Hungry For Hippotherapy: Equine Sessions Can Be Important Component of Integrated PT Program

May 28th, 2019
By: JobsTherapy.com Content Staff

When a physical therapy patient sits astride a horse who is walking, it might look like the horse is doing all the work, but in reality, the patient also is getting a workout. That’s the message from the American Hippotherapy Association, which wants physical therapists to know that equine therapy sessions can help patients make progress as part of a broader PT program.

In hippotherapy sessions, a patient sits atop a horse as the trained animal is moved in various ways, forcing the patient to constantly adapt to the forward and backward translation of motion, according to PT in Motion, a publication of the American Physical Therapy Association. Since horses typically walk about 100 steps per minute, patients atop a horse for 15 to 25 minutes get 1,500 to 2,500 neuromotor inputs, each one an opportunity for neuromotor learning.

“That movement through space and the visual flow is essential to the development of postural response and sensory integration of the motor system and of functional use of balance reaction,” Susie Rehr, a certified hippotherapy clinical specialist and the executive director of New Jersey-based Special Strides, told PT in Motion. “All of this work changes the pressure gradient in the trunk by the smooth activation of our flexors and extensors.

“They’re also changing their thoracic and abdominal pressures, which affects their respiratory function and postural control. Patients are enhancing breath control and breath support with every step.”

Rehr told PT in Motion that the ribcages of patients with physical handicaps often have developmental defects, causing their abdominal and thoracic pressures – which are vital to the act of breathing – to be difficult to regulate.

“Through all of this dynamic flexion and extension, we’re activating the diaphragm and facilitating breath control and postural control simultaneously,” she told the publication. “This helps PTs, occupational therapists, and speech-language pathologists because all of their patients need to breathe properly. The integration of hippotherapy strategies helps enhance breath support, both for postural control and functional speech.”

According to the AHA, “the term hippotherapy refers to how occupational therapy, physical therapy, and speech-language pathology professionals use evidence-based practice and clinical reasoning in the purposeful manipulation of equine movement to engage sensory, neuromotor and cognitive systems to achieve functional outcomes. In conjunction with the affordances of the equine environment and other treatment strategies or tools, hippotherapy is part of a patient’s integrated plan of care.

“Simply put, hippotherapy refers to the use of equine movement as a treatment tool within occupational therapy, physical therapy or speech-language pathology treatment.”

The goal of hippotherapy is to address medical needs, impairments and functional limitations, and it can prove useful for patients of all ages, from children to seniors in their 80s, but it is a supplement, not a replacement, for traditional PT, according to PT in Motion.

Many patients respond positively when given the opportunity to receive PT outdoors, away from the traditional PT setting, and the bond between horse and patient can be especially rewarding, PT in Motion said.

In one example cited by the publication, an autistic boy who consistently avoided eye contact and physical touching hugged a horse after a therapy session, which his parents saw as a major breakthrough. The boy had been seated backward on the horse so that he would see his surroundings moving away from him and getting smaller, instead of toward him in a way that he might see as “coming at him” or attacking him. The practice allowed the boy to take in a wealth of visual information in a non-threatening way and helped with his visual-motor integration, PT in Motion said.

Hippotherapy is being used to help patients with a wide range of conditions, including multiple sclerosis, traumatic brain injuries, incomplete spinal cord injuries, cerebral palsy, autism, stroke, Parkinson’s disease, spina bifida, Down syndrome, developmental delays, DiGeorge syndrome, Prader-Willi syndrome, arthrogryposis, genetic and chromosomal disorders, spinal muscular atrophy, muscular dystrophy, and Pompe disease, according to PT in Motion.

Research shows that patients can indeed benefit from hippotherapy. In children with spastic bilateral cerebral palsy (CP), Gross Motor Function Measure and Pediatric Balance Scale values improved significantly, according to a study cited by PT in Motion. In another study, hippotherapy improved adductor muscle asymmetry in patients with spastic CP, and in a pilot study on children with CP, hippotherapy was found to improve head and trunk stability.

Having an experienced horse handler and a “side walker” on both sides of the horse is essential, PT in Motion said. The horse handler can give the horse instructions as the PT, occupational therapist or speech-language pathologist focuses on the patient. The side walkers walk alongside the horse and make sure the patient doesn’t fall off.

Rehr told PT in Motion that with hippotherapy, PTs can co-treat with OTs or SLPs just as they would in other clinical settings (though some insurance plans will not cover co-treatment sessions). A PT could be working with the patient on balance and postural control, for example, while the OT on the other side of the patient is asking the child to track a toy or an SLP is working with the patient on linguistics.

Clinicians can learn how to incorporate hippotherapy into their treatment programs by enrolling in four-day introductory or advanced training programs administered by the AHA. They then can sit for an exam to become certified by the American Hippotherapy Certification Board as either a hippotherapy clinician or clinical specialist.

To identify nearby hippotherapy facilities, clinicians can contact local riding establishments, the AHA, the Professional Association of Therapeutic Horsemanship International or the Equine Assisted Growth and Learning Association, PT in Motion said. Those organizations train instructors and certify their member centers in hippotherapy.

Rehr told PT in Motion that study data and her experience as a hippotherapy clinical specialist show that patients can get a lot out of hippotherapy, and that it’s not just pointless horsing around. “I don't have to guess if this is working; I test it every day,” she said. “I know I'm affecting a functional outcome.”

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