Research in Developmental Disabilities 34 (2013) 2442–2448

Contents lists available at SciVerse ScienceDirect

Research in Developmental Disabilities

Muscle reaction function of individuals with intellectual

disabilities may be improved through therapeutic use
of a horse
Paraskevi Giagazoglou *, Fotini Arabatzi, Eleftherios Kellis,
Maria Liga, Chrisanthi Karra, Ioannis Amiridis
Laboratory of Neuromechanics, Department of Physical Education and Sports Science, Serres, Aristotle University of Thessaloniki, Greece

A R T I C L E I N F O A B S T R A C T

Article history: Reaction time and muscle activation deficits might limit the individual’s autonomy in
Received 17 February 2013 activities of daily living and in participating in recreational activities. The aim of the
Received in revised form 19 April 2013 present study was to assess the effects of a 14-week hippotherapy exercise program on
Accepted 22 April 2013 movement reaction time and muscle activation in adolescents with intellectual disability
Available online 7 June 2013 (ID). Nineteen adolescents with moderate ID were assigned either to an experimental
group (n = 10) or a control group (n = 9). The experimental group attended a hippotherapy
Keywords: exercise program, consisting of two 30-min sessions per week for 14 weeks. Reaction time,
Reaction time
time of maximum muscle activity and electromyographic activity (EMG) of rectus femoris
Muscle activation
and biceps femoris when standing up from a chair under three conditions: in response to
Adapted physical training
Hippotherapy
audio, visual and audio with closed eyes stimuli were measured. Analysis of variance
Mental retardation designs showed that hippotherapy intervention program resulted in significant
EMG improvements in reaction time and a reduction in time to maximum muscle activity of
the intervention group comparing to the control group in all 3 three conditions that were
examined (p < 0.05). The present findings suggest that the muscle reaction function of
individuals with ID can be improved through hippotherapy training. Hippotherapy
probably creates a changing environment with a variety of stimuli that enhance deep
proprioception as well as other sensory inputs. In conclusion, this study provides evidence
that hippotherapy can improve functional task performance by enhancing reaction time.
ß 2013 Elsevier Ltd. All rights reserved.

1. Introduction

Individuals with intellectual disabilities (ID) are characterized by a lower ability to understand new or complex
information and to learn and apply new cognitive, social and motor skills. Successful performance of motor skills is
dependent on the individual’s ability to establish and maintain stability throughout a sequence of controlled movements
(Smail & Horvat, 2005). A common characteristic observed during voluntary movements among individuals with ID is that
they need more time to initiate and respond to movements (Latash, 2000). Reaction time is an index of sensori-motor
performance in sports (Nakamoto & Mori, 2008) and reflects the time between application of a stimulus (e.g., sound or flash
of light) and response to the stimulus (Welford, 1980). The shorter the reaction time people have, the sooner they will be able
to react to the actions around them. Thus, in the case of an unexpected sudden situation or danger they will protect
themselves in a very short time.

* Corresponding author at: 58, Irodotou Street, 62125 Serres, Greece. Tel.: +30 2310 991066.
E-mail address: pgiagaz@phed-sr.auth.gr (P. Giagazoglou).

0891-4222/$ – see front matter ß 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ridd.2013.04.015
 P. Giagazoglou et al. / Research in Developmental Disabilities 34 (2013) 2442–2448 2443

