John Seivert: Hippotherapy, without the hippopotamus
Nope. This article is not about hippopotamuses and physical therapy.
It’s about treatment with the help of a horse “Hippotherapy.” “Hippo” from the Greek word meaning horse, combined with “therapy.”
References to the physical and emotional benefits of horseback riding date back to the 1600s. The medical and equine professionals took notice of therapeutic riding when Liz Hartel, a woman with polio, won the silver medal for dressage in the 1952 Olympic games. It wasn’t long before therapeutic riding was being used for rehabilitation in England and then in North America.
The “Ride to Walk” organization in Lincoln, California began in 1985 with one pony named Freckles and four riders. Dr. Kristine Corn is the founder and director of the Ride to Walk facility since its inception and now has two physical therapists and a support staff of six others to provide three days therapeutic, hippotherapy and independent riding on 10 horses.
The late Barbara Heine from Woodside was the past president of the American Hippotherapy Association, and in her 1995 article “Introduction to Hippotherapy” describes the differences between classic and regular hippotherapy.
Classic hippotherapy began in the 1960s in Europe. It is performed by physical therapists, occupational therapists, or a speech-language pathologist with extensive training in treating patients with a vast array of neurological conditions in children and adults. In classic hippotherapy, it is purely the horse’s movement that influences the client. The client may be positioned astride the horse facing forward, backward, prone, or supine. The client passively interacts with and responds to, the horse’s movement.
Regular hippotherapy, on the other hand, is the treatment approach of using the horse as described with the classic method with the addition of the treatment principles that apply to the particular profession of the therapist providing the service.
The evidence supporting the efficacy of hippotherapy in conjunction with traditional physical therapy has been demonstrated in several disorders. Hippotherapy is used in the treatment of children with cerebral palsy, Down syndrome, muscular dystrophy, emotional and learning disabilities. Common adult diagnoses treated are for multiple sclerosis, brain injuries, and strokes. Hippotherapy and therapeutic horseback riding have been shown to improve coordination, gross motor skills, midline postural control, head control, and coordination.
A 2003 study demonstrated that children and adolescents with spastic quadriplegia showed a definite improvement in trunk flexibility and functional capacity after treatment with hippotherapy.
How it works
When a client with spasticity is facing forwards on horseback, he/she is positioned to inhibit the extensor spasticity of the legs and applies a long stretch of the hip adductors. This position is beneficial in reducing the muscle tone (spasticity) that is usually high in trunk control and postural movement. The movement of the horse generates continuous vestibular inputs causing the client to adjust to these movements constantly. Reactions of corrections and balance are stimulated and thus may lead to increase postural control, aiding the muscles of the trunk and extremities.
While observing Dr. Corn treat several patients, I saw the value of hippotherapy at work. One young man, Jonathon, of 20 years old and in a wheelchair for his cerebral palsy with spasticity had a fantastic transformation in his trunk and head posture once he was on the horse. Jonathon has been attending hippotherapy sessions with Dr. Corn and the staff for 18 years. He was able to turn his head further while on the horse. His improved trunk posture combined with the horses’ movements of walking around the arena created a decrease in his leg and arm spasticity that also allowed him to reach further with his arms.
The weekly sessions have allowed Jonathon to maintain his trunk and extremity flexibility with improved trunk control to sit in his wheelchair, which he is in most of the day, with less tightness and enhanced posture.
Jonathon’s mother told me, “He just beams with excitement for hours after each session,” as she wiped the tears from her eyes.
Another patient I observed, Emma, a young girl of 9, had low tone from cerebral palsy. Her condition was the opposite type of secondary disorder than Jonathon’s. Dr. Corn sat behind Emma on the horse with one hand holding her head up and the other hand holding up her trunk. This girl was elated to be back on the horse doing laps around the arena. Throughout the session, I witnessed her head and neck posture improved as her tone increased with the horses’ movements.
The Ride to Walk program serves the communities of Sacramento and Placer counties. I look forward to the day when Nevada County, a vibrant equine community, has a certified hippotherapy program that can serve these clients with life-long disorders.
While observing Dr. Corn’s interview with Richard Hunt, from K-Love radio, he asked her what motivated her to keep doing this work. Her eyes filled with tears and without words pointed to several of the kids on horseback receiving their treatment sessions of hippotherapy.
“Look at those kids,” she said. “You see the smile on their faces?”
There wasn’t a dry eye in the place. Thanks, Dr. Corn, for providing such an excellent program for these severely involved children with disabilities that can show improvements with the help of hippotherapy.
Visit http://www.ridetowalk.org or call 916-791-2747 for more information on hippotherapy and the Ride to Walk program.
John Seivert is a doctor of physical therapy and he has been practicing for 34 years. He opened Body Logic Physical Therapy in Grass Valley in 2001. He has been educating physical therapists since 1986. Contact him at firstname.lastname@example.org.
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