Hippotherapy Aids Children with Sensory and Motor Issues

Hippotherapy is a type of horseback riding ("hippos" is the Greek word for horse) that is used by physical, occupational and speech therapists to aid children and adults with neuromuscularskeletal disorders of many kinds. These include problems with coordination, balance, posture, muscle tone and decreased mobility. Other ideal candidates for this kind of treatment include children with issues related to communication, attention and sensorimotor functioning. Hippotherapy is useful for addressing issues that stem from a wide variety of medical conditions, such as cerebral palsy, Down syndrome, sensory integrative dysfunction and learning and language disabilities. The goals of the therapy are to improve gross motor skills, such as sitting, standing and walking; strengthen speech and language skills; and improve behavioral and cognitive abilities.

When a rider is on horseback, the horse's movement provides both sensory and motor input. The movements are similar to the human movement pattern of the pelvis. Most children are placed on a "natural ride" atop the horse, which uses stirrups but no saddle, to allow for maximum proprioceptive input. This makes it easier for the child to learn to coordinate his body with the rhythm of the horse. "Exercises," such as riding with hands on the head or out to the sides, improve balance and coordination. These can be made into a game for children, who may pretend to be an airplane or Superman. Standing up in the stirrups or doing sit-ups on the horse are great ways to improve trunk strength. A child may also push her hands on the horse's neck or back to receive sensory input from hands to feet.

A client experiences the hippotherapy program at Melmark (see sidebar on page 58).

The therapist may change the horse's gait in order to change the input to the rider, or may change horses all together to give the child a different sensory and motor experience. As the rider improves, challenges can easily be made greater.

Hippotherapy gives countless opportunities for socialization and language activities both on and off the horse. Sometimes several riders are in the ring at the same time, each with her own therapist. Together, they may play games, such as basketball, or have relay races on horseback. Children who are unable to stop their movements on the ground have newfound success at playing games such as Red Light, Green Light using the horse to aid inhibition of movement.

The upright posture that is necessary for horseback riding helps a child with low tone learn to use his diaphragm, which leads to improved speech. Focused language activities, like finding letters and pictures spread out throughout the ring, aid language comprehension and speech. Learning to interact with the other riders under the guidance of a therapist improves social skills.

The stable also affords a multitude of therapeutic experiences. Children may use grooming equipment to work on grooming the horses. This activity teaches sequencing, and gives both gross and fine motor stimulation. Sweeping and shoveling the barn is "heavy work" to improve muscle tone. Additionally, these tasks serve as transitions to the "on-horse" time.

Finding a quality program can sometimes be challenging, however. Diane Helgeland, founder of Rosewood Therapy Challenge in Lake Forest, IL, says that many hippotherapy programs are not for profit because the are expensive to operate. She warns that, because of this, programs sometimes use donated horses or buy "used" horses that may have arthritis or other equine ailments. The goal is for the horse to give good symmetrical input, which will not happen if the animal is not sound. The horse should be capable of "walking up under itself," meaning that, when the horse is walking, its back foot will step in the same places as the front foot just was. Helgend says a young, healthy horse will walk about 2000 steps in 30 minutes, giving an enormous amount of input to the child. Arthritic horses do not have this mobility.

Helgeland buys all her horses and buys them young (by age five), then trains them specifically for hippotherapy. The horses have ongoing training rides, without riders, to keep up their skills. The average hippotherapy horse can only work for five years.

all of Helgeland's staff have a background in pediatrics. She herself was a special education teacher, and was raised around horses. "My horses are my livelihood... I train my own therapists to know how to work with them properly."

In addition to the therapists, volunteers are utilized. Every rider has a therapist at her side and a volunteer as a "side walker." Some children may also have a second side walker. The volunteers range from retirees to teenagers.

Helgeland is attracted to hippotherapy because it is a "holistic, realistic activity." She sees it as a normalizing experience for many children who may struggle with other after-school activities. "In this arena," she says, "they feel successful."

The comprehensiveness of the treatment can lead to rapid results. Once on the horse and moving, the children are getting sensory input, their pelvises are being stimulated and their trunks are being strengthened. all of this input is very organizing and also serves to help inhibit excess movement. This is of benefit to children with attentional issues and behaviorally challenges children as well as those with sensory and motor planning problems.

Helgeland says she usually starts to see results in six weeks. The results are functional; that is, children have better posture or coordination. The goal is not so much to teach them to ride a horse.