Previous studies have reported longer reaction times in individuals with ID (Horvat, Ramsey, Amestoy, & Croce, 2003;
Zafeiridis et al., 2010). Nevertheless, the underlying mechanisms for these differences have not been extensively studied
(Inui, Yamanishi, & Tada, 1995; LeClair & Elliott, 1995; Un & Erbahçeci, 2001). Davis (1987) suggested that muscle activation
and EMG variability could be the reason for the movement delays observed in this population. However, Horvat et al. (2003)
did not confirm these findings as they observed similar patterns of consistency across trials in motor unit recruitment and
muscle activation for individuals with and without ID. However, it has been suggested that visual and vestibular information
are not used effectively by individuals with ID, since movements are often delayed or inefficient (Horvat, Croce, & Zagrodnik,
2010). Thus, it is essential to offer variable practice activities to provide sensory information which is used to control
movements in space and to produce feedback for movement adaptations (Horvat et al., 2010). These adaptations could be
achieved in various ways such as by changing the order in which the agonist muscles are recruited, by modifying the size of
the muscle contraction, which is reflected in EMG amplitude, or by altering the degree of antagonist activation (van der
Heide & Hadders-Algra, 2005).
Hippotherapy is a therapeutic method which is based on equine movement. It provides such stimulation that is very
difficult to reproduce in any other traditional therapy setting and creates a valuable environment for learning new motor
strategies that could be used by the child in daily functional activities (McGibbon, Benda, Duncan, & Silkwood-Sherer, 2009).
The rationale for hippotherapy is that the horse’s gait provides a precise, smooth, rhythmic, and repetitive pattern of
movement to the rider that is similar to the mechanics of human gait (Bertoti, 1988; Uchiyama, Ohtani, & Ohta, 2011). This
rhythmical movement, combined with the warmth of the horse’s body provides deep proprioception as well as other sensory
input (Bertoti, 1988). Adjusting to the horse’s movements also involves alterations in muscle utilization and joint
movements which, over time, may lead to increased muscle activity (McGibbon et al., 2009).
Therefore, the movement of the horse provides a variety of inputs to the rider, which may be used to facilitate improved
muscle activation and movement responses. Better movement responses to auditory or visual stimuli may help individuals
with ID to react quicker in the case of any unexpected sudden daily situation like a car horn or an obstacle on their walking
way. Thus, the improved process of sensory information would result in appropriate movement responses and consequently
to safer daily lives.
To our knowledge, no previous study has investigated the effects of a hippotherapy intervention program in muscle
activation and movement responses in individuals with ID. Although many previous studies recommended hippotherapy as
a treatment effort to address impairments and improve functional outcomes for individuals with disabilities (for a review
see, Zadnikar & Kastrin, 2011), there is only one recent study provided evidence that hippotherapy can be an effective
intervention for improving functional outcomes and can be recommended as an alternative mode of therapy for improving
balance and strength in individuals with ID (Giagazoglou, Arabatzi, Dipla, Liga, & Kellis, 2012). This study, however,
examined postural balance responses while reaction time adaptations were not addressed. Although individuals with ID
show longer reaction time responses compared with individuals with typical development (Davis, 1987; Horvat et al., 2003),
changes in these variables after hippotherrapy intervention programs have not been previously investigated. A deficit in
these variables might limit the person’s autonomy in activities of daily living and in participating in recreational activities.
Children with ID react to the environmental stimulus more slowly and unpredictably than those with typical
development while movement performance is often delayed or inefficient (Horvat et al., 2010). These impairments are
possibly related to the confirmation of stimuli and the lateness in preparing the proper movement by individuals with ID
(Horvat et al., 2003). Since the target movement is hard to perform, children with ID need longer reaction and performance
time (Un & Erbahçeci, 2001). Therefore, it is essential to establish whether movement responses in persons with ID can be
improved by proper training. Therefore, the aim of the present study was to assess the effects of a hippotherapy intervention
program on movement and reaction time to visual and auditory stimuli and on muscle activation adaptations in adolescents
with ID.

2. Method

2.1. Experimental design

A randomized group pre–post test design was applied. Participants with ID were assigned either to an experimental or a
control group. The experimental group followed a 14-week hippotherapy intervention program. The participants were
tested prior to the start and after the end of the 14-week period by performing a rising from a chair task in response to audio
and visual stimuli. The dependent variables included movement reaction time and time to maximal EMG activation of the
knee muscle.

