Search Results (17)

Stroke is a neurological disease caused by a sudden, localized vascular lesion in the central nervous system. The objective of this systematic review (SR) was to analyze the effects of complementary interventions such as hippotherapy (HPT) and mechanical horse riding simulators (MHRSs) compared to conventional physiotherapy, no treatment, or other therapies in individuals with this condition. A literature search was conducted in six databases from January to November 2025. The PICOS research strategy was used to establish the study eligibility criteria. The Cochrane RoB 2 tool was used to assess the risk of bias, and the PEDro scale was used to evaluate the methodological quality of the studies. Meta-analyses, including calculating mean differences (MDs) and 95% confidence intervals (CIs), were performed using Cochrane Review Manager (RevMan). Ten articles were included in the SR, and seven in the meta-analysis. Meta-analyses revealed significant differences in dynamic balance with the Berg Balance Scale in HPT (MD = 1.62; 95% CI = 0.72–2.51; p < 0.01) and MHRSs (MD = 1.21; 95% CI = 0.06–2.36; p = 0.04). In conclusion, HPT and MHRSs may provide potential benefits for functional mobility in people with stroke. However, the limited number of studies makes it difficult to draw definitive conclusions. Full article

Magnetorheological (MR) semi-active suspensions offer clear advantages in improving ride comfort and handling stability, yet their engineering applications are often hindered by strong nonlinear hysteresis of the damper, the randomness of road excitations, and the reliance on manual tuning of controller parameters. To address these issues, this paper proposes an integrated framework of “experimental modeling–semi-active implementation–adaptive control.” First, characteristic tests of the MR damper are conducted, based on which a current-dependent Bouc–Wen forward model is established. Tianji’s Horse Racing Optimization (THRO) is then employed for parameter identification to reproduce the hysteresis behavior accurately. Second, a back propagation (BP) neural network-based inverse current model is developed to achieve rapid mapping from “desired damping force” to “driving current,” enabling semi-active actuation. Furthermore, a radial basis function (RBF) neural network is embedded into the active disturbance rejection control (ADRC) structure to estimate the system Jacobian online and to tune key extended state observer (ESO) gains in real time, forming the proposed RBF-ADRC strategy and thereby enhancing disturbance observation and compensation capability. Simulation results under pulse-road and Class-C random-road excitations show that, compared with the passive suspension, the proposed method reduces the root mean square error values of sprung-mass acceleration, suspension dynamic deflection, and tire dynamic load by 25.14%, 18.71%, and 11.61%, respectively, while also outperforming skyhook control and fixed-gain ADRC. Frequency-domain results further show stronger attenuation in the low-frequency band relevant to body vibration. Under pulse excitation, RBF-ADRC yields smaller peak and trough body accelerations and faster post-impact recovery. Under ±30% sprung-mass variations, it achieves the best worst-case and fluctuation-range robustness among the compared strategies and remains close to offline retuning. These results demonstrate that the proposed method improves both control performance and robustness while reducing the need for repeated manual calibration. Full article

