The Effects of Hippotherapy on Standing Balance in Patients with Incomplete Cervical Spinal Cord Injuries: A Pilot Study


The present study was designed to evaluate the effects of hippotherapy on standing balance in patients with incomplete cervical spinal cord injuries. Ten patients (8 men and 2 women) who were diagnosed with cervical levels of injury between 3 and 6, and D according to the ASIA Impairment Scale. All patients were tested by the physiotherapists prior to and after hippotherapy treatment. Standing balance was measured using the Interactive Balance System (IBS). The weight distribution index was significantly increased in application of hippotherapy compared with control groups in patients with a neurologic level of cervical 3 and 4, and with Brown-Sequard syndrome, respectively. However, most of the patients exhibited no significant changes in the standing balance index, such as F1, F2-4, F5-6, F7-8, and SI scores, after hippotherapy. These results suggest that hippotherapy did not have a significant effect on the standing balance of patients with incomplete cervical spinal cord injuries.

Share and Cite:

Choi, B. , Kim, J. , Lee, J. and Kim, J. (2013) The Effects of Hippotherapy on Standing Balance in Patients with Incomplete Cervical Spinal Cord Injuries: A Pilot Study. Neuroscience and Medicine, 4, 7-15. doi: 10.4236/nm.2013.41002.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] R. Bailey, V. Kaskutas, I. Fox, C. M. Baum and S. E. Mackinnon, “Effect of Upper Extremity Nerve Damage on Activity Participation, Pain, Depression, and Quality of Life,” Journal of Hand Surgery, Vol. 34, No. 9, 2009, pp. 1682-1688. doi:10.1016/j.jhsa.2009.07.002
[2] C. Fekete and A. Rauch, “Correlates and Determinants of Physical Activity in Persons with Spinal Cord Injury: A Review Using the International Classification of Functioning, Disability and Health as Reference Framework,” Disability and Health Journal, Vol. 5, No. 3, 2012, pp. 140-150. doi:10.1016/j.dhjo.2012.04.003
[3] A. D. Nichol, A. M. Higgins, B. J. Gabbe, L. J. Murray, D. J. Cooper and P. A. Cameron, “Measuring Functional and Quality of Life Outcomes Following Major Head Injury: Common Scales and Checklists,” Injury, Vol. 42, No. 3, 2011, pp. 281-287. doi:10.1016/j.injury.2010.11.047
[4] P. Krawetz and P. Nanace, “Gait Analysis Spinal Cord Injured Subjects: Effects of Injury Level and Spasticity,” Archives of Physical Medicine and Rehabilitation, Vol. 77, No. 7, 1996, pp. 635-638. doi:10.1016/S0003-9993(96)90000-3
[5] R. Kizony, L. Raz, N. Katz, H. Weingarden and L. T. Weiss, “Video-Capture Virtual Reality System for Patients with Paraplegic Spinal Cord Injury,” Journal of Rehabilitation Research & Development. Vol. 42, No. 5, 2005, pp. 595-608. doi:10.1682/JRRD.2005.01.0023
[6] N. Benjuya, I. Melzer and J. Kaplanski, “Aging-Induced Shifts from a Reliance on Sensory Input to Muscle Cocontraction during Balanced Standing,” The Journals of Gerontology, Vol. 59, No. 2, 2004, pp. 166-171.
[7] S. Wydenkeller, M. Liechti, R. Muller and A. Curt, “Impaired Scaling of Responses to Vestibular Stimulation in Incomplete SCI,” Experimental Brain Research, Vol. 175, No. 1, 2006, pp. 191-195. doi:10.1007/s00221-006-0688-z
[8] S. D. Anderson, D. G. Anderson and A. R. Vaccaro, “Skeletal Fracture Demographics in Spinal Cord-Injured Patients,” Archives of Orthopaedic and Trauma Surgery, Vol. 124, No. 3, 2004, pp. 193-196. doi:10.1007/s00402-003-0605-x
[9] D. S. Marigold, J. J. Eng, A. S. Dawson, J. T. Inglis, J. E. Harris and S. Gylfadóttir, “Exercise Leads to Faster Postural Reflexes, Improved Balance and Mobility, and Fewer Falls in Older Persons with Chronic Stroke,” Journal of the American Geriatrics Society, Vol. 53, No. 3, 2005, pp. 416-423. doi:10.1111/j.1532-5415.2005.53158.x
[10] F. P. Carpes, F. B. Reinehr and C B. Mota, “Effects of a Program for Trunk Strength and Stability on Pain, Low Back and Pelvis Kinematics, and Body Balance: A Pilot Study,” Journal of Bodywork and Movement Therapies, Vol. 12, No. 1, 2008, pp. 22-30. doi:10.1016/j.jbmt.2007.05.001
[11] S. F. Nadler, G. A. Malanga, L. A. Bartoli, J. H. Feinberg, M. Prybicien and M. Deprince, “Hip Muscle Imbalance and Low-Back Pain in Athletes: Influence of Core Strengthening,” Medicine & Science in Sports & Exercise, Vol. 34, No. 1, 2002, pp. 9-16. doi:10.1097/00005768-200201000-00003
