Alternative Treatment Modalities

Hippotherapy

Tx strategy that utilizes the equine movement as part of an integrated program to improve balance, strength, and flexibility

Hippotherapy: GMFCS 1 Effects

- Increased stride length

- Increased walking speed

- Decrease ant pelvic tilt

- Increased score on GMFM dimension E

Hippotherapy: GMFCS 2 Effects

- Increased stride length

- Increased walking speed

- Decrease ant pelvic tilt

- Increased score on GMFM dimensions D and E

Hippotherapy: GMFCS 3 Effects

- Improvements in postural control in sitting

- Increased score on GMFM dimensions C and D

Hippotherapy: GMFCS 4 Effects

- Increased score on GMFM dimensions B and C

- Significant reduction of hip adductor spasticity

Hippotherapy: GMFCS 5 Effects

- Increased score on GMFM dimensions B and C

- Significant reduction of hip adductor spasticity

Hippotherapy for Tone Level of Evidence

Medium level for spasticity reduction

Hippotherapy for Motor Level of Evidence

High level for balance symmetry

Hippotherapy Best Practice

Hippotherapy + HEP = Best practice to make functional improvements

E Sim

Externally elicited action potential to cause a m contraction

Action Potential

A brief electrical impulse that travels along a cell

- Enables communication between neurons and mm

Frequency

Number of times a pulse is applied in one second

- Hz

Intensity/Pulse Amplitude

Amount of current (voltage) delivered to the electrodes during each pulse

- mA

Pulse Width

Duration between the start and end of each electrical pulse

- micro seconds

- shorter duration used on smaller mm

On/Off Ratio

Duration the stimulation is turned on versus off

- seconds

Ramp

Gradual increase then decrease in intensity to facilitate adaptation, reduce discomfort, and promote tetany between different m groups

3 Types of E Stim

1. FES

2. NMES

3. TENS

FES

Intentionally timed stimulation with specific functional activity

- Bioness and walkaide

NMES

Stim that can be administered at rest or with functional activity

TENS

Used for pain

E STIM has 1A (strong) Evidence to Address: ___? (4)

- Foot drop

- Walking speed

- Balance

- Distance of gait

Kinesio Tape: "I" Cut

M support, pain relief, postural cues

Kinesio Tape: "Y" Cut

Allows for movement of a joint

Kinesio Tape: "X" Cut

Mainly pain relief

Kinesio Tape: Fan Cut

Edema/inflammation

Taping Tissue Tension: 0-15%

Lymphatic drainage and pain

Taping Tissue Tension: 15-25%

M lengthening and relaxation

Taping Tissue Tension: 25-35%

M strengthening and facilitation

Taping Tissue Tension: 50-75%

Mechanical correction

Taping Tissue Tension: 75-100%

Ligamentous techniques

Taping Considerations: Distal to proximal

Inhibition

Taping Considerations: Proximal to distal

Facilitation

Taping for Torticollis

Not a primary method of management

Taping for CP

Improved postural control with and acutely following removal of tape

Whole Body Vibration

Oscillatory input to the whole body through a force plate

Whole Body Vibration: Wobble Feature

Side-alternating movement pattern that allows for the pelvis to tilt to enhance a natural weight shift of the body

Whole Body Vibration: Post-Surgery Precautions

- Wait 12 weeks post ortho surgery

- Wait 6 weeks post SDRs