Participants Children with spastic CP who met the inclusion and exclusion criteria were recruited for this study. The inclusion criteria were as follows: 1) age 3 to 12 years, 2) body weight less than 40 kg, and 3) gross motor function classification system (GMFCS) level I to IV. The exclusion criteria were as follows: 1) chemodenervation therapy in the previous 6 months, 2) selective dorsal rhizotomy within the past year, 3) moderate to severe intellectual disability, 4) uncontrolled seizure, 5) poor visual or hearing acuity, and 6) previous participation in hippotherapy or THR.
We asked the parents of the recruited children who met inclusion and exclusion criteria whether they desired hippotherapy for their children and could feasibly attend riding sessions. The parents of 45 children agreed to participate. During this study, 5 children dropped out for various rea- sons, such as acute illness or injury unrelated to hippotherapy. Another 6 children did not complete the Gross Motor Function Measure (GMFM) assessment after hippotherapy. Thus, data from a total of 34 children (15 boys and 19 girls) were used to investigate the effects of hippotherapy.
As controls, we recruited 21 children with CP who were waiting to begin hippotherapy or whose parents could not attend hippotherapy for various reasons such as scheduling problems. The children in both experimental and control groups had been attending a 30 minute session of outpatient physical and occupational therapy once a week. This study was approved by the Institutional Review Board and Ethics Committee of Severance Hospital