EquineassistedRehabilitaonfor B · PDF filesongs: Lean on Me, ... movie like, The Black...

Equine-‐assisted Rehabilita1on for Breast Cancer Pa1ents

by Catherine Hand, Advanced Instructor PATH Intl.

_______________ November, 2012

1 Catherine Hand -‐ 2012

The Healing Power of Horses Horses not only smell fear, they smell chemotherapy.

By overcoming their own fear,

and through the strength of their bodies, the steady beat of their hearts, and their deep

breathing,they can help us heal.

Catherine Hand -‐ 2012 2

Purpose

To Demonstrate and Explain Principles

and Methods

of Equine-‐assisted rehabilitaCon

for recovering breast cancer paCents.


Equine Assisted RehabilitaCon for Breast Cancer PaCents Outline

Part I A. AssumpCons B. PreparaCon

C. The Four Principles Part II Methods Part III Timing and Sequencing of Sessions Part IV Bonding Part V PrecauCons


Assump8ons – The Client


1.   The breast cancer patient needs physical and emotional revitalization

2.   Her vital functions have been impaired.

3.   Her self image has been impacted by surgery and treatment.

4.   She is tactilely defensive.

5.   She needs to physically reconnect to her body and to others.

6.   She is seeking an alternative therapy.

7.   She is weakened, and may have trouble breathing and supporting her own weight.

8.   She does not need to know how to ride a horse.

Assump8ons – The Horse 1.  The horse is no taller than 14

hands. 2.  The horse has beauty, is

comfortable, round and can carry 150lbs.

3.  The horse is not in pain and has been trained to stand square on command, and breath in Cme with the equine specialist at the mounCng block or ramp.

4.  The horse is not easily distracted, leads well, and moves rhythmically to music.

6

Catherine Hand -‐ 2012

Assump8ons – Equipment


1.   Padded Vaulting Barrel with handles to practice positions before mounting the horse.

2.   Three step, 3’ high platform, or ramp for ease of mounting.

3.   Thick vaulting pad and surcingle.

4.   Round pen or small arena preferably level.

5.   Sunscreen and insect repellant for people and horse.

6.   Boom box with working CD player - battery operated or power outlet.

7.   Barrel or stand for boom box

8.   Bottled water for all (hydration essential).

9.   Oximeter to measure oxygen and heart rate.

1. Adjustable height VaulCng Barrel 2. Oximeter (available online) PaCent wears oximeter in pouch around her neck. Therapist reads pulse and oxygen saturaCon before and aUer session.

Normal

reading

This patient started with pulse of 125 and oxygen saturation rate of 78%. She wore a portable oxygen tank.

Special Equipment


Patient wears oximeter

(purchase online or at Walmart)

in pouch hanging around

her neck.

Nurse or therapist reads

before exercise

and again after patient

lies on the horse. Before: 125 high heart rate over 78 % low blood oxygen

After 60 seconds lying down on the horse: 92 normal heart rate over 90% blood oxygen

Reading Oximeter Before and AOer


Assump8ons -‐The Environment

1.  Free of spectators, noise or distracCons 2.  Quiet enough to concentrate on music. 3.  Adults only except for trained volunteers. 4.  Separate from/ out of view of other riding

acCviCes. 5.  Ideally under shade of cover if possible for

first sessions. (medicaCons can cause UV hyper-‐sensiCvity)


Prepara8on : Horse and Volunteers The Horse

1.  trained to stand square at mounCng block 2.  trained to accept all body posiCons by

pracCce with able bodied volunteers. Volunteers 1.  experience the posiCons themselves on the

barrel 2.  pracCce dismount assist from the barrel 3.  pracCce posiCons on the horse.


