Top

Published in:

Open Access 01-12-2021 | Research article

Effects of equine-assisted activities on attention and quality of life in children with cerebral palsy in a randomized trial: examining the comorbidity with attention-deficit/hyperactivity disorder

Authors: Bomi Ahn, Yoo-Sook Joung, Jeong-Yi Kwon, Dong Ik Lee, Soohwan Oh, Byoung-Uk Kim, Jung Yoon Cha, Ji-Hae Kim, Ji Young Lee, Hye Yeon Shin, Yun Sik Seo

Published in: BMC Pediatrics | Issue 1/2021

Abstract

Background

Attention problems and decreased quality of life are frequently accompanied in Cerebral Palsy (CP), which can negatively affect rehabilitation of physical disability. However, the majority of affected children remain untreated in the aspects of attention or psychosocial factors. Equine-Assisted Activities and Therapies (EAAT) use horse as a therapeutic modality including grooming as well as mounted riding activities in which patients exercise and experience mounted stimulation. It is known to help improve attention in children with ADHD, so that it can be an exercise therapy that is expected to improvement of attention as well as rehabilitating effects in CP patients. EAA may be a promising strategy to address the unmet need for CP patients. This study aims to investigate the efficacy of EAA for children with CP, those with both CP and ADHD and confirm the comorbidity between CP and ADHD.

Methods

Forty-six children with cerebral palsy participated in this study. For the exercise group, they participated in a 40-min session twice a week for a 16-week period, while the control group engaged in daily life without any special treatments. Each children individually were assessed on attention and psychological wellbeing at baseline and post-treatment. Comorbidity were identified based on the Diagnostic and Statistical Manual of Mental Disorder 5th edition (DSM-5) and confirmed by Korean Kiddie-Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL).

Results

Perseveration rated using the Conner’s Performance Test (CPT) showed a significant decrease only in the exercise group (p < .024). However, no significant improvement in children’s quality of life was observed after EAA program compared with control group. Among the total participants, fifteen children (31.91%) were diagnosed with ADHD. When conducting an additional analysis with the subsample of CP patients diagnosed with ADHD, the d’, commission error and perseveration showed a significant decrease only in the exercise group. Children with CP and ADHD reported an improvement in quality of life both in exercise and control group, but only in the exercise group social functioning exhibited a significant difference.

Conclusion

The positive effects of the EAA on attention and quality of life were confirmed. Children with CP in the exercise group were more capable to sustain their attention longer. Those with CP and ADHD showed an increase in attention and perceived to have better social skills after receiving 16 weeks of EAA compared to those in the control group. Considering high comorbidity of CP and ADHD, it seems that the EAA program could be the better alternative treatment for CP with attentional problem. The results of this study will contribute to growing evidence for the efficacy of EAA in children especially with CP and ADHD.

Trial registration

This trial was registered on ClinicalTrials.gov (NCT03870893). Registered 26 July 2017.

Whitney DG, Warschausky SA, Peterson MD. Mental health disorders and physical risk factors in children with cerebral palsy: a cross sectional study. Dev Med Child Neurol. 2018;61:579–85.CrossRef

Bjorgaas HM, Elgen I, Boe T, Hysing M. Mental health in children with cerebral palsy: does screening capture the complexity? Sci World J. 2013;2013:1–7. https://doi.org/10.1155/2013/468402.CrossRef

Sigurdardottir S, Indredavik MS, Eiriksdottir A, Einarsdottir K, Gudmundsson HS, Vik T. Behavioural and emotional symptoms of preschool children with cerebral palsy: a population-based study. Dev Med Child Neurol. 2010;52(11):1056–61. https://doi.org/10.1111/j.1469-8749.2010.03698.x.CrossRefPubMed

Gabis VL, Tsubary MN, Leon O, Ashkenasi A, Shefer S. Assessment of abilities and comorbidities in children with cerebral palsy. J Child Neurol. 2015;30(12):1640–5. https://doi.org/10.1177/0883073815576792.CrossRefPubMed

Bjorgaas HM, Hysing M, Elgen I. Psychiatric disorders among children with cerebral palsy at school starting age. Res Dev Disabil. 2012;33(4):1287–93. https://doi.org/10.1016/j.ridd.2012.02.024.CrossRefPubMed

Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007;164(6):942–8. https://doi.org/10.1176/ajp.2007.164.6.942.CrossRefPubMed

American Psychiatric Association. Diagnostic and Statistical Manual Disorders. 4th ed. Washington, DC: American Psychiatric Association; 2013. p. 2000. https://doi.org/10.1176/appi.books.9780890425596.CrossRef

Faraone SV, Biederman J, Mennin D, Gershon J, Tsunag MT. A prospective four-year follow-up study of children at risk for ADHD: psychiatric, neuropsychological, and psychosocial outcome. J Am Acad Child AdolescPsychiatricy. 1996;35(11):1449–59. https://doi.org/10.1097/00004583-199611000-00013.CrossRef

Jang B, Song J, Kim J, Kim S, Lee J, Shin HY, Kwon JY, Kim YH, Joung YS. Equine-assisted activities and therapy for treating children with attention-deficit/hyperactivity disorder. J Altern Complement Med. 2015;00:1–8.

