Proximat Case Study

case_study_proximat-4BSc student Casey McDougall (pictured) recently undertook her studies focusing on hip abduction in children with cerebral palsy, and used Proximat.
Her research programme is ‘’ The influence of equine conformation on hip abduction of two children with cerebral palsy before and after Hippotherapy.’’ This is part of her studies for her BSc (Hons) in Equine Science. Casey is mentored by Physiotherapist Lynne Munroe, through Reaseheath College (Harper Adams University).

Hippotherapy is a physiotherapy treatment using the specific qualities of horse conformation and movement to effect positive change for people with impairment. To date there has been little scientific enquiry into these equine characteristics and the relationship to a specific impairment. This study seeks to address this by investigating the influence of equine conformation and the range of hip abduction (moving away from the mid line) of two children with cerebral palsy (CP).

Clinical Assessment

Materials and Cerebral Palsy
Two participants took part in this study, both diagnosed with CP. Two horses that routinely take part in Hippotherapy sessions were also used, and each participant stayed on the same horse for the duration of the study which was 6 weeks. A variety of measuring techniques were used throughout the study, such as; Proximat, Goniometer, OnTrack gait analysis, and a Flexicurve.

Proximat was found to be very suitable for this study and pragmatic difficulties that may have been encountered using a goniometer were avoided.
The largest joint in the human body is the hip joint. It causes the majority of problems from a functional perspective, along with difficulties when it comes to walking, sitting and lying in children with Cerebral Palsy. Children with CP are born with potentially normal hips but problems develop gradually as the child grows and deforms under the influence of abnormal forces that are caused by tight muscle group and abnormal patterns of movement (Miller, 2005).

Spastic adductors are hypothesised to be a contributing factor to the excessive internal rotation found in some patients (Arnold et al, 2000).

Approach

Methods
Using the Proximat the hip abduction of each participant was measured before mounting. The Proximat was laid out on the double size Martello mounting block (Martello, not dated) and the measurements were taken with the assistance of the physiotherapist. The measuring process is brief and carried out in the same routine to keep consistency for both reliable results as well as making it more familiar for the participants. Each time the right leg was measured first, followed by the left. Both participants were relaxed and comfortable with the process, thus suggesting there was minimal added restriction to their range of motion.

After dismounting the participants are assisted to the table to be measured again. The same measuring process is carried out, with the degree of hip abduction recorded.

Outcome

Results revealed both participants to have benefitted from the 30 minute Hippotherapy sessions. T-test carried out on participant one showed to have a statistically significant difference in both legs.
Several studies have shown that the trunk size and shape of the horse’s back is the main conformational characteristic that influences the rider.
In comparison to participant one, participant two showed a range of base hip abduction angles, throughout the 6 weeks mainly in the left leg, ranging from 40° to 65° inconsistently.
This shows a strong positive correlation within the data. No studies were found that focussed on each individual leg of the patients, this made it difficult to make comparisons.
This study was carried out over 6 weeks and only consisted of a 30 minute session each week. Furthermore this study only had 2 participants, for further tests a larger study group would be recommended to allow for a greater reliability and significance to potentially be recorded.
The participant’s hip abduction measurements were carried out with the supervision of an experienced chartered physiotherapist. The variability in the measurements was minimised by ensuring that the same routine was followed, such as the same leg was measured first each time, the children did not walk the few meters from dismounting the horse to the mounting block.
Furthermore Proximat showed only 3° to 12° error, compared to previous studies that have recorded goniometry to have an error of 15° to 28° (JCM, 2007).

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