An evaluation tool was developed based on the International Classification of Functioning Disability and Health (ICF) and ICF-Children and Youth systems to quantify the beneficial effects of equine rehabilitation. This tool was used to assess the effects of equestrian therapy (ER) and onotherapy (Ono) on physical and psycho-social performances of adults with intellectual disability. A general improvement in autonomy and social integration was observed for subjects undergoing horse and donkey therapy. ER and Ono produced maximum benefits at six and three months respectively, and benefits persisted over time. Although the agreement between the psychologists' tool and instructors' tool was slight, both measured similar improvements in subjects undergoing equine rehabilitation.
Analysis Of Hippotherapy Outcome Measureslacygardner
This paper describes the use of hippotherapy with children who have autism spectrum disorders (ASD). It details the rationale, frames of references and a review of the literature. Furthermore, descriptions of a capstone project are provided on the investigation of hippotherapy outcome measures being used by current occupational therapists. Five hippotherapy sites were visited and at least one full day of sessions was observed at each. Occupational therapists were also interviewed about current practices. Findings support the use of non-standardized testing for measuring outcomes of children with ASD. Also noted are the various methods for delivering hippotherapy services.
TOWARDS CEREBRAL PALSY DIAGNOSIS: ANONTOLOGY BASED APPROACHijseajournal
Cerebral Palsy (CP) is one of the most complicated disabilities which is a permanent motor disorder
causing mental and physical disabilities. Different reports published by different health organizations
asked for researches on CP disability in order to improve diagnosis. Globally, there are different
researches conducted to improve CP diagnosis, but most of those studies do not diagnose CP in children’s
early ages, which limit the treatment impact. This paper report on a research conducted to develop an
ontology-based approach to diagnose children with CP in early ages. In this paper, Ontology was used to
represent CP domain. Then, a set of manually built rules have been optimized through a knowledge-based
survey to be used in CP diagnosis. The proposed approach improves CP diagnosis and by consequence
positively reflects physical therapy treatment. The proposed approach was evaluated by a real dataset
consisted of 70 pre-diagnosed cases, where 84% correctly diagnosed.
Curriculum Vitae of Dr. Spencer M. Robinson, Executive Director and Chief of Research and Development, Center for Applied Social Neuroscience (CASN). Current as of 3/7/2019.
Validation of the safety attitudes questionnaire (short form 2006) in Italian...Ruby Med Plus
Abstract
Background: Studying safety attitudes of front-line workers can help hospital managers take initiatives to improve
patient safety. The Safety Attitudes Questionnaire, a psychometric tool that measures safety attitudes in health
facilities, has been used and validated in several languages worldwide but there is no Italian version available.
Hence, the study is aimed at cross-culturally validating the questionnaire (short form 2006) in Italian at two hospitals in
the Veneto region (northeastern Italy).
Methods: The translation and linguistic adaptation process of the questionnaire followed the World Health Organization
guidelines. The questionnaire was delivered to staff working in four departments in two hospitals. Confirmatory factor
analysis was used to assess the content validity of a pre-specified factor model that recognizes seven safety
factors of the SAQ. Retest was performed to assess reliability. Internal consistency of items and safety factors
was evaluated via Cronbach’s alpha.
Results: Response rate was 60 % (n = 261/433). Test-retest correlation between items and factors showed a
high degree of agreement. Goodness-of-fit indices demonstrated an acceptable hypothesis model with seven
safety factors. Cronbach’s alpha of a whole questionnaire was 0.85, demonstrating a good internal consistency.
Polychoric correlations showed that the factors are well correlated with each other. Stress recognition was
found to have negative correlation with other safety factors.
Conclusions: The Safety Attitudes Questionnaire in Italian language has satisfactory psychometric characteristics and is a valid instrument to measure safety culture in Italian hospitals.
Analysis Of Hippotherapy Outcome Measureslacygardner
This paper describes the use of hippotherapy with children who have autism spectrum disorders (ASD). It details the rationale, frames of references and a review of the literature. Furthermore, descriptions of a capstone project are provided on the investigation of hippotherapy outcome measures being used by current occupational therapists. Five hippotherapy sites were visited and at least one full day of sessions was observed at each. Occupational therapists were also interviewed about current practices. Findings support the use of non-standardized testing for measuring outcomes of children with ASD. Also noted are the various methods for delivering hippotherapy services.
