Gait and Gross Motor Improvements in a Two-Year-Old Child With Arthrogryposis After Hippotherapy Intervention Using a Norwegian Fjord

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Abstract

A 2-year-old child with arthrogryposis multiplex congenita (AMC) was prescribed occupational therapy using hippotherapy intervention. Multiple joint contractures present at birth affecting joint function are characteristics of AMC. Twenty-five 30-min hippotherapy sessions were conducted. The Battelle Developmental Inventory Second Edition (BDI-2) was used to measure the subject's motor skills, and a computerized motion capture system was used to measure gait parameters. Data were collected prestudy (before intervention), midstudy (after 14 sessions), and poststudy (after 25 sessions). An 18-year-old 14.2 hand Fjord gelding which had high rotational movement that stimulates core development was selected for all sessions. The BDI-2 scores showed gross motor improvements at each time point with the percent delays decreasing from 57% prestudy, 32% midstudy, to 6% poststudy after 25 sessions of hippotherapy. Similarly, gross motor percentile rank (PR) (among all children) improved in a linear fashion at the same time points from <1% (initial), 9% (midstudy), and 50% (poststudy). Fine motor skills did not improve with treatment. Gait analysis (poststudy vs. prestudy) showed increased gait speed (121%), increased right (108%) and left (86%) step lengths, decreased step width (−50%), and improved gait symmetry. In a follow-up BDI-2 administered 6 months after the hippotherapy was finished, improvements continued in gross motor skills (0% delay and PR 84%). Gait analysis showed continued improvements in several but not all gait parameters. This case report that showed early intervention with hippotherapy was beneficial for this subject with AMC and warrants further studies.

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