Equine-assisted therapy and fall risk in an older adult post-cerebrovascular accident: a case study
DOI:
https://doi.org/10.47197/retos.v82.119277Keywords:
Elderly , equine-assisted therapy, mobility limitation, postural balance, strokeAbstract
Introduction: Stroke is one of the leading causes of disability in older adults, resulting in impairments that compromise their autonomy. Among these impairments, deterioration of balance and gait stand out as factors that increase the risk of falls. In light of this scenario, equine-assisted therapy emerges as a rehabilitative intervention that uses the horse's movement to promote neuromuscular response together with postural control.
Objective: To determine the impact of an equine-assisted therapy program on fall risk in an older adult with stroke.
Methodology: A single case study of a 70-year-old man with hemiparesis secondary to a hemorrhagic stroke, with pretest and posttest evaluation using the Tinetti Scale as the measurement instrument for fall risk.
Results: Following the intervention, the balance score remained unchanged, while the gait dimension showed an increase from 3 to 8 points, statistically supported by the Reliable Change Index (RCI=3.25). The overall scale score increased from 14 to 19 points, allowing the participant to be reclassified from a "high risk" to a "moderate risk" level of falls.
Conclusion: In this case study, equine-assisted therapy was associated with a reduction in fall risk, particularly through changes in the gait dimension, while static balance remained unchanged. Given the inherent limitations of the single case design, these findings should be interpreted as exploratory evidence suggesting the potential of equine-assisted therapy as a complementary strategy, without implying the establishment of a definitive causal relationship.
References
Anguita Córdova, K. D., González Díaz, G. D. C., Villagra Parra, E. N., Navarrete Hidalgo, C. B., & Sanhueza Inzunza, T. A. (2019). Beneficios de la terapia asistida por caballos en las variables de la marcha en personas mayores de 18 años, con deficiencias motoras secundarias, ante un accidente cerebrovascular o esclerosis múltiple. MHSalud,16(2), 29-45. https://dx.doi.org/10.15359/mhs.16-2.3
Araujo, T. B., Silva, N. A., Costa, J. N., Pereira, M. M., & Safons, M. P. (2011). Effect of equine-assisted therapy on the postural balance of the elderly. Revista Brasileira de Fisioterapia, 15(5), 414-419. https://doi.org/10.1590/s1413-35552011005000027
Canbek, J., Fulk, G., Nof, L., & Echternach, J. (2013). Test-retest reliability and construct validity of the Tinetti Performance-Oriented Mobility Assessment in people with stroke. Journal of Neurologic Physical Therapy, 37(1), 14–19. https://doi.org/10.1097/NPT.0b013e318283ffcc
Carr, J. H., & Shepherd, R. B. (2010). Neurological rehabilitation: Optimizing motor performance (2.ª ed.). Elsevier Health Sciences. https://books.google.com.mx/books?id=19pfDwAAQBAJ
Forero J. (2025). Uso de las terapias complementarias para la neuroplasticidad del adulto mayor. Una revisión narrativa de literatura. [Tesis de licenciatura] Universidad de Ciencias aplicadas y Ambientales U.D.C.A. https://repository.udca.edu.co/server/api/core/bitstreams/0b87d351-11fe-4b24-b545-cfe3ab3cb538/content
Gámez-Calvo, L., Gamonales, J. M., León, K., & Muñoz-Jiménez, J. (2021). Efectos terapéuticos de la hipoterapia para personas mayores: revisión de la literatura. Archivos de Medicina del Deporte, 38(3), 198-208. DOI:10.18176/archmeddeporte.00044
Gross Naschert, E. (2006). Equinoterapia: La rehabilitación por medio del caballo. Trillas.
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19. https://doi.org/10.1037/0022-006x.59.1.12
Kazdin, A. E. (2011). Single-case research designs: Methods for clinical and applied settings (2nd ed.). Oxford University Press.
