1. Introduction to Hippotherapy and Adaptive Riding Presented by Kelley Newman, DPT, PCS, HPCS PATH Region 5 Conference August 9 th, 2014

2. Course Objectives Be able to define hippotherapy and adaptive riding, and clarify the difference Be able to explain the basic principles of hippotherapy as a treatment tool, and why it is effective Be able to explain how therapy on the horse translates to improvements in functional skills in land-based goals

3. Course Outline Introduction to Equine-Assisted Activities and Therapies Hippotherapy Principles Translating Practice into Function Visual Demonstration Questions and Answers

4. About Me… Originally from Chicago Attended Vanderbilt for undergrad, Columbia for grad Pediatric physical therapist for Vanderbilt Children’s Hospital and Saddle Up! – Pediatric Clinic Specialist – Hippotherapy Clinical Specialist – PATH Advanced Riding Instructor – FEI/USEF National Para-Equestrian Classifier Current AHA Board Secretary Hobbies: Running, swimming, riding, hiking, anything outdoors Philanthropic interests: Vanderbilt Buddy Program, Music City Trykes

5. Therapy vs Hippotherapy Hippotherapy is a physical, occupational, or speech therapy treatment strategy utilizing equine movement – Hippo is the greek word for horse: ie: therapy with the help of a horse Treatments address impairments, functional limitations and disabilities in patients with neuromotor and sensory dysfunction This treatment strategy is used as part of an integrated treatment program to achieve functional goals Is a therapy treatment strategy, not a different kind of therapy – Other examples: swing, balance ball, therasuit

6. Adaptive Riding Adaptive riding is an equine-assisted activity for the purpose of contributing positively to the cognitive, physical, emotional and social well- being of individuals with special needs Therapeutic vs. Adaptive Riding Aims are developing horseback riding skills; any gains that occur in functional life skills are a secondary benefit

7. Equine-Assisted Activities and Therapies (EAAT) Equine-Assisted Activities (EAA) Equine-assisted activities are any specific center activity, e.g.. therapeutic riding, mounted or ground activities, grooming and stable management, shows, parades, demonstrations, etc., in which the center’s clients, participants, volunteers, instructors and equines are involved. Equine-Assisted Therapy (EAT) Equine-assisted therapy is treatment that incorporates equine activities and/or the equine environment. Rehabilitative goals are related to the patient’s needs and the medical professional’s standards of practice. Equine-Facilitated Learning (EFL) Equine Facilitated Learning (EFL) is an educational approach to equine-assisted activities. EFL content is developed and organized by credentialed practitioners with the primary intent to facilitate personal growth and development of skills through equine interactions.

8. Equine-Assisted Activities and Therapies (EAAT) Equine-Facilitated Psychotherapy (EFP) – EFP is defined as an interactive process in which a licensed mental health professional working with or as an appropriately credentialed equine professional, partners with suitable equine(s) to address psychotherapy goals set forth by the mental health professional and the client. Interactive Vaulting – Interactive Vaulting is an activity in which the students perform movements on and around the horse. These movements can be very simple such as sitting without holding onto the surcingle or a more elaborate compulsory move such as kneeling or standing on the horse. It all depends on the individual needs of the vaulter. Therapeutic/Adaptive Driving – Carriage Driving offers students with physical, mental, sensory or emotional disabilities the rewards of interaction and control of a horse or pony while driving from a carriage seat or in their own wheelchair in a carriage modified to accommodate their wheelchair.