Demonstra8ng Posi8on on the Vaul8ng Barrel


Volunteers Prac8ce Posi8ons on Barrel

Prac8ce posi8ons Prac8ce Dismount


Volunteers Prac8ce Posi8ons on

Horse


Practice Positions on Horse Practice Dismount from Horse

Prepara8on: The Client

1.  The client (whose range of moCon in both arms and legs is constricted), should be introduced to the posiCons first on vaulCng barrel to loosen joints.

2.  Clients may have weak legs or sCff hip joints. To prevent cramping upon mounCng, barrel height should be 56” or less. Steps to the barrel should be at least 18” high.


The Four Principles

1.  Re-‐sensiCzing the Person Through Touch

2. AcCvaCon of the Vagus Nerve 3.  Synchronized Breathing 4. Synchronized Movement to Music


Principle 1. Re-‐sensiCze the person

through touch.


Grooming: the Client 1.  Re-‐sensiCzaCon through touch. 2.  Empowerment – to act, not to be acted upon; to touch,

not to be touched. Grooming: the Horse 1.  DesensiCze the horse, reducing his reacCvity (example: to

possible chemical residue in the client’s skin). 2.  Heighten the horse’s awareness of the client’s energy

level and create an energy field between the two. Grooming InteracCon: Building trust between the two.


Planned and Gradual Touch Principle 1-‐ Method: Planned and gradual touch -‐ Grooming

Touch – On the Ground

Create an energy field between the horse and the client


Client and Horse Overcoming Fear on the Ground

Forming Bond of Trust before Moun8ng


Principle 1. Method Re-sensitize and Stabilize the Client


Two types of touch A. Hand Touch – skin to skin contact (maintains homeostasis

of internal functions)

B. Touch – body to body (in pediatrics: KMC – Kangaroo mother care treatment regulates heart rate and breathing)

Touch Body to Body

Principle 1. -‐ Touch Neurological reorienta8on -‐ posi8on Touch through skin


Principle 1. -‐ Touch Finding the horse’s hips and feeling the skin


Principle 1.

Touch-‐ Full Body Contact Full-‐body contact

between client and horse allows

Vagus Nerve SCmulaCon and

alignment of physical rhythms (breath, heart beat).


Biofeedback

Exchanging heat and energy between horse and client



Full Body Contact

Laying the upper body on the horse

Placing the chest on the contour of the croup

Upper Body Contact Points • Diaphragm

• Vagus Nerve X

• Rib Cage

• Shoulder

• Inner arm

• Cheek

• X


Principle 2. AcCvaCon of the Vagus Nerve

Posi8on of the Vagus Nerve Nexus in the Center of the chest


Func8ons of the Vagus Nerve Automa8cally regulates the stability

(homeostasis) of all the vital internal organs (the “Viscera”)

•  Heart rate •  Respiratory rate •  Body temperature •  Controls inflamma8on •  Metabolism •  Diges8on and elimina8on


Diagram of the Vagus Nerve

Controls Nexus or Plexus in

•  Ears the red •  Nose box in •  Throat center •  Heart of the •  Lungs chest •  Stomach •  Bowel •  Genitals



The Vagus Nerve Controls the Parasympathe8c Nervous System


The Sympathe8c versus the

Parasympathe8c Nervous Systems •  Sympathe8c -‐ controls the Fight/Flight reac8on. It pumps adrenalin, speeds up the heart rate, puts body on high alert in response to fear, danger or shock.

•  Parasympathe8c -‐ regulates the stability of internal organs for rest and healing. Suppresses adrenalin, slows the heart rate and regulates breathing.


Principle 2. Method Vagus Nerve SCmulaCon

Through Body to Body Contact

Vagus Nerve SCmulaCon 1.  Switch to parasympatheCc nervous system 2.  SynchronizaCon of client/horse rate of respiraCon,

heart rate 3.  Release of muscle tension, relaxaCon 4.  Increased Oxygen intake and saturaCon level

33


Principle 3. Synchronized Breathing

The client who is stressed from treatment breathes through the upper chest taking shallow breaths (pan8ng).