[12] J. S. Petrofsky, E. G. Johnson, A. Hanson, M. Cuneo, R. Dial, R. Somers, G. De La Torre, A. Martinez, M. McKenzie and B. Forrester, “Abdominal and Lower Back Training for People with Disabilities Using a 6 Second abs Machine: Effect on Core Muscle Stability,” The Journal of Applied Research, Vol. 5, No. 2, 2005, pp. 345-359.
[13] P. Herrero, A. Asensio, E. Garcia, A. Marco, B. Olivan and A. Ibarz, “Study of the Therapeutic Effects of an Advanced Hippotherapy Simulator in Children with Cerebral Palsy: A Randomized Controlled Trial,” BMC Musculoskeletal Disorders, Vol. 11, 2010, p. 71. doi:10.1186/1471-2474-11-71
[14] H. E. Lechner, T. H. Kakebeeke, D. Hegemann and M. Baumberger, “The Effect Hippotherapy on Spasticity and on Mental Well-Being of Persons with Spinal Cord Injury,” Archives of Physical Medicine and Rehabilitation, Vol. 88, No. 10, 2007, pp. 1241-1248. doi:10.1016/j.apmr.2007.07.015
[15] D. Silkwood-Sherer and H. Warmbier, “Efeects of Hippotherapy on Postural Stability, in Persons with Multiple Sclerosis: A Pilot Study,” Journal of Neurologic Physical Therapy, Vol. 31, No. 2, 2007, pp. 77-84.
[16] J. L. Encheff, C. Armstrong, M. Masterson, C. Fox and P. Gribble, “Hippotherapy Effects on Trunk, Pelvic, and Hip Motion during Ambulation in Children with Neurological Impairments,” Pediatric Physical Therapy, Vol. 24, No. 3, 2012, pp. 242-250. doi:10.1097/PEP.0b013e31825c1dc3
[17] D. B. Bertoti, “Effect of Therapeutic Horseback Riding on Posture in Children with Cerebral Palsy,” Physical Therapy, Vol. 68, No. 10, 1998, pp. 1505-1512.
[18] H. E. Lechner, S. Feldhaus, L. Gudmundsen, D. Hegemann, D. Michel, G. A. Zach and H. Knecht, “The ShoetTerm Effect of Hippotherapy on Spasticity in Patients with Spinal Cord Injury,” Spinal Cord, Vol. 41, No. 9, 2003, pp. 502-505. doi:10.1038/
[19] F. M. Maynard Jr., M. B. Bracken, G. Creasey, J. F. Ditunno Jr., W. H. Donovan, T. B. Ducker, S. L. Garber, R. J. Marino, S. L. Stover, C. H. Tator, R. L. Waters, J. E. Wilberger and W. Young, “International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association,” Spinal Cord, Vol. 35, No. 5, 1997, pp. 266-274. doi:10.1038/
[20] U. Oppenheim, A. Kohen-Raz, R. Kohen-Raz, M. Azarya and D. Alex, “Postural Characteristics of Diabetic Neuropathy,” Diabetes Care, Vol. 22, No. 2, 1999, pp. 328-332. doi:10.2337/diacare.22.2.328
[21] M. Friedrich, H. J. Grein, C. Wicher, J. Schuetze, A. Mueller, A. Lauenroth, K. Hottenrott and R. Schwesig, “Infuence of Pathologic and Simulated Visual Dysfunctions on the Postural System,” Experimental Brain Research, Vol. 186, No. 2, 2008, pp. 305-314. doi:10.1007/s00221-007-1233-4
[22] S. Schwartz, O. Segal, Y. Barkana, R. Schwesig, I. Avni and Y. Morad, “The Effect of Cataract Surgery on Postural Control,” Investigative Ophthalmology & Visual Science, Vol. 46, No. 3, 2005, pp. 920-924. doi:10.1167/iovs.04-0543
[23] A. Hammer, Y. Nilsagard, A. Forsberg, H. Pepa, E. Skargren and B. Oberg, “Evaluation of Therapeutic Riding (Sweden)/Hippotherapy (United States). A Single-Subject Experimental Design Study Replicated in Eleven Patients with Multiple Sclerosis,” Physiotherapy Theory and Practice, Vol. 21, No. 1, 2005, pp. 51-77. doi:10.1080/09593980590911525
[24] C. Manella and D. Backus, “Gait Characteristics, Range of Motion, and Spasticity Changes in Response to Massage in a Person with Incomplete Spinal Cord Injury: Case Report,” International Journal of Therapeutic Massage & Bodywork. Vol. 4, No. 1, 2011, pp. 28-39.
[25] C. Quint and M. Toomey, “Powered Saddle and Pelvic Mobility: An Investigation into the Effects on Pelvic Mobility of Children with Cerebral Palsy of a Powered Saddle which Imitates the Movements of a Walking Horse,” Physiotherapy, Vol. 84, No. 8, 1998, pp. 376-384. doi:10.1016/S0031-9406(05)61458-7
[26] T. Suzuki, S. Sonoda, E. Saitoh, K. Onogi, H. Fujino and T. Teranishi, “Prediction of Gait Outcome with the KneeAnkle-Foot Orthosis with Medial Hip Joint in Patients with Spinal Cord Injuries: A Study Using Recursive Partitioning Analysis,” Spinal Cord, Vol. 45, No. 1, 2007, pp. 57-63. doi:10.1038/
[27] B. Heine, “Hippotherapy. A multisystem Approach to the Treatment of Neuromuscular Disorder,” Australian Journal of Physiotherapy, Vol. 43, No. 2, 1997, pp. 145-149.
[28] S. Mu?oz-Lasa, G. Ferriero, R. Valero, F. Gomez-Mu?iz, A. Rabini and E. Varela, “Effect of Therapeutic Horseback Riding on Balance and Gait of People with Multiple Sclerosis,” Giornale Italiano di Medicina del Lavoro ed Ergonomia, Vol. 33, No. 4, 2011, pp. 462-467.

Copyright © 2021 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.