2.2. Participants

Nineteen healthy male adolescents (age = 15.3  2.1 years) with ID participated in the study. The sample included only males
since the specific school from which the sample was chosen has only three female students who did not express their willingness
to participate in the program. Participants were equally divided into groups based on five criteria: age, height, weight, school
placement (residential school for children with disabilities) and moderate IQ level. The evaluation phase included information
derived from the files of the official developmental team assigned by the Greek State regarding the IQ of each individual as it was
2444 P. Giagazoglou et al. / Research in Developmental Disabilities 34 (2013) 2442–2448

measured in previous years using the Wechsler Intelligence Scale. Next, the subjects were assigned to two groups, where each
individual of the experiment group was paired with an individual of the control group in terms of IQ to ensure that both groups
started from the same reference point prior intervention. Ten participants (mean age = 15.2  1.9 years, height = 163  11.5 cm,
body weight = 62.2  11.9 kg) comprised the experimental group (EG) and attended a 14 week hippotherapy program. Nine
participants (mean age = 15.3  2.2 years, height = 164  7.6 cm, body weight = 62.3  12.2 kg) comprising the control group (CG)
followed their regular school schedule. All children attended the same school and were enrolled only in the physical activities as
stipulated by educational plans within their school setting. The study was approved by the Institutional Review Board for use of
Human subjects. All parents or legal guardians provided written informed consent prior to participation. The intelligence
quotients (IQ) of the participants were determined by the Weschler Intelligence Scale test. The participants had IQ that was within
a range for individuals with moderate intellectual disability (42  8).

2.3. Testing procedures and instrumentation

Each participant reported to the exercise laboratory in the morning. Upon arrival to the laboratory, height and body
weight (Seca, Hamburg, Germany) were measured. To assess reaction time, the participants were instructed to sit on an
armchair on a normal comfortable posture, with their feet slightly touching on the ground and with the arms by their sides.
Each participant was requested to perform three different tasks. During the first task, they were asked to rise from the
armchair as fast as possible upon seeing a light stimulus that was placed in front of them, 65 cm away on the wall, and to
stand on the ground as stable as they can for 5 s. During the second task, the participants followed the same procedure except
that they had to rise from the chair after a sound stimulus which was a verbal signal of ‘‘go,’’ coming from a point 65 cm
behind them. In the third task, the participants had to rise from the chair after a verbal signal of ‘‘go’’ but they had to perform
the task with eyes closed. All three tasks were performed in the same order by all participants and the assessment included
two measurements in each task with a 2-min rest between trials. Ample time was provided for familiarization.
After the familiarization with the tasks, the skin was shaved and cleaned with alcohol and bipolar surface electrodes
(Model SS2, Biopac Systems, Inc., Goleta, CA, bipolar silver/silver chloride electrodes, center-to-center interelectrode
distance = 2 cm) were applied to the belly of rectus femoris and on the patella for bipolar EMG recording (MP100, Biopac
System, Inc.) in order to measure reaction time. Clicking on the PC mouse triggered the lamp stimulus as well as EMG
recording. Reaction time (ms) was defined as a period between the onset of a visual or auditory stimulus and the beginning of
muscle activity as recorded by change in EMG (Horvat et al., 2003). The time interval between initiation and completion of
the action (total time from movement initiation until standing upright) was defined as movement time, as it was suggested
by Horvat et al. (2003).

2.3.1. Electromyography activity (EMG)

EMG activity of the right rectus femoris (RF) and biceps femoris (BF) was recorded with a Biopac EMG100C unit (Biopac
Systems Inc., CA, USA). The electrodes were interfaced to a portable amplifier/transmitter (Model TEL100 M, Biopac Systems,
Inc., Goleta, CA, Common mode rejection ratio >110 db at 50/60 Hz, bandwidth = 10–500 Hz; gain = 500). The unit was
interfaced to a Biopac MP100 Data Acquisition unit (Biopac Systems, Inc., Goleta, CA) and converted into digital form at a rate
of 1000 Hz. For the electrode placement we followed the guidelines of the surface electromyopraphy for the non-invasive
assessment of muscles (SENIAM) project (Hermens, Freriks, Merletti et al., 1999).
For the RF, the electrodes were placed in the middle of the distance between the anterior spina iliaca and the superior part
of the patella, whereas for the BF the electrodes were placed at the midpoint between the ischial tuberocity and the lateral
epicondyle. The electrode placement was marked with permanent ink to ensure a fixed electrode placement between
measurements. The signal was filtered using a band pass filter (15–450 Hz) to avoid noise from other electrical devices and
movement artifacts. Following full wave rectification, the root mean square (RMS) was calculated with a step of 10 samples.
The EMG of each muscle was then expressed as a percentage of the EMG value during the maximal voluntary contraction.
The outcome variables were the RMS of the RF and BF. For the EMG activity, the RMS was assessed using a time window of
5 s and the mean value from the movement initiation until the end was calculated. During each task, the maximal RMS values
were first used for further analysis. Subsequently, the time from movement initiation to maximal RF activity (TmaxRF) and
maximal BF activity (TmaxBF) were recorded.

