Efficacy of simulated equestrian therapy in improving gait parameters among children with Down syndrome: a randomized controlled trial

Main Article Content

Maha Siddiqui
Sumaira Farooqui
Jaza Rizvi
Bashir Ahmed Soomro


OBJECTIVE: To compare the effectiveness of Simulated Equestrian Therapy (SET) and Standard Physical Therapy (SPT) in improving gait parameters among children with Down syndrome (DS).

METHODS: This single-blinded, randomized controlled trial was conducted at Dar-ul-Sukun Institute and Dr. Zaiuddin Hospital, Karachi, Pakistan, from April to August 2023. Sixty individuals, meeting the selection criteria were randomly assigned to either the treatment group (n=30) receiving SET or the control group (n=30) undergoing SPT. Nevertheless, two participants from each group either discontinued the treatment or failed to comply with the therapy and 56 participants (n=28 in each group) were included for analysis. Safety measures included recording blood pressure and heart rate before and after each session. Temporal gait parameters were assessed using the 10-Meter Walk Test at baseline, 6 weeks, and 12 weeks. Data was analyzed using Medcalc software.

RESULTS:  Temporal gait parameters were analyzed for 56 (33 males and 23 females) children with DS in both groups. Mean age of patients in SET & SPT groups was 7.89±1.7 and 8.07±0.76 years respectively. Baseline showed similar scores in both groups. At 6 weeks, SET demonstrated significant improvement in cadence (1.78 SPM to 1.35) and gait velocity (2.11 MPS to 2.79), paralleled by SPT (cadence: 2.01 to 1.32 SPM, gait velocity: 2.12 to 2.83 MPS). Between-group analysis revealed no significant differences.

CONCLUSION: Both SET & SPT effectively improve gait parameters in children with Down syndrome. The comparable outcomes highlight SET as a viable alternative, providing clinicians and caregivers additional options for personalized therapeutic approaches.

Article Details

How to Cite
Siddiqui, M., S. Farooqui, J. Rizvi, and B. A. Soomro. “Efficacy of Simulated Equestrian Therapy in Improving Gait Parameters Among Children With Down Syndrome: A Randomized Controlled Trial”. KHYBER MEDICAL UNIVERSITY JOURNAL, vol. 16, no. 1, Mar. 2024, pp. 38-44, doi:10.35845/kmuj.2024.23508.
Original Articles


Kazemi M, Salehi M, Kheirollahi M. Down syndrome: Current status, challenges and future perspectives. Int J Mol Cell Med 2016;5(3):125-33.

Lanzoni M, Kinsner-Ovaskainen A, Morris J, Martin S. Socio-economic regional microscope series - EUROCAT – Surveillance of congenital anomalies in Europe: epidemiology of Down syndrome 1990-2014. Publications Office of the European Union, Luxembourg, 2019, ISBN 978-92-76-00574-2, https://doi.org/10.2760/70796,JRC115824

Foley C, Killeen OG. Musculoskeletal anomalies in children with Down syndrome: an observational study. Arch Dis Child 2019;104(5):482-7. https://doi.org/10.1136/archdischild-2018-315751

Azfar M, Khan I, Iqbal N, Khawar N, Abid K. Oral health of individuals with down syndrome in Karachi, Pakistan. J Pak Dent Assoc 2018;27(4):190-4. https://doi.org/10.25301/JPDA.274.190

World Health Organization. WHO-Genes and Human Disease;2018. [Accessed on: May 10, 2023]. Available from URL: https://www.who.int/genomics/public/geneticdiseases/en/index2.html

Lim PQ, Shields N, Nikolopoulos N, Barrett JT, Evans AM, Taylor NF, et al. The association of foot structure and footwear fit with disability in children and adolescents with Down syndrome. J Foot Ankle Res 2015;8(1):4. https://doi.org/10.1186/s13047-015-0062-0

Carter K, Sunderman S, Burnett SW. The effect of vestibular stimulation exercises on balance, coordination, and agility in children with Down syndrome. Am J Psychiatry Neurosci 2018;6(2):28-32. https://doi.org/10.11648/j.ajpn.20180602.11

Weber A, Martin K. Efficacy of orthoses for children with hypotonia: A systematic review. Pediatr Phys Ther 2014;26(1):38-47. https://doi.org/10.1097/PEP.0000000000000011

Zago M, Duarte NAC, Grecco LAC, Condoluci C, Oliveira CS, Galli M. Gait and postural control patterns and rehabilitation in Down syndrome: a systematic review. J Phys Ther Sci 2020;32(4):303-14. https://doi.org/10.1589/jpts.32.303