TOWARDS CEREBRAL PALSY DIAGNOSIS: ANONTOLOGY BASED APPROACHijseajournal
Cerebral Palsy (CP) is one of the most complicated disabilities which is a permanent motor disorder
causing mental and physical disabilities. Different reports published by different health organizations
asked for researches on CP disability in order to improve diagnosis. Globally, there are different
researches conducted to improve CP diagnosis, but most of those studies do not diagnose CP in children’s
early ages, which limit the treatment impact. This paper report on a research conducted to develop an
ontology-based approach to diagnose children with CP in early ages. In this paper, Ontology was used to
represent CP domain. Then, a set of manually built rules have been optimized through a knowledge-based
survey to be used in CP diagnosis. The proposed approach improves CP diagnosis and by consequence
positively reflects physical therapy treatment. The proposed approach was evaluated by a real dataset
consisted of 70 pre-diagnosed cases, where 84% correctly diagnosed.
Curriculum Vitae of Dr. Spencer M. Robinson, Executive Director and Chief of Research and Development, Center for Applied Social Neuroscience (CASN). Current as of 3/7/2019.
Validation of the safety attitudes questionnaire (short form 2006) in Italian...Ruby Med Plus
Abstract
Background: Studying safety attitudes of front-line workers can help hospital managers take initiatives to improve
patient safety. The Safety Attitudes Questionnaire, a psychometric tool that measures safety attitudes in health
facilities, has been used and validated in several languages worldwide but there is no Italian version available.
Hence, the study is aimed at cross-culturally validating the questionnaire (short form 2006) in Italian at two hospitals in
the Veneto region (northeastern Italy).
Methods: The translation and linguistic adaptation process of the questionnaire followed the World Health Organization
guidelines. The questionnaire was delivered to staff working in four departments in two hospitals. Confirmatory factor
analysis was used to assess the content validity of a pre-specified factor model that recognizes seven safety
factors of the SAQ. Retest was performed to assess reliability. Internal consistency of items and safety factors
was evaluated via Cronbach’s alpha.
Results: Response rate was 60 % (n = 261/433). Test-retest correlation between items and factors showed a
high degree of agreement. Goodness-of-fit indices demonstrated an acceptable hypothesis model with seven
safety factors. Cronbach’s alpha of a whole questionnaire was 0.85, demonstrating a good internal consistency.
Polychoric correlations showed that the factors are well correlated with each other. Stress recognition was
found to have negative correlation with other safety factors.
Conclusions: The Safety Attitudes Questionnaire in Italian language has satisfactory psychometric characteristics and is a valid instrument to measure safety culture in Italian hospitals.
Needs, Demands and Reality of People with Neuromuscular Disorders Users of Wheelchair by Thais Pousada in Examines in Physical Medicine & Rehabilitation
BUSI 230Project 1 InstructionsBased on Larson & Farber sectio.docxRAHUL126667
BUSI 230
Project 1 Instructions
Based on Larson & Farber: section 2.1
Use the Project 1 Data Set to create the graphs and tables in Questions 1–4 and to answer both parts of Question 5. If you cannot figure out how to make the graphs and tables in Excel, you are welcome to draw them by hand and then submit them as a scanned document or photo.
1. Open a blank Excel file and create a grouped frequency distribution of the maximum daily temperatures for the 50 states for a 30 day period. Use 8 classes. (8 points)
2. Add midpoint, relative frequency, and cumulative frequency columns to your frequency distribution. (8 points)
3. Create a frequency histogram using Excel. You will probably need to load the Data Analysis add-in within Excel. If you do not know how to create a histogram in Excel, view the video located at: http://www.youtube.com/watch?v=_gQUcRwDiik. A simple bar graph will also work.
If you cannot get the histogram or bar graph features to work, you may draw a histogram by hand and then scan or take a photo (your phone can probably do this) of your drawing and email it to your instructor. (8 points)
4. Create a frequency polygon in Excel (or by hand). For help, view http://www.youtube.com/watch?v=7Q-KdmDJirg(8 points)
5. A. Do any of the temperatures appear to be unrealistic or in error? If yes, which ones and why? (4 points)
B. Explain how this affects your confidence in the validity of this data set. (4 points)
Project 1 is due by 11:59 p.m. (ET) on Monday of Module/Week 1.
International Journal o f Clinical and Health Psychology (2014) 14, 216-220
International Journal
of Clinical and Health Psychology
w w w .elsevier.es/ijchp
THEORETICAL ARTICLE
The end of mental illness thinking?
