An Introduction to Occupational Therapy, Physical Therapy, and ...

An Introduction to Occupational

Therapy, Physical Therapy, and

Speech-Language Pathology

Incorporating Hippotherapy in

Clinical Practice

www.americanhippotherapyassociation.org

Provided by the American Hippotherapy Association, Inc.

Outline

• Objectives

• Description of hippotherapy

• Why the horse?

oPurposeful manipulation of equine movement

oAfffordances 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 find a therapist?

Incorporating Hippotherapy in Clinical Practice AHA Inc. Copyright 2016.

Upon viewing this presentation, the family member 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 movement of the horse can be used as a

therapy tool to help patients achieve functional goals.

• Verbalize the difference between therapy and adaptive riding,

and make a decision on which model is the most appropriate for

their family member.

• Identify resources for how to get a family member involved in

therapy services incorporating hippotherapy as a treatment

strategy.


Objectives

• 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.


Description of Hippotherapy

• Horses used in a therapy setting have received substantial specialized training in order to optimize the movement quality transmitted to the patient.

• The movement of the horse is multi-dimensional and provides simulation of what a normal walking pattern should feel like: it is rhythmic, consistent, and predictable, just as human walking is.

• The movement is repetitive and allows the patient ample opportunity to practice and refine balance responses, leading to improvements in core stabilization and postural control.

• The movement of the horse cannot be duplicated by any piece of equipment.

• Dynamic movement of the horse combined with the dynamic environment leads to functional change.


Why the horse?

• The therapist can modify the movement

of the equine to appropriately

stimulate/challenge their patient:

o Can change the horse’s tempo and

speed

o Can change the direction the horse is

walking

• 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, lying on

back or belly


Purposeful Manipulation of Equine Movement

• 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


Affordances of the Equine Environment

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


Indications for Utilization of Hippotherapy as a Treatment Strategy

These lists are a sample of impairments/diagnoses which may benefit

and are not all-inclusive.

• The focus of occupational therapy is

the use of activity; the horse provides

an engaging platform for healing.

• The movement of the horse impacts the

whole person, providing input that the

therapist can alter to physical, sensory,

cognitive, and emotional systems to

address daily living skills.

• Occupational therapists can incorporate

the horse into treatment through using

movement, ground activities, and

relationships with the horse.


Occupational Therapy Principles

• Development of balance

o Patients can improve their core stability by

working to stay centered on the horse with

movement challenges

o Improvements are seen in posture as patients

use their muscles to maintain an upright

position on the moving surface

• Influence on musculoskeletal function

o Movement of the horse influences movement

of the pelvis and spine in a multi-dimensional

pattern and provides simulation of what a

normal walking pattern should feel like

o Positioning on the horse can help improve

range of motion and posture


Physical Therapy Principles

• Influence of postural mechanisms affecting

speech

o The movement of the horse helps improve

posture and trunk control, which are needed for

coordination and timing of sufficient respiratory

support, speech production, and vocal control

• Influence on cognitive and linguistic function

o The movement of the horse provides repetitive,

multi-system sensory stimulation

o This helps with the development or regulation of:

More normal arousal states

Attentional focus

Communication


Speech and Language Therapy Principles

• 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.


Evidence-Based Practice

http://www.americanhippotherapyassociation.org/research/

• 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


Therapy vs Adaptive Riding

Therapy Adaptive Riding

Description Medical treatment (OT, PT, SLP)utilizing the movement of the horse as a treatment strategy to address functional goals

Recreational activity providing horseback riding lessons for individuals with special needs

Completed by Licensed occupational, physical, or speech therapist

Certified adaptive riding instructor

Goals Land-based activities and functional skills individualized to the specific needs of the patient

Skills associated with riding a horse

Setting One-on-one treatment Individual, semi-private, or group lessons

Payment Billable through insurance for partial or full reimbursement

Paid by family

Timeline Episodes of care model: plan of care individualized to patient, progress is periodically reassessed to determine need for ongoing services

Can become a lifetime activity


Clarification

Therapy Adaptive Riding

Treatment session Riding lesson

Patient Rider

Horse handler Leader

Therapy goals Riding goals

Episode of care; length determined by therapist based on patient’s progress toward goals

Riding session; based on calendar of facility, usually 2-3 months


Terminology

• 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


American Hippotherapy Association, Inc.

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


How do I find a therapist?


What questions do I ask a prospective therapist?

What type of education do you have in hippotherapy in addition to your licensure credentials?

Have you taken an American Hippotherapy Association, Inc. course? Which one(s)?

Do you have additional credentials, such as HPCS or AHCB certified?

Can you present a clear picture of the differences between therapy and adaptive riding?

What elements are in place to ensure safety during a treatment session? Who is involved in the session in addition to the therapist?

How is payment made?

Does the therapist bill the insurance company?

Does the family pay directly and then collect from the insurance company?

Do I need a referral from my doctor?

How do I get started?

Is there an evaluation first?

Does that include assessment on the horse?

An Introduction to Occupational Therapy, Physical Therapy, and ...

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