Introduction

Hello and welcome to this blog presentation. My name is Jaimee Martens and I am an Occupational therapy student completing my final year of the Bachelor of Occupational Therapy Degree. This blog will provide a professional development opportunity for you the reader, my peers and potential colleagues. It will also present an aspect of my learning and which I am passionate about.

The topic that this blog will cover is :

 The benefits of hippotherapy for children with cerebral palsy and how hippotherapy can be used in occupational therapy.

 This blog intends to explore the benefits that hippotherapy has for children with cerebral palsy. Hippotherapy can be used in occupational therapy as an intervention and this will be explored in my blog.

 This marks the start of my expedition through making a blog that focuses on hippotherapy and the positive effects that a horse can have on someone with cerebral palsy.  Having been an avid horse lover all my life and now being a keen rider for many years, I wanted to learn and explore more in depth what potentially a horse can do to help others. I remember hearing through the years about hippotherapy and horses having a positive effect on people with disabilities, so now is the time to find out more! I have not personally seen an occupational therapist using this type of therapy but have experienced how a horse can help someone heal and lift your spirits when you are feeling low.

 

Objectives within this blog:

·         Blog entry Two: Definitions

·         Blog entry Three: History of hippotherapy

·         Blog entry Four: Evidence & Research

·         Blog entry Five: Crux of occupational therapy practice

·         Blog entry Six: My professional development & reflection

Blog Entry Two – Definitions and meanings

Blog Entry Two – Definitions and meanings

What is hippotherapy

Therapeutic Riding: is a term that has been used for many years to encompass the variety of equine activities in which people with disabilities participate. Though still commonly used, this ‘umbrella’ term has caused confusion among the medical community. When the therapist utilizes the movement of the horse as a treatment strategy to improve neuromuscular function, it is important to consistently use the correct terminology and refer to it as “hippotherapy”. (American Hippotherapy Association, 2010)

Hippotherapist: People conducting hippotherapy sessions are physical, occupational or speech therapists. Hippotherapy is merely a treatment strategy used by these skilled practitioners to achieve functional outcomes. (American Hippotherapy Association, 2010)

Hippotherapy: Hippotherapy is a physical, occupational, or speech and language therapy treatment strategy that utilizes equine movement. Hippotherapy literally means “treatment with the help of the horse” from the Greek word, “hippos” meaning horse. Specially trained physical and occupational therapists use this treatment for clients with movement dysfunction. In Hippotherapy, the horse influences the client rather than the client controlling the horse. The client is positioned on the horse and actively responds to his movement. The therapist directs the movement of the horse; analyses the client’s responses; and adjusts the treatment accordingly. This strategy is used as part of an integrated treatment program to achieve functional outcomes. (American Hippotherapy Association, 2010)

Horse Handler: The person in charge of the handling of the hippotherapy horse during the treatment session. This person should have extra training in handling horses specifically for hippotherapy.

Reference

American Hippotherapy Association (2010). Hippotherapy as a treatment strategy. Retrieved from http://www.americanhippotherapyassociation.org/hippotherapy/hippotherapy-as-a-treatment-strategy/

Blog post 3 – History of Hippotherapy

The therapeutic value of riding horses has been known since the days of ancient Greece. Hippocrates was the first to describe the therapeutic benefits of horseback riding, calling it a universal exercise with a ‘‘healing rhythm’’. The value of horseback riding for the rehabilitation of persons with physical disabilities has been recognized since 1875 when Chassaignac, a physiotherapist, noted that as a result of the riding experience, the rider’s balance was improved, muscles were strengthened, joints became more supple, and there was a marked improvement in the rider’s morale. More recently, in the 1960s, therapeutic riding centres emerged throughout Europe, Canada, and the United States.

 

Classic Hippotherapy vs. Modern hippotherapy

This therapy reflects the German model that has been practiced throughout Europe since the 1960s. Classic hippotherapy is performed with 1 rider (the patient) and at least1 therapist (a physiotherapist, occupational therapist, or a speech–language therapist) and a horse. “The therapist uses the three-dimensional movement of the horses back as an apparatus to manipulate the passive body of the patient. The treatment consists entirely of the horse’s movement and the patient’s response to this movement. The patient may be positioned astride the horse in different positions such as facing forward or backward, or lying prone or supine. This therapy, based on the positive effect of the horse’s movement on the person, is beneficial for the rehabilitation of neuromuscular” (Grandos & Ferna’andez Agi, 2011, pg. 192).

