial or potentially beneficial for the child by parents of children receiving or waiting for hippotherapy services [31], a finding that is consistent with the current study results. Some other facilitators, which have not previously been reported in the literature, are reported by this survey (Table 4): a reduction of the child’s inadequate behaviors; contact with nature; responsibility taken by the child; sensory stimulation; and the fact that hippotherapy resembles a leisure pursuit from the parents’ perspective.

Regarding the barriers to the use of hippotherapy, a predominant reason that emerged from the current study was the cost associated with this modality. In contrast, the risk of injury or fall was not identified by the parents. This latter result is consistent with the findings of Léveillé et al.’s [31] study, in which parents reported little risk to the use of hippotherapy compared to its benefits, mentioning, among other elements, the presence of qualified therapists. These authors also pointed out that the associated risks did not seem to be a major concern and that there seemed to be minimization of risks by parents. Some other obstacles that were reported by parents in the current survey, which have not previously been identified in the literature, included the child’s social skills deficits and difficulties managing emotions. This finding regarding social skills is interesting given that it is also one of the reasons mentioned by parents for trying hippotherapy. The fact that this area is also considered an obstacle reinforces the importance of the relationship established between the humans and horses.

While recognizing the prudence required given the limited sample size, the current study revealed that, according to their parents, children’s life habits are most often positively influenced by hippotherapy. Mobility and Interpersonal relationships are the life habits for which a statistically significant association with hippotherapy was revealed when the potentially neutral responses regarding impact were removed. These findings are consistent with the results of Potvin-Bélanger et al.’s [1] systematic review. It is worthy of note that the life habits considered more important by parents were among those for which a perceived positive association with hippotherapy was reported. Although some prudence is required in the interpretation of this finding insofar as the parents may be more inclined to see a positive influence in these areas, it is also logical that parents might be more inclined to continue their children’s involvement in hippotherapy if they believe that this modality has a positive influence on areas they believe to be important.

It was not possible to measure a significant statistical relationship between the perceived benefits of hippotherapy and the type of therapist involved due to an insufficient sample size. However, the current research revealed that more OTs appear to be involved in the use of hippotherapy in Quebec compared to PTs and SLPs. This finding may not be surprising given occupational therapy’s focus upon a wide variety of daily living activities, for example, feeding (Nutrition), dressing (Personal care), writing (Education, Communication), playing (Recreation), attending school (Education), using assistive devices (Mobility), and taking part in significant social activities (Interpersonal relationship) (36). In comparison, the interventions of PTs and SLPs tend to be associated with a narrower range of life habit categories (respectively Mobility and Recreation, and Communication and Interpersonal relationship).

4.1 Strengths and limitations

The survey questionnaire was guided by the rigorous and well-recognized DCP model. This model permitted the documentation of a large array of relevant variables for establishing a portrait of the intervention in hippotherapy in two dedicated clinics in Quebec. The survey was pre-tested by individuals possessing relevant expertise. In addition, the questionnaire was entirely anonymous, which made it possible to reduce the potential of social desirability among participants influencing their responses in favor of hippotherapy. Another strength of the study concerns the statistical analyses used. The proportion test permitted a measurement of the extent to which the responses of the subjects’ sample was representative of those of the actual parent population (37).

The main limitation of this study concerns the size of the sample obtained. The participation rate was lower than anticipated, despite the considerable efforts made to stimulate dissemination by the hippotherapy organizations. Several reasons may explain the obtained rate, including: the reduced time available for parents at the beginning of the school year; the impossibility of validating the number of emails sent by the organization due to confidentiality issues; and changes in parents’ email addresses. Given the large proportion of respondents whose children had hippotherapy interventions performed by OTs, it would have been necessary to obtain more responses in which the interventions were provided by other disciplines in order to answer our third research question. Regarding the positive results found for the first research question, some caution is required given the small number of subjects with which this proportion was revealed; that is, there may have been participant bias as the parents who decided to participate may have been more inclined to respond favorably. Due to the confidentiality concerns, little information was obtained regarding parents’ characteristics that may have influenced their perceptions. Given the lapse of time between the beginning and end of the hippotherapy interventions and the completion of the questionnaire, it is not possible to rule out the potential influence of a memory bias nor confusion between the effects of hippotherapy and other services received simultaneously by the majority of the children. Finally, it is possible that the perceived positive changes in life habits are related not only to the children’s participation in hippotherapy but also to its combination with the use of assistive devices and home adaptations.

4.2 Implications for future research

The use of standardized assessments and measures within experimental design studies would allow a more precise identification and comprehension of the effect of hippotherapy on life habit categories, as some life habits seem more important and positively influenced from the parents’ perspective. Further research should document the perception of therapists and their use of hippotherapy, as it would be beneficial to the understanding of hippotherapy in different settings and ensure a safe and relevant use regarding potential benefits and risks. Finally, other surveys, interviews and assessments using, for example, the Paediatric Activity Card Sort (38) could be conducted with the children to understand their experience and perceptions of the effect of hippotherapy on their life habits.

5. Conclusions

This survey conducted with parents of children receiving hippotherapy services from two organizations in Quebec revealed various facilitators and obstacles for recommending hippotherapy as well as parents’ prioritization of life habits for their children. The results also suggest a perceived global positive association between hippotherapy and 10 out of 12 life habit categories. Further research is needed to document the experience of professionals and children with hippotherapy and its benefits on life habits and social participation using experimental design studies and relevant tools.

Footnotes

Acknowledgments

We would like to acknowledge the data analysis support provided by Jean Leblond.

The first author was supported by a Masters scholarship from the Chair in Cerebral Palsy of Université Laval and the Faculty of Medicine (Université Laval).

Conflict of interest

The authors have no conflict of interest to report.

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Hippotherapy and life habits with children with motor deficit and neurodevelopmental impairment: A pilot survey of parents

Abstract

PURPOSE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1. Introduction

2. Methods

2.1 Design

2.2 Participants

2.3 Measures

2.4 Procedure

2.5 Data analysis

3. Results

3.1 Personal factors of children who received hippotherapy

Table 1 Personal factors of children who received hippotherapy ( n = 26)

Table 2 Characteristics regarding hippotherapy interventions received ( n = 26)

Table 3 Frequency of parents’ reasons for trying hippotherapy ( n = 26)

Table 4 Frequency of different factors associated with facilitators and obstacles for using hippotherapy as reported by parents ( n = 26)

Table 5 Association between hippotherapy and life habits ( n = 26)

Table 6 Frequency of parents’ priorities regarding their children’s life habits ( n = 26)

4. Discussion

4.1 Strengths and limitations

4.2 Implications for future research

5. Conclusions

Footnotes

Acknowledgments

Conflict of interest

References

Table 1
Personal factors of children who received hippotherapy ( $n=$ 26)

Table 2
Characteristics regarding hippotherapy interventions received ( $n=$ 26)

Table 3
Frequency of parents’ reasons for trying hippotherapy ( $n=$ 26)

Table 4
Frequency of different factors associated with facilitators and obstacles for using hippotherapy as reported by parents ( $n=$ 26)

Table 5
Association between hippotherapy and life habits ( $n=$ 26)

Table 6
Frequency of parents’ priorities regarding their children’s life habits ( $n=$ 26)