Effects of a 12-Session Hippotherapy Program on Balance, Anxiety, and Cognitive Function in Children with Developmental Coordination Disorder: A Three-Participant ABA Single-Case Study
Hosna Khadivi1
, Behrouz Abdoli1, Elham Azimzadeh1, Mohammad Mahdi Amini2, Zahra Mansourjozan3
1Faculty of Sport Sciences, Shahid Beheshti University, Tehran, Iran
2Faculty of Sport Sciences, Islamic Azad University, Mashhad, Iran
3Laboratory of Intelligent Machines, Lut University, Lappeenranta, Finland
Keywords: Developmental coordination disorder, hippotherapy, balance, anxiety, cognitive function, rehabilitation.
Abstract
Objective: This study investigated the effects of a 12-session hippotherapy program on balance, anxiety, and cognitive function in children with Developmental Coordination Disorder (DCD).
Materials and Methods: A single-subject reversal (ABA) design was conducted with three children aged 8-10 years with DCD. Participants received hippotherapy three times per week for four weeks. Balance was assessed using the Biodex Balance System, anxiety with the Spence Children's Anxiety Scale, and cognitive function with the computerized Wisconsin Card Sorting Test.
Results: All participants demonstrated marked improvements in static and dynamic balance during the intervention (percentage of non-overlapping data: 75-100%; Cohen's d = 1.2-2.1). These gains were partially sustained at follow-up. In contrast, changes in anxiety and cognitive outcomes varied: one child showed meaningful improvement, while the others had minimal or no change.
Conclusion: Hippotherapy produced consistent and clinically relevant improvements in balance in children with DCD, suggesting its potential as an effective adjunct to motor rehabilitation. Effects on anxiety and cognitive performance were less consistent, highlighting the need for individualized therapeutic planning and larger controlled trials.
Cite as: Khadivi H, Abdoli B, Azimzadeh E, Amini MM, Mansourjozan Z. Effects of a 12-session hippotherapy program on balance, anxiety, and cognitive function in children with developmental coordination disorder: a three-participant ABA single-case study. Turk J Sports Med. 2026; https://doi.org/10.47447/tjsm.964
Ethical approval for this study was granted by the Shahid Beheshti University Ethics Committee (ID: IR.SBU.1402.079).
Concept: HK, BA, EA, MMA, ZM; Design: HK, BA, EA, MMA, ZM; Data Collection and/or Processing: HK; Analysis and Interpretation: HK, ZM; Writing Manuscript: HK, ZM; Critical Reviews: HK, ZM, BA, EA, MMA. All authors contributed to the final version of the manuscript and discussed the results and contributed to the final manuscript.
The authors declared no conflicts of interest with respect to authorship and/or publication of the article.
The authors received no financial support for the research and/or publication of this article.