Background and Objectives: Horse riding simulators (HRS) provide rhythmic, repetitive, and multidirectional movements analogous to horseback riding, which may facilitate postural control, balance, and functional abilities in children with cerebral palsy (CP). This study aimed to investigate the effects of the HRS application on the muscle tone of the lower extremity, gross motor function, trunk postural control, balance, gait functions, and functional independence in children with CP. Materials and Methods: A quasi-experimental study included 30 children with cerebral palsy (17 hemiparetic, 13 diparetic; mean age, 9.3 ± 3.2 years). All participants received Neurodevelopmental Therapy (NDT) for eight weeks, followed by eight weeks of HRS plus NDT, in a sequential design. Outcomes included the Modified Ashworth Scale (MAS), Myoton^®PRO, Gross Motor Function Measures (GMFM)-88, Pedalo^® Sensamove Balance Test (Pedalo^® SBT), Pediatric Balance Scale (PBS), Trunk Impairment Scale (TIS), gait analysis parameters, and Functional Independence Measure (WeeFIM). Assessments were made at baseline, the 8th, and the 16th week. Results: At week 16, after incorporating HRS, all MAS parameters demonstrated greater improvements compared to those achieved during the first eight weeks of NDT alone (ES: 0.728–0.931, p < 0.05). Myoton^®PRO measurements showed a significant reduction in gastrocnemius stiffness (ES = 0.672, p < 0.05) in hemiparetic children and decreases in hip adductor (ES: 0.649, p < 0.05) and gastrocnemius-soleus (ES: 0.766–0.865, p < 0.05) stiffness from week 8 to 16 in diparetic children following HRS intervention. Total scores on the GMFM-88, WeeFIM, TIS, and PBS improved significantly, with large effect sizes observed both from baseline to week 16 and from week 8 to 16 (ES: 0.771–0.886, p < 0.05). Additionally, Pedalo^® SBT scores increased following HRS intervention from baseline to week 16 (ES = 0.599–0.602, p < 0.05). Conclusions: HRS integrated with conventional NDT may improve muscle tone, motor function, balance, gait, and functional independence in children with cerebral palsy, representing a valuable adjunct to standard rehabilitation. These findings provide the first evidence that simulator-assisted interventions may benefit daily activities in children with cerebral palsy. Full article

Background: Autism spectrum disorder (ASD) is an early childhood and lifelong neurodevelopmental disorder. Many studies have confirmed that motor skills and physical activity interventions can improve motor development in ASD individuals and ultimately improve their quality of life. However, systematic evidence is lacking on whether motor skills and physical activity interventions improve motor development among children with ASD. Methods: A systematic search of the CNKI, PsycINFO, PubMed, Web of Science, and Google Scholar databases was conducted for publications through 30 July 2023. Citation tracking and reference tracking were also used, and this study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Results: Of 8908 studies initially retrieved, 57 met the selection criteria and were evaluated. The overall quality of the evidence, assessed using PEDro, was low. The evaluated studies included 1622 children with ASD, among which 517 were males, from level II to IV, and ranging in age from 3 to 17 years. Five types (physical activity interventions, motor skill interventions, hippotherapy, equine-assisted or simulated horse riding interventions, exergaming interventions, and physical education interventions) of motor development interventions were used, and 57 studies achieved some positive results for improvements in motor development among children with ASD. Furtherly, eight studies reported motor development acquisition, retention, or transfer. Children with ASD learn well from different types of instructors, including teachers, coaches, camp counselors, physical therapists, and peers. Conclusions: Motor skills and physical activity interventions improved motor development among children with ASD, the effect of which would continue until the end of the interventions. Full article

Background/Objectives: Cerebral palsy (CP) can have a negative impact on gross motor function. Conventional hippotherapy and horse-riding simulators (HRS) have shown promising results on gross motor function in populations with neurological disorders. This review aims to update the knowledge on the effectiveness of hippotherapy on gross motor function in children with CP. Methods: A search was conducted in Academic Search Ultimate, CINAHL, Medline complete, and PEDro covering publications between 2012 and 2022. Two authors identified studies that met the inclusion criteria; a third author resolved discrepancies. Studies were included if they analyzed the effects of hippotherapy on the gross motor function of children with CP. The quality of the methodology was assessed according to the PEDro scale. Results: Of the 150 studies initially identified, 9 were included in this review. The studies showed fair (N = 3) and good (N = 6) methodological quality on the PEDro scale. The majority used conventional hippotherapy (N = 7), while a minority used HRS (N = 2). The most commonly used protocol for conventional hippotherapy was 1–2 sessions of 30–45 min per week for 8 weeks (N = 4), whereas for HRS, these protocols were varied. Seven studies on conventional hippotherapy and one study on HRS showed improvements in gross motor function. However, the hippotherapy protocols were not very standardized and the samples were neither homogeneous nor representative. Conclusions: Conventional hippotherapy and HRS appear to have evidence to support their benefits on gross motor function in children with CP. However, more clinical trials with standardized protocols and more representative samples are needed to confirm these effects. Full article

