Read an Excerpt
Special Needs, Special Horses
A Guide to the Benefits of Therapeutic Riding
By Naomi Scott
University of North Texas PressCopyright © 2005 Naomi Scott
All rights reserved.
A fourteen-year-old with cerebral palsy, frail of limb but stout with courage, grips the surcingle handle tightly. His body sways slightly with each stride of his palomino mount as it is led around a large arena. Another volunteer and I walk on either side, holding him firmly on the bareback pad, supporting his thighs, offering smiles and praise.
An instructor follows, closely observing and encouraging, "You're doing great, Brandon. Try to relax. They won't let you fall."
Slowly his muscles, taut beneath my fingers, begin to soften. His fear of the unknown turns to excitement and he grins, then laughs out loud, again and again. He is riding a horse for the first time. To him it's just fun. He doesn't know it is going to spare him the ordeal of surgery.
A five-year-old autistic boy, who does not speak, and barely communicates, gazes vacantly into space as I lead his horse away from the mounting area. After a couple of laps, the child smiles, leans forward, reaches out, and taps his horse on the neck, his way of saying, "Let's trot." We pick up the pace, breeze flicks tousled curls from his forehead, and he laughs, his hand in the air. His instructor has worked for weeks to connect this gesture with trotting, which his smiles and body language show he loves to do.
A breakthrough? Perhaps.
An ancient Greek sage's observation, "The outside of a horse is the best thing for the inside of a man," is more profound than he could have imagined. Equine assisted activities actually improve the quality of life for many physically, mentally, and emotionally challenged. But perhaps the sage did know this. Hippocrates spoke of "riding's healing rhythm."
We cannot know how much people's lives may have been improved from riding, down through the centuries, when a large percentage of the world population made their living from the land with the aid of horses. Many no doubt also rode these wonderful, all-purpose animals, and reaped abundant rewards from it, without realizing the extent of the benefits they were receiving.
The marvelous programs using the motion of a horse as a treatment strategy have been reported to achieve improvements greater than conventional methods of therapy, while providing recreational and social pleasure to children and adults.
Dramatic results have been documented. The most fantastic one I have seen personally is the case of Brandon Barnette, the fourteen-year-old mentioned above, where impending surgery was deemed unnecessary after a few months of regular sessions on a horse.
"Riding aligns the hips, and promotes stability. That's the same thing surgery would do," reports Brandon's mother. Brandon's story appears in chapter sixteen.
Many equally amazing benefits are credited to equine assisted activities, examples of which are related in the profiles presented in this book.
Riding programs afford an opportunity to interact socially, and enter into competition, for those unable to participate in other sports. As contestants rein their horses around the show ring, then reach down to accept a gleaming trophy, medal, or ribbon, the expressions of pride and accomplishment on smiling faces are exactly the same as those you see on your television when an athlete takes the Olympic Gold.
In addition, the recreational nature of riding removes the negative connotation many have toward therapy, particularly for children, or the mentally challenged, who might not understand why they must endure monotonous, perhaps even painful, treatments.
Riding can also facilitate other types of therapy. An example of this is a Parkinson's patient whose rigidity and tightness limited the degree of adjusting his doctor, Ronald Faries, D.C., could do. After a few hippotherapy sessions, the tension relaxed, allowing for expanded treatment. "At first I had to lift him off the table. Now he does push-ups on it," Dr. Faries said.
A psychological plus is that when mounted on a big horse, a rider can look down at his world, instead of up, as those who use a wheelchair must do.
TYPES OF ACTIVITIES
From the Greek word hippos, meaning horse, the term literally means "treatment with the help of a horse," and refers to the use of the horse's movement as a treatment tool to improve neuromuscular function. A true medical intervention, it is administered by licensed Physical Therapists, Occupational Therapists, Speech-Language Pathologists, or assistants, who have received training in the principles of hippotherapy.
The therapeutic qualities of riding are recognized by many medical professionals, including the American Physical Therapy Association and the American Occupational Therapy Association.
The horse's walk provides sensory input through motion, which is variable, rhythmic, and repetitive. The resultant responses in the patient are similar to human movement patterns of the pelvis while walking. The variability of the horse's gait enables the therapist to grade the degree of sensory input to the patient, and then use this movement in combination with other treatment strategies to achieve desired results.
Patients engage in activities on the horse which are enjoyable, and challenging, and they respond enthusiastically to this pleasant experience in a natural setting.
