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  • Ajzenman et al reported improved stability and postural para


    Ajzenman et al reported improved stability and postural parameters in ASD children after EAT. Other authors presented similar findings,61, 62, 63, 64 although the studies were conducted among children with CP, and reported improved muscle symmetry,, stability of the head and the trunk, motor function, and stability.Zadnikar and Kastrin, based on their analysis of 10 studies, confirmed improved stability and posture control in children with CP, whereas Vermohlen et al reported improved balance, spasticity, and quality of life in 70 patients with Multiple Sclerosis undergoing HPOT. Other authors, who investigated children and adolescents with posture and motor impairment, did not find statistically significant improvements regarding these parameters after hippotherapy. Improved social functioning (interaction, engagement, communication) was reported in 10 studies presented in our analysis,,,25, 26, 27, 28,,. Wilson et al in their qualitative study, found that HPOT contributed to higher confidence, self-esteem, self-control, coping skills, and a decrease in undesirable behaviors in healthy adolescents. Their findings are supported by a study of Hession et al who investigated the effects of TR on the mood, cognitive competence and gait parameters in children with dyspraxia. These authors emphasized not only the beneficial effects of a physical motion of riding a horse, but also the potential value of audiovisual stimulation during equine-assisted therapy. Beat-based rhythms which are experienced while horseback riding may stimulate the areas of the Z-VDVAD-FMK sale responsible for memory, perception of emotions, motor control, and learning.68, 69, 70 Notably, Hwang Jang et al conducted an analysis on the effects of hippotherapy on dexterity and psychosocial functioning of children with CP but found no significant improvements in psychosocial functioning. Beneficial effects of EAAT have been reported by most authors whose studies were discussed in the review and included better social functioning, reduced aggressiveness, and improved stability of the trunk. Regardless, data presentation, not to mention analysis, synthesis and generalization, present a considerable challenge due to lack of a standardized approach to the subject. No consensus on the effectiveness of the therapy, a great variety of the tools and scales used by the researches and, most of all, of the investigated factors deem most of the results valuable but not easily measurable and comparable. Furthermore, there is a distinct lack of studies on EAAT which meet the quality requirements. The available publications frequently display methodology lapses, mostly stemming from small sample size, lack of comparison group, and blinding. The use of different EAAT therapeutic protocols, and especially different methods of measuring their effectiveness, constitute yet another problem, which often lowers the quality of a study. Despite all of the abovementioned areas for improvement, the analysis left us in no doubt about the benefits of EAAT for ASD patients, chief among them social functioning. Even lack of comprehensive analysis is not able to obscure the evidence of great value and effectiveness of EAAT. Our attempt to analyze the findings of the available literature reports might encourage other researchers to conduct studies with a larger sample size, more standardized methods of therapy and outcome measurements, which in turn will allow for a comprehensive and objective evaluation of clinical usefulness of EAAT.
    Study limitations
    Conflicts of interest
    Introduction Glutamatergic synapses are the most prevalent excitatory synapses in the central nervous system (CNS). The glutamate released at the synapses is taken up by neurons and astrocytes via sodium-dependent glutamate transporters, also termed excitatory amino acid transporters (EAATs) (Nicholls and Attwell, 1990, Anderson and Swanson, 2000, Maragakis and Rothstein, 2001, Schousboe, 2003; Fig. 1A). Astrocytes take up the majority of released glutamate, and astrocytic glutamate transport is vital for proper performance of both the mature and the developing CNS (Rothstein et al., 1996, Tanaka et al., 1997, Matsugami et al., 2006, Petr et al., 2015). Up to now, five transporter subtypes (EAAT 1-5) have been identified and cloned from mammalian tissues, with astrocytes mainly expressing EAAT1 and EAAT2 (Danbolt, 2001). The isoforms share many common structural and molecular properties; but they differ in functional characteristics such as glutamate transport rates and substrate affinities (Vandenberg and Ryan, 2013, Fahlke et al., 2016).