Background: Mechanical horse-riding simulator (HRS) exercises are a type of therapy based on the use of robotic or mechanical devices that produces movement similar to a real horse with the aim of simulating hippotherapy. This review analyses the effectiveness of HRS therapies in patients with cerebral palsy (CP). Methods: A systematic review and a meta-analysis were carried out by searching studies in PubMed Medline, SCOPUS, Web of Science, CINAHL, PEDro and SciELO up until October 2022. We selected clinical trials that assessed the effectiveness of HRS therapy, compared to other interventions, in patients with CP. The main variables were gross motor function (its global score and dimensions, such as sitting ability), functional balance, spasticity, hip range of motion (ROM), posturographic balance and satisfaction. The risk of bias was assessed using the Cochrane Risk of Bias Tool. The pooled effect was calculated using Cohen’s Standardized Mean Difference (SMD) for a 95% confidence interval (95% CI). Results: Twelve studies were included in the systematic review, and 10 were included in the meta-analysis, providing data from 343 patients with spastic diplegic CP. Our findings revealed that HRS plus physiotherapy is more effective than physiotherapy in improving the total gross motor function (SMD 0.98; 95% CI 0.35–1.62), sitting ability of the gross motor function (SMD 0.84; 95% CI 0.32–1.36) and functional balance (SMD 0.6; 95% CI 0.1–1.08), and HRS therapy is better than sham to improve pelvic abduction ROM (SMD 0.79; 95% CI 0.21–1.37). Conclusions: Horse-riding simulator-based therapy is an effective therapy to improve gross motor function, functional balance and abduction pelvic ROM in children with CP, in comparison to physiotherapy or sham. Full article

Hippotherapy is a popular rehabilitation method for children with cerebral palsy (CP), which is done by riding an actual horse or a horse riding simulator (HRS) device. Riding a real horse is more expensive than using an HRS device due to its high maintenance cost. However, most HRS devices commonly sold in the market are designed as exercise devices, not rehabilitation devices. Most of them are designed to simulate a horse’s walk, trot, canter, or gallop gait at various speeds. Hippotherapy aims to improve the walking ability of CP patients. Therefore, the device should aim to replicate the walking gait of a healthy human, the end goal of hippotherapy. This problem motivates us to design and build a specialized HRS device replicating the walking gait of a healthy human that is suitable for hippotherapy, which is achievable by simulating a horse walking gait with several adjustments. We first studied and observed the walking gait cycle of a horse, then analyzed and derived a formulation of it. We then continue by designing an HRS device using a single electrical rotational motor and mechanical means to replicate the walking gait of a horse, then tune it to an extent to replicate a human walking gait. To measure the performance of our design, we compare the gait of the user when riding our device versus walking. Full article

Horse riding exercise, also known as hippotherapy is a popular treatment for children with cerebral palsy (CP). However, the need for trained therapist, massive land use, and expensive maintenance of the horse ranch makes hippotherapy not affordable or even available for most patients in Indonesia. This problem motivates us to consider mechanical horse riding simulator machines to replace actual horse hippotherapy. However, most patients are children and are easily bored when asked to do monotonous activities for an extended period. The room setting also does not give the patient visual inputs that usually help motivates the children in real-horse hippotherapy activities. To solve this problem, we designed an exercise game (exergaming) software which we named Sirkus Apel, providing the patients with fun activities while doing the therapy. We also design an inertial sensor-based controller that lets the patients control the in-game horse by their back movements, which also benefits CP patients. To make the visual input enjoyable to the user while also considering the user’s safety, we built a convex mirror-based dome virtual reality to provide an immersive 3-D experience. We then project the game content to the dome to provide an immersive experience to the patients making it as if they are riding a real horse inside the game. Full article

