An Introduction to Occupational Therapy, Physical Therapy, and Speech-Language Pathology Incorporating Hippotherapy in Clinical Practice ...
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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?
AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical Practice
Objectives
Upon viewing this presentation, the medical professional will be able to:
• Identify how occupational therapy, physical therapy, and speech-
language 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)
AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical Practice
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.
AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical Practice
Why the horse?
• Horses used in a therapy setting have
received substantial specialized training
in order to provide the symmetry, self-
carriage, and straightness needed to
optimize the movement quality
transmitted to the patient.
• The movement of the horse is multi-
dimensional 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.
AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical Practice
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.
AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical Practice
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
AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical Practice
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
AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical Practice
Indications for Utilization of
Hippotherapy as a Treatment Strategy
By presentation: By diagnosis:
• Impaired muscle tone • Developmental delay
• Cerebral palsy
• Impaired range of motion
• Autism spectrum disorder
• Impaired postural alignment • Brain injury
• Impaired dynamic postural control • Sensory processing disorders
• Impaired communication • Functional curvature of the spine
• Impaired sensorimotor function • Neuromuscular dysfunction
• Genetic syndromes
• Impaired mobility
• Dyspraxia
• Impaired coordination
• Developmental coordination
• Impaired cognitive function disorder
These lists are a sample of impairments/diagnoses which may benefit
and are not all-inclusive.
AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical Practice
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. AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical Practice
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
AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical PracticeSpeech 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
AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical PracticeEvidence-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. AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical Practice
Therapy vs Adaptive Riding
• Adaptive riding is an equine-
assisted 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
AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical PracticeClarification
Therapy Adaptive Riding
Description Medical treatment (OT, PT, SLP) Recreational activity providing
utilizing the movement of the horse horseback riding lessons for individuals
as a treatment strategy to address with special needs
functional goals
Completed by Licensed occupational, physical, or Certified adaptive riding instructor
speech therapist
Goals Land-based activities and functional Skills associated with riding a horse
skills individualized to the specific
needs of the patient
Setting One-on-one treatment Individual, semi-private, or group
lessons
Payment Billable through insurance for partial Paid by family
or full reimbursement
Timeline Episodes of care model: plan of care Can become a lifetime activity
individualized to patient, progress is
periodically reassessed to determine
need for ongoing services
AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical PracticeTerminology Therapy Adaptive Riding Treatment session Riding lesson Patient Rider Horse handler Leader Therapy goals Riding goals Episode of care; length Riding session; based on calendar determined by therapist based on of facility, usually 2-3 months patient’s progress toward goals AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical Practice
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 AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical Practice
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
AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical PracticeHow 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
AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical PracticeMore Information for the Therapist: Career Path
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:
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
AHA Inc. Copyright 2016. Incorporating Hippotherapy in Clinical PracticeHow 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
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