Hippotherapy is generally indicated for children and adults with mild to severe neuromusculoskeletal dysfunction. Resulting conditions which may be modified with hippotherapy are abnormal muscle tone, impaired balance responses, impaired coordination, impaired communication, impaired sensorimotor function, postural asymmetry, poor postural control, decreased mobility, and limbic system issues related to arousal, motivation, and attention. Functional limitations relating to gross motor skills such as sitting, standing, walking; speech and language abilities; and behavioral and cognitive abilities, may be improved with hippotherapy.
Primary medical conditions, which may manifest some or all of the above problems and may be indications for hippotherapy, are cerebral palsy, cerebral vascular accident (stroke), developmental delay, Down syndrome, functional spinal curvature, learning or language disabilities, multiple sclerosis, sensory integrative dysfunction, and traumatic brain injury. However, hippotherapy is not for every patient. Specially trained health professionals must evaluate each potential rider on an individual basis.
A better quality of life has been attained, through hippotherapy or recreational riding, by some with other conditions including amputations, cardiovascular accident, muscular dystrophy, Parkinson's disease, spina bifida, spinal cord injuries, and visual impairments.
2. Equine Facilitated Psychotherapy (EFP)
EFP is a form of experiential psychotherapy that includes, but is not limited to, equine activities such as handling, grooming, lunging, riding, driving, and vaulting. The administering therapist must be an appropriately credentialed mental health professional.
The unique relationship formed with a horse provides the client with opportunities to enhance self-awareness, and re-pattern maladaptive behaviors, feelings, and attitudes.
Isabella (Boo) McDaniel, M.Ed., co-founder of the Equine Facilitated Mental Health Association (EFMHA), wrote: "The definition of therapeutic riding has been expanded and enhanced by including those whose mental health, emotional well-being, and ability to learn have been severely challenged.
"EFMHA members, parents, teachers, therapists, and hospital administrators, are seeing first-hand that self-esteem grows by leaps and bounds once riders experience their own competence on and around a horse. This 'can do' attitude helps develop a sense of worth which is essential to the whole process of rebuilding broken lives."
EFP may be used for people with psychosocial issues and mental health needs that result in any significant variation in cognition, mood, judgment, insight, anxiety level, perception, social skills, communication, behavior, or learning. Examples of this are anxiety, attention deficit hyperactivity disorder, autism, behavioral difficulties, depression, language (receptive or expressive) disorders, major life changes (such as environmental trauma, divorce, grief and loss), mood disorders, personality disorders, post traumatic stress disorder, psychotic disorders, and schizophrenia.
EFP denotes an ongoing therapeutic relationship with clearly established treatment goals and objectives developed by the therapist, in conjunction with the client. It both promotes personal exploration of feelings and behaviors, and allows for clinical interpretation.
Complementing EFP is Equine Facilitated Experiential Learning, which promotes personal exploration of feelings and behaviors in an educational format. It falls under the heading of equine assisted activities, and may be conducted by a NARHA instructor, an educator, or a therapist. The term implies that persons learn about themselves through interaction with their environment, including the people, animals, and situations involved.
EFP, or EFEL, helps clients with specially designed interactive experiences, which may promote psychosocial healing and growth through the following: improving self-esteem and self-awareness, developing trust in a safe environment, providing social skills training, encouraging sensory stimulation and integration, combining body awareness exercises with motor planning and verbal communication, developing choice-making and goal-setting skills, developing sequencing and problem-solving skills, encouraging responsibility, and promoting pro-social attitudes through care-giving experiences.
The tools used to strive for these results include the simple hands-on activities of working with a horse, in a natural outdoors environment. Learning to care for the animal — grooming, saddling, riding, feeding — requires following directions, working with a group, sequencing, completing tasks, building skills, having confidence, finishing a project, and trusting adults. At the end of the session, the client can feel that he did things right because the horse responded.
Information about precautions or contraindications to EFP can be obtained from NARHA. Chapter fourteen contains examples of programs for helping troubled youth.
3. Recreational Riding Clients ride under the direction of a trained, certified therapeutic riding instructor, privately or in a group. The objective is to enhance quality of life through physical and emotional stimulation, while learning horsemanship skills.
Although each type of activity has specific procedures and objectives, the fundamentals overlap. The human body and psyche being interwoven, most participants in one category receive some benefits which are generally associated with the others.
Riders with more serious disabilities often start with hippotherapy, then when their strength and balance have improved sufficiently, they progress to recreational riding.CHAPTER 2
The benefits of equine assisted activities (EAA) or therapeutic riding, though numerous and varied, can be grouped into four categories: physical, psychological, functional (cognitive), and educational.
