1. In Pediatric Patients With Down Syndrome, Is Hippotherapy Effective For Increasing Postural Control and Improving Gait Mechanics? Kori Ivanchak, DPT Student Madelaine Nolan, DPT Student Down syndrome (DS) is the most commonly occurring chromosomal condition, which affects more than 400,000 people in the United States. Common characteristics of DS result in movement disorders, which limit the child’s ability to participate in daily activities. However, when stimulated appropriately, children with DS can attain mature levels of movement. If there is no atlantoaxial instability, DS is a disorder that can benefit from hippotherapy. Riding simulates the mechanics of normal gait, including hip and pelvic rotation, weight shifting, and proprioceptive stimulation. Sitting on the dynamic surface of the horse challenges the child’s postural control, balance, and righting reactions. The purpose of this poster is to examine the effects of hippotherapy on postural control and gait mechanics in pediatric patients with DS. Three of the studies used bareback pad for the treatment while the other study used “appropriate tack.” Treatment Parameters: 30 minute sessions for 11 weeks. The child was placed in three different positions and asked to perform therapeutic activities 40 to 45 minute sessions, 2x per week for six weeks. Treatment was individualized. One-hour group class, 1x per week for seven weeks. Sessions included stretching, strengthening, dynamic balance and reaching exercises. 50 minute sessions, 1x per week for 13 week. Activities were designed to stimulate various tonal adjustments. Significant change in GMFM for child 1 with a similar pattern for child 2 1 Item E (running, walking, and jumping) of the GMFM demonstrated the largest improvements in both children 1 Accelerometers showed more stability of the head (child 1) or the trunk (child 2) 1 The PBS and ASKp were statistically different between baseline and post- intervention measures 2 Significant difference on GMFM between pre-test and post-test 1 when blocked by subject 3 No significant difference in gait speed 3 Significant difference in ankle kinematics during gait for all participants 4 No significant difference in knee kinematics during gait 4 Statistically significant change was not seen in child 2 due to possible ceiling effect. 1 A trend of increased gait speed was observed. 3 Promotes motor control, increased tone, and reeducation of postural reflexes and balance reactions. Changes were not due to normal maturation. 3 Limitations: Number of subjects Control of daily activities No treatment protocol across studies One article was written in Portuguese, terminology is not consistent with American PTs. 4 Increases postural stability in order to stabilize vision and coordinate muscle synergies 1 Improves muscle performance in fundamental motor skills 1 A viable strategy for reducing balance deficits and improving the performance of ADLs in children with mild to moderate balance problems 2 Improves anticipatory and reactive postural control strategies in response to complex sensory input 2 Improves gross motor function in children with developmental delays 3 Changes appear to persist even after the program ends 3 Normalize ankle kinematics from toe off to the start of midswing phase of gait 4 The research on the effects of hippotherapy on children with Down syndrome remains fairly limited; however, there is evidence to support that it is effective for increasing postural control and improving gait mechanics in this population. Background: Purpose: Methods : Four relevant research articles were found. One article is a case report and three articles are repeated-measures design. Participants ages ranged from 28 months to 16 years old. Children’s diagnoses included balance disorders, developmental delays, and DS. Interventions:Results: www.elementshealthspace.com Discussion: Conclusion: 1.Champagne D, Dugas C. Improving gross motor function and postural control with hippotherapy in children with Down syndrome: case reports. Physiotherapy theory and practice. Nov 2010;26(8):564-571. 2.Silkwood-Sherer DJ, Killian CB, Long TM, Martin KS. Hippotherapy—An Intervention to Habilitate Balance Deficits in Children With Movement Disorders: A Clinical Trial. Physical Therapy. 2012;92(5):707-717. 3.Winchester P, Kendall K, Peters H, Sears N, Winkley T. The effect of therapeutic horseback riding on gross motor function and gait speed in children who are developmentally delayed. Physical & occupational therapy in pediatrics. 2002;22(3-4):37-50. 4.Copetti F, Mota C, Graup S, Menezes K, Venturini E. Angular kinematics of the gait of children with Down's syndrome after intervention with hippotherapy. Revista Brasileira de Fisioterapia. 2007;11(6):503-507. Summary: References: