Studies have shown a positive effect of THR intervention in children with disabilities including Autism spectrum disorders, cerebral palsy, Down syndrome, spina bifida and developmental delay. There is lack of literature pertaining to THR and its effects on the HRV of children with disabilities. This study assessed such effects. The increase in the RR interval reflects the overall HRV. As the RR interval pre-THR was increased over the six sessions, the hypothesis that THR over the period of six sessions would increase the overall HRV of children with disabilities can therefore be accepted. The findings from this study showed that THR intervention of six sessions elicited a change in HRV of children with disabilities.
However, the changes obtained were not adequate to make conclusive measures as to whether sympathetic or parasympathetic activity is predominantly increased after the six sessions.
Positively, the THR intervention has been shown to contribute to the improved social interaction, independency, family adjustments and play skills of children with disabilities, hence improving quality of life. Due to the lack of literature on the effects of THR on the HRV of children with disabilities, this study provides a basis for further research to be conducted to obtain more information on THR as a tool to improve the parasympathetic activity of children with disabilities.
40 REFERENCES
All, A., Loving, G., & Crane, L. (1999). Animals, horseback riding and implications for rehabilitation therapy. Journal of Rehabilitation, 65(3), 49-57.
Barber, C. (2008). A guide to physiotherapy in cerebral palsy. Paediatrics and Child Health, 18(9), 410-413.
Bass, M., Duchowny, C., & Llabre, M. (2009). The effect of therapeutic horseback riding on social functioning in children with autism. Journal of Autism Development Disorder, 39(9), 1261- 1267.
Bilchick, K., & Berger, R. (2006). Heart rate variability. Journal of Cardiovascular and Electrophysiology, 17(6), 691-694.
Blair, E., & Watson, L. (2006). Epidemiology of cerebral palsy. Seminars in Fetal and Neonatal Medicine, 11, 117-125.
Borges, M., Werneck, M., Silva, M., Gandolfi, L., & Pratesi, R. (2011). Therapeutic effects of a horse riding simulator in children with cerebral palsy. Arquivos de Neuro-Psiquiatria 69(5), 799- 804.
Bouquier, L., Amand, M., & Van Eecke, D. (2013). Heart rate variability during sleep in children with multiple disabilities. Archives de Pediatrie, 20(12), 1278-1287.
Bowes, C., & Cook, B. (2007a). Severe and complex neurological disability. USA: Butterworth Heinemann.
Bowes, C., & Cook, B. (2007b). The value of horse riding and hydrotherapy in the management of severe and complex disability.
Bradshow, J. (2001). Developmental disorders of the frontostriatal system. USA and Canada:
Psychology Press.
Brill, M. (2008). Autism. New York: Marshall Cavendish.
Camntech. (2014). Wearing the actiheart. Retrieved 19 September, 2015, from http://www.camntech.com/products/actiheart/wearing-the-actiheart
Cans, C., De la Cruz, J., & Mermet, M. (2008). Epidemiology of cerebral palsy. Paediatrics and Child Health, 18(9), 393-398.
Chessa, M., Butera, G., Lanza, G., Bossone, E., Delogu, A., De Rosa, G., et al. (2002). Role of heart rate variability in the early diagnosis of diabetic autonomic neuropathy in children. Herz Urban and Vogel, 27, 785-790.
Colhoun, H., Underwood, S., Fuller, J., & Rubens, M. (2001). The association of heart rate variability with cardiovascular risk factors and coronay artery calcification. Diabetes Care, 24, 1108- 1114.
Crawley, R., Cawley, D., & Retter, K. (1994). Therepeutic horseback riding and self concept in adolescents with special educational needs. Anthrozoos, 7, 129-134.
Davis, E., Davies, B., Wolfe, R., Raadsveld, R., Heine, B., Thomason, P., et al. (2009). A randomized controlled trial of the impact of therapeutic horse riding on the quality of life, health and function of children with cerebral palsy. Developmental Medicine and Child Neurology, 51, 111-119.
Desai, S., & Fayetteville, N. (1997). Down syndrome. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 84, 279-285.
Eyal, G., Hart, B., Onculer, E., Oren, N., & Rossi, N. (2010). The autism matrix. United Kingdom:
Polity Press.
Finnie, N. (Ed.). (2004). Handling the young child with cerebral palsy at home (3rd ed.). USA:
Butterworth-Heinemann publishing.
