Evidence Supports Benefits of Therapeutic Riding and Hippotherapy

The researchers reviewed and analyzed previous studies of horseback riding interventions for patients with various types of motor (movement) dysfunction—for example, cerebral palsy, multiple sclerosis, and stroke.

 A comprehensive review identified 16 studies evaluating two types of interventions: therapeutic riding, defined as some type of adaptive or modified horseback riding with a therapeutic goal; or hippotherapy, which uses the movement of the horse for therapeutic purposes.

Eight studies assessed the effects of equine-assisted therapies for children with cerebral palsy, including a total of 434 patients. Four studies evaluated the use of these interventions to improve mobility in older adults with multiple health problems and disabilities, 90 patients; and three studies addressed patients with multiple sclerosis, 52 patients. One study, including 20 patients, assessed the use of hippotherapy for patients after a stroke.

The results suggested that therapeutic riding or hippotherapy had a "significant positive impact" in all groups of patients studied. Individual studies reported small but significant improvements in outcomes such as balance, motor function, posture, gait, muscle symmetry, pelvic movement, psychosocial factors, and quality of life.

Eight studies provided sufficient data for pooled analysis (meta-analysis) of specific measures of balance and gross motor function. On a measure of balance, the effects of therapeutic riding were not significantly greater than for other types of therapy.

There was evidence of positive effects on several dimensions of gross motor function, but no statistically significant effect on the overall motor function score.

Mrs. Stergiou comments, "The evidence for therapeutic riding and hippotherapy is encouraging, but with gaps in that there are very few studies of these interventions in the international literature." She notes that the ability to perform meta-analysis is limited by the small size of the studies and the different measurements used.

Within these limitations, the available evidence suggests that therapeutic riding and hippotherapy can be beneficial for patients with neuromotor disabilities. 

The studies show improvement on measures of walking and gross motor function in children with cerebral palsy. The research also provides evidence of increased balance and leg muscle strength in older adults, including stroke survivors.

Further studies will be needed to examine how horseback riding interventions affect other important outcomes, such as daily activity levels and patient self-competence.

"Equine-assisted therapies potentially provide advantage for cognitive, emotional, and social well-being," Dr. Stergiou and coauthors write. "Individuals who participate have the opportunity to simultaneously experience, benefit and enjoy the outdoors, which might not otherwise be readily available."

Click here to read "Therapeutic Effects of Horseback Riding Interventions: A Systematic Review and Meta-analysis."

Article: "Therapeutic Effects of Horseback Riding Interventions: A Systematic Review and Meta-analysis." (doi: 10.1097/PHM.0000000000000726)

Caring for the Caregiver

Newswise, March 13, 2017 - During cancer treatment, the main focus is on the patient. However, a cancer diagnosis affects the entire family, including caregivers.

A caregiver is any person who supports a patient during treatment; this can be a spouse, partner, sibling, son, daughter, or friend. Taking on the role of a caregiver can change the dynamic in a relationship. Partners who were once equals can now have an imbalance and a child can often need to take on a parental role. Often the caregiver’s needs can be overlooked.

It is important for the caregiver to keep their body and mind healthy in order to provide the best care to the patient. While this seems easier to say than do, working in some self-care does not have to take a lot of time or money.

Ways to put yourself first:

Let go of guilt. It is natural to feel guilty for taking time for yourself when your loved one needs so much. Try to remember why all airlines instruct passengers to put their own oxygen mask on first before helping others. The reason behind this is simple: You cannot care for someone else when you are depleted. It is important to acknowledge guilty feelings and find a safe place to share them, but do not allow them to stop you from caring for yourself.

Build in fun. Create a list of activities that make you happy. Playing your favorite song, taking a bubble bath, or going for a walk are just some of the possibilities.

Relax. Simple breathing exercises, guided imagery, meditation, and proper sleep habits. There’s even an app for that! You can download apps like Headspace and Calm to help guide you in relaxation practice.

Self-compassion. Cut yourself some slack! When you care for yourself and a loved one, it is normal to experience stress. Recognizing this stress in a non-judgmental way and taking small steps to combat it is the first step in self-care.

Your oncology social worker is there to help patients and caregivers and can help you make a personalized plan to cope with the burden of being a caregiver.

Mindfulness Shows Promise as We Age, but Study Results Are Mixed

Scientists still searching for best approaches in older adults

Newswise, March 9, 2017 – As mindfulness practices rise in popularity and evidence of their worth continues to accumulate, those who work with aging populations are looking to use the techniques to boost cognitive, emotional and physiological health.

But studies so far have shown mixed results in the elderly, and more investigation is needed to determine exactly how best to apply mindfulness in that population, a new review of the research to date has found.

A majority of the 27 studies in the review suggest that the focused attention at the core of mindfulness benefits older people, but others don’t point to improvements.

And that should prompt more rigorous investigations in search of interventions likely to do the most good, researchers from The Ohio State University found. Their analysis appears in the journal Frontiers in Aging Neuroscience.

