Serebral Palsili Çocuklarda Hipoterapinin Fizyolojik Etkileri
Özet
Serebral palsi (SP), erken çocukluk döneminde motor fonksiyon, denge ve postür bozukluklarıyla kendini gösteren kalıcı bir nörolojik tablodur. Geleneksel rehabilitasyon yöntemlerinin yanı sıra, son yıllarda alternatif bir fizik tedavi yaklaşımı olarak hipoterapi (at binme terapisi) kabul görmeye başlamıştır. Hipoterapinin nörofizyolojik etki mekanizması; atın ritmik, üç boyutlu hareketleri ve vücut sıcaklığının hastaya aktarılması esasına dayanır. Bu dinamik süreç; vestibüler, görsel ve somatosensöriyel sistemleri aynı anda uyararak beyindeki motor öğrenme mekanizmalarını ve postural kontrolü harekete geçirir. At sırtındaki dik duruş, gövde kaslarının koordinasyonunu geliştirirken, pelvik mobilizasyon sağlar ve patolojik kas tonusunu (spastisiteyi) azaltarak kaslarda gevşeme yaratır. Ayrıca, çocukların çevreyle etkileşimini artırarak iletişim becerilerine, solunum düzenine ve psikososyal gelişime katkıda bulunur. Ciddi ortopedik ve nörolojik kontrendikasyonları olmayan orta ve ağır düzeyde nöromotor disfonksiyonlu çocuklarda güvenle uygulanabilen bu yöntem, geleneksel klinik ortamlarda taklit edilemeyen benzersiz bir duyusal spektrum sunarak çocukların günlük yaşam kalitesini ve fonksiyonel kapasitesini artırmada stratejik bir tamamlayıcı tedavi olarak öne çıkmaktadır.
Cerebral palsy (CP) is a permanent neurological condition characterized by motor function, balance, and postural impairments emerging in early childhood. Alongside traditional rehabilitation, hippotherapy (equine-assisted therapy) has gained recognition as an alternative physical therapy approach. The neurophysiological mechanism of hippotherapy relies on transferring the horse's rhythmic, three-dimensional movements and body temperature to the patient. This dynamic process simultaneously stimulates vestibular, visual, and somatosensory systems, activating motor learning mechanisms and postural control in the brain. Maintaining an upright posture on the horse improves trunk muscle coordination, provides pelvic mobilization, and induces muscle relaxation by reducing pathological muscle tone (spasticity). Furthermore, it enhances communication skills, respiratory regulation, and psychosocial development by increasing interaction with the environment. Safely applicable to children with moderate-to-severe neuromotor dysfunction who lack strict orthopedic or neurological contraindications, this method offers a unique sensory spectrum unreplicable in conventional clinical settings. Consequently, hippotherapy stands out as a strategic complementary treatment that effectively enhances functional capacity and overall quality of life.
Referanslar
Christine C, Dolk H, Platt MJ, et al.; SCPE Collaborative Group. Recommendations from the SCPE collaborative group for definingand classifying cerebralpalsy. Dev Med Child Neurol Suppl 2007; 109: 35-8.
NHS Choices. "Symptoms of Cerebralpalsy". NHS Gov.UK. 15 March 2017. Archivedfromtheoriginal on 7 April 2017. Retrieved 6 April 2017.
Berg EL, Causey A. The life-changing power of the horse: equine-assisted activities and therapies in the US. Anim Front. 2014;4:72–75.
Mutoh T, Mutoh T, Tsubone H. et al. Ihara Impact of Long-Term Hippotherapy on the Walking Ability of Children With Cerebral Palsy and Quality of Life of Their Caregivers CLINICAL TRIAL published: 13 August 2019 doi: 10.3389/fneur.2019.00834
Krägeloh-Mann I, Cans C. Cerebral palsy update. Brain Dev 2009; 31: 537-44.
Yüksel A. Serebral Palsi; Etiyolojisi, Tanı ve Ayırıcı Tanısı Turkiye Klinikleri J PM&R-Special Topics. 2009;2(2):8-12
Nieuwenhuijsen C, Donkervoort M, Nieuwstraten et.al. Experienced problems of young adults with cerebralpalsy: targets for rehabilitation care. Arch Phys Med Rehabil 2009;90(11):1891–7.
Gabis LV, Tsubary NM, Leon O, et al. Assessment of abilities and comorbidities in children with cerebralpalsy. J Child Neurol 2015;30(12):1640–5.
Sellier E, Platt MJ, Andersen GL, et al. Decreasing prevalence in cerebralpalsy: a multi-site European population-basedstudy, 1980 to 2003. Dev Med Child Neurol 2016;58(1):85–92. Crossref
Yang H, Einspieler C, Shi W, et al. Cerebralpalsy in children: movements and postures during early infancy, dependent on preterm vs. fullterm birth. Early Hum Dev 2012; 88: 837-43.
Walshe M, Smith M, Pennington L (14 November 2012). "Interventions for drooling in children with cerebral palsy". The Cochrane Database of Systematic Reviews. 11: CD008624. doi:10.1002/14651858.CD008624.pub3. PMID 23152263.
Aisen ML, Kerkovich D, Mast J. et al. Cerebral palsy: clinical care and neurological rehabilitation. Lancet Neurol 2011; 10: 844-52.
El-Sobky TA, Fayyad TA, Kotb AM. et al. (25 September 2017). "Bonyre construction of hip in cerebralpalsy children Gross Motor Function Classification Systemlevels III to V: a systematic review". Journal of Pediatric Orthopedics. Part B. 27 (3): 221–230. doi:10.1097/BPB.0000000000000503. PMID 28953164.
