Therapist-Designed Adaptive Riding in Children With Cerebral Palsy: Results of a Feasibility Study

Mattana Angsupaisal; Baudina Visser; Anne Alkema; Marja Meinsma-van der Tuin; Carel G. B. Maathuis; Heleen Reinders-Messelink; Mijna Hadders-Algra

doi:10.2522/ptj.20140146

Therapist-Designed Adaptive Riding in Children With Cerebral Palsy: Results of a Feasibility Study

Mattana Angsupaisal, Baudina Visser, Anne Alkema, Marja Meinsma-van der Tuin, Carel G. B. Maathuis, Heleen Reinders-Messelink, Mijna Hadders-Algra^*

^*Corresponding author for this work

EXtremities Pain Active lifestyle aNd Disability (EXPAND)

Research output: Contribution to journal › Article › Academic › peer-review

11 Citations (Scopus)

Abstract

Background. It is debatable whether adaptive riding (AR) in children with cerebral palsy (CP) improves postural control and gross motor development.

Objective. The study aim was to explore the feasibility of an extensive assessment protocol for a randomized controlled trial of therapist-designed adaptive riding (TDAR) in children with CP, with the goals of assessing the effect on child outcomes and evaluating working mechanisms of sitting postural control.

Design. A pretest-posttest group design with 2 baseline measurements was used.

Methods. Six children (1 girl, 5 boys; age range = 6 -12 years, median age = 8 years 9 months) with bilateral spastic CP (Gross Motor Function Classification System level III) participated. Outcomes were evaluated 3 times (TO, T1, and T2) at 6-week intervals. TO and T1 were baseline measurements; between T1 and T2, a TDAR intervention including an integrated program of postural challenge exercises (2 times per week for 1 hour) was applied. The complex protocol included the 88-item Gross Motor Function Measure (GMFM-88) and electromyographic (EMG) recording of postural muscle activity during reaching while sitting (EMG recording at T1 and T2 only).

Results. The protocol was feasible. Median GMFM-88 scores changed from 64.4 at TO to 66.7 at T1 and from 66.7 at T1 to 73.2 at T2. The change scores for all children exceeded the minimal clinically important difference of the GMFM-88. Five of 6 children showed a decrease in stereotyped top-down recruitment between Ti and T2.

Limitations. Study limitations included the lack of a control group, small sample size, and potential assessor bias for all but the EMG parameters.

Conclusions. The feasibility of the complex protocol was established. The data suggested that a 6-week TDAR intervention may improve gross motor function and may reduce stereotyped postural adjustments in children with CP. The limited results warrant replication in a well-powered randomized controlled trial.

Original language	English
Pages (from-to)	1151-1162
Number of pages	12
Journal	Physical Therapy
Volume	95
Issue number	8
DOIs	https://doi.org/10.2522/ptj.20140146
Publication status	Published - Aug-2015

Keywords

QUALITY-OF-LIFE
GROSS MOTOR FUNCTION
YOUNG-CHILDREN
POSTURAL ADJUSTMENTS
PHYSICAL-THERAPY
MUSCLE-ACTIVITY
HIPPOTHERAPY
RESPONSIVENESS
ADOLESCENTS
PROGRAM

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@article{1370ab54a9dc45658d00234b7aa3f2da,

title = "Therapist-Designed Adaptive Riding in Children With Cerebral Palsy: Results of a Feasibility Study",

abstract = "Background. It is debatable whether adaptive riding (AR) in children with cerebral palsy (CP) improves postural control and gross motor development.Objective. The study aim was to explore the feasibility of an extensive assessment protocol for a randomized controlled trial of therapist-designed adaptive riding (TDAR) in children with CP, with the goals of assessing the effect on child outcomes and evaluating working mechanisms of sitting postural control.Design. A pretest-posttest group design with 2 baseline measurements was used.Methods. Six children (1 girl, 5 boys; age range = 6 -12 years, median age = 8 years 9 months) with bilateral spastic CP (Gross Motor Function Classification System level III) participated. Outcomes were evaluated 3 times (TO, T1, and T2) at 6-week intervals. TO and T1 were baseline measurements; between T1 and T2, a TDAR intervention including an integrated program of postural challenge exercises (2 times per week for 1 hour) was applied. The complex protocol included the 88-item Gross Motor Function Measure (GMFM-88) and electromyographic (EMG) recording of postural muscle activity during reaching while sitting (EMG recording at T1 and T2 only).Results. The protocol was feasible. Median GMFM-88 scores changed from 64.4 at TO to 66.7 at T1 and from 66.7 at T1 to 73.2 at T2. The change scores for all children exceeded the minimal clinically important difference of the GMFM-88. Five of 6 children showed a decrease in stereotyped top-down recruitment between Ti and T2.Limitations. Study limitations included the lack of a control group, small sample size, and potential assessor bias for all but the EMG parameters.Conclusions. The feasibility of the complex protocol was established. The data suggested that a 6-week TDAR intervention may improve gross motor function and may reduce stereotyped postural adjustments in children with CP. The limited results warrant replication in a well-powered randomized controlled trial.",

keywords = "QUALITY-OF-LIFE, GROSS MOTOR FUNCTION, YOUNG-CHILDREN, POSTURAL ADJUSTMENTS, PHYSICAL-THERAPY, MUSCLE-ACTIVITY, HIPPOTHERAPY, RESPONSIVENESS, ADOLESCENTS, PROGRAM",

author = "Mattana Angsupaisal and Baudina Visser and Anne Alkema and {Meinsma-van der Tuin}, Marja and Maathuis, {Carel G. B.} and Heleen Reinders-Messelink and Mijna Hadders-Algra",

year = "2015",

month = aug,

doi = "10.2522/ptj.20140146",

language = "English",

volume = "95",

pages = "1151--1162",

journal = "Physical Therapy",

issn = "0031-9023",

publisher = "Oxford University Press",

number = "8",

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T1 - Therapist-Designed Adaptive Riding in Children With Cerebral Palsy