Richard Pemberton3 *, Tony Wainwrightb
<DCrossMark
ELSEVIER
DOYMA
a University o f Brighton, United Kingdom
b University o f Exeter, United Kingdom
Received 26 May 2014; accepted 15 June 2014
A vailable on lin e 9 July 2014
KEYWORDS A b s tra c t M ental he alth th e o ry and p ra ctice are in a s ta te o f sig nifica nt flu x . This th e o re t-
Diagnosis; ic a l a rtic le places th e position taken by th e British Psychological Society Division o f C linical
F o rm u la tio n ; Psychology (DCP) in th e c o n te x t o f c u rre n t p ra ctice and seeks to c ritic a lly exam ine some o f
DSM-5; th e key fa cto rs th a t are d rivin g these transfo rm a tion s. The im petus fo r a co m p le te overhaul
W e llb e in g ; o f existing th in k in g comes fro m th e m a n ife stly poor perform ance o f m e n ta l health services in
T h e o re tic a l s tu d y w hich those w ith serious m e n ta l health problem s have reduced life expectancy. It advocates
using th e advances in our understanding o f th e psychological, social and physical mechanisms
th a t underpin psychological w e llb e in g and m e n ta l distress, and re je c tin g th e disease m odel o f
m e n ta l distress as p a rt o f an ou td a te d paradi ...
Effects of the PNF Technique on Increasing Functional Activities in Patients ...Remedypublications1
Introduction: Clinical features of spinal cord injury are described as part of neurological syndromes
of commotion, complete and incomplete lesions. Paraplegia is a consequence of spinal injury in
the thoracic, lumbar and sacral part of the spine characterized by partial (paraparesis) or complete
loss of function below the level of injury. There are many secondary complications, and the most
important ones are proprioceptive deficits and reduced balance that greatly reduce the participation
of patients in their daily activities.
Aim: The aim of this study was to determine the ability of the PNF technique to increase the
functional activity of a patient with incomplete spinal cord injury (TH11 - TH12) included in the
PNF therapy for six months.
Results: The problem the subject noted when taking the initial status was walking over longer
distances and walking up the stairs. Functional abilities of the subject were evaluated by Spinal Cord
Independence Measure (SCIM) and Berg balance scale. Evaluation was performed prior to, in the
middle of, and after the intervention. The subject was included in the PNF therapy twice a week for
45 minutes in a period of 6 months. There was an increase in the results of the Berg Balance Scale
test as well as SCIM results in the area of the locomotion, specifically in the area of mobility in bed,
mobility inside and outside the house at 10 meters to 100 meters distance and using the stairs.
Conclusion: The results of this study show that the PNF technique might have a positive effect on
increasing the functional abilities of subjects with incomplete spinal cord injury. However, further
research is required with a larger number of subjects to make a final conclusion on the effect of the
PNF technique on the functional abilities of persons with spinal cord injuries.
13: Development, test and systematic description of two complex interventions...ICF Education
Poster presentation at the 2nd International Symposium: ICF Education. 30 June 2017 (Cape Town).
THEME: ICF Environmental Factors: Catalyst for person-centred healthcare
http://www.icfeducation.org
Teaching Techniques: Neurotechnologies the way of the future (Stotler, 2019)Jacob Stotler
Presenting alternative to drugs from nuerotechnologies and teaching about clinical use of neurothreapy and therapeutic effectiveness of biological aspects of the use of clinical technologies.
Wessex AHSN is pleased to announce the publication of a short report on the evaluation of how people feel when they experience new models of care. The report has been produced in partnership with R-Outcomes and the Centre for Implementation Science (University of Southampton) and responds to local evaluation guidance, published by NHS England in June 2017, that calls for a strengthened focus on capturing and evaluating patient and residents’ experience of transformed services.
Needs, Demands and Reality of People with Neuromuscular Disorders Users of Wheelchair by Thais Pousada in Examines in Physical Medicine & Rehabilitation
BUSI 230Project 1 InstructionsBased on Larson & Farber sectio.docxRAHUL126667
BUSI 230
Project 1 Instructions
Based on Larson & Farber: section 2.1
Use the Project 1 Data Set to create the graphs and tables in Questions 1–4 and to answer both parts of Question 5. If you cannot figure out how to make the graphs and tables in Excel, you are welcome to draw them by hand and then submit them as a scanned document or photo.