This study aimed to evaluate the effect of a horse-riding simulator (HRS) with virtual reality (VR) on gross motor function, balance control, and body composition in children with spastic cerebral palsy (CP). Seventeen preschool and school-aged children with spastic CP were included; 10 children in the intervention group (HRS group) received 30 min of HRS with VR training twice a week for a total of 16 sessions in addition to conventional physiotherapy. Seven children in the control group were instructed to perform home-based aerobic exercises twice a week for 8 weeks in addition to conventional physiotherapy. Gross motor function measure (GMFM) and body composition were evaluated before the first session and after the last session. Before and after the 2-month intervention, Pediatric Balance Scale and Timed Up and Go test were evaluated for the HRS group. GMFM scores and body composition changed significantly in the HRS group (p < 0.05). However, no significant differences were observed in the control group. Changes in the GMFM total scores, GMFM dimension D scores, and skeletal muscle mass significantly differed between the HRS and control groups (p < 0.05). HRS with VR may be an effective adjunctive therapeutic approach for the rehabilitation of children with CP. Full article

Virtual reality (VR) can present advantages in the treatment of chronic low back pain. The objective of this systematic review and meta-analysis was to analyze the effectiveness of VR in chronic low back pain. This review was designed according to PRISMA and registered in PROSPERO (CRD42020222129). Four databases (PubMed, Cinahl, Scopus, Web of Science) were searched up to August 2021. Inclusion criteria were defined following PICOS recommendations. Methodological quality was assessed with the Downs and Black scale and the risk of bias with the Cochrane Risk of Bias Assessment Tool. Fourteen studies were included in the systematic review and eleven in the meta-analysis. Significant differences were found in favor of VR compared to no VR in pain intensity postintervention (11 trials; n = 569; SMD = −1.92; 95% CI = −2.73, −1.11; p < 0.00001) and followup (4 trials; n = 240; SDM = −6.34; 95% CI = −9.12, −3.56; p < 0.00001); and kinesiophobia postintervention (3 trials; n = 192; MD = −8.96; 95% CI = −17.52, −0.40; p = 0.04) and followup (2 trials; n = 149; MD = −12.04; 95% CI = −20.58, −3.49; p = 0.006). No significant differences were found in disability. In conclusion, VR can significantly reduce pain intensity and kinesiophobia in patients with chronic low back pain after the intervention and at followup. However, high heterogeneity exists and can influence the consistency of the results. Full article

The horse riding simulator (HRS) reportedly has a beneficial effect on motor function and balance in children with cerebral palsy (CP). However, by itself, the HRS is not a sufficient source of challenge and motivation for children. To address this issue, we combined the HRS with virtual reality (VR) to promote somatosensory stimulation and motivation. Sixteen children (ages: 5–17 years) with CP and presenting Gross Motor Function Classification System (GMFCS) levels I–IV were enrolled in the study. Using a head-mounted display and controllers, interventions were carried out over 30-min periods (two rides lasting 12 min each, along with a six-min rest period) twice a week over a period of eight weeks (16 sessions in aggregate). The Pediatric Balance Scale (PBS), Gross Motor Function measure (GMFM)-88, and GMFM-66 scores of each participant were measured before and after the interventions. Statistically significant improvements were observed in the PBS, GMFM-66, the total GMFM-88 scores, and those corresponding to dimensions D and E of GMFM-88 after the intervention (p < 0.05). This study demonstrates that VR-incorporated HRS is effective in improving motor function and balance in children with CP and that its incorporation in conventional PT programs could yield beneficial results. Full article

