The objective of this study was to investigate the effectiveness of Simulated Equestrian Therapy and Neuro-Motor Therapy in improving Motor Proficiency among Down syndrome children using a double-blinded Randomized Controlled Trial. This study was conducted at Dar-ul-Sukun Institute and Dr. Ziauddin Hospital from April to September 2023 by enrolling a total of 56 participants with Down syndrome (DS) after obtaining informed, voluntary assent from the guardians of the participants. Each participant was allocated randomly to the treatment group (n = 28) that received Simulated Equestrian Therapy (SET) and the control group (n = 28) that received Neuro-motor Therapy (NMT) using the envelop method of simple random sampling. The participants and their guardians were blind to the allocations. Participants ' blood pressure and heart rate were recorded before and after each session to ensure safety. Each participant was assessed at baseline and after 6th and 12th week of intervention using Bruinink's test of motor proficiency (BOT-2). The data was analyzed using Medcalc software. The results reveal significant findings for improving motor proficiency after 12th week of intervention of SET and NMT. No protocol was found to be superior to another in improvement of the tested parameters. Hence, our study concludes that SET and NMT effectively improve motor proficiency among DS children. However, studies with a follow-up period should be conducted to further evaluate these therapies' long-term benefits.

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