1. Open a blank Excel file and create a grouped frequency distribution of the maximum daily temperatures for the 50 states for a 30 day period. Use 8 classes. (8 points)
2. Add midpoint, relative frequency, and cumulative frequency columns to your frequency distribution. (8 points)
3. Create a frequency histogram using Excel. You will probably need to load the Data Analysis add-in within Excel. If you do not know how to create a histogram in Excel, view the video located at: http://www.youtube.com/watch?v=_gQUcRwDiik. A simple bar graph will also work.
If you cannot get the histogram or bar graph features to work, you may draw a histogram by hand and then scan or take a photo (your phone can probably do this) of your drawing and email it to your instructor. (8 points)
4. Create a frequency polygon in Excel (or by hand). For help, view http://www.youtube.com/watch?v=7Q-KdmDJirg(8 points)
5. A. Do any of the temperatures appear to be unrealistic or in error? If yes, which ones and why? (4 points)
B. Explain how this affects your confidence in the validity of this data set. (4 points)
Project 1 is due by 11:59 p.m. (ET) on Monday of Module/Week 1.
International Journal o f Clinical and Health Psychology (2014) 14, 216-220
International Journal
of Clinical and Health Psychology
w w w .elsevier.es/ijchp
THEORETICAL ARTICLE
The end of mental illness thinking?
Richard Pemberton3 *, Tony Wainwrightb
<DCrossMark
ELSEVIER
DOYMA
a University o f Brighton, United Kingdom
b University o f Exeter, United Kingdom
Received 26 May 2014; accepted 15 June 2014
A vailable on lin e 9 July 2014
KEYWORDS A b s tra c t M ental he alth th e o ry and p ra ctice are in a s ta te o f sig nifica nt flu x . This th e o re t-
Diagnosis; ic a l a rtic le places th e position taken by th e British Psychological Society Division o f C linical
F o rm u la tio n ; Psychology (DCP) in th e c o n te x t o f c u rre n t p ra ctice and seeks to c ritic a lly exam ine some o f
DSM-5; th e key fa cto rs th a t are d rivin g these transfo rm a tion s. The im petus fo r a co m p le te overhaul
W e llb e in g ; o f existing th in k in g comes fro m th e m a n ife stly poor perform ance o f m e n ta l health services in
T h e o re tic a l s tu d y w hich those w ith serious m e n ta l health problem s have reduced life expectancy. It advocates
using th e advances in our understanding o f th e psychological, social and physical mechanisms
th a t underpin psychological w e llb e in g and m e n ta l distress, and re je c tin g th e disease m odel o f
m e n ta l distress as p a rt o f an ou td a te d paradi ...
Effects of the PNF Technique on Increasing Functional Activities in Patients ...Remedypublications1
Introduction: Clinical features of spinal cord injury are described as part of neurological syndromes
of commotion, complete and incomplete lesions. Paraplegia is a consequence of spinal injury in
the thoracic, lumbar and sacral part of the spine characterized by partial (paraparesis) or complete
loss of function below the level of injury. There are many secondary complications, and the most
important ones are proprioceptive deficits and reduced balance that greatly reduce the participation
of patients in their daily activities.
Aim: The aim of this study was to determine the ability of the PNF technique to increase the
functional activity of a patient with incomplete spinal cord injury (TH11 - TH12) included in the
PNF therapy for six months.
Results: The problem the subject noted when taking the initial status was walking over longer
distances and walking up the stairs. Functional abilities of the subject were evaluated by Spinal Cord
Independence Measure (SCIM) and Berg balance scale. Evaluation was performed prior to, in the
middle of, and after the intervention. The subject was included in the PNF therapy twice a week for
45 minutes in a period of 6 months. There was an increase in the results of the Berg Balance Scale
test as well as SCIM results in the area of the locomotion, specifically in the area of mobility in bed,
mobility inside and outside the house at 10 meters to 100 meters distance and using the stairs.
Conclusion: The results of this study show that the PNF technique might have a positive effect on
increasing the functional abilities of subjects with incomplete spinal cord injury. However, further
research is required with a larger number of subjects to make a final conclusion on the effect of the
PNF technique on the functional abilities of persons with spinal cord injuries.
13: Development, test and systematic description of two complex interventions...ICF Education
Poster presentation at the 2nd International Symposium: ICF Education. 30 June 2017 (Cape Town).
