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Hippotherapy

(Greek = “hippos” = horse)

Treatment that uses the multidimensional movement of the horse.

 

Professions using hippotherapy treatment:

1. Occupational Therapy
2. Physical Therapy (Physiotherapist)
3. Speech-Language Pathology
4. Therapeutic riding instructor - certified instructor

 


Examples of different perspectives:

1. Child reaching for a ring:

PT
OT
SLP
TRI
  • Improve coordination and strength of the pelvic, trunk, and shoulder muscles.
  • Provide stability to reach forward without loss of balance.
  • Challenges the riders balance during a functional activity.
  • Increase awareness of the body in space
  • Work on bilateral or unilateral reach and release of an object.
  • Improve visual scanning and visual perceptual skills
  • To process a two step command, for instance "grab the ring and give it to Sarah"
  • To design an activity to challenge the use of arms and hands in preparation for riding skills(using the reins, legs, or voice to make the horse stop and start)

2. Child sitting backward with weight on upper extremities:

PT
OT
SLP
TRI
  • Promote shoulder rotation, opposite hip rotation
  • Provide joint position information (improve crawling)
  • Increase abduction range of hips (improve sitting posture)
  • Improve proprioception through the joints of upper extremities
  • Provide tactile sensation through the hands
  • Improve body awareness and sensory integratoin to promote use of arms and hands in functional activities (eating and dressing)
  • Improve strength of the neck muscles for better head support
  • Improve posture for speech production
  • Improve coordination of respiratory muscles to increase air flow for better speech production
  • Improve oral motor functions and decrease drooling
  • An activity to stimulate awareness of the horse's back and front movements
  • Increasing socialization and awareness of others
  • To relax the rider whose hips are tight causing them to squeeze or push their heels into the horse.

 


Administration of Treatment:


- To provide safe, effective instruction, the certified instructor facilitates the sessions.
- An OT, PT, SLP, or Physiotherapist collaborates with the instructor and provides guidance regarding appropriate goals, special adaptations, and program adjustments.
- Horses are selected for their gait patterns, girth, and temperment. The qualities are then matched to the needs of the patient.

Safety Equipment:

Helment, Devonshire stirrups (position feet/prevent sliding through)

Quick release - used to unhook a rider in case of a fall

The horse wears a blanket and a surcingle (fleece or foam pad and gripping handles strapped around the belly)

The Mounting Process
- If the patient can walk - a step up platform with railing is used (either fixed or portable)
- If the patient is in a wheelchair or has a severely impaired gait - a ramp is used to help transfer the patient onto the horse
- The horse should be mounted from the left side
- If the patient can walk - he can stand while supporting himself with his hands and swing his right leg over the horses back, then sit down
- If the patient is in a wheelchair - he is seated on the horse sideways, then turned. His right leg is lifted over the horses head and neck. Tone-reducing positions should be encouraged if spasticity increases during this phase of mounting. (Chin on chest, rounded back, bent hips)
- If the patient is a child with severe spasticity - tone-reduction can be acheived if the child lies prone across the horses back in a "flour-sack" position.
- The horse must stand still during mounting. The horse leader/certified instructor secures the horse by standing in front of its head and calms it.
Treatment On The Horse
- The horse walks, trots, or backs up on command as the rider assumes various positions and engages in therapeutic exercises and games.
- At all times 2 volunteers (side walkers), walk beside the patient to facilitate participation and ensure safety.
- The certified instructor leads the horse while the therapist uses activities and directs movement of the horse through collaboration with the instructor.
- The activities and movements are meaningful to the patient and specifically address the functional goals of that patient.
- Specifically to Occupational Therapy - Hippotherapy can reflect occupation. (i.e. Grooming the horse, mastery of a recreational activity and building a special bond/relationship with the animal).
- Hippotherapy can benefit the development of balance and other postural responses, muscle strength and coordination, ROM, socialization, self esteem, self confidence, eye hand coordination, visual spacial skill, bilateral coordination, motor planning, and body awareness.
The Dismount Process
- The horse must stand quietly as the patient is brought from the straddle seat back to the side seat where the right leg is lifted over the horses head and neck - the horse lowers its head during this phase. The patients feet must be parallel so they can take over weight bearing (stand).
- The patient should do as much as possible for himself, however if needed, there are helpers to provide assistance.
- A rest period is recommended afterward to allow the treatment to be successful (lying down - breathing techniques)