Because a horse's gait closely emulates that of a human, horseback riding gently and rhythmically moves the rider's body in a manner comparable to walking. We all know how important walking is; experts say it is the only exercise we need if it is done consistently.
The most measurable effects from the way a horse's motion moves the body include: greater strength and agility, improved balance and posture, weight-bearing ability, improved circulation, respiration, and metabolism. No other modality mimics the walking gait of a human and stimulates virtually every movement system in the body.
Walking takes more than muscles. It takes balance, a delicate coordination of different parts of the body and brain. Riding a horse allows the brain to practice correct walking movement patterns, giving not only the muscles an opportunity to experience the motion, but also the vestibular system, particularly for a person who moves very little.
Riding also normalizes muscle tone. An animal with smooth, flowing motion relaxes high-toned muscles, while a choppy gait has the opposite effect of increasing tone.
The equine temperature runs four to five degrees higher than a human's; this extra warmth can help reduce spasticity and stretch muscles, particularly in the legs. A bareback pad is often used, especially for hippotherapy, allowing the rider to absorb more warmth and massaging motion from the horse than he would in a saddle of heavy leather.
The benefits gained from merely sitting on a moving horse are augmented by having the client perform simple actions, in both hippotherapy and recreational riding. Stuffed toys are scattered around the arena or outside for children to locate and pick up; a rider is given colorful rings to hang on a peg, or reach for as a sidewalker holds them far enough away to require a good stretch; a rider might hold a baton with both hands, behind his back or over his head, to improve posture and balance. A favorite of the riders is basketball, with the horse positioned as far from the hoop as the rider's ability permits.
Recreation and fun are perhaps the most obvious of the psychological benefits. EAA also causes the release of endorphins. Not only do endorphins produce feelings of emotional well-being, they are also physically healing. Most of the physically challenged do not have the opportunity to engage in other activities which stimulate endorphin release.
Another of the psychological benefits is the empowerment one feels by regaining a sense of control over one's own body. Also, having control of environment — in this case, the horse — promotes feelings of power, both internal and external.
Research indicates that people who have pets are healthier, mentally and physically. This has resulted in the modern practice of taking animals to visit in nursing homes and hospitals — dogs and cats, and, yes, even miniature horses. EAA allows the client to bond with the animal. Social interaction with instructors, therapists, volunteers, other clients, and animals is an important part of the therapy.
FUNCTIONAL, OR COGNITIVE BENEFITS
This includes learning skills to function in the world, like the simple act of reaching above one's head.
1. Sequencing tasks — A single chore (stopping a horse or hanging rings on a peg) for someone with impaired skills can be a series of steps, each done one at a time. Learning to put the steps together in the right order, which often doesn't come naturally, can be helpful in daily life.
2. Hand-eye coordination — For example, approaching the end of the arena the rider sees the rail loom closer and his hands, holding the reins, make the moves that turn the horse. Throwing a basketball into a hoop, or catching a ball, combine hand-eye coordination with balance and stretching.
3. Multi-tasking — Simultaneously, a rider holds the reins in the correct position; squeezes with his legs; sits erect; listens to and follows directions from the instructor; and watches the horse in front of him lest his mount get too close.
4. Sensory integration — In the example above, the rider is actively involved in using three senses at once. The integration must always be active. It cannot be learned in a passive situation such as sitting outside and hearing wind blow, while seeing a dog run, feeling a neck massage, and smelling flowers.
5. Left/right discernment.
6. Spatial orientation (external and internal) — Some have trouble judging distances to objects or other people (external), and sitting in a wheelchair can impair the sense of one's own body (internal). Awareness of body and distance can be taught more easily while the client is on a moving horse.
7. Motor planning — A rider learns to train the muscles to carry out the task at hand. For example, as a horse approaches an obstacle, the rider must lift his hands that hold the reins, move them right or left to guide his mount into the turn, and apply pressure with the appropriate leg to reinforce the command from the reins.
Particularly through game playing, riders learn to identify colors, numbers and shapes, animals, etc. A favorite game is for each participant to be given a slip of paper describing one or more of the toy animals or other objects placed on tree limbs, fence posts, etc. The rider looks for the matching object, guides his mount to it, and reaches to retrieve it. This game involves every functional skill listed above (if the rider is instructed which hand to use), plus stretching and balance.
Excerpted from Special Needs, Special Horses by Naomi Scott. Copyright © 2005 Naomi Scott. Excerpted by permission of University of North Texas Press.
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