Gross Motor Function Measure (GMFM) – Article Review

Posted on: February 27, 2021 | By: kcolby | Filed under: Gross Motor Function Measure (GMFM)

Article Title: The Effectiveness of Hippotherapy to Recover Gross Motor Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis

Purpose: To analyze effectiveness of Hippotherapy (HPT) interventions on gross motor function in children with CP

Study Population, Methods, & Outcome Measures:

  • Comprehensive literature search through PubMed, Web of Science (WoS), Scopus, and Embase databases with keywords: “hippotherapy” & “cerebral palsy” and no publication date nor language filters
  • Inclusion criteria based on PICOS model: population had to have a CP diagnosis, intervention had to be HPT, comparison had to be between HPT and traditional PT intervention or placebo, outcome had to be GMFM, and study design had to be RCT
  • Exclusion criteria: studies with healthy participants, >1 intervention comparison, and use of HPT simulators to carry out intervention
  • Two reviewers independently selected, reviewed, and extracted data from the chosen articles
  • PEDro used to assess methodological quality of the studies:
    • A total of 10 RCTs were analyzed in the systematic review with 452 total participants while only 2 studies were analyzed for the meta-analysis
    • Age of participants with CP ranging from 5.7-9.6 years old
    • Sample size ranged from 15-73 participants
    • Outcomes analyzed included gross motor function, balance, spasticity, and muscle activity
    • Outcome measures included GMFM-66 total scores, GMFM-88 total scores, and GMFM-88 dimensions A-E (other measuring instruments utilized by some articles were force plate, EMG, PEDI-FSS, PBS, MAS, etc.)

Intervention:
Hippotherapy (HPT) was the intervention (experimental group) for each article analyzed, however, specific HPT protocols differed between studies and control group varied between studies (some participants received no treatment while others received general PT or other exercise). Frequency and duration of intervention differed between studies.

  • Hippotherapy (HPT) is an equine-assisted therapy intervention that has been growing in popularity as a way to promote motor recovery in patients with CP, especially in terms of gross motor skills involved with functional mobility. It is often used as a complementary therapy option to traditional PT to help with improving neurological functions and sensory processes for patients with neurological disorders.
  • HPT works through transmission of warmth and rhythmic impulses from the horse to the subject’s body. The type of movement experienced by the individual while on the horse is similar to the movement experienced during gait which ultimately stimulates balance reactions leading to improved postural balance and trunk control.
  • Through several studies, HPT has been found to have positive physical, social, cognitive, and psychological effects. Muscle coordination & symmetry, postural alignment, postural balance, performance in ADL, and quality of life all improved for subjects with CP when HPT was used as the intervention.

Results:
There is a potential benefit of HPT intervention on improvement of gross motor function for children with CP. Findings on GMFM-66 and GMFM-88 dimensions A, B, and E indicated that HPT interventions allowed significant improvements on gross motor function specifically lying and rolling, sitting, and walking.

Strengths:
A comprehensive literature review was carried out to create this systematic review and meta-analysis. Overall quality of the studies was acceptable. Most studies had 30+ participants, which is high considering recruiting subjects with CP is challenging. The main intervention used was consistent throughout every study (HPT). This review’s findings matched those of the 2012 systematic review by Whalen and Case-Smith.

Limitations:
Small sample sizes with RCTs (only 2 studies used in the meta-analysis), HPT intervention protocols were variable/not generalizable, double-blinding not possible for most studies, lack of long-term follow-up, and varied statistical comparison scales and instruments to assess clinical differences. Also, possible useful articles referenced in other scientific databases were unable to be included in this review.

Conclusion:
HPT interventions were found to be effective in improving gross motor function in subjects with CP. Rhythmic and symmetrical movement of the horse stimulated proprioception and balance reactions. The findings of this review suggest that HPT is a promising intervention that could be used in the neuro rehab setting in conjunction with neurodevelopmental-based methods for improving gross motor function in children with CP.

  • Favorable results gathered via GMFM-66 total scores and GMFM-88 dimensions A, B, and E. Also, improvements for balance recovery, motor learning, and reduction of muscle spasticity
  • 30-45 min HPT sessions 2x/wk for 8-12wks could produce significant positive effects on gross motor function in children with CP

References:
Guindos-Sanchez LD, Lucena-Anton D, Moral-Munoz JA, Salazar A, Carmona-Barrientos I. The Effectiveness of Hippotherapy to Recover Gross Motor Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis. Children. 2020; 7(9):106. https://doi.org/10.3390/children7090106

 

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