THEME: ICF Environmental Factors: Catalyst for person-centred healthcare
http://www.icfeducation.org
Teaching Techniques: Neurotechnologies the way of the future (Stotler, 2019)Jacob Stotler
Presenting alternative to drugs from nuerotechnologies and teaching about clinical use of neurothreapy and therapeutic effectiveness of biological aspects of the use of clinical technologies.
Wessex AHSN is pleased to announce the publication of a short report on the evaluation of how people feel when they experience new models of care. The report has been produced in partnership with R-Outcomes and the Centre for Implementation Science (University of Southampton) and responds to local evaluation guidance, published by NHS England in June 2017, that calls for a strengthened focus on capturing and evaluating patient and residents’ experience of transformed services.
COVID-19 PCR tests remain a critical component of safe and responsible travel in 2024. They ensure compliance with international travel regulations, help detect and control the spread of new variants, protect vulnerable populations, and provide peace of mind. As we continue to navigate the complexities of global travel during the pandemic, PCR testing stands as a key measure to keep everyone safe and healthy. Whether you are planning a business trip, a family vacation, or an international adventure, incorporating PCR testing into your travel plans is a prudent and necessary step. Visit us at https://www.globaltravelclinics.com/
Veterinary Diagnostics Market PPT 2024: Size, Growth, Demand and Forecast til...IMARC Group
The global veterinary diagnostics market size reached US$ 6.6 Billion in 2023. Looking forward, IMARC Group expects the market to reach US$ 12.6 Billion by 2032, exhibiting a growth rate (CAGR) of 7.3% during 2024-2032.
More Info:- https://www.imarcgroup.com/veterinary-diagnostics-market
DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
Prevention Strategies: Education, healthy coping mechanisms, community support, and policies are vital in preventing substance use.
Harm Reduction Strategies: Safe use practices, medication-assisted treatment, and naloxone availability aim to reduce harm.
Seeking Help for Addiction: Recognizing signs, available treatments, support systems, and resources are essential for recovery.
Personal Stories: Real stories of recovery emphasize hope and resilience.
Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
Resources: Provide contact information and links for further support.
This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
KEY Points of Leicester travel clinic In London doc.docxNX Healthcare
In order to protect visitors' safety and wellbeing, Travel Clinic Leicester offers a wide range of travel-related health treatments, including individualized counseling and vaccines. Our team of medical experts specializes in getting people ready for international travel, with a particular emphasis on vaccines and health consultations to prevent travel-related illnesses. We provide a range of travel-related services, such as health concerns unique to a trip, prevention of malaria, and travel-related medical supplies. Our clinic is dedicated to providing top-notch care, keeping abreast of the most recent recommendations for vaccinations and travel health precautions. The goal of Travel Clinic Leicester is to keep you safe and well-rested no matter what kind of travel you choose—business, pleasure, or adventure.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)blessyjannu21
Neurological system includes brain and spinal cord. It plays an important role in functioning of our body. Encephalitis is the inflammation of the brain. Causes include viral infections, infections from insect bites or an autoimmune reaction that affects the brain. It can be life-threatening or cause long-term complications. Treatment varies, but most people require hospitalization so they can receive intensive treatment, including life support.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
ALKAMAGIC PLAN 1350.pdf plan based of door to door delivery of alkaline water...rowala30
Alka magic plan 1350 -we deliver alkaline water at your door step and you can make handsome money by referral programme
we also help and provide systematic guideline to setup 1000 lph alkaline water plant
Rate Controlled Drug Delivery Systems, Activation Modulated Drug Delivery Systems, Mechanically activated, pH activated, Enzyme activated, Osmotic activated Drug Delivery Systems, Feedback regulated Drug Delivery Systems systems are discussed here.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
2. 2 N. Borioni et al.
Disability & Rehabilitation
psychomotor, emotional, communicative functions. Equestri-
an rehabilitation (ER) improves posture, balance, and overall
function by decreasing muscle stifness, improving head and
trunk postural control, and developing balance reactions in
trunk. Also, equine therapy inluences patient’s conidence
and feeling of pleasure by touching, stroking, grooming and
giving verbal commands to the horse/donkey. he strength of
the helping relationship, characterized by warmth, empathy,
trust, acceptance and elaboration, is the most powerful pre-
dictor of positive outcome [11].
he general need of validated evaluation tools that prop-
erly assess functional changes in subjects undergoing equine
therapy was clearly emerged from the analysis of the literature.
