b'Small-scale study suggestsImplantable devices may decrease the utility of hippotherapy benetsurinary urgency, incontinenceResearchers from the University of Thessaly,Researchers from four university hospitals in Greece, reviewed ve high-quality studiesin France studied the effectiveness of sacral to investigate the effects of hippotherapy neuromodulationintreatingneurogenic horse-assisted therapyon individuals withoveractive bladder in people with MS. The MS. A total of 147 participants (121 women,studyincluded38adults withMS who 26 men) took part in these studies. The reviewreceived a two-stage SNM procedure between found hippotherapy helped improve balance,2013 and 2023. An implantable pulse generator reduce fatigue and spasticity, increase musclewas placed in 33 patients (87 percent), indicating strength, ease pain, and enhance quality ofclinical success. After treatment, participants life. Treatment was typically done one to twohad fewer daytime and nighttime urinations, times per week for three to 12 weeks. Althoughand less urgency and incontinence. Nearly the results were positive, the authors emphasized the need for more large-scale, long-term studieshalf (46 percent) maintained these benets to conrm and expand on these ndings. Theve years later. The results suggest that SNM ndings were published in Multiple Sclerosisis a promising long-term treatment option for and Related Disorders.bladder issues in people with MS. The study Thrower- As a neurologist working at anwas published in Multiple Sclerosis and MS center with a focus on rehabilitation, ImRelated Disorders. a big fan of our rehabilitation team. OneThrower- Bladder dysfunction is a common specialized form of physical therapy for thoseissue affecting those living with MS and can living with MS is hippotherapy, or physicalhave signicant effects on quality of life. MS therapy on horseback. Hippo is derived fromcan result in a small, overactive bladder the Greek word for horse, and this form ofcharacterized by urinary urgency, frequency, treatment offers some unique benefits.and incontinence. In others, MS causes a large, Hippotherapists are typically physical,underactive bladder that never fully empties. occupational, or speech therapists who haveThis may also result in incontinence and an done advanced training to offer therapy withincreased risk for UTIs. There are treatment horses. Hippotherapy may be covered by health insurance as a form of physical therapy.options for all MS-related bladder symptoms. Hippotherapy is different from therapeuticOne of those options is sacral neuromodulation. riding. The latter may involve adaptive ridingThis involves the surgical implantation of a lessons, may focus on emotional well-being,devicethatsendselectricalsignalstothe is more recreational, and is not typicallybladder to help restore more normal function. covered by insurance. There are currently two available devices, the This review article looked at the resultsInterStimandadevicefrom Axionics. As of five randomized controlled trials on thedemonstratedbythisstudy,thesedevices effects of hippotherapy in MS. Hippotherapymay result in a decrease in urinary urgency was shown to have benets for fatigue, balance,and incontinence. Prior to implanting one of pain, quality of life, gait, and muscle strength.these devices, a trial of an external device is In my experience, hippotherapy can be antypically conducted to gauge effectiveness. excellent rehabilitation option and is also aThis therapy would be coordinated through a fun adventure.urologist. 41 msfocusmagazine.org'