“Mindfulness is a practice that really serves as a way to foster a greater quality of life and there’s been some thought that it could help with cognitive decline as we age,” said Stephanie Fountain-Zaragoza, lead author of the study and a graduate student in psychology.

“Given the growing interest in mindfulness in general, we wanted to determine what we know right now so that researchers can think about where we go from here,” she said.

The good news so far: The evidence from a variety of studies points to some benefits for older adults, suggesting that mindfulness training might be integrated into senior centers and group homes, the researchers found.

Older people are an especially important population to study given diminished social support, physical limitations and changes in cognitive health, the researchers point out.

Studies of mindfulness meditation usually involve three types of practices. The first, focused attention, involves sustained attention to a single thing (such as the breath) and an effort to disengage from other distractions.

Open monitoring meditation, often seen as the next step up in mindfulness, includes acknowledging the details of multiple phenomena (sensations, sounds, etc.) without selectively focusing on one of them.

“This includes being open to experiencing thoughts and sensations and emotions and taking them as they come and letting them go,” Fountain-Zaragoza said.

Loving-kindness meditation encourages a universal state of love and compassion toward oneself and others.

“The goal with this is to foster compassionate acceptance,” said senior author Ruchika Shaurya Prakash, director of Ohio State’s clinical neuroscience laboratory and an expert in mindfulness.

In addition to looking at how mindfulness contributed – or did not – to behavioral and cognitive functioning and to psychological wellbeing, some of the research also looked at its potential role in inflammation, which contributes to a variety of diseases.

In all categories of study, including inflammatory processes, Prakash and Fountain-Zaragoza found mixed results.

The hope is that mindfulness could help the elderly preserve attention and capitalize on emotional regulation strategies that naturally improve as we age, Prakash said.

“Around 50 percent of our lives, our minds are wandering and research from Harvard University has shown that the more your mind wanders, the less happy you are,” she said.

“Mindfulness allows you to become aware of that chaotic mind-wandering and provides a safe space to just breathe.”

In older people, mindfulness ideally has the potential to help with cognition, emotion and inflammation, but little research has been done so far and those studies that have been done have had mixed results and scientific limitations.

While most of the studies in the review showed positive results, the field is limited and would benefit greatly from larger randomized controlled trials, Fountain-Zaragoza said.

“We want to really be able to say that we have strong evidence that mindfulness is driving the changes we see,” she said.

No Spoilers! Most People Don't Want to Know Their Future

Learning what the future holds, good or bad, not appealing to most, study says

Newswise, March 9, 2017-- Given the chance to see into the future, most people would rather not know what life has in store for them, even if they think those events could make them happy, according to new research published by the American Psychological Association.

“In Greek mythology, Cassandra, daughter of the king of Troy, had the power to foresee the future. But, she was also cursed and no one believed her prophecies,” said the study’s lead author, Gerd Gigerenzer, PhD, of the Max Planck Institute for Human Development. “In our study, we’ve found that people would rather decline the powers that made Cassandra famous, in an effort to forgo the suffering that knowing the future may cause, avoid regret and also maintain the enjoyment of suspense that pleasurable events provide.”

Two nationally representative studies involving more than 2,000 adults in Germany and Spain found that 85 to 90 percent of people would not want to know about upcoming negative events, and 40 to 70 percent preferred to remain ignorant of upcoming positive events.

Only 1 percent of participants consistently wanted to know what the future held. The findings are published in the APA journal Psychological Review.

The researchers also found that people who prefer not to know the future are more risk averse and more frequently buy life and legal insurance than those who want to know the future.

This suggests that those who choose to be ignorant anticipate regret, Gigerenzer said. The length of time until an event would occur also played a role: Deliberate ignorance was more likely the nearer the event.

For example, older adults were less likely than younger adults to want to know when they or their partner would die, and the cause of death.

Participants were asked about a large range of potential events, both positive and negative.

For example, they were asked if they wanted to know who won a soccer game they had planned to watch later, what they were getting for Christmas, whether there is life after death and if their marriage would eventually end in divorce.

Finding out the sex of their unborn child was the only item in the survey where more people wanted to know than didn’t, with only 37 percent of participants saying they wouldn’t want to know.

Although people living in Germany and Spain vary in age, education and other important aspects, the pattern of deliberate ignorance was highly consistent across the two countries, according to the article, including its prevalence and predictability.

“Wanting to know appears to be the natural condition of humankind, and in no need of justification. People are not just invited but also often expected to participate in early detection for cancer screening or in regular health check-ups, to subject their unborn babies to dozens of prenatal genetic tests, or to use self-tracking health devices,” said Gigerenzer .

 “Not wanting to know appears counterintuitive and may raise eyebrows, but deliberate ignorance, as we’ve shown here, doesn’t just exist; it is a widespread state of mind.”

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Article: “Cassandra’s Regret: The Psychology of Not Wanting to Know,” by Gerd Gigerenzer, PhD, Max Planck Institute for Human Development, and Rocio Garcia-Retamero, PhD, University of Granada, Spain. Psychological Review, March, Vol. 124, No. 2.