Shallow breathing, thoracic or “clavicular” breathing, or chest breathing is the drawing of minimal breath into the lungs, usually by drawing air into the chest area using the intercostal muscles rather than throughout the lungs via the diaphragm. Shallow breathing can result in or be symptomaCc of rapid breathing and hypervenClaCon. It can be caused by anxiety or radiaCon damage to lungs.


The purpose of Synchronized Breathing is to change “Clavicular” shallow breathing to abdominal

breathing in order to bring needed oxygen to the brain and muscles

•  In clavicular breathing or clavicle breathing, air is drawn into the chest by the raising of the shoulders and collarbone (clavicles), and simultaneous contracCng of the abdomen during inhalaCon.

•  This impacts posture (hunching the shoulders) and is symptomaCc of anxiety or illness.


Pressure and release of the Diaphragm 1.Pressing body into the contour of the horse’s back, creates pressure ac8va8ng the nerves on the diaphragm similarly to ac8va8ng of the Vagus nerve in the chest.

2. Pushing back into the upright posiCon, releases this pressure making the diaphragm drop, allowing air to rush deep into the lungs helping to promote abdominal breathing.

3. Relaxing and dropping shoulders, opening the mouth and allowing the air to be expelled from her lungs expels carbon dioxide and toxicity.

4. Energy and euphoria result as the brain receives more oxygen. Energy is enhanced from synchroniza8on with the healthy horse’s breathing rhythm and release of toxins.


Pressure on the Diaphragm

Diaphragm

Croup

contour


Principle 3-‐Method for Synchronized Breathing

•  The horse must breathe for the client to breathe with the horse (unsure horse can hold its breath)

•  Leader must be aware of the horse’s breathing and breathe with the horse to relax him so the sides of his barrel will expand and contract like a bellows so as to be felt by the client.

•  The client’s calves touch the barrel (horse’s rib cage) and move as the horse’s lungs move the rib cage out and in.

•  The client synchronizes her breaths with the movement (expansion and contrac8on of the horse’s sides as it inhales and exhales).


Points of Contact -‐ Lower Body

1.  Calves next to Lungs

2.  Heels next to Heart

3.  Thighs warmed by horse’s back


2.

1.

3.

Synchronized Breathing Through Legs Client feels movement of horse’s breathing through her calves.

It takes about 60 seconds to coordinate. Client strokes haunch as she breathes with the horse.


Expulsion of Breath from the Upright Posi8on

•  Diaphragm drops •  Lungs fill •  Shoulders back •  Blow out toxins •  Drop Shoulders •  Relax •  Sit deeper •  Breath deeper


Relaxed Seat, Shoulders and Euphoria aOer Synchronized Breathing Exercise


The Dismount Effect of Oxygena8on on Equilibrium

Unless port sores exist on the chest making direct contact uncomfortable, the dismount should enable further full body contact. Rather than pushing off and away from the horse, the client is encouraged to lean into the horse as she slides to the ground and to hold that posiCon as she regains her balance on her feet. She has taken in more oxygen and may need a moment to sehle.


The Dismount with Close Contact


Staying close-‐spending a moment with the horse aOer the dismount

Client and Horse Breath Together and Bond 45


Principle 4. Synchronized Movement to Music •  Physical and EmoConal IntegraCon through movement to clients favorite music.

•  Harmonious synchronized group rhythm where client, volunteer team, and horse all move together

•  Client creates an emoConal memory inspired by her music -‐ a visualiza8on to support her through her recovery.

•  Music allows the team to share her emoCon as she gives her pain over to the horse who carries her toward rehabilita8on.


Purpose of Movement

•  It is not necessary to teach independent riding or to move faster than the walk.

•  The objecCve is to loosen the pelvis to move in rhythm with the horse to a specific beat.

•  The client then breathes with that rhythm as her pelvis follows the horse’s movement.