Gabriels, R., Agnew, J., Holt, K., Shoffner, A., Zhaoxing, P., Ruzzano, S., et al. (2012). Pilot study measuring the effects of therapeutic horseback riding on school-age children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders, 6(2), 578-588.
41
Garner, B., & Rigby, B. (2015). Human pelvis motions when walking and when riding a therapeutic horse. Human Movement Science, 39, 121-137.
Ghorban, H., Sedigheh, R., Marzieh, G., & Yaghoob, G. (2013). Effectiveness of therapeutic horseback riding on social skills of children with autism spectrum disorder in Shiraz, Iran. Journal of Education and Learning, 2(3), 79-84.
Harris, A., McGregor, J., Perencevich, E., Furuno, J., Zhu, J., Peterson, D., et al. (2006). The use and interpretation of quasi-experimental studies in medical informatics. Journal of the American Medical Informatics Association, 13(1), 16-23.
Homnick, T., Henning, K., Swain, C., & Homnick, D. (2015). The effect of therapeutic horseback riding on balance in community-dwelling older adults: A pilot study. Journal of Applied Gerontology, 34(1), 118-126.
Ionatamishvili, N., Tsverava, D., Loriya, M., Sheshaberidze, E., & Rukhadze, M. (2004). Riding therapy as a method of rehabilitation of children with cerebral palsy. Human Physiology 30(5), 561- 656.
Kang, K. (2015). Effects of mechanical horseback riding on the balance ability of the elderly. Journal of Physical Therapy Science, 27, 2499-2500.
Kurosawa, T., Iwata, T., Dakeishi, M., Ohno, T., Tsukada, M., & Marata, K. (2007). Interaction between resting pulmonary ventilation function and cardiac function assessed by heart rate variability in young adults. Biomedical Research, 28(4), 205-211.
La Rovere, M., Pinna, G., Hohnloser, S., Marcus, F., Mortara, A., Nohara, R., et al. (2001). Baroreflex sensitivity and heart rate variability in the identification of patients at risk for life threatening arrhythmias: Implications for clinical trials. Circulation, 103(16), 2072-2077.
La Rovere, M., Pinna, G., Maestri, R., Mortara, A., Capomolla, S., Febo, O., et al. (2003). Short term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients.
Circulation, 107(4), 565-570.
Lanning, B., Matyastik-Baier, M., Ivey-Hatz, J., Krenek, N., & Tubbs, J. (2014). Effects of equine assisted activities on autism spectrum disorders. Journal of Autism and Developmental Disorders, 44, 1897-1907.
Lessick, M., Shinaver, R., Post, K., Rivera, J., & Lemon, B. (2004). Therapeutic horse riding:
Exploring this alternative therapy for women with disabilities. AWHONN Lifelines, 8(1), 48- 53.
Levitt, S. (Ed.). (2010). Treatment of cerebral palsy and motor delay (3rd ed.). Australlia: Blackwell science.
Lombardi, F., & Mortara, A. (1998). Heart rate variability and cardiac failure. Heart, 80, 213-214.
Makivic, B., Nikic, M., & Willis, M. (2013). Heart rate variability (HRV) as a tool for diagnostic and monitoring performance in sport and physical activities. Journal of Exercise Physiology, 16(3), 103-131.
Michels, N., Sioen, I., Clays, E., De Buyzere, M., Ahiens, W., Huybrechts, I., et al. (2013). Children's heart rate variability as stress indicators: association with reported stress and cortisol.
Biological Pyschology, 94, 433-440.
Miller, J., & Alstan, A. (2004). Therapeutic riding: An educational tool for children with disabilities as viewed by parents. Journal of Southern Agricultural Education Research, 54(1), 113-123.
Moodithaya, S., & Avadhany, S. (2009). Comparison of cardiac autonomic activity between pre and post-menopausal women using heart rate variability. Indian journal of physiology and pharmacology, 53(3), 277-234.
Naidoo, R., Nqwena, Z., Reimers, L., Peters, K., Sookan, T., & McKune, A. (2014). Acute heart rate variability responses to a therapeutic horseback riding session in children with autsim spectrum disorders: A pilot study. Scientific and Educational Journal of Therapeutic Riding, 19, 10-24.
42
O'brien, I., O'hare, P., & Corrall, R. (1986). Heart rate variability in healthy subjects: Effect of age and the derivation of normal ranges for test of autonomic function. British Heart Journal, 55, 348-354.