Corsi C, Cimolin V, Capodaglio P, Condoluci C, Galli M. A biomechanical study of gait initiation in Down syndrome. BMC Neurol 2019;19:1-8. https://doi.org/10.1186/s12883-019-1288-4

Ruiz‐González L, Lucena‐Antón D, Salazar A, Martín‐Valero R, Moral‐Munoz JA. Physical therapy in Down syndrome: Systematic review and meta‐analysis. J Intellect Disabil Res 2019;63(8):1041-67. https://doi.org/10.1111/jir.12606

Pankaj G, Avani K, Salil V. Prevalence of down syndrome in western India: A cytogenetic study. J Adv Med Med Res 2015;5(10):1255-9. https://doi.org/10.9734/BJMMR/2015/13648

Champagne D, Corriveau H, Dugas C. Effect of hippotherapy on motor proficiency and function in children with cerebral palsy who walk. Phys Occup Ther Pediatr 2017;37(1):51-63. https://doi.org/10.3109/01942638.2015.1129386

Ghafar MA, Abdelraouf OR. Effect of virtual reality versus traditional physical therapy on functional balance in children with down syndrome: A randomized comparative study. Int J Physiother Res 2017;5:2088-94. https://dx.doi.org/10.16965/ijpr.2017.146

Tudor-Locke C, Ducharme SW, Aguiar EJ, Schuna JM, Barreira TV, Moore CC, et al. Walking cadence (steps/min) and intensity in 41 to 60-year-old adults: the CADENCE-adults study. Int J Behav Nutr Phys Act 2020;17(1):137. https://doi.org/10.1186/s12966-020-01045-z

Middleton A, Fritz SL, Lusardi M. Walking speed: The functional vital sign. J Aging Phys Act 2015;23(2):314-22. https://doi.org/10.1123/japa.2013-0236

Shirley Ryan Ability Lab. 10 Meter Walk Test; 2023. [Accessed on: May 10, 2023]. Available from URL: https://www.sralab.org/rehabilitation-measures/10-meter-walk-test

Sutherland DH, Olshen RI, Cooper LE, Woo SL. The development of mature gait. J Bone Joint Surg Am 1980;62(3):336-53.

Naito M, Aoki S, Kamide A, Miyamura K, Honda M, Nagai A, et al. Gait analysis in Down syndrome pediatric patients using a sheet‐type gait analyzer: Pilot study. Pediatr Int 2015;57(5):860-3. https://doi.org/10.1111/ped.12691

Kim HW, Nam KS, Son SM. Effects of virtual reality horse riding simulator training using a head-mounted display on balance and gait functions in children with cerebral palsy: A preliminary pilot study. J Kor Phys Ther 2019;31(5):273-8. https://doi.org/10.18857/jkpt.2019.31.5.273

Moriello G, Terpstra ME, Earl J. Outcomes following physical therapy incorporating hippotherapy on neuromotor function and bladder control in children with Down syndrome: A case series. Phys Occup Ther Pediatr 2020;40(3):247-60. https://doi.org/10.1080/01942638.2019.1615601

Portaro S, Cacciola A, Naro A, Cavallaro F, Gemelli G, Aliberti B, et al. Can individuals with Down syndrome benefit from hippotherapy? An exploratory study on gait and balance. Dev Neurorehabil 2020;23(6):337-42. https://doi.org/10.1080/17518423.2019.1646830

Mutoh T, Mutoh T, Tsubone H, Takada M, Doumura M, Ihara M, et al. Impact of long-term hippotherapy on the walking ability of children with cerebral palsy and quality of life of their caregivers. Front Neurol 2019;10:834. https://doi.org/10.3389/fneur.2019.00834

Manikowska F, Jóźwiak M, Idzior M, Chen PJ, Tarnowski D. The effect of a hippotherapy session on spatiotemporal parameters of gait in children with cerebral palsy-pilot study. Ortop Traumatol Rehabil 2013;15(3):253-7. https://doi.org/10.5604/15093492.1058420

Pau M, Condoluci C, Zago M, Galli M. Men and women with Down syndrome exhibit different kinematic (but not spatio‐temporal) gait patterns. J Intellect Disabil Res 2019;63(1):64-71. https://doi.org/10.1111/jir.12560

Hekal OA, Darwish MM, Attia AAM, Osman ZA, Ahmed I. Effect of selected play activities on adaptive skills among children with down syndrome. Int J Res Appl Nat Soc Sci 2017;5(11):77-86.

Palisano RJ, Walter SD, Russell DJ, Rosenbaum PL, Gémus M, Galuppi BE, et al. Gross motor function of children with Down syndrome: creation of motor growth curves. Arch Phys Med Rehabil 2001;82(4):494-500. https://doi.org/10.1053/apmr.2001.21956