North Fraser Therapeutic Riding Association

Transcription

1 North Fraser Therapeutic Riding Association PO Box Meadowvale Shopping Centre, Pitt Meadows, BC V3Y 2G website: NFTRA RIDER PACKAGE Welcome to the North Fraser Therapeutic Riding Association and thank you for your interest in our programs. NFTRA is a non-profit charitable organization enriching the lives of children and adults who experience physical, mental, emotional or social challenges by providing safe and professional therapeutic equine programming. We offer four sessions of approximately 7-13 weeks each year in the winter, spring, summer and fall. There are over 100 riders receiving therapy each week from our 10 equine therapists. Our lessons are conducted by certified instructors using the time and talents of over 100 volunteers per week. Most lessons are minutes in duration with group and private lessons. Lessons run Monday through to Saturday. The minimum age of a rider is three years old. We offer both mounted and unmounted therapeutic lessons. Step One: Have the Physician s Referral forms completed by the interested rider s physician. Ensure they read through the list of guidelines/contraindications while completing the referral. Step Three: Complete the Rider Contact Form Step Four: Mail or drop off the fully completed Rider Package to the NFTRA Office. Once your Rider Package has been processed our Program Coordinator will contact you to set up a Rider Assessment. After the Assessment is completed we will discuss scheduling options and work towards placing your rider into the program programs@nftra.ca Mailing NFTRA PO Box Meadowvale Shopping Center Pitt Meadows, BC V3Y 2G7 Physical NFTRA Office (use 2 nd driveway) Park Lane Maple Ridge, BC *Do not send mail to this address

2 - 2 - Funding Information for Riders FAQ: How much does Therapeutic Riding cost? Our therapeutic riding lesson fees are highly subsidized by government funding through BC Gaming and private and corporate donations along with annual fundraising events like our horse show and pub nights. Without the support of the community we would not be able to provide this valuable service. The weekly lesson fee paid by riders reflects 33% of the actual costs of offering these therapeutic services. FAQ: How do I pay? Riders are billed (invoices are ed) before the start of the session. Payment is due at the first lesson. We accept cheques, cash and e-transfers (send e-tranfers to manager@nftra.ca). Autism Funding: For riders who would like to use their Autism Funding, please state this under the Billing portion of the Rider Information Form. Once the rider is placed into the program NFTRA will provide you with an Estimate which is for you to refer to when submitting your Request to Pay (therapeutic riding is classified under Specialized Therapeutic Activities and is billed out at $80 per hour or $40 per half hour). The parent is responsible to ensure their Autism Funding is current & available. Once approved, NFTRA will receive a copy of the authorization letter by mail. At Home Program Funding: For riders who would like to use their At Home Program Funding, please state this under the Billing portion of the Rider Information Form. As we have the option to bill under OT and/or PT, please stipulate which therapy you would like us to use. Once the rider is placed into the program NFTRA will apply to the At Home Program on your behalf for coverage of therapeutic riding (therapeutic riding is billed out at $80 per hour or $40 per half hour). You will receive a copy of the authorization letter by mail, as will NFTRA. Riders choosing to use Autism or At Home Program Funding are subject to a *refundable $200 rider deposit upon registration with NFTRA. This deposit covers the cost of any missed lessons, as we cannot bill missed lessons to the government. *If a rider misses a lesson $40 is deducted from their deposit and they are asked to top up the deposit before the start of each new riding session. If the rider leaves the program we will refund the deposit (less any missed lessons for the current riding session). If a rider never misses a lesson the $200 deposit remains and carries on into each riding session. Other Funding Providers: We work with many different funding providers such at Variety, CKNW Orphans Fund, Lions, Kiwanis, and various schools and school districts. If you have funding available and would like to use it for therapeutic riding please write this under the Billing portion of the Rider Information Form and we will work with you to ensure all the paperwork and authorizations are completed. Our lessons are billed out at $80 per hour or $40 per half hour. Private Pay and Private Funded Riders: Full payment for the riding session (and any outstanding fees) is required before the session starts. Make cheques payable to NFTRA, dishonored cheques will be subject to a $50.00 penalty.

3 - 3 - NFTRA RIDER CONTACT/INFORMATION FORM (PLEASE PRINT CLEARLY) RIDERS NAME: City: Birth date: Diagnosis: MOTHER S NAME: address: FATHER S NAME: address: Postal Code: Cell or Work: Cell or Work: DOCTOR S NAME: Phone number: ASSOCIATION/ GROUP HOME NAME: Care worker/contact: EMERGENCY CONTACT ( Other than above) Name: Cell or Work: Name: City: BILLING & FUNDING INFORMATION Postal Code: PLEASE INFORM US OF ANY CHANGES IMMEDIATELY.