Orsila, R., Virtanen, M., Luukkaala, T., Tarvainen, M., Karjalainen, P., Viik, J., et al. (2008). Perceived mental stress and reactions in heart rate variability - A pilot study among employees of an electronics company. International Journal of Occupational Safety and Ergonomics, 14(3), 275-283.
Paramedicine. (2010). The electrocardiagram: Part V. Retrieved 08 February, 2016, from http://paramedicine101.blogspot.co.za/2009/09/electrocardiogram-part-v.html
Peacock, J. (2000). Cerebral palsy. USA: Capstone Press.
Pitchot, V., Busso, T., Roche, F., Garet, M., Costes, F., Duverney, D., et al. (2002). Autonomic adaptations to intensive and overload training periods: A laboratory study. Medicine and Science in Sports and Exercise, 34(10), 1660-1666.
Porges, S. (1995). Cardiac vagal tone: A physiological index of stress. Neuroscience and Biobehavioral reviews, 19(2), 167-186.
Porges, S., Doussard-Roosevelt, J., & Maiti, A. (1994). Vagal tone and the physiological regulation of emotion. Society For Research in Child Development, 59, 167-186.
Riding for the Disabled Association. (1987). Horse riding for the disabled Australian Journal of Physiotherapy, 33(3), 202-207.
Roizen, N., & Patterson, D. (2003). Down’s syndrome. The Lancet, 361, 1281-1289.
Saleem, S., Hussain, M., Majeed, S., & Khan, M. (2012). Gender differences of heart rate variability in healthy volunteers. Journal of Pakistan Medical Association, 62(5), 422-425.
Salusa. Actiheart. Retrieved 19 September, 2015, from http://www.salusa.se/actiheart.html
Schroeder, E., Whitsel, E., Evans, G., Prineas, R., Chambless, L., & Heiss, G. (2004). Repeatability of heart rate variability measures. Journal of Electrocardiology, 37(3), 163-172.
Snider, L., Korner-Bitensky, N., Kammann, C., Warner, S., & Saleh, M. (2007). Horseback riding as a therapy for children with cerebral palsy: Is there evidence of its effectiveness? Physical and Occupational Therapy in Paediatrics, 27(2).
Stickney, M. (2010). A qualitative study of the health benefits of a therapeutic riding program for children with autism spectrum disorders. University of Kentucky, Lexington.
Takase, B., Kitamura, H., Noritake, M., Nagase, T., Kurita, A., Ohsuzu, F., et al. (2002). Assessment of diabetic autonomic neuropathy using twenty-four-hour spectral analysis of heart rate variability: A comparison with the findings of the Ewing battery. Japanese Heart Journal, 43, 127-135.
Taskforce. (1996). Heart rate variability: Standards of measurements, physiological interpretation and clinical use. European Heart Journal 17, 354-381.
Thomas, J., Nelson, J., & Silverman, S. (Eds.). (2005). Research methods in physical activity (5th ed.).
United States of America: Human Kinetics.
Tsuji, H., Larson, M., Venditti, F. J., Manders, E., Evans, J., Feldman, C., et al. (1996). Impact of reduced heart rate variability on risk for cardiac events: The Framingham study. Circulation, 94(11), 2850-2855.
Van de Hout, C., & Bragonje, S. (2010). The effect of equine assisted therapy in children with autism spectrum disorders. Vrije Universiteit, The Netherlands.
Wallace, A. (2009). Development of a questionnaire to determine change in the occupational performance of pre-school children with Autism Spectrum Disorders receiving Occupational Therapy – Sensory Integration. University of Witwatersrand.
Ward, S., Whalon, K., Rusnak, K., Wendell, K., & Paschall, N. (2013). The association between therapuetic horseback riding and social communication and sensory reactions of children with autism. Journal of Autism and Developmental Disorder.
Willis, C. (2009). Creating inclusive learning environments for young children. USA: Corwin Press.
43
Winchester, P., Kendall, K., Peters, H., Sears, N., & Winkley, T. (2002). The effect of therapeutic horseback riding on gross motor function and gait speed in children who are developmentally delayed. Physical and Occupational Therapy in Paediatrics
22(3-4), 37-50.
Wuang, Y., Wang, C., Huang, M., & Su, C. (2010). The effectiveness of simulated horseback riding in children with autism. Adapted Physical Activity Quarterly Journal, 27(2), 113-126.