Not all children take to horses, however. New smells, new people and being moved by a horse can be difficult or frightening for some children. Helgeland says that, for these children, she starts with fewer transitions or perhaps just has them walk on the horse until they feel more comfortable.

Helgeland also points out a less tangible but equally important benefit of hippotherapy: the sense of pride and achievement that comes from the children's accomplishments. Because the therapy is so multifaceted, children often come out of it having learned something a little different every time. But they always come out of it with confidence as they sit proudly upon their horses.

Will Rogers Saw It * By Nicole Maello

As many individuals are probably aware or may have inferred, the term "hippotherapy" does not refer to the healing powers of a 5,000- pound hippopotamus. Rather, the term is used to describe a therapeutic horseback-riding program for those who are mentally or physically challenged, or possess emotional disabilities.

The benefits of hoseback riding gained national attention after James Brady, press secretary to Former President Ronald Reagan, was shot during an attempted assassination of the president. Paralyzed, Brady sought hippotherapy to aid him in is quest for rehabilitation. Twenty years later, equine-facilitated therapy became recognized worldwide as a helpful instrument for assisting individuals with disabilities to conquer both physical and mental challenges.

It seems that Will Rogers may not have been so far off when he claimed, "There is nothing so good for the inside of a man as the outside of a horse."

One form of proof is Gabe Levey, who just turned four this past March and commenced hippotherapy sessions the summer after his third birthday. At age three, Gabe was capable of saying a fair number of words, but was making very slow progress in putting those words together and expressing his thoughts and ideas verbally. Gabe had participated in an early intervention program and was receiving speech therapy twice a week; but even so, his mother says, "Language was coming in very slowly, and it started to affect his social behavior."

Gabe's parents were bewildered, since Gabe was obviously a bright child. Shortly, they came into contact with Sheri Haiken, Gabe's hippotherapist. "There was an instant connection and we began this new therapy last summer. When Gabe returned to pre-school in September, his teachers had already noticed the difference in him," explains his mother, Bianca Levey. A year after beginning the therapy, Gabe has bloomed. "He's progressed in leaps and bounds at all levels-language, social interaction, muscle tone-and continues to do so. It was as if he was watching the game from the sidelines and just didn't now how to play, and now he's in the game, playing hard and wanting to do better," says Bianca.

The key to Gabe's success is that hippotherapy works different areas simultaneously to enable better output. It is a more holistic approach to speech therapy. "The best part is he's having a blast and working hard without knowing it's hard work. We're thrilled and so is he," says Bianca.

Recognition of hippotherapy's benefits is slowly growing. Danelle Kern, a member of the physical therapy staff at Loma Linda University Medical Center and Children's Hospital describes hippotherapy as "totally special and unique." She says, "No other machine has ever been invented to take the place of a horse's muscle groups moving from side to side, forward and back, up and down. These closely mimic the human gait."

Bethany Lee, an occupational therapist, believes that the warmth, smell, sight and feel of a moving horse pr\ovide valuable therapy by flooding a rider's senses. "All this sensory information assists the body in normalizing itself," she says.

Perhaps the most convincing evidence that hippotherapy works was reported by Dr. Daniel Bluestone, a pediatric neurologist who followed the progress of children undergoing the treatment. By comparing MRI scans over time, Bluestone discovered that the repetitive movement of riding actually produced physical changes in the brains of the participating children. he insists that hippotherapy is effective in helping rework networks within the cerebellum and within the motor system in the cerebrum.

Clint Ojibway began hippotherapy five years ago. At the time, he was seven years old and had undergone faceto-face, one-on-one speech therapy at a table, since being diagnosed with autism at two years of age. "It was time to expand his world and take therapy on the road, so to speak," explains Glint's mother, Therese Ojibway.

Therese had noticed the calming effect horses had on Clint since he began taking pony rides as a toddler. Her intuitions and input from articles led her to seek out a hippotherapy program for Clint.

Finding a Quality Hippotherapy Program: Some Questions to Ask

* Were your horses bought or donated?

* What are the horses' ages?

* How many horses do you have?

* How often do they get training rides?

* Who trains the animals and the therapists?

* What do you do for ongoing staff training?

* What is the background of each therapist?

* Will my child work with the same therapist every time?

* What is your approach if a child is resistive to therapy?

* How do you measure improvement?