Kim, Y. N., & Lee, D. K. (2015). Effects of horse-riding exercise on balance, gait, and activities of daily living in stroke patients. Journal of Physical Therapy Science, 27(3), 607–609. https://doi.org/10.1589/jpts.27.607
López-Roa, Lina María, & Moreno-Rodríguez, Efraín Darío. (2015). Hipoterapia como técnica de habilitación y rehabilitación. Universidad y Salud, 17(2), 271-279. https://doi.org/10.22267/rus.151702.11
Martínez Ortega, Rosa María, Tuya Pendás, Leonel C, Martínez Ortega, Mercedes, Pérez Abreu, Alberto, & Cánovas, Ana María. (2009). Characterization of the Spearman Correlation Ranks Coefficient. Revista Habanera de Ciencias Médicas,8(2) http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1729519X2009000200017&lng=es&nrm=iso
Mejía Suarez, R, Picón Rojas, E y Suárez Castellanos, I. (2021). Análisis de publicaciones sobre equino terapia. [Tesis en licenciatura]. Universidad Cooperativa de Colombia, Facultad de Ciencias Sociales. https://hdl.handle.net/20.500.12494/33032
National Clinical Guideline Centre. (2023). Stroke rehabilitation: Long-term rehabilitation after stroke (NICE guideline NG128). https://www.nice.org.uk/guidance/ng236
Organización Mundial de la Salud. (1999). Promoting independence following a stroke. https://www.who.int/publications/i/item/promoting-independence-following-a-stroke
Organización Mundial de la Salud. (2022). Rehabilitation. https://www.who.int/health-topics/rehabilitation#tab=tab_1
Organización Mundial de la Salud. (2023). Stroke: Key facts. https://www.emro.who.int/health-topics/stroke-cerebrovascular-accident/index.html
Öztürk, S., Aydoğdu, O., & Sarı, Z. (2024). Efficacy of hippotherapy simulator exercise program in patients with stroke: A randomized single-blind clinical trial. Topics in Stroke Rehabilitation, 31(6), 576–584. https://doi.org/10.1080/10749357.2024.2310425
Picazo, J. M. (2022). Las terapias asistidas con caballos: el “animal de terapia“ entre la dominación especista y la cooperación mutualista. Revista Latinoamericana de Estudios Críticos Animales, 9(2), 68-89 .https://revistaleca.org/index.php/leca/article/view/379
Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C.,Becker, K., Biller, J., Brown, M., Hoh, B., Jauch, E. C., Kidwell, C, S., Leslie Mazwi, E. M., Ovbiagele, B., Scott, A., Sheth, K. N., Southerland, A. M.,Summers, D. V, & Tirschwell, D. L. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50(12). https://www.ahajournals.org/doi/full/10.1161/STR.0000000000000211
Puy L. & Jouvent E. (2020). Accidente cerebrovascular en el paciente anciano. EMC - Tratado de Medicina, 24(1), 1-6. https://doi.org/10.1016/S1636-5410(20)43329-X
Quezada Calle, E., Rosado Álvarez, M. M., Romero Ibarra, O.P., Peralta Machado, J. D. (2025). Análisis articular de la marcha en fase de balanceo en sujetos con secuelas neurológicas. Retos, 68, 1635–1643. https://doi.org/10.47197/retos.v68.116381
Sacco, R. L., Kasner, S. E., Broderick, J. P., Caplan, L. R., Connors, J. J., Culebras, A., Elkind, M. S. V., George, M. G., Hamdan, A. D., Higashida, R. T., Hoh, B. L., Janis, L. S., Kase, C. S., Kleindorfer, D. O., Lee, J. M., Moseley, M. E., Peterson, E. D., Turan, T. N., Valderrama, A. L., & Vinters, H. V. (2013). An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 44(7), 2064–2089. https://doi.org/10.1161/STR.0b013e318296aeca
Sánchez, H., dos Santos, G., de Morais Sanchez, E., Maia, L., & da Silva, L. (2024).Contributions of Equine Therapy after Stroke. Annals of Physiotherapy & Occupational Therapy, 7(3). https://doi.org/10.23880/aphot-16000265
Silva, S. B. C. A., Hruschka, A. C. C. B., Moraes, A. G., Leal, J. C., Silva, M. L. d., & Paz, L. P. d. S. (2021). Effectiveness of hippotherapy and therapeutic horseback riding on 13balance in hemiparetic patients after stroke. Fisioterapia Em Movimento, 34. https://doi.org/10.1590/fm.2021.34201
Stergiou, A. N., Ploumis, A., Kamtsios, S., Markozannes, G., Christodoulou, P., & Varvarousis, D. N. (2025). Effects of Equine-Assisted Therapy: A Systematic Review and Meta-Analysis. Journal of clinical medicine,14(11), 3731. https://doi.org/10.3390/jcm14113731
Tinetti M. E. (1986). Performance-oriented assessment of mobility problems in elderly patients. Journal of the American Geriatrics Society, 34(2), 119–126. https://doi.org/10.1111/j.1532-5415.1986.tb05480.x
Wang, S., Xue Lun, Z., Lian Xu, W., Hui Fang, Z., Xiao, L., Yao, T, Zhang, Y., Ma,J., Zeng, Y & Zhang, L. (2022). Epidemiology of intracerebral hemorrhage: a systematic review and meta-analysis. Frontiers in Neurology, 13, 2-12. https://doi.org/10.3389/fneur.2022.915813
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