Review of “Changes in Motor Skill Proficiency After Equine-Assisted Activities and Brain-Building Tasks in Youth with Developmental Disorders”, by Rigby and Grandjean

The Research Sub-Committee recently reviewed the article “Changes in Motor Skill Proficiency After Equine-Assisted Activities and Brain-Building Tasks in Youth with Developmental Disorders”, by Rigby and Grandjean, published in Frontiers in Veterinary Science, 2015.   While it is exciting to see more research investigating strategies to help individuals with various neurodevelopmental disorders enhance their quality of life, a number of concerns exist regarding accurate terminology, research design, the scope of practice among professionals described in the article implementing therapeutic interventions focusing on enhancing motor skills, and the overall conclusions.

 In the introduction, the authors refer to equine-assisted therapy (EAT) as hippotherapy.  Hippotherapy is a treatment tool; the umbrella term EAT does not accurately reflect either the use of hippotherapy as a treatment tool, nor the intervention under investigation in the current study. As you are aware, hippotherapy is the purposeful use of equine movement by licensed PT, OT, and SLP clinicians.  The introduction does not clearly delineate between EAT, hippotherapy, and the provided equine-assisted activities (EAA), making the important distinctions between these various activities and treatment tools unclear to the reader.  It is critical to describe the differences to help promote clarity about the proper utilization of services amongst the medical community, payment sources, and clients. Additional information about terminology is available at https://www.americanhippotherapyassociation.org.

The participants in this study were 25 children, ages 5-16 with various neurodevelopmental disorders, most commonly attention deficit hyperactivity disorder and autism spectrum disorder. Investigators implemented a repeated measures design with 5 data collection episodes, 8 weeks apart over 32 weeks.  The first two data collections were to establish baseline, the 3rd data collection occurred after the EAA of 45-60 minutes one time per week, followed by a washout 8-week period with data collection.  The final experimental phase was a “Gaitway” intervention that occurred 90 minutes one time a week. Final data collection occurred 1 year after the initial data collection for 7 participants who continued the GaitWay intervention.  This design examines 2 different interventions, provided consecutively with a wash-out period.

The equine assisted activity, as described in this study, focus on individuals learning horsemanship skills on or off the horse, which is more correctly described as adaptive riding or therapeutic riding. The GaitWay sessions began with the same horsemanship activities, and then concluded with “brain-building activities” designed and provided by a speech therapist. These “brain-building activities” consisted of multi-sensory and task-oriented activities with instructions for follow through at home; these activities are more appropriate for either a licensed physical or occupational therapist to deliver given their training on vestibular rehabilitation, balance, posture, and motor development. These areas of physical function are not within the scope of practice for speech language pathologists or certified therapeutic riding instructors.  It is critical that practitioners work within their license and scope of practice for safety, effectiveness, and reimbursement considerations.

The primary outcome measure used was the Short Form of the Bruininks-Oseretsky Test of Motor Proficiency-Version 2 (BOT-2).  Authors also requested anecdotal comments from the caregivers of the participants. 

The authors report improved scores on the BOT-2 and anecdotal improvements in balance, coping skills, and academic performance, particularly after the GaitWay intervention.  However, there are several limitations to the conducted analyses not noted by the authors. First, analyses included sub-test scores of the BOT-2 short form, which are based on very few items, and meant to be used only as a screening tool with the Short Form total score. For statistical analysis the short form total score has been found to have good reliability, but the validity is limited due to the low number of skills tested. Further breaking it down and trying to analyze each individual score would further degrade the validity of the test. Second, authors used raw scores rather than standard scores; given the 32-week or 1-year timespan of the study, raw scores would be expected to improve without intervention due to natural development. Furthermore, authors do not consider published standard errors of measurement available for the BOT-2. Therefore, caution should be used in interpreting the results of this study, as it is unknown if improvements should be attributed to natural development or to the interventions. 

 In summary, we appreciate the investigation of tools and activities to promote physical activity and participation in children with neurodevelopmental disorders. However, we strongly encourage readers of this published study to carefully consider the use of terminology described, the practitioner scope of practice, analysis methods, and the presented conclusions. Given the serious limitations in the study’s analysis and conclusions, we do not believe this study should guide the practice of therapists incorporating horses into their interventions.

Thank you for your time and consideration of our critique,

The American Hippotherapy Association, Inc. Research Sub-Committee

 

References:

Rigby, Davis, Bittner et al. Changes in Motor Skill Proficiency After Equine-Assisted Activities and Brain-Building Tasks in Youth with Neurodevelopmental Disorders. Frontiers in Veterinary Science (2020)7:22;1-12.

 https://www.americanhippotherapyassociation.org/assets/docs/AHA-Terminology-Final-12-2-18.pdf, accessed 5/12/2020

 https://www.sralab.org/rehabilitation-measures/bruininks-oseretsky-test-motor-proficiency-second-edition, accessed 5/12/2020

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