2.4. Intervention program

All participants in the experimental group followed a 35 min hippotherapy intervention, twice a week for 14 weeks. The
design of the intervention was reflective of a typical intervention provided through the hippotherapy program. The
participants mounted the horse from a ramp or stool with the assistance of the therapist. A medium-size horse that had been
used for hippotherapy sessions for more than 8 years, with calm, tolerant, and consistent temperament and not be highly
reactive to novel stimuli, was used for the intervention purposes.
The intervention was individualized according to the child’s needs and administered by the primary researcher, a physical
therapist specialized in hippotherapy, in consultation with a riding instructor. Notes were kept on all sessions by the
researcher and modifications to activities and exercises were adjusted to the participant’s response to the riding lessons.
Riding a horse in hippotherapy provided an excellent motive to all participants that increased their feelings of enjoyment and
 P. Giagazoglou et al. / Research in Developmental Disabilities 34 (2013) 2442–2448 2445

maintain their interest toward exercise for the whole 35 min therapeutic session. Although sessions were individualized,
similar activities were performed by all participants. They began their sessions sitting forward, standing in their stirrups and
once they found their balance (not falling over the horse’s shoulder or falling back into the saddle), they sank slowly into the
saddle repeating various exercises.
Each session was comprised of a 10-min warm-up, a 20 min therapeutic riding session, and a 5 min cool-down period. The
warm up consisted of a slow walk (4–4.5 km/h) and progressed to a moderate walk (4.5–5.5 km/h) in a large oval pattern in a
right and left direction. While the horse walked, participants were encouraged to maintain postural alignment with
symmetry of head, trunk, and lower extremities and to sit independently with little or no assistance. Gradually, the degree of
difficulty of the activities increased by modifying the movements, introducing stretches and games including catching,
throwing, and placing balls, rings, and toys. Exercises contained trunk rotation components, for example reaching for the
horse’s ears or tail with one hand, reaching for the opposite knee or diagonally, toward the ceiling. Other exercises involved
maintaining balance while holding both arms in the air (abducted or flexed toward the ceiling) or riding without visual input,
as well as lying prone with the arms around the horse’s neck while the horse was either moving or standing still, and then
rising again.
Moreover, the participants experienced changes in direction, standing in their stirrups with hands on the horses
shoulders, weaving among cones, riding 10 and 20 m circles moving both right and left, serpentine patterns, changing
direction on the diagonal, figure 8’s, walking over ground poles, as well as changes in speed of the horse, from a slow walk (4–
4.5 km/h) to a medium walk (5.5–6.4 km/h) to a trot (12–14 km/h). Postural adjustment was required whenever the horse
moved or when changes in speed or direction took place. Gradually, after few weeks of the participants’ familiarization with
hippotherapy, the difficulty of the activities increased by performing the exercises partly with eyes open and partly with eyes
closed. The cool down periods consisted of changing the trot to a moderate walk and finally to a slow walk.
As for control group, participants adhered to their regular school schedule, which included participation in physical
education activity at a frequency of two times per week, for 40 min. A regular class in a school for children with disabilities
usually includes 6–8 children with differ disabilities and various levels of intelligence. Thus, each class of children with ID is
quite heterogeneous creating a challenge to provide equal participation opportunities.