A further priority identiied is the use of standard classiica-
tion criteria for assessing functions, such as those reported in
the International Classiication of Functioning Disability and
Health (ICF [12]). Recent papers on rehabilitation theories
suggest that ICF may be regarded as a new paradigm which
has integrated the individual model of disability with the so-
cial model of disability [13,14]. he emphasis on environmen-
tal factors and human functioning as well as the interaction
between the two represents a revolution in the way we think
about rehabilitation.
ICF is not a measurement tool but rather a classiication
system, therefore the present research faces two challenges,
translating measures of functional status and environmental
aspects into the ICF language [15], and managing major dif-
iculties which prevent a reliable and standard measurement of
the rehabilitation outcome. Among them, the heterogeneous
interpretation of terms describing therapeutic activities involv-
ing equines, the lack of common rehabilitation protocols, and
the poor sensitivity of the few available validation tools are the
most critical issues. As a direct consequence of these limita-
tions, no large scale trials have been performed so far [10,16].
In order to ill the gaps emerging from the literature, a re-
search program was started at Villa Buon Respiro in Viterbo,
Italy, a rehabilitation centre specialized in equine therapy,
inalized to (i) evaluate the beneicial efect of ER and Ono on
adults with intellectual disability (ID) (ii) explore and assess
two evaluation tools based on the ICF [12] and ICF-CY clas-
siication [17], for personnel with psychological training and
for equestrian instructors, respectively. We decided to use also
the ICF-CY classiication in order to gather as many informa-
tion as possible, given its wider and more complete range of
tools. Furthermore, the use of the ICF-CY classiication will
facilitate the use of these tools in children undergoing ER.
Materials and methods
Study design and subjects
An evaluation tool based on the ICF and ICF-CY classiication
system was developed by a team composed of neurologists,
psychiatrists, psychologists, and all equestrian instructors (pro-
fessionals specialized in ER). his tool aimed at measuring the
health condition and domains of subjects undergoing equine
rehabilitation according to relevant items reported in the ICF.
Most of the evaluation features included in this evaluation
tool were designed to be applied only by personnel with
psychological training (Tool A), and therefore, a simpliied ver-
sion of this list, ater removing neuro-psychological items, was
developed for the use of all therapists involved in the rehabilita-
tion program (Tool B). A copy of these tools, both for ER (Tool
A-ER; Tool B-ER) and for Ono (Tool A-Ono; Tool B-Ono),
can be downloaded from the oicial website of the rehabilita-
tion centre (http://buonrespiro.sanrafaele.it/rep/pubblicazioni.
asp?hw=12&id_reparto=703). he irst aim of the analysis was
to assess the degree of concordance between the two evaluation
toolsinmeasuringtheimprovementofselectedabilitiesinadults
with ID. he comparative evaluation was performed in a group
of subjects undergoing Ono (at the beginning of the study, ater
3 months, 6 months, and 12 months), and in a smaller group
undergoing ER (at the beginning of the study, ater 6 months, 12
months, and 18 months). he assessment of individual perfor-
mances was done independently and blindly between person-
nel with psychological training and equestrian instructors. he
performance of the two tools was also compared in the diferent
areas covered by the evaluation program. Finally, the timing at
which the improvements were observed and their persistence
over time were evaluated.
Eight adult individuals undergoing equine therapy with
horses (ER) (mean age=42.9; SD=1.5), and iteen individu-
als undergoing therapy with donkeys (Ono) (mean age=38.6;
SD=8.6) were evaluated with both the functioning measure-
ment tools over time. No changes were expected in the cognitive
status of subjects included in the study, given their adult age.
No external controls were recruited and performance at T0 was
considered as reference. In the group undergoing Ono, there
were two subjects afected by slight (13.3%), nine afected by
moderate (60.0%), and four by severe intellectual impairment
(26.7%); in the ER sample, one subject was afected by slight
(12.5%), ive by moderate (62.5%), and two by severe intellectual
impairment (25.0%). Some selected clinical and demographic
characteristics of the two study groups are summarized in
Table I. he extent of intellectual impairment was assessed at
the beginning of treatment by a psychiatrist and a psychologist
through a physical examination and a clinical interview with the
use of the Vineland Adaptive Behavior Scale [18]. All measure-
ments were performed independently by psychologists and by
Table I. Characteristics of the two study groups undergoing equestrian
rehabilitation.