T2 - Results of a Feasibility Study

AU - Angsupaisal, Mattana

AU - Visser, Baudina

AU - Alkema, Anne

AU - Meinsma-van der Tuin, Marja

AU - Maathuis, Carel G. B.

AU - Reinders-Messelink, Heleen

AU - Hadders-Algra, Mijna

PY - 2015/8

Y1 - 2015/8

N2 - Background. It is debatable whether adaptive riding (AR) in children with cerebral palsy (CP) improves postural control and gross motor development.Objective. The study aim was to explore the feasibility of an extensive assessment protocol for a randomized controlled trial of therapist-designed adaptive riding (TDAR) in children with CP, with the goals of assessing the effect on child outcomes and evaluating working mechanisms of sitting postural control.Design. A pretest-posttest group design with 2 baseline measurements was used.Methods. Six children (1 girl, 5 boys; age range = 6 -12 years, median age = 8 years 9 months) with bilateral spastic CP (Gross Motor Function Classification System level III) participated. Outcomes were evaluated 3 times (TO, T1, and T2) at 6-week intervals. TO and T1 were baseline measurements; between T1 and T2, a TDAR intervention including an integrated program of postural challenge exercises (2 times per week for 1 hour) was applied. The complex protocol included the 88-item Gross Motor Function Measure (GMFM-88) and electromyographic (EMG) recording of postural muscle activity during reaching while sitting (EMG recording at T1 and T2 only).Results. The protocol was feasible. Median GMFM-88 scores changed from 64.4 at TO to 66.7 at T1 and from 66.7 at T1 to 73.2 at T2. The change scores for all children exceeded the minimal clinically important difference of the GMFM-88. Five of 6 children showed a decrease in stereotyped top-down recruitment between Ti and T2.Limitations. Study limitations included the lack of a control group, small sample size, and potential assessor bias for all but the EMG parameters.Conclusions. The feasibility of the complex protocol was established. The data suggested that a 6-week TDAR intervention may improve gross motor function and may reduce stereotyped postural adjustments in children with CP. The limited results warrant replication in a well-powered randomized controlled trial.

AB - Background. It is debatable whether adaptive riding (AR) in children with cerebral palsy (CP) improves postural control and gross motor development.Objective. The study aim was to explore the feasibility of an extensive assessment protocol for a randomized controlled trial of therapist-designed adaptive riding (TDAR) in children with CP, with the goals of assessing the effect on child outcomes and evaluating working mechanisms of sitting postural control.Design. A pretest-posttest group design with 2 baseline measurements was used.Methods. Six children (1 girl, 5 boys; age range = 6 -12 years, median age = 8 years 9 months) with bilateral spastic CP (Gross Motor Function Classification System level III) participated. Outcomes were evaluated 3 times (TO, T1, and T2) at 6-week intervals. TO and T1 were baseline measurements; between T1 and T2, a TDAR intervention including an integrated program of postural challenge exercises (2 times per week for 1 hour) was applied. The complex protocol included the 88-item Gross Motor Function Measure (GMFM-88) and electromyographic (EMG) recording of postural muscle activity during reaching while sitting (EMG recording at T1 and T2 only).Results. The protocol was feasible. Median GMFM-88 scores changed from 64.4 at TO to 66.7 at T1 and from 66.7 at T1 to 73.2 at T2. The change scores for all children exceeded the minimal clinically important difference of the GMFM-88. Five of 6 children showed a decrease in stereotyped top-down recruitment between Ti and T2.Limitations. Study limitations included the lack of a control group, small sample size, and potential assessor bias for all but the EMG parameters.Conclusions. The feasibility of the complex protocol was established. The data suggested that a 6-week TDAR intervention may improve gross motor function and may reduce stereotyped postural adjustments in children with CP. The limited results warrant replication in a well-powered randomized controlled trial.

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KW - GROSS MOTOR FUNCTION

KW - YOUNG-CHILDREN

KW - POSTURAL ADJUSTMENTS

KW - PHYSICAL-THERAPY

KW - MUSCLE-ACTIVITY

KW - HIPPOTHERAPY

KW - RESPONSIVENESS

KW - ADOLESCENTS

KW - PROGRAM

U2 - 10.2522/ptj.20140146

DO - 10.2522/ptj.20140146

M3 - Article

SN - 0031-9023

VL - 95

SP - 1151

EP - 1162

JO - Physical Therapy

JF - Physical Therapy

IS - 8

ER -

Therapist-Designed Adaptive Riding in Children With Cerebral Palsy: Results of a Feasibility Study

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