Certification needed to use hippotherapy:

1. Licensed or registered to practice PT, OT, or SLP
2. Training in the classic principles of hippotherapy equine movement and equine psychology (i.e. an AHA approved 3 or 4 day course)
3. Must be equivalent of a NARHA-registered instructor or, if not, have a NARHA-registered instructor assisting with the horse at all treatment sessions
4. Maintains current professional and general liability insurance (initial evaluation, documentation, discharge criteria and billing will follow the structure consistent with the profession of the therapist who is using hippotherapy)

For more info on certification, click here


Some examples of disabilities that can be treated with this method:
(Can be used with children as young as 2 yrs of age through adulthood)

  • Cerebral Palsy
  • Muscular Dystrophy
  • Autism
  • Learning Disabled
  • Sensory Integration
  • Stroke
  • Traumatic Head Injuries
  • Aspergers
  • Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder
  • Attachment Disorder
  • Multiple Sclerosis
  • Developmental Disability
  • Mental Retardation
  • Fragile X
  • Parkinsons Disease

Additional impairments that can be treated:

  • Visual impairments
    OR
  • Hearing impairments
  • OT Example: May use letters (large black print on a white background),Numbers, shapes, and pictures around the arena

 


Intervention:

Positioning and Movement: Specific positions and movement are used depending on the specific needs and goals of the client:

 

 

SI intervention is commonly practiced in Hippotherapy treatment:
Sensory integration = receiving tactile, visual, auditory, gustatory, olfactory, vestibular and proprioceptive input
  • Sensory information helps to normalize the body
  • The brain is constantly developing and changing (remodel neural networks)
  • The warmth, smell, sound, sight, and feel of a moving horse flood the rider's senses
  •  

     

    Some Examples of activities used:

     

     

  • Tactile: Grooming the horse and sustained contact with the horse while riding
  • Vestibular: Different gaits, sudden starting and stopping, changing direction and assuming different positions while riding (prone, supine)
  • Proprioceptive: Actively changing positions on the horse, and pushing the broom when cleaning the horses stalls (heavy work activities)
  •  


    Areas within the Buffalo area using Hippotherapy:

    Currently, there are no quality programs using Hippotherapy, however, there are 8 areas using therapeutic horseback riding (which is different from hippotherapy).

    Therapeutic horseback riding is conducted only by a certified instructor and focuses on learning horsemanship (teaching riding skills) for group/social education.

    The American Hippotherapy Association (AHA) defines Hippotherapy as "a term that refers to the use or the movement of the horse as a tool by physical therapists, occupational therapists, and speech-language pathologists to address impairments, functional limitations, and disabilities in patients with neuromusculoskeletal dysfunction."

    Difference between Hippotherapy & Therapeutic Riding
    Hippotherapy
    Therapeutic Riding

    -Sessions are generally provided on a 1:1 basis (therapist -> client)

    -Use techniques such as neurodevelopmental techniques, sensory integration and motor control theories

    -Sessions are generally groups of 2-6 individuals per riding instructor (provide private lessons)

    -May use supplemental techniques from non equestrian realms such as education, physical education or recreational therapy

     

     

     

     

    Similarities between Hippotherapy & Therapeutic Riding
    1. Volunteer side walkers and horse leaders
    2. Equipment might be used, such as toys or other props
    3. Activities and games are sometimes incorporated
    4. Horse may wear a variety of tack in either activity, such as different kinds of saddle pads or fleece pads
    5. The riders position on the horse may be changed

    Here is a link to the Winslow Therapeutic Center in Warsaw, NY.
    (This center has both therapeutic riding and hippotherapy programs)

     


    Success Stories Using Hippotherapy

    Success Stories/Case Studies Using Hippotherapy


    “By touching the human spirit, riding produces a feeling of freedom from the bonds of a wheelchair or deformity and imparts an enhanced self-concept and heightened self-esteem.”
    Kathryn L. Splinter-Watkins, MOT, OTR/L
    Susan C. Calhoun, MS, OTR/L

    Lindy Schoch
    5th yr. OT student
    D'Youville College