9. EAAT Equine-Assisted ActivitiesEquine-Assisted Therapies -Adaptive Riding-Hippotherapy -Equine-Facilitated Learning-Equine-Facilitated Psychotherapy -Interactive Vaulting -Therapeutic/adaptive driving

10. Clarification HippotherapyAdaptive Riding DefinitionMedical treatment (PT, OT, SLP) utilizing the movement of the horse as a treatment strategy to address functional goals Recreational activity providing horseback riding lessons for children with special needs Completed byLicensed physical, occupational or speech therapist Certified adaptive riding instructor GoalsLand-based activities and functional skills individualized to the specific needs of the patient Skills associated with riding a horse SettingOne-on-one treatmentIndividual, semi-private, or group lessons PaymentBillable through insurance for partial or full reimbursement Paid by family TimelineEpisodes of care model; plan of care individualized to patient, progress is periodically reassessed to determine need for ongoing services Can become a lifetime activity

11. Terminology HippotherapyAdaptive Riding Treatment sessionRiding lesson PatientRider Dynamic moving surfaceHorse Horse handlerLeader Therapy goalsRiding goals

12. Hippotherapy Principles Why is hippotherapy effective as a treatment strategy? – Three dimensional movement – Rhythmic – Repetitive – Motivational Coming from a PT perspective… additional benefits based on each discipline

13. Hippotherapy Principles Three dimensional movement – Movement of horse’s pelvis is tri-planar, mirrors the same three movement planes as the human pelvis Anterior-posterior Lateral Rotational – Provides central nervous system stimulation to the muscles involved in walking – Simulation of what a normal gait pattern should feel like; sense of rhythm

14. Hippotherapy Principles Rhythm – The movement of the horse is consistent and predictable, just as human walking is – Movement can be modified by the therapist during a treatment session based on patient response Allows patient to work on feedback (responsive) and feedforward (anticipatory) control Assist with development of balance reactions and motor control

15. Hippotherapy Principles Repetitive – Number of “steps” or movement challenges during a typical treatment session is in excess of 2,000 repetitions – Compared to number of repetitions in a typical clinic using a balance ball or swing, 30-60, done manually by therapist, not necessarily consistent – Allows patient ample opportunity to practice and refine balance responses, leading to improvements in motor control Explanation of static vs dynamic balance, weight shifting, gross motor development

16. Hippotherapy Principles Motivational – Horse as a movement tool is very powerful and motivational to children – Has potential to be more exciting than therapy in a standard clinic- seems more like play than therapy – Often more motivated to participate – Development of relationship with horse, therapy team Movement of the horse cannot be duplicated by any piece of equipment

17. Turning Therapy into Function Model of Therapy- International Classification of Function (ICF) – Impairment- body and systems level – Functional Limitation- activity level – Participation Restriction- community participation level

18. Explanation of ICF ImpairmentBody and systems levelWeak abdominal muscles/ poor trunk control Functional LimitationActivity levelPoor sitting balance/ unable to sit for more than 10 seconds unassisted Participation RestrictionCommunity participation level Unable to sit with peers during circle time at school

19. Turning Therapy into Function Example of therapy goal: – “Johnny will be able to sit in ring position on the floor for 3 minutes independently on 4/5 trials to enable him to participate in circle time with his classmates.” How can we use the movement of the horse to address this?

20. Turning Therapy into Function Answer: – Can use movement of the horse to work on trunk control and static balance Alterations in pace- lengthening and shortening of stride Halt-walks Schooling figures: large and small circles, serpentines, reverses – Importance of trunk control for stability and function- “it’s all about the middle” Proximal vs. distal stability

21. Let’s try another… ImpairmentBody and systems levelWeak leg muscles, poor coordination skills Functional LimitationActivity LevelUnable to walk up/down stairs without handrail, unable to climb up/down from couch Participation RestrictionCommunity participation level Unable to walk up/down steps to playground equipment or climb up/down equipment to play with peers

22. Turning Therapy into Function Example of Therapy Goal – “Sophie will walk up and down 3 steps to slide with SBA on 3/5 trials to enable her to play with her peers on the playground.” How can we use the movement of the horse to address this?

23. Turning Therapy into Function Answer: – Many functional activities can be practiced in combination with the horse’s movement, making the activity dynamic and challenging Movement transitions while the horse is moving Completing sit to stand transitions while the horse is moving Balancing in challenging weight-bearing positions while the horse is moving

24. Visual Demonstraton Disclaimer on terminology

25. Question and Answers