Choice of Music


1.   Music should have 4 beats to correspond to walk

2.   It should not be high pitched, but in the lower tonal range.

3.   Tempo should not be fast, but easy to follow at a slow walk.

4.   Percussion beat is helpful as in for example belly dance music.

5.   New age or meditation, hard rock, heavy metal music may lack a strong enough beat or agitate the horse making group synchronization difficult.

6.   Romantic theme is desirable.

7.   Vocals are ok if the voice is in the lower range. Suggested songs: Lean on Me, Natural Woman, Wind Beneath my Wings, etc.

8.   Big orchestral numbers not recommended unless particularly meaningful to the client (example sound track from a favorite movie like, The Black Stallion).

9.   The horse should be rehearsed with the music to gauge reaction.

Influence of Music on the Horse •  Horses respond to the energy and speed of music. •  Music cues the starts and stops. Assign someone to control the CD player. Instructor cues the music with thumbs up or down. Volume can be decreased to a count of 3 – 4 being whoa to prepare the horse and leader for a smooth halt.

•  Music should not be played during instrucCons or discussion. Do not talk while music is playing. It takes full concentra8on to move in rhythm with music.

•  Power cord to the player is best so failing baeeries don’t interrupt the flow.


Sequence of Riding Posi8ons

1.  Rider holding loose cohon loop rope reins (clipped to halter rings – no bit) giving from the elbow)

2. Rider hands on her hips to feel hip and pelvic movement

3. Rider drops hands to the sides, drops shoulders, lengthens leg and concentrates on abdominal breathing along with the rocking of the pelvis


Sequence of Riding Posi8ons to Music 1. Client holds loose rein

Giving with the elbows and following with the seat to the horse’s pelvic movement


Sequence of Riding Posi8ons to Music 2. Client puts hands on hips.


Client feels the roll of the pelvis with hands on her hips and opens her mouth to breath in rhythm with the movement – shoulders here are still up and tense.

Sequence of Riding Posi8ons to Music

3. Client’s arms hang to the side


Her seat sinks, her legs relax, the horse drops his head and synchronized movement is achieved. The rider can now follow the horse’s movement as

he walks in step to her music.

Client Leads the Horse to Music at the end of the 4th Session

Harmony Client and Horse

After sharing Bodies

Emotion,

Movement

And Music

Are together in a Bubble-

breathing in synchronization

The horse will follow her even if she does not know how to lead a horse.


Leader’s and Side Walker’s Posi8ons Leading to Music is an Art

1.  Leader holds loose lead walking in step alongside horse’s head (not in front dragging or behind pulling – giving the horse room to move his head naturally)

2.  Sidewalkers in step with the leader to reinforce the horse’s rhythm.

3.  All should be stepping forward on the same foot ( right or leO) at the same 8me with the beat.


How does this look done correctly?


How does it look done incorrectly?


Leading Correctly to Music


Incorrect Leading PosiCon

Leader and walkers gehng steps synchronized, but leader throws horse off balance by blocking the horse’s head causing

rider to fall off to the outside


Leader should have a lead line, not lead with the reins 59

Gehng Posi8on Right – Feeling Horse and Music


Part III. Timing and Sequence of Sessions Plan for a 4 week Session

A.   Introductions (assessing client’s limitations and orienting volunteers)

1. First Session: (using oximeter and balance exercises on barrel)

a. Introducing client to the horse

b. Introducing client to the volunteers

c. Introducing client to grooming and

d. Introducing client to barrel exercises.

2. Second Session: Introduce client’s music after grooming and barrel exercises.

a. Mount the horse: 5 minutes lying down on the horse. Total time on horse - 10 minutes including the dismount – no music.

b. Music: Rehearsing the horse (no rider) and team to client’s music

for client to see her music in motion.