Equestrian
rehabilitation Onotherapy
N° 8 15
Age (mean) 42.9 38.6
Sex Men 87.5% 87.7%
Women 12.5% 12.3%
Environment Institutionalized 50.0% 60.0%
Non-institutionalized 50.0% 40.0%
Intellectual disability Slight 12.5% 13.3%
Moderate 62.5% 60.0%
Severe 25.0% 26.7%
Comorbidity Psychiatric 37.5% 73.3%
Medical 12.5% 6.7%
Neurologic 12.5% 6.7%
Nothing 37.5% 13.3%
Disabil
Rehabil
Downloaded
from
informahealthcare.com
by
IRCCS
San
Raffaele
on
10/13/11
For
personal
use
only.
4. 4 N. Borioni et al.
Disability & Rehabilitation
where,
F p I pb
as s
i
n
as is
i
n
a a
= and =
max( )
= =
∑ ∑
1 1
and, i=item; a=area; s=subject; p=score; pb=baseline
score.
A linear regression model was itted to each therapy and
each group of raters to determine the treatment performance
over time within and between areas. Scatter plot and quantile-
quantile plot conirmed the normality of residuals. he time
when a individual achieved the maximum score, per each
item, was considered to evaluate the timing of the treatment
efects. he persistence of these efects was evaluated accord-
ing to the average frequency of subjects achieving their maxi-
mum score, and described with time-line plots.
he critical limit for signiicance was ixed at 5%. he
sotware used for the analysis was SPSS V.13.0 (SPSS Inc.,
Chicago, IL, USA).
Results
ER
he overall agreement between the psychologists’ and the in-
structors’ evaluation scores was rather slight, although in the
cognitive area, the κ coeicient reached the value K=0.279
(p=0.001). he poorest concordance was in the motor-
praxis (K=0.122, p=0.001) and in the afective-relational
(K=0.154, p=0.001) areas. he instructors gave lower scores
to individual performance, except for the autonomy area. No
comparison between the two evaluators was possible for the
neuro-psychological and communication areas, since the in-
structor’s tool did not include these parameters.
A general improvement was observed in subjects under-
going rehabilitation with horses (Figure 1). In particular, the
psychologists observed signiicant improvements in auton-
omy (∆Bau
=31.4%, p=0.001), motor-praxis (∆Bm−p
=18.5%,
p=0.035), afective-relational (∆Ba−e
=33.7%, p < 0.001), and
cognitive(∆Bcog
=41.6%,p<0.001)areas.Ontheotherhand,the
instructors recorded improvements in autonomy (∆Bau
=39.9%,
p < 0.001), afective-relational (∆Ba−e
=26.7%, p=0.002), and
cognitive (∆Bcog
=55.2%, p < 0.001) areas. Considering the areas
of major psychological pertinence, an improvement over base-
line was observed in neuro-psychological area (∆Bn−p
=38.6%,
p < 0.001), while no evidence of improvement was reached in
the communication area (∆Bcom
=8.8%; p=1.000).
he distribution of subjects’ performances over the study
period showed that 75% of individuals reached their best per-
formance in most areas ater 12 months of therapy. he only
exception concerns the psychologists, which found the high-
est frequency of subject reaching the maximum score before
6 months in communication and afective-relational areas
Figure 1. Relative improvement over baseline (ΔRO%) by group of raters and area (*p < 0.05; **p < 0.01). (A) he improvement relative to the
equestrian rehabilitation (ER). (B) he improvement relative to the onotherapy (Ono).
Disabil
Rehabil
Downloaded
from
informahealthcare.com
by
IRCCS
San
Raffaele
on
10/13/11
For
personal
use
only.
6. 6 N. Borioni et al.
Disability & Rehabilitation
Further parameters to be evaluated were the timing in
which the improvements were observed, and their persistence
over time. he majority of subjects reached their maximum
improvement 3 months ater the start of the therapy almost in
each area for both group of raters (Table III). Two exceptions
were observed in the afective-relational and communication
areas, the instructors registered the individual maximum
score 12 months ater the start of therapy, 21% and 40% of
subjects, respectively. On the other hands, the psychologists
scored the best performance in the cognitive areas ater 6
months of treatment. To further explore the timing of sub-
jects’ best performance, we set the moment when the 75% of
subjects reached the maximum score as a threshold. For both
group of raters and for most areas, this value was reached at
3 months, with a few exceptions, i.e. according to instructors,
the maximum score in the afective-emotional and relational
area was reached at 6 months, and in the communication area,
12 months ater the start of the rehabilitation program. On the
other hand, the psychologists measured the maximum score
in the autonomy, neuro-psychological and cognitive areas af-
ter 6 months of treatment (Table III).