For some time, Clint participated in a group lesson to enhance his skills with social interaction and following directions. During this time period, his riding skills were improving to the point where he could ride through an obstacle course, controlling the horse himself with the reins and his body movements. Clint also learned to ride the horse in different positions to develop his reflexes and increase strength in his trunk. he was so eager to do his "circus tricks" that his hippotherapist had to remind him to wait until his side-walkers were ready. These tricks were more than simple fun and entertainment; the strength Clint built while doing them helped his vocal volume.

The motivation is high when the volume of Clint's voice gets the horse to do as he pleases, especially when he says "TROT!" The smile on Clint's face when he is trotting is priceless. "Now that he's become an adolescent, Clint is more prone to mood swings and self- control has become a goal," says Therese. Remaining calm, holding good posture on the horse and speaking slowly with breath control are significant achievements. "It is amazing how much control he shows when he knows that, if he makes any sudden movements or inappropriate vocalizations, he does not get to trot. There's speech therapy and positive motivation for you!" she says.

MILLIGAN HILL EQUINE ASSISTED THERAPY PROGRAM

at The Center for Discovery

If one seeks to understand the benefits of PT, OT, and speech/ language therapy that are provided via hippotherapy, it is necessary to understand the science and the art of therapeutic intervention.

Consultation with pediatricians, primary care physidans, neurologists, neurosurgeons and orthopedists yields objective information that is used to determine the possibility for accommodation of various individuals. These individuals may present asymmetrical alignment; questionable joint integrity; presence of seizure activity; placement of an intrathecal baclofen pump or g- tube; significantly limited attention and/or hyperactivity; and atypical registration, processing or response to tactile, proprioceptive or vestibular input.

After everyone is agreed that the treatment strategy of hippotherapy is indicated, evaluation and planning that incorporates transdisciplinary considerations begins. At the Center for Discovery, the theoretical model for therapeutic intervention correlates with the motor control theory that is a systems theory. Summarily, a systems approach suggests that movement patterns are based on the task and context of the movements and the physical dynamics of the body. Given this model, assessment and treatment planning for hippotherapy shares common ground with other therapy strategies, because one must identify the individual's functional abilities and limitations as well as identify the body system(s), task components and contextual factors that will influence the performance of the selected task.

The therapists at The Center for Discovery have all received special training through the American Hippotherapy Association to incorporate hippotherapy into a treatment session.

Possibly the most important aspect of the therapy, however, is a phenomenon which no words can describe: the shared relationship (in fact, the friendship that often blossoms) between the individual and the horse. Beyond the use of a mechanical lift or specially- constructed mounting block, beyond a myriad of developmental positions, beyond incorporation of pads, adapted surcingles, balls, peanuts, noodles and boppies, there is an alliance that derives from the possibility of freedom in the movement that the horse and therapy team provide.

The Milligan Hill Equine Assisted Therapy Program at The Center for Discovery is always focused on the science of therapeutic interventions, yet always strives to focus on the art of the human and animal connections during the hippotherapy process.

Hippotherapy: Exceptional Treatment with Multiple Benefits

by Bernadette R. McNulty, PhD

Melmark (a facility in Berwyn, PA) offers a hippotherapy program that brings together therapists, horsemanship professionals and trained volunteers to pursue therapy goals during a highly integrated 30-minute treatment session. During non-winter months, occupational and physical therapists team with horses for this unique treatment modality. The dynamic movement of the horse combines with specific riding patterns to facilitate desired postural responses. Variations in stride-shortened to lengthened- and transitions of gait-walk, trot, halt-are combined with specific movement patterns such as serpentines, figures of eight and spirals, all to improve aspects of posture. Specific therapy goals typically involve improving trunk control, endurance, coordination and range of motion, as well as normalizing muscle tone.

Hippotherapy appeals to-and is often successful with-clients who dislike or haven't experienced success with other types of therapy. For several students who came to Melmark in wheelchairs, highly immobile, it has been an integral part of a m ulti-faceted treatment process that enabled them to progress steadily toward walking unassisted. Students become engaged and enjoy their work, leading them to make greater progress in therapy.

Hippotherapy is a single aspect of Melmark's animal program. They believe that horseback riding offers participants a rare opportunity to improve posture, balance, mobility and functioning, while enhancing self-esteem, confidence and motivation, attention span and capacity for bonding. The sports riding program, available to residents of all ages, engages clients in riding activities within a ring or trail. They reap physical, psychological and social benefits while enjoying a very special multisensory experience. And for those who cannot ride because of specific disabilities, helping to groom and care for horses also provides unique benefits.

Dorothea L. De Cutis, MD