Hippotherapy and Occupational Therapy
As more and more programs have been established in the United States, the remarkable benefits of Hippotherapy as a therapeutic modality are becoming more and more recognized and more available. The training of an occupational therapist is well suited to help guide these individualized programs. Understanding a child's social, emotional, and physical needs and how to optimally facilitate these areas will increase the effectiveness of these Hippotherapy programs. Because Hippotherapy provides intensive sensory input, understanding sensory integration principles becomes especially important.
Hippotherapy not only addresses social, emotional, and physical aspects of a child's development, but it also provides the opportunity to develop competency and mastery in a recreational activity or competitive sport. Thus, Hippotherapy thereby matches very well with the occupational and sensory integrative frame of references.
Therapeutic Benefits Of Hippotherapy
Sensorimotor foundations for higher skill development in praxis and coordination can be facilitated through Hippotherapy. These skills typically are generalized with improvements seen in daily living skills. Increased competency is also noted in increased independence in individual riding skills.
Physically using a horse as a therapeutic medium is extremely powerful and unique. One of the remarkable aspects of therapeutic horseback riding is that the three-dimensional motion caused by the horse's pelvic movement is very similar to the natural human pelvic movements. As a person rides on a horse, his or her hips will respond to the rhythmic movements of the horses' pelvic movements. The riders experience often for the first time, normal weight shift, trunk elongation, and mobility. Elongation of tight muscles can be achieved through the neutral warmth of the horse's body and the muscle response to the inhibiting rhythmic movement and slow stretch provided during riding. Positioning on the horse can also help facilitate muscle
Relaxation. For example, an individual with Cerebral Palsy can be draped on their stomach over the back of the horse which will provide rhythmic movement, neutral warmth, and inverted position to help decrease tone before assuming a seated position. Improved spinal alignment and mobility have been documented changes resulting from Hippotherapy.
In order for a rider to maintain position on the horse, the rider will automatically use pelvic, leg and abdominal muscles, thus strengthening these muscles. When a rider exercises while seated on a horse, the pelvis is automatically held stable by the horses' body, thereby allowing specific exercises and activities that incorporate rotation and elongation to be very powerfully effective without much cognitive effort by the rider Use of a variety of gaits will provide different types of vestibular input to the rider.
During steady walking, or with an even strided horse, the rider experiences a rhythmic 3‑dimensional rocking movement throughout the trunk which tends to be calming and facilitates visual orientation, attending, and focus. During a trot or fast walk of a jerkier striding horse, proprioceptive input through the trunk and increased vestibular input facilitates increased alertness, balance, and trunk extension and flexion, postural alignment, balance responses, body awareness, and midline.
Changing the physical riding position on the horse will also potentially facilitate postural orientation, midline, weight shift, proprioceptive and vestibular input. For example, having the child weight bear in 4‑point position on the back of the horse while the horse is moving, intensifies proprioceptive and vestibular input as the child works to maintain position on an unstable surface. This very quickly facilitates improved attending and focus, weight shift, postural stability/mobility patterns.
Vestibular processing can definitely be facilitated with this modality. On a fundamental level this modality provides an opportunity for individuals with significant physical challenges to move effortlessly through space for the first time. This may be a very novel experience for some riders with disabilities. Experiencing spatial awareness through space without the stress and strain of trying to make tight and uncooperative muscles work can lay important foundations for improved visual spatial awareness and orientation in space. Hippotherapy can provide a child with very normal movement experiences that he/she may not otherwise experience. Therefore, making sure the child is posturally aligned during riding is of tremendous therapeutic value to enhance appropriate feedback of successful and correct postural stature. Exercises and sensory activities can decrease lordotic posture or sacral sitting.
Facilitation of vestibular functioning can also be achieved through changing the plane of the child's head during specific activities (i.e., lying down on the horse, lying back on the horse, etc.). In addition, changing the horse's gait, integrating abrupt and sudden changes in the horse's direction, incorporating sudden stops and starts with the horse, all add facilitation of proprioceptive and vestibular input within the context of fun and motivating activity.
Facilitating upper extremity range of motion, strengthening, trunk rotation, midline crossing, midline stability and visual orientation can easily be integrated into the exercises and games provided within the therapeutic session. These exercises take on a challenging but very fun and exciting element as the horses' body becomes a significant therapy tool. Upper extremity positioning also influences trunk posture. For example, arm horizontal abduction will increase upper trunk extension and upright trunk posture.
Throughout the riding sessions, a child receives constant tactile and proprioceptive feedback through the physical contact with the horse. However, specific activities and instruction are usually incorporated in these programs, which include grooming and physical stroking and affection with the horse, which enhances tactile processing and emotional bonding.
Beginning stages of bonding and sets the foundation for the reciprocal aspects of true friendship. Children who have had difficulties bonding, many times will feel more comfortable when engaged with a special animal on a regular basis. A relationship begins to establish. It's been found many times that suddenly the child is initiating the care for the horse and attempting to take care of the horse's needs spontaneously as they learn to respect and connect with the animal. This can be a prerequisite to developing social ties with peers and family members.
Because of the emotional connection that develops between the rider and horse, and the comfort that a child can have with a horse that they ride frequently, Hippotherapy can be used to help set up feelings of connectedness and belongingness which can support a child's emotional, social and spiritual development.
Training Necessary ‑for Hippotherapy Programs It is extremely important that a team effort be established if the therapist has limited equestrian skill and background. The therapist needs to have a well-rounded background. Understanding sensory integrative principals and neurodevelopmental techniques is critical. The North American Riding for the Handicapped Association is a good resource for training. (P.O. Box 3350, Denver, CO 50233)
Hippotherapy is a very powerful therapeutic tool which easily fits into sensory integration and occupational frames of reference. It provides a fun and motivating experience which develops physical foundations for higher skill development and can potentially develop into a recreational interest and hobby. It has potential to facilitate physical, emotional, social, and spiritual aspects of human development within a purposeful, motivating activity.
Adapted from article by Nancy Lawton Shirley, O.T.R. Occupational Therapist
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