As far as persistence is concerned, according to the in-
structors, the improvements remained constant ater the
third month with the exception of the communication area,
whereas the psychologists reported a constant increment in
most areas until 6 months. A diferent trend was observed in
the motor-praxis area, with stable scores up to sixth month,
followed by a rapid decrease, and for the communication area,
with scores decreasing from 3 to 6 months and then increas-
ing again up to 12 months (Figure 2).
Discussion
Equine rehabilitation successfully rehabilitates people with in-
tellectualandlearningdisabilities.hehorse/donkeymovement
andthenon-clinicalenvironmentimprovenotonlyphysicalbut
also mental, social, communication, and behavioral outcomes.
Disabled people oten develop a bond with the horse/donkey
that alleviates feelings of loneliness and isolation.
he need of a reliable evaluation of beneits from ER on
physical and cognitive abilities of subjects with ID is a lead-
ing priority in the ield. he assessment of suitable outcomes
to quantify the improvement, and the development of vali-
dated tools of evaluation, are the two major milestones. In
this manuscript, we presented the results of a double analysis
comparing psychologists and equestrian instructors, as well
as and ER vs. Ono.
he irst aim of the study was to evaluate the beneicial ef-
fect of equine rehabilitation with horse and donkey on physi-
cal and psycho-social performances of adults with ID.
he study results showed that both psychologists and in-
structors recorded a signiicant improvement in the autonomy,
cognitive and afective-relational areas in ER. hese indings
conirmed the suitability of the tool developed by the authors
to register behavioral changes in the study subjects, as well as
the beneicial efect of treatment. Furthermore, the study pro-
vided a basic information useful for the planning of individual
rehabilitation programs, which is the time required to get the
treatment efect. he highest performance was reached ater
12 months of therapy with the exception of the communica-
tion and afective-relational areas rated by psychologists which
found the best performance before 6 months.
AsregardsOno,theevaluationofpsychologistsandinstruc-
tors was quite diferent. he psychologists recorded signiicant
improvements in autonomy, afective-relational and cognitive
areas, in contrast with the instructors scores, which emphasiz-
es the improvement in the motor-praxis and communication
areas. he highest improvement was reached for both raters
at 3 months with a few exception. As far as the persistence
of beneits over time is concerned, the instructors reported
a constant increasing trend ater the third month, while the
psychologists ater 6 months.
he results of this study showed that both horse and don-
key therapies help disabled people to become more aware of
the surrounding environment, thanks to the consistent reac-
tion of the animal to patient’s actions. his controlled interac-
tion allows the patient to engage his mind and to lengthen the
attention span and focus. Horse and donkey also provide
positive acceptance and increase conidence and self-esteem
in the patient which enhances the level of participation.
he diiculty of measuring the efect of equine rehabili-
tation, along with the need of standard classiication criteria
for assessing outcomes, was the second aim of the study. Two
new measurement tools, based on the ICF-CY classiication,
Table III. Frequency distribution of 15 subjects undergoing onotherapy according to the moment when they reach the maximum score, by group of raters and
by area.
Areas Number of items
Baseline 3 months 6 months 12 months
% % % cum. % % cum. % % cum.
Instructors
Autonomy 2 40.0 40.0 80.0 3.3 83.3 16.7 100.0
Motor-praxis 1 46.7 33.3 80.0 13.3 93.3 6.7 100.0
Afective-relational 5 50.7 18.7 69.3 9.3 78.7 21.3 100.0
Cognitive 3 51.1 26.7 77.8 8.9 86.7 13.3 100.0
Communication 2 46.7 10.0 56.7 3.3 60.0 40.0 100.0
Psychologists
Autonomy 10 34.7 28.0 62.7 27.3 90.0 10.0 100.0
Motor-praxis 10 68.5 12.1 80.6 6.1 86.7 4.2 90.9
Neuro-psychological 6 45.6 24.4 70.0 21.1 91.1 8.9 100.0
Afective-relational 18 59.6 17.0 76.7 13.7 90.4 8.1 98.5
Cognitive 4 38.3 11.7 50.0 30.0 80.0 20.0 100.0
Communication 10 67.3 14.7 82.0 6.7 88.7 11.3 100.0
Disabil
Rehabil
Downloaded
from
informahealthcare.com
by
IRCCS
San
Raffaele
on
10/13/11
For
personal
use
only.