Xie, Y., Jiao, Q., Guo, S., Wang, F., Cao, J., & Zang, Z. (2005). Role of parasympathetic overactivity in water immersion stress-induced gastric mucosal lesion in rat. Journal of applied physiology, 99, 2416-2422.
Yamamoto, Y., & Hughson, R. (1991). Coarse-graining spectral analysis: New method for studying heart rate variability. Journal of Applied Physiology, 7(3), 1143-1150.
Yukishita, T., Lee, K., Kim, S., Yumoto, Y., Kobayashi, A., Shirasawa, T., et al. (2010). Age and sex- dependent alterations in heart rate variability: Profiling the characteristics of men and women in their 30's. Anti-Ageing Medicine, 7(8), 94-99.
Zadnikav, M., & Kastrin, A. (2011). The effect of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: a meta-analysis. Journal of Medicine and Child Neurology, 53, 683-691.
44 APPENDICES
Appendix Ia: Letter to the owner of Ridge Top Equine Centre
18 February 2013
Dear Tracey Cummings
RE: EFFECTS OF THERAPEUTIC HORSE RIDING ON THE HEART RATE VARIABILITY IN CHILDREN WITH DISABILITIES
I am currently a masters’ Biokinetics students at the University of KwaZulu-Natal. As part of my masters curriculum, I am required to complete a research project. I am aware that you conduct riding lessons with multiple-disability children.
This letter serves to request permission to conduct the above-mentioned study. We would like to set up a meeting with you to discuss the details of the study.
I look forward to a favourable response.
Thanking you
Zingisa Nqwena Dr Rowena Naidoo
University of KwaZulu Natal (Supervisor)
Mobile: 0739765901 Mobile: 0837772813
45
Appendix Ib: Permission from the riding school
20th February 2014
Dear Zingisa Nqwena
RE: The effects of therapeutic horse riding on the heart rate variability of children with disabilities
This letter serves to confirm that we have received your request to conduct your study in our premises, with our horses, testing the heart rate variability of children during their normal riding sessions.
We are pleased to inform you that it is our pleasure to give you consent on this. You can proceed with the study as soon as you get ethical clearance from the ethics committee. The testing should however only be performed only to those children whose parents have signed and returned your consent forms and should be conducted with their regular SARDA Durban instructor and volunteers in attendance.
Should you require additional information please contact us on [email protected] and we will be happy to assist.
Kind regards
Fiona Muhl Tracey Cumming
Chairperson SARDA Durban Branch Senior Instructor/program co- ordinator
46
Appendix II: Information Sheet, Consent to Parents and assent to children
RE: EFFECTS OF THERAPEUTIC HORSE RIDING ON HEART RATE VARIABILITY IN CHILDREN WITH DISABILITIES
Date: 06 February 2014 Dear parent / guardian
My name is Zingisa Zine Nqwena currently a masters Biokinetics students at the University of KwaZulu-Natal, reachable on the following contact details: 0739765901, email [email protected].
Your child is being invited to consider participating in a study that involves research, where testing involving heart rate monitoring will be conducted during their normal therapeutic horse riding lessons. The aim and purpose of this research is to determine whether the horse riding has an effect on selected activities such as play skills, sleep patterns and social interaction of your child. The objective of the study is to examine if the therapeutic horse riding promotes the activity of the parasympathetic nervous system, putting children in a more calm and relaxed state. The study is expected to enrol 50 participants in total who undergo the horse riding lessons at South African riding for the disabled (SARDA) at Ridgetop Equestrian Centre, Durban.
The testing will involve the following procedures: Two electrodes will be fitted on the chest area and the non-invasive actiheart monitor attached to the electrodes for data collection. The recordings will be taken five minutes before their riding lesson off the horse, recording during their 15-20 minute riding lesson and after the lesson for a period of five minutes, off the horse. The total duration required for the testing per week is 25-30 minutes for each session. The duration of your child’s participation if they choose to enrol and remain in the study is expected to be approximately five-months, with measurements taken once a week for that period. Parents/guardians will also be required to complete an Occupational Performance questionnaire (OPQ) to compare any changes in the quality of life of children before a child started the therapeutic horseback riding (THR) and after, to assess any improvements that might be due to the THR. As the parent, you have an option to leave blank any questions you feel are not applicable or are unsure of.