10.

Konicarova J, Bob P, Raboch J. Balance deficits and ADHD symptoms in medication naïve school-aged boys. Neuropsychiatr Dis Treat. 2014;10:85–8. https://doi.org/10.2147/NDT.S56017.CrossRefPubMedPubMedCentral

11.

Tervo RC, Azuma S, Fogas B, Fiechtner H. Children with ADHD and motor dysfunction compared with children with ADHD only. Dev Med Child Neurol. 2002;44(6):383–90. https://doi.org/10.1017/s0012162201002250.CrossRefPubMed

12.

McEvoy RE, Rogers SJ, Pennington BF. Executive function and social communication deficits in young autistic children. J Child Psychol Psychiatry. 1993;34(4):563–78. https://doi.org/10.1111/j.1469-7610.1993.tb01036.x.CrossRefPubMed

13.

Mayes S, Calhoun S. WISC-IV and WISC-III profiles in children with ADHD. J Atten Disord. 2006;9(3):486–93. https://doi.org/10.1177/1087054705283616.CrossRefPubMed

14.

Prior M, Sason A, Freethy C, Geffen G. Auditory strategies in hyperactive children. J Child Psychol Psychiatry. 1985;26(2):289–304. https://doi.org/10.1111/j.1469-7610.1985.tb02267.x.CrossRefPubMed

15.

Colver A, Rapp M, Eisermann N. Self-reported qualify of life of adolescents with cerebral palsy: a cross-sectional and longitudinal analysis. Lancent. 2014;385(9969):21–7.

16.

Novak I, Hines M, Goldsmith S. Clinical prognostic messages from a systematic review of cerebral palsy. Pediatrics. 2012;130:1285–312.CrossRef

17.

Barkley RA, Fischer M, Smallish L, Fletcher K. The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. J Abnorm Psychol. 2002;111(2):279–89. https://doi.org/10.1037/0021-843X.111.2.279.CrossRefPubMed

18.

Lee S, Choi JW, Kim KM, Kim JW, Kim S, et al. The guideline of diagnosis and treatment of attention-deficit/hyperactivity disorder: developed by ADHD translational research center. J Korean Acad Child Adolesc Psychiatry. 2016;27(4):236–66.CrossRef

19.

Gross-Tsur V, Shalev SR, Badihi N, Manor O. Efficacy of methylphenidate in patients with cerebral palsy and attention-deficit hyperactivity disorder (ADHD). J Child Neurol. 2002;17(12):863–6. https://doi.org/10.1177/08830738020170121401.CrossRefPubMed

20.

Rigby BR, Grandjean PW. The efficacy of equine-assisted activities and therapies on improving physical function. J Altern Complement Med. 2016;22(1):9–24. https://doi.org/10.1089/acm.2015.0171.CrossRefPubMed

21.

Bizub AL, Joy A, Davidson L. “It’s like being in another world”: demonstrating the benefits of therapeutic horseback riding for individuals with psychiatric disability. Psychiatric Rehabil J. 2003;26(4):377–84. https://doi.org/10.2975/26.2003.377.384.CrossRef

22.

Tyler JJ. Equine psychotherapy: worth more than just a horse laugh. Women Ther. 1994;15(3-4):139–46. https://doi.org/10.1300/J015v15n03_11.CrossRef

23.

Oh Y, Joung YS, Jang B, Yoo JH, Song J, et al. Efficacy of hippotherapy versus pharmacotherapy in attention-deficit/hyperactivity disorder: a randomized clinical trial. J Altern Complement Med. 2018;1:1–9.

24.

Kwak KJ, Oh SW, Kim CT. Korean Wechsler intelligence children-fourth edition manual. Seoul: Hakjisa; 2011.

25.

So YK, Noh JS, Kim YS, et al. The reliability and validity of Korean parent and teacher ADHD rating scale. J Korean Neuropsychiatr Assoc. 2002;41:283–9.

26.

Jang CH. The effect of horse riding machine exercise on attention and balance in children with ADHD. Korean Acad Kinesiol. 2012;14(3):63–70. https://doi.org/10.15758/jkak.2012.14.3.63.CrossRef

27.

