The influence of therapeutic horse riding on neuropsychological outcomes in children with Tourette Syndrome

Abstract

The aim of this study was to determine executive function outcomes after an equi-therapy intervention in a group of Tourette syndrome children. Equi-therapy is a new form of therapeutic horse riding, which is related to the stimulation of the vestibular system through sensory integration in the brain. For this study a non-equivalent control group design was implemented. The study consisted of 8 Tourette syndrome children aged between 9 and 15, who were referred after a definite Tourette syndrome diagnosis from various neurologists and paediatricians. Both groups were evaluated on a battery of 6 neuropsychological tests measuring various aspects of executive function before and after receiving the therapeutic horse riding intervention. The tests used were the Wisconsin Card Sorting Test, the Stroop Colour Word Test, the Rey-Osterrieth Complex Figure Test, the Trail Making Test A and B, the Raven’s Standard Progressive Matrices and the Symbol Digit Modalities Test. Qualitative inputs were also included in the study. These consisted of behavioural checklists completed by the participants’ parents, the evaluation of the participants’ copy drawings as ’frontal’ or ’normal’ obtained from the Rey-Osterrieth Complex Figure test, and results of tests that were administered by an occupational therapist as part of the required evaluation for the therapeutic horse riding (equi-therapy) itself. Results of the neuropsychological tests indicated significant differences for the Wisconsin Card Sorting Test, Stroop Colour Word Test and the Symbol Digit Modalities Test, indicating improvements in selective attention, cognitive flexibility, visualspatial constructional ability, visuomotor integration, visual memory and organisational strategies. The qualitative results indicted improvements in emotional and behavioural aspects. Executive abilities are a very complex system and evaluation should always include robust and sensitive neuropsychological tests. It seems as if Tourette syndrome could be directly related to executive dysfunction, but not in a simple manner as aspects may vary due to other more complex factors that may contribute to these dysfunctions. However, for equi-therapy as an alternative form of therapy, the opportunity should not be lost to establish its efficacy because of the possible beneficial outcome.