47
The project is designed to non-invasively read the heart rates of your children with a heart rate monitor and there are no known risks that may harm your child in any way by the heart rate monitor. While horse riding is a physically demanding potentially dangerous activity, due care will be taken to ensure the safety of your child at all times. This will be done by ensuring the sessions are conducted as they currently are, by having qualified instructors and trained volunteers working alongside your child on well trained horses. In case of injuries that might occur, e.g. due to falling, there is a first aid kit available and the instructors have valid First-aid certificates and emergency medical contact numbers are on display at the premises.
The study could be of benefit for you and your child, as the results will show if horse riding is therapeutic and is relaxing for your child through assessing the heart rate. The study could also provide the basis for future studies to build upon as it should provide some indication as to the change in stress levels of children. This could have a great significance for the future of treatment of children with disabilities.
This study has been ethically reviewed and approved by the UKZN Biomedical research Ethics Committee (BF074/14).
In the event of any problems or concerns/questions you may contact the researcher at UKZN on 0739765901 or the UKZN Biomedical Research Ethics Committee, contact details as follows:
BIOMEDICAL RESEARCH ETHICS ADMINISTRATION Research Office, Westville Campus
Govan Mbeki Building Private Bag X 54001 Durban
4000
KwaZulu-Natal, SOUTH AFRICA
Tel: 27 31 2604769 - Fax: 27 31 2604609 Email: [email protected]
Participation is entirely voluntary and participants may withdraw at any point without any disadvantage or penalty. Notifications should be made to the researcher should you wish for your child to withdraw.
48
There will be no costs incurred by participants as a result of participation in the study and no incentives or reimbursements for participation in the study.
Your child will be allocated a number and alphabetical code to ensure that confidentiality and anonymity is maintained throughout the study.
Results of this project may be published but any data included will in no way be linked to your child. The data collected will be securely stored in such a way that only the researchers will be able to gain access to it. At the end of the project any personal information will be destroyed immediately except that, as in accordance with the University's research policy.
Raw data on which the results of the project depend will be retained in a secure storage place for five years, after which will be destroyed by incineration.
All children must have written permission from parents or caregivers before they can participate in the study. If interested, please sign the form consenting for your child to participate in this study. Feedback concerning their heart rate variability and the overall study results will be provided to parents and the riding instructor/s.
Thanking you
Zingisa Nqwena Dr Rowena Naidoo
University of KwaZulu Natal (Supervisor)
Mobile: 0739765901 Mobile: 0837772813
49 Parent consent form for participation
EFFECTS OF THERAPEUTIC HORSE RIDING ON HEART RATE VARIABILITY IN DISABLED CHILDREN
I………(name of parent/guardian) have been informed about the study entitled Effect of Therapeutic Horse Riding on Heart Rate Variability of Children with Disabilities by Zingisa Zine Nqwena.
I understand the purpose and procedures of the study.
I have been given an opportunity to answer questions about the study and have had answers to my satisfaction.
I declare that my child’s participation in this study is entirely voluntary and that I may withdraw at any time without affecting any treatment or care that I would usually be entitled to.
I have been informed that I am free to leave blank any questions that I feel are not applicable or unsure of, when answering the questionnaire.
I have been informed that there is no compensation or medical treatment if injury occurs to me as a result of study-related procedures.
I have been informed that the results of the project may be published but my anonymity will be preserved.
I have been informed that a copy of the signed consent form will be given to me should I give permission for my child to participate in the study.
If I have any further questions/concerns or queries related to the study I understand that I may contact the researcher at UKZN Westville campus, Department of Sport Science on 0312607669 or mobile on 0739765901.
50
If I have any questions or concerns about my child’s rights as a study participant, or if I am concerned about an aspect of the study or the researchers then I may contact:
BIOMEDICAL RESEARCH ETHICS ADMINISTRATION Research Office, Westville Campus
Govan Mbeki Building Private Bag X 54001 Durban
4000
KwaZulu-Natal, SOUTH AFRICA
Tel: 27 31 2604769 - Fax: 27 31 2604609 Email: [email protected]
____________________ ____________________
Signature of Parent/guardian Date
Child assent to participate
I ………..(name of child) give permission to be part of the study. I understand what the researcher wants to figure out and aware of the test that will be done on me, which include monitoring my heart rate during my normal riding lessons. I understand that I have a choice to be part of the study and I can stop participating anytime I want during the study with no disadvantage.
_______________________ __________________
Signature of child Date