2.5. Statistical analysis

An analysis of variance (two-way ANOVA) with repeated measures was used to examine differences between the two
sessions (pre–post) between the two groups (EG-CG) in each dependent variable. Post hoc Tukey tests were used in case of
significant interactions. The level of significance was set at p < 0.05.

3. Results

The reaction time (RT) results are presented in Fig. 1. The ANOVA tests indicated a significant group x time interaction
effect on RT in testing condition with light stimulus (F1,17 = 40, p < 0.05) and significant main effect of time (F1,17 = 53.5,
p < 0.05) and group (F1,17 = 10.54, p < 0.05). Post hoc analysis showed that the intervention group showed a significant
reduction (p < 0.01) in RT from pre (0.55  0.06 s) to post training session (0.45  0.08 s) while no differences in control group
before (0.60  0.08) and after (0.59  0.04 s) training period were observed.
For the sound task, the ANOVA indicated a significant group  time interaction effect on RT (F1,17 = 24.1 p < 0.05) and
significant main effect of time (F1,17 = 28.29, p < 0.05) and of group (F1,17 = 7.81, p < 0.05). The experimental group showed a
significant reduction (p < 0.01) in RT from pre (0.49  0.04 s) to post (0.42  0.03 s) training period. No differences were
observed for the control group (pre: 0.51  0.05 vs post: 0.52  0.04 s).
Similarly, the ANOVA showed a significant group  time interaction effect (F1,17 = 20.6, p < 0.05) and time effect
(F1,17 = 21.27, p < 0.05) but no significant group effect (F1,17 = 4.00, p > 0.05) on RT during the NoVision condition The
experimental group showed a significant reduction in RT from 0.52  0.08 s (pre) to 0.42  0.05 s, post-training,
respectively (p < 0.05). No differences were observed within the control group in this task (0.53  0.05 and 0.52  0.05 s, pre-
vs. post-training).

sec LS sec SS sec CE-SS EG

,70 ,60 ,70 CG
,60 * ,50 * ,60
,50 ,50 *
,40
,40 ,40
,30
,30 ,30
,20 ,20
,20
,10 ,10 ,10
,00 ,00 ,00
Pre Post PRE POST PRE POST

Fig. 1. Training associated changes in reaction time after light, sound and sound with closed eyes stimulus (LS, SS and CE-SS respectively), * Significant
differences from pre to post training (p < 0.05).
2446 P. Giagazoglou et al. / Research in Developmental Disabilities 34 (2013) 2442–2448

Table 1
Time of maximal rectus femoris (RF) and biceps femoris (BF) activity after light, sound and sound with closed eyes stimulus (LS, SS, SS-CE, respectively),
means and SD values, pre and post training for experimental and control group.

Experimental group (n = 10) Control group (n = 9)

Rectus femoris Biceps femoris Rectus femoris Biceps femoris

Pre Post Pre Post Pre Post Pre Post

LS 0.27  0.039 0.22  0.04* 0.25  0.03 0.21  0.03* 0.293  0.03 0.291  0.02 0.29  0.02 0.28  0.02
SS 0.26  0.02 0.22  0.03* 0.22  0.04 0.19  0.03* 0.27  0.01 0.28  0.02 0.25  0.03 0.26  0.02
SS-CE 0.26  0.04 0.21  0.05* 0.24  0.03 0.20  0.04* 0.27  0.03 0.26  0.03 0.26  0.04 0.27  0.04
* p < 0.05 pre to post.