Background and objectives: Chronic pain is a complex global public health problem that affects the health status, quality of life, activities of daily living, and different work-related variables. Riding a horse may lead to some benefits in chronic pain patients through the improvement of postural control and other biopsychosocial processes. Therefore, this systematic review and meta-analysis aimed to evaluate the effects of horse riding (with real or simulated horses) on chronic pain. Materials and methods: A systematic literature search was carried out in accordance with PRISMA guidelines in Web of Science (WOS) and PubMed (Medline) electronic databases. Eleven articles (seven randomized controlled trials) were selected to be included in the review. Due to some risk of bias concerns, two meta-analyses (using postintervention or change-from-baseline measures) were conducted utilizing Review Manager Software (RevMan 5.3). Results: Horse-riding simulators significantly reduced the pain levels of patients with low back pain (p = 0.03, with a SMD of −1.14 and a 95% CI from −2.16 to −0.11) using change-from-baseline measures. However, the p-value in the meta-analysis with the postintervention measures was 0.06. Regarding interventions with real horses, it was not possible to conduct a meta-analysis due to the low number of studies. Conclusion: Horse riding could be a useful exercise to reduce pain, but more studies are needed to make evidence-based recommendations and to compare the effects of horse-riding with real and simulated horses. Full article

Osteochondrosis dissecans (OCD) is a degenerative disease of the cartilage leading to osseous fragments in the joints. It is important in horse breeding both from an animal welfare and an economic perspective. To study adequate breeding strategies to reduce OCD prevalence, a lifelike simulation of the breeding program of German Warmblood horses was performed with the R package MoBPS. We simulated complex breeding schemes of riding horses with different selection steps and realistic age structure, mimicking the German situation. As an example, osseous fragments in fetlock and hock joints were considered. Different scenarios, either using threshold selection, index selection or genomic index selection, respectively, were compared regarding their impact on health and performance traits. A rigorous threshold selection as well as the integration of OCD in a selection index at the stage of stallion licensing and chosen frequency of use in breeding cases on a selection index that includes breeding values for OCD traits performed best on a comparable level. Simply integrating OCD in this breeding value was less effective in terms of OCD reduction. Scenarios with a higher reduction of OCD also showed a slightly reduced improvement in the riding horse performance traits. Full article

Mechanical horse-riding simulators consist of a device that mimics the movement of a real horse, generating between 50 and 100 three-dimensional physical movements (forward and back, left and right, up and down). The main objective of this study is to analyze the effectiveness of mechanical horse-riding simulators to improve postural balance in subjects with neurological disorders. The search was conducted during January–March 2019 in PubMed, Physiotherapy Evidence Database (PEDro), Cochrane, Web of Science, CINAHL, and Scopus. The methodological quality of the studies was evaluated through the PEDro scale. A total of seven articles were included in this systematic review, of which four contributed information to the meta-analysis. Statistical analysis showed favorable results for balance in stroke patients, measured by the Berg Balance Scale (standardized mean difference (SMD) = 3.24; 95%; confidence interval (CI): 1.66–4.83). Not conclusive results were found in sitting postural balance, measured using the Gross Motor Function Measure-66 (GMFM-66) Sitting Dimension, in patients with cerebral palsy. Most studies have shown beneficial effects on postural balance compared with conventional physical therapy. However, due to the limited number of articles and their low methodological quality, no solid conclusions can be drawn about the effectiveness of this therapy. Full article

There is still a lack of studies focused on trunk neurorehabilitation. Accordingly, it is unclear which therapeutic modalities are the most effective in improving static/dynamic balance after brain damage. We designed a pilot study on hippotherapy to assess its short- and mid-term effect on dynamic postural balance in patients with moderate-to-severe sensorimotor impairment secondary to cerebral palsy. Five patients aged 15.4 ± 6.1 years old were recruited. All of them had moderate-to-severe alterations of the muscle tone with associated postural balance impairment. Standing and walking were also impaired. Ten minutes horse riding simulator followed by twenty minutes hippotherapy session were conducted during five session days separated by one week each. We analyzed the displacement of the Center of Pressure (COP) on the sitting surface of the simulator’s saddle by means of a customized pressure pad. We measured the general behavior of the COP displacement as well as the postural adjustments when pace changed from walk to trot to walk during the sessions and among sessions. Statistical analysis revealed an improved postural control both by the end of the session and from session 1 to session 5. These results suggest that hippotherapy might support regularization of postural control in a long-term neurorehabilitation context. Full article