Efeitos da equoterapia no controle postural, equilíbrio, função motora grossa e qualidade de vida de crianças e jovens com paralisia cerebral

Abstract

The hippotherapy is a complementary therapeutic modality that seeks to promote changes in the functionality of children and young people with cerebral palsy (CP). Knowing the domains in which this therapy causes both direct and indirect effects, and identify the mechanisms that produce their effects, contributes to broadening and deepening of the knowledge available on the hippotherapy. For this, the present study used the Treatment Theory (TT) and Enablement Theory (ET) models to analyze the hippotherapy effects on children and youth with cerebral palsy of different ages, topographies and severities. The main aim of this study was to evaluate changes in postural control and balance, gross motor function and quality of life (QoL) of children and young people with CP undergoing hippotherapy for a period of six months. It was conducted a quasi-experimental study of single group (n = 31) with longitudinal follow-up of six months including three repeated measurements (T1, T2, T3). To assess postural control and balance and gross motor function, the tests Early Clinical Assessment of Balance (ECAB) and the Gross Motor Function Measure (GMFM-88), were used respectively. QoL was measured through interviews with the main caregiver of the participant using the Cerebral Palsy Quality of life Questionnaire for Children: primary caregiver questionnaire (CPQOL-Child). Participants were stratified by age (04-07 years and 08-12 years), severity (mild, moderate and severe), topography of the members involved (diplegia, hemiplegia, and quadriplegia) and previous time of hippotherapy (between 3-6 months and more than 6 months). The results revealed that children and young people with CP showed significant improvements in all outcomes, regardless of their age and characteristics of the CP condition. The analysis model proposed based on the taxonomy of rehabilitation treatments (TT and ET) allowed different interpretation of the effects promoted by hippotherapy, identifying the mechanism of action (horses step and rectification demands) and their active ingredients (activation of muscles involved in postural correction, vestibular and visual information stimuli), target outcome (postural control and balance) and indirect outcomes that extend the functional benefits of this therapy (gross motor function and QoL). We recommend that the model of analysis proposed relations and suggested structure should be empirically tested in order to consolidate hippotherapy, grounding it on solid scientific evidence.