Timing and Sequence of Sessions Third and Fourth Sessions

B.   Synchronizing Movement to Music

3.Third Session: In an arena – 25 minutes total

a. Standing still prone exercise – 5 minutes

b. Walking to music mounted - 20 minutes

4. Fourth Session: In an arena - 30 minutes total

a. Standing still prone exercise - 5 minutes

b. Mounted walking to music- posture and breathing – 15 minutes

c. Client leading horse to music (leader assist) – 10 minutes

d. bonding with the horse and sharing with the group

Ongoing Sessions: Include the lying prone portion each time for no more than 5 minutes. Increase riding time for longer stretches for balance and lower body strength


Watching the Sequence online


To watch how to do this on film, go to youtube.com: Breastcancerrehab chanel

http://www.youtube.com/watch?v=3cZF5IIWLlo&feature=share&list=UUrMpL68cf5iZN8bLnnFNLAw

There you can follow the filming in three phases over a 4 week period of all the steps outlined in this presentation.

or see the same videos on website home page

http://www.dreamriderequestriantherapy.com

Part IV. Bonding Can the Horse Touch the Client? If yes, how, how much, and when? 1. If the first principle is for the client to be able to act, not be acted upon, when can the horse express himself? When can the horse touch? 2. How does the horse (who has absorbed so much pain, and accepted such in8mate contact), express what he has shared with the client?


The horse has feelings too!



Bonding after a full session-the horse thanks the client

Bonding

The horse releases tension aOer the session

The horse has accepted our burden and pain, absorbed it, and now in his way, he lets it go. The client should see how he does this to learn from the horse that this too will pass.


Part V. PrecauCons Try to get a physicians release if possible.


Part V. Precau8ons

1.   Severe osteoporosis (can be cause by standard anti-estrogen

hormone drug treatments: examples - Tamoxifen, Anastrozole, Aromatase Inhibitors.

2.   Ambient Temperatures over 80 degrees Fahrenheit (Dehydration: client at risk for heat stroke especially if on high dose anti-estrogens or steroids).

3.   Hip joint cramping at mount (joint weakness can be due to drugs or inactivity – alleviate by practicing on barrel to lubricate joints).

4.   Extreme tactile defensiveness (avoidance of being hugged or touched by others - can be from pain or shame).

5.   Severe PTSD- hyper reactivity – can result in anxiety attack

6.   Impaired vision, dizziness or imbalance due to pain medications or side effect of anti-estrogens.

7.   Open sores from chemo ports in arms or chest or surgical scars not yet healed.

8.   Radiation burns on chest still sensitive to touch.


Why we should do this: Famous horse women who died of breast cancer without the benefit of equine-‐assisted therapy.

Moira C. Harris

Horsewoman, author of over 10 books about horses, and editor of “Horseman’s News,” died of breast cancer in 2009. Her sister sent this picture to Dream Rider in 2010 and made a donation in her memory.


70

Barbara Glasgow,

The grandmother of hippotherapy dies of Breast cancer.

Barbara L. Glasgow, 55, passed away on Saturday morning, May 23rd 2009 in Pocono Medical Center after a long battle with breast cancer.

Called the "grandmother of hippotherapy " by her colleagues, Barbara was instrumental in fostering the creation of the American Hippotherapy Association (AHA) and the furtherance of the use of the horse in treatment by physical, occupational and speech therapists.

She was the recipient of the NARHA James Brady Professional Achievement Award and the perpetual Barbara Glasgow Award for AHA Therapist of the Year.


Breast Cancer is not a Disability, nor is it always terminal.

It can be disabling. One in every eight women will suffer from

this disease.

There is currently no rehabilitation available.

The horse can help.

PATH international can do this.

We can do this. Catherine Hand -‐ 2012 72

Thank You . . . Catherine Hand [email protected]

http://www.dreamriderequestriantherapy.com


EquineassistedRehabilitaonfor B · PDF filesongs: Lean on Me, ... movie like, The Black...

Documents

Transcript of EquineassistedRehabilitaonfor B · PDF filesongs: Lean on Me, ... movie like, The Black...