Present-day hippotherapy is a treatment approach that uses the movement of the horse as in classic hippotherapy, but with the added component of psychological intervention. Modern hippotherapy is used to achieve physical, psychological, cognitive, social, behavioural, and educational goals. It represents a multidisciplinary form of treatment that can be applied by a physiotherapist, occupational therapist or psychologist. This treatment approach uses activities with a horse to address the specific needs of a patient. “The American Hippotherapy Association, the largest hippotherapy association in the world, defines hippotherapy as a physical, occupational, and speech therapy treatment strategy that utilizes equine movement. It is referred to as a ‘‘passive’’ type of riding, in which the horse moves the rider” (Grandos & Ferna’andez Agi, 2011, pg. 192). The gait of a horse has been shown to resemble that of the human walking, so by sitting on the walking horse, riders can go through the motions of walking without placing any weight on their legs. Modern hippotherapy is not only used for physical rehabilitation.

 You tube clip – Hippotherapy activities -

References:

Granados, A. C., & Ferna’andez Agi, I. (2011). Why Children With Special Needs Feel Better with Hippotherapy Sessions: A Conceptual Review. The Journal of alternative and complementary medicine. 17 (3), 191-197. Doi: 10.1089/acm.2009.0229

Tenaglia, K. (2010). Hippotherapy activities.  Retrieved from http://health.uml.edu/thc/HealthIssues/Hippotherapy/Hippotherapy_Website.html

Blog 4 – Evidence and Research

There is a significant quantity of research evidence to support that the positive relationship between hippotherapy and well-being and that it is intertwined. The strength of the effect of hippotherapy on ones’ health is dependent on the relationship between the person, environment and occupation. There are numerous articles on the journal databases supporting the use of hippotherapy with children with cerebral palsy. I chose to look at 5 specific articles which supported using hippotherapy for children with cerebral palsy.  The results are quite similar between these chosen articles and all recommend hippotherapy as a tool to helping improve these children’s quality of life.

A conceptual reviews conclusion is that “Hippotherapy, by affecting multiple systems such as the sensory, muscular, skeletal, limbic, vestibular, and ocular systems simultaneously, leads to psychological, social, and educational benefits that will be evidenced in behavioural patterns used in other environments” ” (Grandos & Ferna’andez Agi, 2011, pg. 191).. Not only does hippotherapy target movement it also benefits the children psychologically and socially and this then helps the children education as they are more likely to be able to participate like the other children.

“Hippotherapy also helps children with cerebral palsy reduce their anterior and posterior head rotation and translation. This suggests that hippotherapy helps increase the child’s stability of the head and trunk in response to perturbations at the pelvis”( Shurtleff & Engsberg, 2010, Pg. 150). These findings show that using hippotherapy will benefit these children as they will have better head and trunk stability and will be able to have a better posture and stronger muscles then if they hadn’t had hippotherapy intervention.

 There is little evidence from the users’ perspective however I found the first qualitative study that looks at the benefits from the users’ perspective, it is important to look at the person experience and their opinions. “The main effects of hippotherapy, as identified by users and parents, are normalisation of muscle tone, improved trunk control, improved walking ability, carry over effects of hippotherapy to activities of daily living, and increased self-efficacy, confidence, and self-esteem. This study provided unique and new insights into the context in which hippotherapy happens, as well as its effects on impairment, activity, participation, and quality of life in people with cerebral palsy” (Debuse, Gibb & Chandler, 2009. Pg. 174).

 “Hippotherapy is proven to significantly improve symmetry of muscle activity compared to cerebral palsy children that were not subjected to hippotherapy. Postural control and balance were also improved during hippotherapy” (Zadnikkar & Kastrin, 2011, pg. 684). As occupational therapists we know that having a child with cerebral palsy, they struggle with postural control and balance. If we can help these children by them participating in hippotherapy it will help them in the long run and influence functioning in activities of daily life and improve quality of life in children with cerebral palsy.

Overall I believe there are a lot of benefits of hippotherapy for children with cerebral palsy. I believe that hippotherapy is an important step in helping children with cerebral palsy. As an occupational therapy student I believe that hippotherapy would be great to be used in occupational therapy, it would be something that a lot of children love and at the same time the child is improving in a range of ways. Horses are amazing animals and can make the world of difference for people by incorporating them into our interventions.

Benefits

· Physical abilities: Muscle tone, balance, coordination, muscle strength, flexibility, fitness, posture, gait (ability to walk), respiration, circulation, metabolism, sensory perception and integration, independence: self-care and mobility.

· Psychological abilities: Concentration, problem solving and decision making, insight, motivation, self-esteem, confidence, learning/practicing concepts e.g. letters, numbers, colours, distances, shapes etc.

· Social abilities: Communication and social skills, learning appropriate behaviour and manners, interaction with peers: individuals and groups, human/animal contact and bonding, building relationships, consideration for others and taking on responsibility.

