An Introduction to Occupational Therapy, Physical Therapy, and Speech-Language Pathology Incorporating Hippotherapy in Clinical Practice Provided by the American Hippotherapy Association, Inc. www.americanhippotherapyassociation.org
Outline Objectives Description of hippotherapy Why the horse? o Purposeful manipulation of equine movement o Afffordances of the equine environment Indications for utilization of hippotherapy as a treatment strategy Principles by discipline Evidence-based practice Therapy vs adaptive riding Who is AHA, Inc.? How do I get involved?
Objectives Upon viewing this presentation, the medical professional will be able to: Identify how occupational therapy, physical therapy, and speechlanguage pathology professionals utilize hippotherapy in the context of their clinical practice Understand why the purposeful manipulation of equine movement is the driving force for functional change in individuals who receive hippotherapy as a part of their overall plan of care Verbalize the difference between therapy and adaptive riding, and make a recommendation for the most appropriate model for their patient Identify where to receive more information to further their education, or how to obtain certification through the American Hippotherapy Certification Board (AHCB)
Description of Hippotherapy 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 the sensory, motor, and cognitive systems to achieve functional outcomes. In conjunction with the affordances of the equine environment and other treatment strategies, hippotherapy is part of a patient s integrated plan of care.
Why the horse? Horses used in a therapy setting have received substantial specialized training in order to provide the symmetry, selfcarriage, and straightness needed to optimize the movement quality transmitted to the patient. The movement of the horse is multidimensional and provides systems-wide impact on human neurophysiology. The horse s movement is rhythmic, low amplitude, consistent, and can be sustained over time. Dynamic movement of the horse combined with the dynamic environment leads to functional change.
Why the horse? Multi-dimensional movement o Movement of horse s pelvis is tri-planar; mirrors the same 3 movement planes as the human pelvis: anterior-posterior, lateral, rotational. o Provides stimulation of what a normal gait pattern should feel like. o Movement of the horse cannot be duplicated by any piece of equipment. Rhythm o The movement of the horse is consistent and predictable, just as human walking is. Repetitive o Number of steps or movement challenges during a typical treatment session is in excess of 2,000 repetitions. o Allows patient ample opportunity to practice and refine balance responses, leading to improvements in core stabilization and postural control.
Purposeful Manipulation of Equine Movement The therapist can modify the movement of the equine to appropriately stimulate/challenge their patient: o Impulsion, tempo, and speed: engagement of the horse s hind legs, how fast they walk, and how many steps they take o Changes in direction: reverses, circles, serpentines, figure-8s o Transitions: from one gait to another, acceleration/deceleration, start-stops The therapist can also modify the position of the patient on the horse to change how the movement influences them: forward-facing, rear -facing, side-sitting, prone, or supine
Affordances of the Equine Environment Takes into consideration other aspects of this setting, which include the social interaction with the horse and other provided supports/interactions from other children and adults Creates a key environment for developing a variety of relationships Creates a unique setting that incorporates the benefits of a more natural environment with novel sensory and motivating experiences for development of functional skills
Indications for Utilization of Hippotherapy as a Treatment Strategy By presentation: Impaired muscle tone Impaired range of motion Impaired postural alignment Impaired dynamic postural control Impaired communication Impaired sensorimotor function Impaired mobility Impaired coordination Impaired cognitive function By diagnosis: Developmental delay Cerebral palsy Autism spectrum disorder Brain injury Sensory processing disorders Functional curvature of the spine Neuromuscular dysfunction Genetic syndromes Dyspraxia Developmental coordination disorder These lists are a sample of impairments/diagnoses which may benefit and are not all-inclusive.
Occupational Therapy Principles The horse provides an engaging platform for healing and the movement of the horse impacts the whole person, providing input that the therapist can alter to physical, sensory, cognitive, and emotional systems. Occupational therapists can incorporate the horse into treatment using movement, ground activities, and relationships with the horse to address functional goals. Sensory input from equine movement stimulates the limbic system, particularly vision, proprioception, vestibular, and olfactory. This system is also involved with emotions. Activation of postural control mechanisms influences arousal.
