Effects of Hippotherapy in Children With Cerebral Palsy

Cerebral palsy is a group of permanent disorders of movement and posture caused by non-progressive disturbances in the developing brain. Children with cerebral palsy may experience limitations in balance, trunk control, posture, mobility, and daily activities.

During hippotherapy, the rhythmic and multidirectional movements of the horse provide continuous sensory and motor stimulation, requiring the child to make repeated postural adjustments. These characteristics may support balance, postural control, muscle activation, and functional performance.

Although the effects of hippotherapy on motor function in children with cerebral palsy have been investigated, evidence regarding its combined effects on physical function, bladder and bowel symptoms, and family quality of life remains limited. Therefore, the present study aims to investigate the effects of hippotherapy on physical function-including balance, trunk control, posture, and handgrip strength-as well as bladder and bowel symptoms and family quality of life in children with cerebral palsy. The findings may contribute to the literature and provide guidance for rehabilitation practices.

• Hippotherapy Program (Other): Participants will receive 30-minute hippotherapy sessions once weekly for 8 weeks in addition to their ongoing special education program. The program will include exercises targeting balance, postural control, trunk stabilization, coordination, muscle strength, upper extremity function, and sensory processing.
• Special Education Program (Other): Participants will continue their ongoing special education program throughout the 8-week study period. The program includes educational activities, speech and language therapy, occupational therapy, proprioceptive activities, and sensory-based interventions according to the individual needs of the child.

Primary outcomes

• Balance [Baseline and at the end of the 8-week intervention]: Balance will be assessed using the Pediatric Balance Scale, a 14-item scale evaluating sitting balance, standing balance, transfers, reaching, turning, and stepping activities. The total score ranges from 0 to 56, with higher scores indicating better balance performance. The scale will be administered by a physiotherapist.
• Trunk Control [Baseline and at the end of the 8-week intervention]: Trunk control will be assessed using the Trunk Control Measurement Scale. The total score ranges from 0 to 58, with higher scores indicating better trunk control. The assessment will be administered by a physiotherapist.
• Posture [Baseline and at the end of the 8-week intervention]: Postural alignment will be assessed using the New York Posture Rating Chart. The total score ranges from 13 to 65, with higher scores indicating better postural alignment. The assessment will be performed by a physiotherapist.
• Handgrip Strength [Baseline and at the end of the 8-week intervention]: Handgrip strength will be measured in kilograms using a hand dynamometer. Three measurements will be obtained for each hand, with a 1-minute rest period between measurements. The mean value of the three measurements will be used in the analysis. Higher values indicate greater handgrip strength.
• Bladder and Bowel Symptoms [Baseline and at the end of the 8-week intervention]: Bladder and bowel symptoms will be assessed using the Bladder and Bowel Dysfunction Questionnaire. The total score ranges from 0 to 52, with higher scores indicating greater symptom severity. The questionnaire will be completed by the child with parental assistance.
• Familiy Quality of Life [Baseline and at the end of the 8-week intervention]: Family quality of life will be assessed using the Cerebral Palsy Quality of Life Questionnaire-Primary Caregiver Form (CP QOL-Child). Each domain is scored from 0 to 100, with higher scores indicating better quality of life. The questionnaire will be completed by the child's parent or primary caregiver.

Sex: All, ages: 7 Years to 15 Years

Inclusion Criteria:

* Aged between 7 and 15 years
* Diagnosis of cerebral palsy confirmed by a specialist physician
* Gross Motor Function Classification System (GMFCS) level I-III
* Ability to understand and follow basic verbal commands
* Ability to stand independently for at least 30 seconds
* No medical contraindications to participation in hippotherapy
* Voluntary participation in the study and written informed consent provided by a parent or legal representative

Exclusion Criteria:

* Presence of an active infection
* Bladder or bowel symptoms caused by an organic condition, such as -Hirschsprung disease or anorectal malformation
* Receipt of hippotherapy within the previous 12 months
* Uncontrolled epilepsy or a seizure within the previous 6 months
* Inability to comply with the assessment or treatment program because of severe behavioral problems
* Inability to attend the treatment program regularly
* Surgery affecting the spine, pelvis, or lower extremities within the previous 12 months
* Severe hip dislocation, atlantoaxial instability, uncontrolled scoliosis, or another orthopedic condition constituting a contraindication to hippotherapy