· Recreational/sport/vocational abilities: Equestrian skills and horse management, develop interests, broaden experiences, challenge and success in competition with self and others, stimulation and/or relaxation, integration and community participation, work experience.

YouTube clip about benefits using real patients

 

References

Debuse, D., Gibb, C., & Chandler, C. (2009). Effects of hippotherapy on people with cerebral palsy from the users’ perspective: A qualitative study. Physiotherapy Theory and Practice. 25(3):174–192. doi: 10.1080/09593980902776662

Granados, A. C., & Ferna’andez Agi, I. (2011). Why Children With Special Needs Feel Better with Hippotherapy Sessions: A Conceptual Review. The Journal of Alternative and Complementary Medicine. 17 (3), 191-197. Doi: 10.1089/acm.2009.0229

Love to know autism. (2013). Hippotherapy. Retrieved from http://autism.lovetoknow.com/Hippotherapy
Shurtleff, T. L., & Engsberg, J. R. (2010). Changes in Trunk and Head Stability in Children with Cerebral Palsy after Hippotherapy:A Pilot Study. Physical & Occupational Therapy in Paediatrics. 30(2). doi: 10.3109/01942630903517223

Zadnikkar, M., & Kastrin, A. (2011).Effects of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: a meta-analysis.. Developmental Medicine & Child Neurology. Pg. 683-691.doi: 10.1111/j.1469-8749.2011.03951.x

Blog Entry Five – Essense of Occupational Therapy

It took me a while to understand how hippotherapy could be linked with occupational therapy. I had always thought that the Riding for disabled was classified as hippotherapy, however was shocked recently to find out that actually it is not hippotherapy but “equine assisted therapy”.

When doing research I was able to find that New Zealand only has ONE qualified hippotherapy team which is in Auckland. Totara Park uses hippotherapy due to the fact they have a physiotherapist on their team to help guide the programme. The reason for the lack of hippotherapy in New Zealand is due to the cost. To use hippotherapy, you need to send 2 people to attend a NZRDA hippotherapy course and to pass the unit standards to goes with in. You must have a therapist (occupational therapist, physiotherapist, speech and language therapist) and a horse handler to attend this course.

The RDA relies on volunteers to help with their programmes and thus funding is limited, this could be a factor in why hippotherapy is not wide range around NZ. The other factor that was raised by people I spoke to was the fact that occupational therapists are not aware of the benefits that horses bring. This can only improve with education and more research articles outlining the fact that occupational therapist can have a role in using hippotherapy

Here is the link to Totara park RDA  - http://www.totaraparkrda.org.nz

Occupational therapists role in Hippotherapy

 The occupational therapist is able to combine the effects of the equine movement with other standard intervention strategies for working on fine motor control, sensory integration, feeding skills, attentional skills, and functional daily living skills in a progressively challenging manner.

What is the difference between hippotherapy and therapeutic riding?

Hippotherapy is completed by a trained therapist (occupational therapist, physiotherapist or speech language therapist), in conjunction with a horse handler and a trained therapy horse. Hippotherapy is a one-on-one treatment and generally occurs year-round until the client meets discharge criteria. The goal of Hippotherapy is for professional treatment to improve functioning in cognition, body movement, and organization and attention levels. In hippotherapy the horse  is influencing the patient.  Therapeutic riding is recreational horseback riding lessons adapted to individuals with disabilities.  It is completed by horse riding instructor in conjunction with volunteers. In Therapeutic riding, individual is often taught riding lessons in a group format, which runs in "sessions". The instructor must respond to the group as a whole, in addition to fostering individual success. The rider influences the horse.

Blog entry Six: My professional development & reflection

Wow, what a lot of learning has gone on since I first started this blog. When I first started hippotherapy did not have much of a meaning to me, nor did I really know the full extent of how amazing this therapy is. My opinion of hippotherapy was that it was still an emerging therapy and I was quite sure that there isn’t much research out there to back up how wonderful it was. I have totally been proven wrong, the amount of articles I have come across that agree that hippotherapy has a place for people with cerebral palsy is wonderful. I had fairly limited insight in to cerebral palsy and the effects it can have on a child's life. It has been such an insightful experience and so encouraging discovering such a wide range of resources that are available and how many support groups, blog's, websites, videos etc. that are being shared among parents, professionals, and carers to improve and support children and families. Although hippotherapy in New Zealand is not widespread, with only one qualified team in NZ using hippotherapy, I think with time and education it will become more popular and used by occupational therapists.

Just remember “Horses put the FUN back into FUNction !!”


Reference :
Copyblogger.com. (2013). Critical thinking. Retrieved from http://www.copyblogger.com/critical-thinking/