Researchers add new twist to a riding simulator for children with cerebral palsy

The children were required to extend their hands to hit targets on the moving horse-riding simulator. Photo: Chang et al.

Adding a virtual reality horseback experience to a riding simulator improved the appeal of the therapy for children with cerebral palsy, researchers report.

Hyun Jung Chang and her fellow researchers at the Sungkyunkwan University School of Medicine in Korea noted that several studies have presented evidence showing the therapeutic potential of horse-riding in children with cerebral palsy.

Riding leads to an improvement in postural stability and body alignment. However, suitable horses are not necessarily accessible or affordable in a clinical environment.

In such cases, horse riding simulators have been used as an alternative. They imitate the passive movement of horse riding and offer the additional advantage of enabling regular therapy with no weather or space restraints.

“However, by itself, the horse-riding simulator is not a sufficient source of challenge and motivation for children,” the researchers reported in the journal Sensors.

Ideally, pediatric neuro-rehabilitation should be fun, motivating, focused, and repetitive, as such exercises are meant to be performed over long periods to produce noticeable improvements in muscle function.

Children, they said, are likely to become bored with a horse riding simulator after a certain period. To address this issue, they combined the use of a horse-riding simulator with a virtual reality experience providing a three-dimensional scene mimicking real horseback riding.

Sixteen children with cerebral palsy, aged 5 to 17, were enrolled in the study.

The study employed a Korean-made horse-riding simulator equipped with eight built-in exercise modes. It is designed to encourage children to perform three-dimensional movements like those required on a real horse.

The researchers added the use of a head-mounted virtual display and controllers for two 12-minute rides carried out within 30-minute sessions. The sessions were provided twice a week over eight weeks. The virtual reality experience had the youngsters reaching out to hit a moving target, and also required them to move their trunk sideways to avoid approaching obstacles.

To reduce the risk of falling, each participant was harnessed.

The participants were assessed on the Pediatric Balance Scale, as well as two Gross Motor Function measure scores, before and after the 16-session program.

Statistically significant improvements were seen in their scores, they reported, indicating that incorporating a virtual reality experience with a horse-riding simulator can deliver improvements.

“Its incorporation in conventional physical therapy programs could yield beneficial results,” they said. “The participants did not suffer from any adverse events, such as falls, pain, dizziness, or sudden changes in blood pressure and heart rate.

“Following the completion of the interventions, the children expressed interest and enjoyment in the exercise, and the feedback of their parents regarding virtual reality-incorporated horse-riding simulator was equally positive.”

Discussing their findings, the researchers said the set of tasks involved in the experiment for most participants was novel, involving massive postural challenges and arousing sufficient interest.

The participants, they said, found the incorporation of virtual reality with the riding simulator to be an exceedingly enjoyable and meaningful activity.

The virtual reality component had the added benefit of being able to provide increasingly difficult postural challenges by incorporating movements such as the stretching or lifting of arms as much as possible, or the tilting of the trunk.

“As the children could not hold onto a handle during the intervention, they were forced to activate their lower extremities, hip muscles, and trunk muscles to compensate for the unstable postural changes of the trunk on a continuous moving saddle.

“This strengthened the muscles in their lower extremity and exerted a positive influence on postural balance and gross motor function.”

The study team comprised Chang, Young Sook Park, Se Hwi O, Da Hye Kim and Chang Woo Kim, all with the Department of Physical Medicine and Rehabilitation at Samsung Changwon Hospital, part of the Sungkyunkwan University School of Medicine; and Yong Gi Jung, with the Department of Otorhinolaryngology-Head and Neck Surgery at the Samsung Medical Center, also part of the Sungkyunkwan University School of Medicine.

Chang, H.J.; Jung, Y.G.; Park, Y.S.; O, S.H.; Kim, D.H.; Kim, C.W. Virtual Reality-Incorporated Horse Riding Simulator to Improve Motor Function and Balance in Children with Cerebral Palsy: A Pilot Study. Sensors 2021, 21, 6394.

The study, published under a Creative Commons License, can be read here.

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