4 - 4 - GUIDELINES FOR PHYSICIANS/THERAPISTS CONTRAINDICATIONS AND PRECAUTIONS FOR THERAPEUTIC RIDING The following condition may represent precautions or contraindications to therapeutic horseback riding if present in potential riders. Therefore, when completing the physician s referral, please note whether these conditions are present and to what degree. Absolute Contraindications: Any of which would prevent your rider from participating in our program 1. Other: Age less than 3 years old Weight over 170lbs (mounted program) Inability to sit up without full support Any condition that the instructor, therapist, physician or program does not feel comfortable treating 2. Orthopedic: Acute arthritis Acute herniated or prolapsed disc Atlanto-axial instabilities Coax arthrosis (degeneration of hip joint) Structural cranial deficits Osteogenesis imperfecta Pathological fractures Spondylothesis Structural scoliosis > 30 degrees, excessive kyphosis or lordosis or hemivertebra Spinal stenosis 3. Neurological: CVA 2 nd to unclipped aneurysm or angioma Paralysis due to spinal cord injury above T6 (adult) Spina bifida associations Chiari II Malformation, Hydromyelia, Tethered Cord Uncontrolled (grand mal) seizures within last 6 months Epilepsy / Seizures please indicate frequency and when the last seizure took place. What medications the rider takes that control seizures. The rider MUST BE free of l generalized seizures for six months prior to getting on a horse or under the strict guidelines of the rider s attending physician 4. Medical/Psychological: Anticoagulants Relative contraindications and precautions: 1. Orthopedic: Arthrogryposis Heterotrophic ossification Hip subluxation, dislocation or dysphasia Osteoporosis Spinal fusion/fixation, Harrington Rods (within 2 years of surgery) Spinal instabilities

5 Spinal orthoses Neurological: Neuromuscular disorders Amyotrophic, Lateral Sclerosis, Fibromyalgia, Gullian Barre, exacerbation of Multiple Sclerosis, Post Polio Syndrome Hydrocephalic shunt 3. Medical/Psychological: Abusive or disruptive behavior Cancer Hemophilia History of skin breakdown or skin grafts Abnormal fatigue Incontinence (must wear protection) Peripheral vascular disease Sensory deficits Serious heart condition or hypertension Significant allergies Surgery within the last three months Uncontrolled diabetes Indwelling catheter Substance abuse Flexion/Extension X-Ray required for Atraumatic Factors that may be associated with an unstable upper cervical spine: Os odontoidum Downs Syndrome (X-ray required at age 5 or older prior to being assessed) Athetoid cerebral palsy Rheumatoid arthritis of cervical vertebrae Congenital torticollis Sprengel deformity Ankylosing spondylitis Congenital atlanto-occipital instability Klippel-Feil syndrome Chiari malformation with condylar hydroplasia Fusion of C2 and C3 Lateral mass degeneration change at C1 C2 Systemic lupus Marquio disease Non-rheumatoid cranial settling Subluxation of upper cervical vertebra due to tumors or infections Idiopathic laxity of the ligaments Gruel s syndrome Lesch-Nyhan syndrome Marshall-Smith syndrome Diffuse idiopathic hyperostosis Congenital chondrodysplasia

6 - 6 - Updated May 2017 PHYSICIAN S REFERRAL FORM (Please print clearly) Name of Rider: Weight (in pounds): (Please weigh rider) Date of Birth and Age: Height (feet/inches): Diagnosis/Disability: Date of Onset: How often should this form be updated/date?* Annually Every 3 Years Every 5 Years (PLEASE CHECK OFF THE APPLICABLE TIME FRAME) *If no time frame is specified, we will assume it should be updated ANNUALLY* YES/NO COMMENTS ABNORMAL/NORMAL IMPAIRMENTS Auditory Impairments Speech Impairments Visual Impairments Circulatory Impairments Sensation Incontinence - Bladder Incontinence Bowel Assistive Devices Psychological or Behavior Concerns Spinal/Joint Abnormalities Spinal Support rods (i.e. Herrington or other) Scoliosis Degree Hip Sublaxation or Dislocation Co-ordination in lower Extremities: Muscle Tone Arms: Muscle Tone Legs: Muscle Tone Trunk/Legs Balance static sitting Balance dynamic sitting Seizures (grand/petit/date) Medication/s please list Medication/s Side Effects

7 Relevant Surgeries/Dates IMPAIRMENTS Tetanus Vaccine/Date Allergies YES/NO ABNORMAL/NORMAL COMMENTS Downs Syndrome & Rheumatoid Cervical Spine X-Rays (Sub-occipital & Atlanto/Axial Joints (Year) Flexion/Extension X-Rays Required/Year When applicable, please include a copy of cervical spine or flexion/extension X-ray report Precautions (if yes please indicate): Comments: In my opinion, this patient can receive riding lessons under proper instruction. I understand that this patient may receive assessment/treatment by a volunteer physiotherapist, occupational therapist or psychologist in conjunction with this riding program regarding his/her physical and/or behavioral abilities/limitation/s in performing with the program. Date: Physician s Signature: Physician s Stamp:

8 - 8 - Seizure Detail Form to Be Filled Out By Physician Patient Name: Please Indicate Type of Seizure(s): Typical Aura (pre-seizure sensations or behaviors): Typical Motor Activity During Seizures: Post-Seizure Behavior and Duration: Average Duration of Seizures: Current Frequency of Seizures, Including Date of Last Known Seizure: (Print Name) (Physician Signature) (Date)