3.1. Time of maximum muscle activity

The maximal rectus femoris activity (TmaxRF) and maximal biceps femoris activity (TmaxBF) results are presented in
Table 1. The ANOVA indicated significant group  time interaction effect (F1,17 = 38.17, p < 0.05) time main effect
(F1,17 = 38.94, p < 0.05) and group main effect (F1,17 = 6.17, p < 0.05) on TmaxRF in the first task with the light stimulus. Post
hoc analysis showed that the intervention group significantly decreased TmaxRF from 0.27  0.03 s to 0.22  0.04 s, after
training (p < 0.01). No differences in control group values before (0.29  0.03 s) and after (0.29  0.04 s) were found (p > 0.05).
Similarly, the ANOVA indicated a significant main effect of time (F1,17 = 22.62, p < 05) and group (F1,17 = 14.96, p < 0.05) and
significant group  time interaction effect on TmaxBF (F1,17 = 14.78, p < 0.05). TmaxBF decreased only in the intervention group
from 0.25  0.03 s to 0.21 0.04 s, after training (p < 0.05).
The ANOVA indicated a significant main effect of time (F1,17 = 17.14, p < 05) and group (F1,17 = 15.82, p < 0.05) on TmaxRF
and on time (F1,17 = 13.96, p < 0.05) and group (F1,17 = 10.96, p < 0.05) on TmaxBF. Similarly, there was a significant
group  time interaction effect on both TmaxRF (F1,17 = 17.37, p < 0.05) and TmaxBF (F1,17 = 12.9, p < 0.05) in the 2nd task
with sound stimulus. Post hoc analysis showed that the intervention group showed less TmaxRF from pre (0.26  0.02 s) to
post (0.22  0.03 s) training (p < 0.01) while TmaxBF also decreased from 0.22  0.04 s to 0.19  0.03 s, post training (p < 0.01).
No differences were observed in the control group (Table 1).
For the NoVision task, the ANOVA indicated a significant group  time interaction effect (F1,17 = 21.84, p < 0.05), time
main effect (F1,17 = 33.28, p < 0.05) and group main effect (F1,17 = 4.88, p < 0.05) on TmaxRF. Similarly, there was
group  time interaction effect (F1,17 = 61.1, p < 0.05) and main effect of time (F1,17 = 76.24, p < .05), but no significant main
effect of group (F1,17 = 3.35, p > 0.05) on TmaxBF. Post hoc analysis showed a significant (p < 0.01) decrease of TmaxRF (from
0.26  0.05 s to 0.21  0.04 s) and TmaxBF (p < 0.01, from 0.24  0.03 s to 0.21  0.04 s) after training. No differences were
observed for the control group (p > 0.05).

3.2. EMG activity

The ANOVA tests showed no statistically significant group  time interaction on mean RF and BF RMS activity on all three
tasks (p > 0.05). However, there was a significant time effect on mean RF activity in the first testing condition with the light
stimulus (F1,17 = 5.74, p < 0.05). Fig. 2 shows EMG records of muscle reaction types in BF and RF activity after auditory
stimulus pre and post training for a representative participant.

Fig. 2. An example of reaction time (RT) and time to maximum EMG of biceps femoris (TmaxBF) and rectus femoris (TmaxRF) to an auditory stimulus
displayed by one participant before (pre) and after (post) training.
 P. Giagazoglou et al. / Research in Developmental Disabilities 34 (2013) 2442–2448 2447