Brossard-Racine M, Hall N, Majnemer A, Shevell MI, Law M, Poulin C, Rosenbaum. Behavioural problems in school age children with cerebral palsy. Eur J Paediatr Neurol. 2012;16(1):35–41. https://doi.org/10.1016/j.ejpn.2011.10.001.CrossRefPubMed

28.

Whitney DG, Warschausky SA, Peterson MD. Mental health disorders and physical risk factors in children with cerebral palsy: a cross-sectional study. Dev Med Child Neurol. 2019;61(5):579–85. https://doi.org/10.1111/dmcn.14083.CrossRefPubMed

29.

Brossard-Racine M, Hall N, Majnemer A, Shevell IM, Law M, Poulin C, Rosenbaum P. Behavioral problems in school age children with cerebral palsy. Eur J Pediatr Neurol. 2012;16(1):35–41. https://doi.org/10.1016/j.ejpn.2011.10.001.CrossRef

30.

Pinquart M. Systematic review: bullying involvement of children with and without chronic physical illness and/or physical sensory disability-a meta-analytic comparison with healthy/nondisabled peers. J Pediar Psychol. 2017;42:245–59.

31.

Kim EJ, Kim Y, Seo WS, Lee SH, Park EJ, Bae SM, Shin D. The revised Korean practice parameter for the attention-deficit hyperactivity disorder (I). J Korean Acad Child Adolesc Psychiatry. 2017;28(2):46–57. https://doi.org/10.5765/jkacap.2017.28.2.46.CrossRef

32.

On SG, Kim EJ. Social understanding and behavior in children with ADHD. Korean J Clin Psychol. 2003;22(4):793–813.

33.

Shumway-Cook A, Woollacott W. Motor control theory and practical applications. Baltimore: Williams &Wilikins; 1995.

34.

Frank A, McCloskey S, Dole RL. Effect of hippotherapy on perceived self-competence and participation in a child with cerebral palsy. Pediatr Phys Ther. 2011;23(3):301–8. https://doi.org/10.1097/PEP.0b013e318227caac.CrossRefPubMed

35.

All AC, Loving GL, Crane LL. Animals, horseback riding, and implications for rehabilitation therapy. J Rehabil. 1999;65:49–57.

36.

Schult PN, Remick-Barlow GA, Robbins L. Equine-assisted psychotherapy: a mental health promotion/intervention modality for children who have experienced intra-family violence. Health Soc Car Commun. 2007;15:265–71.CrossRef

37.

Aberson B, Shure MB, Goldstein S. Social problem-solving intervention can help children with ADHD. J Atten Disord. 2007;11(1):4–7. https://doi.org/10.1177/1087054707299409.CrossRefPubMed

38.

Barkley R. The ecological validity of laboratory and analogue assessment methods of ADHD symptoms. J Abnorm Child Psychol. 1991;19(2):149–78. https://doi.org/10.1007/BF00909976.CrossRefPubMed

39.

McGee RA, Clark SE, Symons DK. Does the Conner’s continuous performance test aid in ADHD diagnosis? J Abnorm Child Psychol. 2000;28(5):415–24. https://doi.org/10.1023/A:1005127504982.CrossRefPubMed

Title: Effects of equine-assisted activities on attention and quality of life in children with cerebral palsy in a randomized trial: examining the comorbidity with attention-deficit/hyperactivity disorder
Authors: Bomi Ahn
Yoo-Sook Joung
Jeong-Yi Kwon
Dong Ik Lee
Soohwan Oh
Byoung-Uk Kim
Jung Yoon Cha
Ji-Hae Kim
Ji Young Lee
Hye Yeon Shin
Yun Sik Seo
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Pediatrics / Issue 1/2021
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-021-02597-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effects of equine-assisted activities on attention and quality of life in children with cerebral palsy in a randomized trial: examining the comorbidity with attention-deficit/hyperactivity disorder

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2021

Neonatal mortality among neonates admitted to NICU of Hiwot Fana specialized university hospital, eastern Ethiopia, 2020: a cross-sectional study design

Determination of 11 minerals in children using inductively coupled plasma mass spectrometry

Spatial variation and determinants of childhood anemia among children aged 6 to 59 months in Ethiopia: further analysis of Ethiopian demographic and health survey 2016

Paternal childcare in early childhood and problematic behavior in children: a population-based prospective study in Japan

The association between ambient air pollution and birth defects in five major ethnic groups in Liuzhou, China

Effects of minimally invasive and traditional surgeries on the quality of life of children with congenital heart disease: a retrospective propensity score-matched study