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Cited by 29Cerebral Palsy and Movement DisordersHuman-Animal Interaction StudiesAttention Deficit Hyperactivity Disorder

Effects of equine-assisted activities on attention and quality of life in children with cerebral palsy in a randomized trial: examining the comorbidity with attention-deficit/hyperactivity disorder

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Ahn, Bomi, Joung, Yoo-Sook, Kwon, Jeong-Yi, Lee, Dong Ik, Oh, Soohwan, Kim, Byoung-Uk, Cha, Jung Yoon, Kim, Ji-Hae +3 more·2021·BMC Pediatrics
DOI 10.1186/s12887-021-02597-0PMC PMC7976699
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Abstract

Background: Attention problems and decreased quality of life are frequently accompanied in Cerebral Palsy (CP), which can negatively affect rehabilitation of physical disability. However, the majority of affected children remain untreated in the aspects of attention or psychosocial factors. Equine-Assisted Activities and Therapies (EAAT) use horse as a therapeutic modality including grooming as well as mounted riding activities in which patients exercise and experience mounted stimulation. It is known to help improve attention in children with ADHD, so that it can be an exercise therapy that is expected to improvement of attention as well as rehabilitating effects in CP patients. EAA may be a promising strategy to address the unmet need for CP patients. This study aims to investigate the efficacy of EAA for children with CP, those with both CP and ADHD and confirm the comorbidity between CP and ADHD. Methods: Forty-six children with cerebral palsy participated in this study. For the exercise group, they participated in a 40-min session twice a week for a 16-week period, while the control group engaged in daily life without any special treatments. Each children individually were assessed on attention and psychological wellbeing at baseline and post-treatment. Comorbidity were identified based on the Diagnostic and Statistical Manual of Mental Disorder 5th edition (DSM-5) and confirmed by Korean Kiddie-Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL). Results: Perseveration rated using the Conner’s Performance Test (CPT) showed a significant decrease only in the exercise group (p < .024). However, no significant improvement in children’s quality of life was observed after EAA program compared with control group. Among the total participants, fifteen children (31.91%) were diagnosed with ADHD. When conducting an additional analysis with the subsample of CP patients diagnosed with ADHD, the d’, commission error and perseveration showed a significant decrease only in the exercise group. Children with CP and ADHD reported an improvement in quality of life both in exercise and control group, but only in the exercise group social functioning exhibited a significant difference. Conclusion: The positive effects of the EAA on attention and quality of life were confirmed. Children with CP in the exercise group were more capable to sustain their attention longer. Those with CP and ADHD showed an increase in attention and perceived to have better social skills after receiving 16 weeks of EAA compared to those in the control group. Considering high comorbidity of CP and ADHD, it seems that the EAA program could be the better alternative treatment for CP with attentional problem. The results of this study will contribute to growing evidence for the efficacy of EAA in children especially with CP and ADHD. Trial registration: This trial was registered on ClinicalTrials.gov (NCT03870893). Registered 26 July 2017.

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  • Ahn et al. [41] found significant improvement in quality of life over time for the EAA group, but these changes were not significantly different at post-test from the control group.

    “Finally, while significant improvement in quality of life was observed over time for the EAA group, these changes were not significantly different at post-test from the control group [41].”

    From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [41]

    The Results section reports significant improvements over time in four quality-of-life subdomains, with no significant difference between the EAA and control groups. It does not establish that overall quality of life improved significantly within the EAA group specifically; in the ADHD subsample, only social functioning improved significantly within that group. The cited copy provides no page numbers. (LLM, conf=0.84)

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  • Ahn et al. [41] found that for children in the ADHD subgroup, the EAA group demonstrated significant improvement in d', commission, and perseveration score, though between-group comparisons in this subsample were not reported.

    “For children in the ADHD subgroup, children in the EAA group demonstrated significant improvement in d’, commission, and perseveration score, though between-group comparisons in this subsample were not reported [41].”

    From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [41]

  • Ahn et al. [41] found that many aspects of attention measured on the Conner's CPT-II test improved with time for the EAA group, but these changes were not significantly different from the control group, except for preservation error.

    “While many aspects of attention measured on the Conner’s CPT-II test improved with time for the EAA group, these changes were not significantly different from the control group, with the exception of preservation error.”

    From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [41]

  • Of the seven active intervention studies, all used randomization for allocation to groups.

    “Of the seven active intervention studies, all used randomization for allocation to groups [41,42,43,45,46,47,48].”

    From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [41]

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Research works printed but not linked: 3

  1. [24]Kwak KJ Oh SW Kim CT Korean Wechsler intelligence children-fourth edition manual 2011 Seoul Hakjisa
  2. [28]Whitney DG Warschausky SA Peterson MD Mental health disorders and physical risk factors in children with cerebral palsy: a cross-sectional study Dev Med Child Neurol 2019 61 5 579 585 10.1111/dmcn.14083 30362114 PMC6450728 · DOI · Paper page
  3. [29]Brossard-Racine M Hall N Majnemer A Shevell IM Law M Poulin C Rosenbaum P Behavioral problems in school age children with cerebral palsy Eur J Pediatr Neurol 2012 16 1 35 41 10.1016/j.ejpn.2011.10.001 22036311 · DOI · Paper page

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Authors
Ahn, B., Joung, Y.-S., Kwon, J.-Y., Lee, D. I., Oh, S., Kim, B.-U., Cha, J. Y., Kim, J.-H., Lee, J. Y., Shin, H. Y., & Seo, Y. S.
Affiliations
  • Samsung Medical Center (KR)
  • Samsung (South Korea) (KR)
Corresponding author
Joung, Yoo-Sook
ORCID
Venue
BMC Pediatrics
Publisher
Springer Science and Business Media LLC
Published
2021-03-19
Volume
21
Issue
1
Pages
135-135
ISSN
1471-2431 (ISSN-L)
DOI
10.1186/s12887-021-02597-0
PMC
PMC7976699
OpenAlex
W3137635588
Cited by
29
References
38
Citations by year
2026: 3 · 2025: 9 · 2024: 7 · 2023: 7 · 2022: 3
FWCI
3.05
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Pediatrics (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Research Foundation of Korea (2017R1A2B4004615)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Cerebral Palsy and Movement Disorders
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Human-Animal Interaction Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
Keywords
equine-assisted activities, equine-assisted therapy, cerebral palsy, attention deficit hyperactivity disorder, comorbidities, attention, quality of life, children, perseveration, social functioning, exercise therapy, psychosocial rehabilitation, social skills, social rejection
MeSH terms
Animals, Attention, Attention Deficit Disorder with Hyperactivity, Cerebral Palsy, Child, Horses, Humans, Quality of Life, Comorbidity

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