The effect of hippotherapy on spasticity and on mental well-being of persons with spinal cord injury.

OBJECTIVES: To determine the effect of hippotherapy on spasticity and on mental well-being of persons with spinal cord injury (SCI), and to compare it with the effects of other interventions.

DESIGN: Crossover trial with 4 conditions.

SETTING: Swiss paraplegic center.

PARTICIPANTS: A volunteer sample of 12 people with spastic SCI (American Spinal Injury Association grade A or B).

INTERVENTIONS: Hippotherapy, sitting astride a Bobath roll, and sitting on a stool with rocking seat. Each session lasted 25 minutes and was conducted twice weekly for 4 weeks; the control condition was spasticity measurement without intervention.

MAIN OUTCOME MEASURES: Clinical rating by a blinded examiner of movement-provoked muscle resistance, using the Ashworth Scale; self-rating of spasticity by subjects on a visual analog scale (VAS); and mental well-being evaluated with the self-rated well-being scale Befindlichkeits-Skala of von Zerssen. Assessments were performed immediately after intervention sessions (short-term effect); data from the assessments were analyzed 3 to 4 days after the sessions to calculate the long-term effect.

RESULTS: By analyzing the clinically rated spasticity, only the effect of hippotherapy reached significance compared with the control condition (without intervention); median differences in the Ashworth scores' sum before and after hippotherapy sessions ranged between -8.0 and +0.5. There was a significant difference between the spasticity-reducing effect of hippotherapy and the other 2 interventions in self-rated spasticity by VAS; median differences of the VAS before and after hippotherapy sessions ranged between -4.6 and +0.05cm. There were no long-term effects on spasticity. Immediate improvements in the subjects' mental well-being were detected only after hippotherapy (P=.048).

CONCLUSIONS: Hippotherapy is more efficient than sitting astride a Bobath roll or on a rocking seat in reducing spasticity temporarily. Hippotherapy had a positive short-term effect on subjects' mental well-being.