Physical Therapy Principles Development of balance and postural control o Patients can improve their core stability by working to maintain midline position on the horse with movement challenges o Improvements are seen in postural tone as patients use their muscles to maintain an upright position on the moving surface o Spontaneous postural adjustments due to the manipulation of equine movement in linear dimension and speeds Influence on musculoskeletal function o Movement of the horse influences movement of the pelvis and spine in a multi-dimensional pattern; it is rhythmic and symmetrical, and allows for many repetitions in a single session o Positioning on the horse can address range of motion, postural control, and skeletal alignment
Speech and Language Therapy Principles Influence of postural mechanisms affecting speech o Equine movement facilitates improvements in postural alignment and control, which are integral for coordination and timing of sufficient respiratory support, speech production, and vocal control Influence on cognitive and linguistic function o Equine movement provides repetitive, multi-system sensory stimulation that is graded and precise. o This helps with the development or regulation of: More normalized arousal states, attentional focus, and communication (expressive, receptive, pragmatic, and higher-level language skills) Well-integrated tactile and proprioceptive systems Well-integrated vestibular system o Efficient speech and language production is dependent on the proper function of each of the above systems
Evidence-Based Practice Hippotherapy has been recognized as scope of practice by the American Occupational Therapy Association, the American Physical Therapy Association, and the American Speech and Hearing Association. Research evidence has been published in their peer-reviewed journals. Research exists supporting the use of equine movement as a treatment strategy by physical therapy, occupational therapy, and speech-language pathology professionals, and is ongoing. A bibliography of this research is included on the AHA, Inc. website: http://www.americanhippotherapyassociation.org/resea rch/ AHA, Inc. releases a bi-annual publication, Hippotherapy, which features a variety of high-quality articles related to clinical skills and research in hippotherapy.
Therapy vs Adaptive Riding Adaptive riding is an equineassisted activity with the purpose of contributing positively to the cognitive, physical, emotional, and social well-being of individuals with special needs o Aims include developing horseback riding skills; any gains that occur in functional life skills are a secondary benefit o Riding lessons for individuals who learn differently due to cognitive, communication, or motor differences
Clarification Description Therapy Medical treatment (OT, PT, SLP) utilizing the movement of the horse as a treatment strategy to address functional goals Adaptive Riding Recreational activity providing horseback riding lessons for individuals with special needs Completed by Goals Licensed occupational, physical, or speech therapist Land-based activities and functional skills individualized to the specific needs of the patient Certified adaptive riding instructor Skills associated with riding a horse Setting One-on-one treatment Individual, semi-private, or group lessons Payment Timeline Billable through insurance for partial or full reimbursement Episodes of care model: plan of care individualized to patient, progress is periodically reassessed to determine need for ongoing services Paid by family Can become a lifetime activity
Terminology Therapy Treatment session Patient Horse handler Therapy goals Episode of care; length determined by therapist based on patient s progress toward goals Adaptive Riding Riding lesson Rider Leader Riding goals Riding session; based on calendar of facility, usually 2-3 months
American Hippotherapy Association, Inc. AHA, Inc. mission statement: To promote excellence through education in equine-assisted therapy AHA, Inc. is a professional non-profit membership organization recognized as part of the international community that provides education, facilitates research, and promotes equine-assisted therapy as an effective treatment used to improve quality of life for individuals with disabilities The AHA, Inc. faculty is dedicated to developing, updating, and teaching curriculum to therapists who are interested in expanding their practice to include hippotherapy to address the needs of their patients
American Hippotherapy Association, Inc. Organization roles and responsibilities: Provide educational curriculum based on evidence-based practice Provide networking opportunities for therapists incorporating equine movement in their practice Create standards of care/best practice statements for the use of equine movement in therapy Facilitate research on equine movement in therapy Organize bi-annual conference. Provide education and outreach on the use of equine movement in therapy to the medical community at large Dialogue with insurance providers to increase level of reimbursement for therapy utilizing equine movement
How do I start incorporating hippotherapy? For therapists: Visit the AHA, Inc. website View the educational curriculum to find Level I Treatment Principles available in your area View the Find a Therapist or Find a Facility page to set up an observation of a treatment utilizing hippotherapy www.americanhippotherapyassociation.org
Educational options: Level I and Level II Treatment Principles Courses: Educate therapists on the principles which guide how to incorporate hippotherapy as a treatment strategy in clinical practice; courses must be taken in sequence Connection Courses: Offer additional education on a variety of topics relative to the utilization of hippotherapy in practice, including neuromuscular connections, the sensory system, core control, and business practice Certification options through AHCB: More Information for the Therapist: Career Path AHCB Certified: Entry-level certification, must pass exam as well as meet hourly practice requirements Hippotherapy Clinical Specialist (HPCS): Advanced-level exam, must pass exam and meet hourly practice requirements
How do I get connected with a therapist? For families or medical professionals wanting to make a referral: Visit the AHA, Inc. website View the Find a Therapist or the Find a Facility page to locate a therapist/facility that offers therapy services incorporating hippotherapy in your area Contact local facility to see what documents they require for new patients, including referral information