RESEARCH ARTICLE Hippotherapy Effects on Trunk, Pelvic, and Hip Motion During Ambulation in Children With Neurological Impairments Jenna L. Encheff, PT, PhD; Charles Armstrong, PhD; Michelle Masterson, PT, PhD; Christine Fox, PhD; Phillip Gribble, ATC, PhD Department of Physical Therapy, The University of Findlay (Dr Encheff), Findlay, Ohio; Department of Kinesiology (Drs Armstrong and Gribble), Physical Therapy Program (Dr Masterson), Department of Foundations of Education (Dr Fox), College of Education, Health Science and Human Service, The University of Toledo, Toledo, Ohio. Purpose: This study investigated the effects of a 10-week hippotherapy program on trunk, pelvis, and hip joint positioning during the stance phase of gait. Methods: Eleven children (6 boys and 5 girls; 7.9 ± 2.7 years) with neurological disorders and impaired ambulation participated. Joint range of motion data were collected via 3-dimensional computerized gait analysis before and after the program. Paired t tests were performed on kinematic data for each joint. Results: Significant improvements (P ≤ .008) and large effect sizes (ESs) for sagittal plane hip positions at initial contact and toe-off were found. No differences in pelvic or trunk positioning were determined, although sagittal plane pelvic positioning displayed a trend toward improvement with large ESs. Several trunk variables displayed moderate ESs with a trend toward more upright positioning. Conclusions: Improvements in pelvic and hip joint positioning and more normalized vertical trunk position may indicate increased postural control during gait after 10 sessions of hippotherapy. (Pediatr Phys Ther 2012;24:242–250) Key words: child, equine-assisted therapy, gait, hippotherapy, kinematics, neurologic disorders INTRODUCTION AND PURPOSE Hippotherapy (HPOT) is a rehabilitation intervention that incorporates activities on horseback into a patient’s plan of care and has been suggested to lead to improve- ments in righting and equilibrium reactions and postural control at the pelvis and trunk, 1-5 decreased hypertonicity at the hips, 6,7 increased pelvic and hip range of motion (ROM), 4,8 and improved general function, 9-11 all of which may affect ambulation. The 3-dimensional (3-D) move- ment of a horse’s back, as it walks, imparts to the rider’s 0898-5669/110/2403-0242 Pediatric Physical Therapy Copyright C  2012 Wolters Kluwer Health | Lippincott Williams & Wilkins and Section on Pediatrics of the American Physical Therapy Association Correspondence: Jenna L. Encheff, PT, PhD, The University of Findlay, 1000 N Main St, Findlay, OH 45840 (encheff@findlay.edu). The authors declare no conflict of interest. DOI: 10.1097/PEP.0b013e31825c1dc3 pelvis a movement pattern that is similar to what occurs during walking. 2 Because of the benefits demonstrated in posture, tone, ROM, and function, and the similarity in pelvic movement during riding to that when ambulating, several authors have attempted to quantify improvements in gait post-HPOT. 8,11-14 Trunk, pelvis, and lower extremity (LE) ROM in chil- dren during ambulation appears to stabilize and reach nor- mal adult values by approximately age 3 to 4 years 15-17 and norms for ROM at each of the major joints of the trunk, pelvis, and LE for each part of the gait cycle have been determined for both healthy adults 18,19 as well as children up to the age of 7 years. 20 Excursion of the trunk, pelvis, or LE joints greater than or less than these normal val- ues may indicate pathologies that affect the normal ROM of the limbs and/or motor control that contributes to the smooth and limited movement of the center of mass during ambulation. Studies examining the effects of HPOT on ambulation have included measures of function often used in ther- apy clinics such as the Pediatric Evaluation of Disability Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited. 242 Encheff et al Pediatric Physical Therapy