Smith M, Kurian MA. (September 2016). "The medical management of cerebral palsy". Paediatric sand Child Health (Submitted manuscript). 26 (9): 378–382. doi:10.1016/j.paed.2016.04.013.
Cans C, Surveillance of Cerebral Palsy in Europe (SCPE).Surveillance of cerebralpalsy in Europe: a collaboration of cerebral palsy surveys and registers. Dev Med Child Neurol 2000; 42: 816-24 .http://dx.doi.org/10.1017/S0012162200001511
Meyers RC, Bachrach SJ, Stallings VA. (2017). "Cerebral Palsy". In Shirley W. Ekvall; Valli K. Ekvall (eds.). Pediatric and Adult Nutrition in Chronic Diseases, Developmental Disabilities, and Hereditary Metabolic Disorders: Prevention, Assessment, and Treatment. Oxford Scholarship Online.
Garfinkle J, Li P, Boychuck Z, et al. Early Clinical Features of Cerebral Palsy in Children Without Perinatal Risk Factors: A Scoping Review Elsevier Inc. Pediatric Neurology 19 July 2019 https://doi.org/10.1016/j.pediatrneurol.2019.07.006
Graham D, Paget SP, Wimalasundera N. (February 2019). "Current thinking in the health care management of children with cerebralpalsy". Medical Journal of Australia. 210 (3): 129–135. doi:10.5694/mja2.12106. PMID 30739332.
Carlberg EB, Löwıng K. Serebral Palsili Çocuklarda Hedefe Yönelik Tedavi Turkiye Klinikleri J PM&R-Special Topics. 2010;3(3):53-7
Helders PJ, Engelbert RH, Custers JW, et al.Creating and being created: the changing panorama of paediatric rehabilitation. Pediatr Rehabil 2003;6:5-12.
Chung CY, Chen CL, Wong AM. Pharmaco therapy of spasticity in children with cerebralpalsy. J Formos Med Assoc 2011; 110: 215-22.
Aisen ML, Kerkovich D, Mast J, et al. Cerebralpalsy: clinical care and neurological rehabilitation. LancetNeurol 2011; 10: 844-52.
Damiano DL. Activity, activity, activity: rethinking our physicaltherapy approach to cerebralpalsy. PhysTher 2006;86: 1534-40
Damiano DL. Rehabilitative Therapies in CerebralPalsy: The Good, the not as Good, and thepossible. Journal Child Neurol,2009; 24:1200-1204.
Wendy H, Wood BE. (2019): Hippotherapy: a systematic mapping review of peer-reviewed research, 1980 to 2018, Disability and Rehabilitation, DOI:10.1080/09638288.2019.1653997
Köseman A, Şeker İ. Hippoterapi ve Terapide Kullanılan Atların Özellikleri Journal of Faculty of Veterinary Medicine, Erciyes University Review Article 12(3), 195-201, 2015
Koca TT, Ataseven H. What is hippotherapy? The indications and effectiveness of hippotherapy North Clin Istanb. 2015; 2(3): 247–252.
Martín-Valero R, Vega-Ballón J, Perez-Cabezas V. Benefits of hippotherapy in children with cerebral palsy: a narrative review European Journal of Paediatric Neurology S1090-3798(17)30174-5
McGee MC, Reese NB. Immediate effects of a hippotherapy session on gait parameters in children with spastic cerebralpalsy. Pediatr Phys Ther 2009;21(2):212-8.
MacKinnon JR, Noh S, Lariviere J, et al. A study of therapeutic effects of horse back riding for children with cerebralpalsy. PhysOccupTherPediatr. 1995;15:17–34.
Sterba JA. Does horse back riding therapy or therapist-directed hippotherapy rehabilitate children with cerebralpalsy? Dev Med Child Neurol. 2007;49:68–73.
Yıldırım Şık B, Çekmece C, Dursun N, et al. Is Hyppotherapy Beneficial for Rehabilitation of Children with Cerebral Palsy? Türk Klin J MedSci. 2012;32:601–8.
Guerino MR, Briel AF, Araújo Md. Hippotherapy as a treatment for socialization after sexual abuse and emotional stress. J PhysTherSci. 2015;27:959–62.
Ajzenman HF, Standeven JW, Shurtleff TL. Effect of hippotherapy on motor control, adaptive behaviors, and participation in children with autism spectrum disorder:a pilot study. Am J OccupTher. 2013;67:653–63.
Lee CW, Kim SG, Yong MS. Effects of hippotherapy on recovery of gait and balance ability in patients with stroke. J Phys TherSci. 2014;26(2):309–11.
American Hippotherapy Association, Inc. Statements of Best Practice for the Use of Hippotherapy by Occupational Therapy, Physical Therapy, and Speech-Language Pathology Professionals Revised February 2021
Lechner HE, Feldhaus S, Gudmundsen L. TheShort-termeffect of hippotherapy on spastisity in Spinal Cord İnjury. SpinalCord, 2003;41:502-505.
Ivanenko Y, Gurfinkel VS. Human Postural Control Front Neurosci. 2018; 12: 171. Published online 2018 Mar 20. doi: 10.3389/fnins.2018.00171
Özal C. ‘Serebral Palsili Olguların Postüral Kontrol ve Reaksiyonlarının Değerlendirilmesi’ Yüksek Lisans Tezi Ankara 2012
Knierim J. Neuroscience Online, an Open-Access Neuroscience Electronic Textbook Chapter 5: Cerebellum Review 20 Oct 2020
https://www.childrenstheraplay.org/cerebral-palsy.(29.01.2022)
Tuzcu EA, Başarslan F, Yılmaz C. et al. Serebralpalsili çocuklarda oküler problemler Dicle Tıp Dergisi 2012;39 (3): 381-386
