Cerebral Palsy (CP) is the most common childhood motor disability. Spasticity, poor range of motion, weakness, and disuse are hallmarks of upper extremity impairment in CP. Children with CP and their parents report better arm and hand function as a priority. Treatments that are fun, engaging, participation-focused, and challenge the upper extremity in meaningful ways are likely to be the most successful in reducing upper extremity impairments. Hippotherapy (physical therapy on horseback) may offer such an option. In this study biomechanical analysis offers a sophisticated and objective measure of quantifying underlying timing and coordination impairments of the upper extremities; first, as an important comparison between children with CP and typical development (TD) (AIM 1) and second, as a potential outcome measure to quantifying the reduction of upper extremity impairments (and approximation to TD) following hippotherapy intervention (AIM 1a).The long-term goal of my dissertation project is to develop a targeted pediatric rehabilitation treatment (hippotherapy) for children with CP that is engaging, reduces upper extremity impairment, and prevents future decline. This project is grounded in the International Classification of Functioning (ICF) framework. We used 3D motion capture during a functional reach-and-grasp task to measure ICF body structures/functions and activity domains (AIM 1); child- and parent-reported measures of ICF activity and participation domains (AIM 2), and the application of these measure to assess a hippotherapy intervention (AIM 1a, AIM 2a). Last, we propose to explore the feasibility of applying measures of patient engagement and enjoyment as ICF personal factors during hippotherapy intervention (AIM 3). We anticipate these measures might cast a window into why hippotherapy is potentially effective. We have demonstrated the ability to measure adherence to a hippotherapy treatment protocol and to execute the reach-and-grasp protocol with children with CP and TD. Through these aims, we will test the overarching hypotheses that 1) children with CP demonstrate slower and less-coordinated reach and grasp in a functional task and poor participation compared to their TD peers and 2) these measures can evaluate change in a hippotherapy intervention, and 3) child engagement and enjoyment of hippotherapy can be quantified. The results of this investigation will guide future study design for hippotherapy clinical trials. With the guidance of my interdisciplinary sponsorship team, the preparation, enactment, analysis, and dissemination of this project will enable me to achieve the goals of my dual-degree program and catapult me to becoming a productive, independent clinician-scientist.
Quantifying impairments in upper extremity function in children with Cerebral Palsy (CP) across domains of the International Classification of Functioning can drive improvement of targeted physical therapy interventions. We evaluate biomechanics and measures of participation, engagement, and enjoyment as measures of improved upper extremity function after hippotherapy. Results from this study can inform future clinical trials to ultimately improve health and quality of life for children with CP.