4. Discussion

The main finding of the present study is that a 14-week training hippotherapy program improved reaction time and time
to maximum muscle activity without significant changes in the magnitude of muscle activation in individuals with ID.
There is evidence that individuals with ID may have disturbed central and peripheral processing components as indicated
by the longer reaction and motor times (Davis, Sparrow, & Ward, 1991; LeClair, Pollock, & Elliot, 1993). Horvat et al. (2003)
observed that patterns of consistency across trials in motor unit recruitment and muscle activation are similar in both
individuals with and without ID, but there are difficulties in the controlling process that could be improved with proper
training. The simultaneous improvement of multiple body systems such as musculoskeletal, vestibular, and ocular, by
hippotherapy may promote alterations and reorganization of the central nervous system and increase the possibility to
transfer this learning experience into other movement patterns used in everyday life activities (Casady & Nichols-Larsen,
2004).
The results of this study showed that the hippotherapy program improved reaction time performance when standing up
from a chair using three different stimuli conditions. These results are in agreement with previous findings, although these
studies used different methodology (Un & Erbahçeci, 2001; Yildirim, Erbahceci, Ergun, Pitetti, & Beets, 2010). Particularly,
active individuals with ID who were playing basketball showed shorter reaction time compared to non active peers when
responding to an auditory or light stimulus via a button-press using the index finger of their dominant hand (Un & Erbahçeci,
2001). A more recent study that used the same methodology found that adolescents with ID who participated in a twelve
week structured physical fitness program improved their reaction time to visual and auditory stimuli (Yildirim et al., 2010).
To our knowledge, only one study examined the effects of exercise on reaction time in young individuals with ID (Song & An,
2004). However, Song and An (2004) did not find significant differences in reaction time after a seven month taekwondo
training program (three times per week). Their results suggested that deficits in the stimulus encoding and planning process
are difficult to be improved through this particular intervention program in individuals with ID.
The main difference between previous studies and our study is that we applied a hippotherapy intervention program. It
has been suggested that hippotherapy may yield functional activity improvements at a relatively short period of time
(Casady & Nichols-Larsen, 2004; Haehl, Giuliani, & Lewis, 1999; McGibbon et al., 2009). Riding a horse in hippotherapy
enhances children’s motivation. Motivating children to be active participants in an activity would most likely improve the
outcome of therapy (Bartlett & Palisano, 2002). Therefore, an attractive activity such as hippotherapy may be primarily
responsible for the improved reaction time displayed by the intervention group in our study. Apart from motivation, another
significant factor which might explain our results is the physiological and motor control demands experienced by children
during horse riding. Particularly, during hippotherapy training, participants are ‘‘forced’’ to continuously respond to a
changing environment which involves a variety of stimuli. Horse riding provides motor and sensory inputs through
variations in gravity (Uchiyama et al., 2011). Such an environment provides deep proprioception as well as other sensory
input while it encourages reaction or movement adaptations (Bertoti, 1988).
The results of this study demonstrated that the intervention group showed significant improvements in time to
maximum muscle activity for both muscles examined (Table 1). Since individuals with ID possess slower speed and accuracy
of voluntary movements due to the lack of opportunities and experience in movement (Horvat et al., 2003) improvement of
experiment group individuals in recruiting and activating motor units is considered a promising result of this study.
Consequently, one may suggest that a hippotherapy intervention affects motor control mechanisms such that the time
needed to activate the necessary motor units for daily tasks and encourages reaction or movement adaptations.
Adjusting to the horse’s movements involves alterations in muscle utilization and joint movements which, over time,
may lead to increased muscle activity (McGibbon et al., 2009). However, the present results indicated that although there
was a tendency of improvement in muscle activity, there were significant differences only in RF muscle activation in the task
of standing up from the chair after an auditory stimulus. The rhythmic, symmetrical walking movement of the horse
heighten body awareness, while repeated small postural adjustments help patients gain a better motor control of their body.
These postural movements largely involve simultaneous hip flexion and knee extension movements, to maintain upright
position during horse riding. This could explain the increases in RF activity as this particular muscle acts as a hip flexor and a
knee extensor. Nevertheless, the absence of any other adaptations in muscle activation indicates that hippotherapy
intervention had a rather minor effect on the magnitude of muscle activation when rising from a chair. This indicates either
that hippotherapy mainly affects muscle tuning and not magnitude of activation or that the task used in the present study
(rising from a chair) were familiar and easy daily tasks that did not require maximal strength ability. It is possible that muscle
activation patterns when performing more powerful tasks, such as jumping, might have been affected by hippotherapy
intervention, although clearly this requires further investigation.
Overall, the findings from this study suggest that hippotherapy can be an effective intervention to improve reaction time
and movement responses for adolescents with ID. Reaction time is a cognitive process which is closely related to the decision
speed that provides one with the necessary information to decide what to do next while performing activities of daily living
or work related tasks. Individuals with ID are slower when performing voluntary movements and therefore they become
more dependent on others and, hence, a lower quality of life. Thus, it seems important during therapeutic sessions to offer
variable practice activities to provide sensory information in different contexts to facilitate learning. The complex sensory
motor stimulation offered by the horse’s movement, provides a training method that could be an effective physical activity
intervention that lead individuals with ID to learn strategies, to receive and process information more effectively.
2448 P. Giagazoglou et al. / Research in Developmental Disabilities 34 (2013) 2442–2448

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