Examining the Feasibility of an Outdoor Therapeutic Horse Carriage As a Perturbation -based Balance Training.

Falls and fall-related injuries are serious and costly health problems, resulting in decreasing in quality of life, reducing mobility and independence and increasing morbidity and mortality. Most falls arise from events originating in the external environment when balance is lost unexpectedly due to a disruption to the base of support (BoS) directly (e.g., slips, trips during waking) or because of a rapid change in the center of mass (CoM) over the BoS (e.g., turns, being pushed). These situations are called externally induced balance perturbations. Reactively stepping and grasping something stable are effective strategies to increase the BoS, as they quickly decelerate the CoM motion, restoring equilibrium and averting falls.

Reactive balance is a critical basis for independent daily functioning; thus, it is a major training component in fall prevention programs. Reactive Balance Training (RBT) exposes participants to repeated unannounced external-induced balance perturbations in a safe and controlled environment aiming to specifically trigger, train and improve balance recovery skills. It was previously shown that adaptation to repeated-perturbation exposure can occur rapidly, even during a single-training session, suggesting that skill acquisition of reactive balance responses was accrued in a short amount of time.

RBT uses different stationary mechatronic systems that usually provide mediolateral or anteroposterior external perturbations during standing and treadmill walking. To date, RBTs lack a vertical component of balance disturbances additionally to a single type of perturbation direction may result in the limited real-life generalization.

the investigators were inspired by the growing body of research intervening humans with animal-assisted therapy, such as horses, to help people as they recover from physical and mental health conditions. Recent reviews of this novel therapeutic intervention indicate that participating in animal-assisted therapy has many benefits in motor and physical ability and also in mental and behavioral health among older, young and hospitalized patients. Therapeutic horseback riding (hippotherapy) intervention programs have been shown to improve balance, gait, and gross motor function in people with stroke, multiple sclerosis, children with cerebral palsy, as well as in older adults. However, traditional therapeutic horseback riding primarily occurs in a sitting position, which may not directly address balance training for situations in which balance losses occur in everyday lives (i.e., walking and standing). Therefore, introducing a dynamic horse-assisted balance training program in a standing position represents an innovative approach with added value.

To enhance the transfer of balance abilities from laboratory settings to real-world scenarios, the investigators propose a novel RBT program, The Equine Dynamic Balance (EDB). This program will introduce 3-dimensinal perturbations in various combined directions, targeting the change in BoS strategies through stepping and grasping as well as fixed-BoS strategies where feet remain stationary. The EDB is an outdoor therapeutic horse carriage, developed by "UDI Challenging Riding". This innovative apparatus serves as a platform for horse-assisted therapy for dynamic balance training while standing.