Hippotherapy

Occupational, Physical, and Speech-Language Pathology Treatment Strategy

What is Hippotherapy?
Hippotherapy is a physical, occupational, and speechlanguage therapy treatment strategy that utilizes equine movement as part of an integrated intervention program to achieve functional outcomes
Common diagnoses include: CP, TBI, stroke, DD, ASD, sensory, and other neuromuscular disorders

Why the horse?

The horse's walk provides sensory input through movement, which is variable, rhythmic, and repetitive. The variability of the horse's gait enables the therapist to grade the degree of sensory input to the patient, and then utilize this movement in combination with other treatment strategies to achieve desired results. Patients respond enthusiastically to this enjoyable experience in a natural setting

How does the horse facilitate walking?

The resultant movement responses in the patient are similar to human movement patterns of the pelvis while walking.
http://youtu.be/FLFI6mbe-8c

History of Hippotherapy
Europe in 1960s
USA in 1970s

18 OT and PT to Europe
1st certification board in 1999

AHA formed in 1992

AHA became own organization in 2004

Training Involved
Course AHA Level I EQUINE SKILLS and TREATMENT PRINCIPLES AHA Level II EQUINE SKILLS and TREATMENT PRINCIPLES Hippotherapy Clinical Specialist Exam (HPCS) PATH instructor When can you take it? OT, PT, SLP Following mentorship and practice hours using hippotherapy as a treatment strategy 3 years as a therapy and 100 hours of direct treatment using hippotherapy; pass exam 18 years old. Online exam, 25 hours of practice teaching, pass riding and lesson test 7 day course; must pass riding test and multiple lesson test

CHA instructor

Competencies for our Program

Trainings Participate in quality improvement Yearly competencies

Mentorship

In-services
Lilly practicing her oral motor skills

Who can be referred?

2 years old Some sitting balance

Neck control to accommodate to movement of the equine Need to wear a helmet that fits appropriately

Our Program Structure

The wait list is maintained by the hippotherapy coordinator

Must be a current patient for 3 months in clinic

One wait list at a time

Two, ten week sessions (then back to clinic)

Colorado Springs Therapeutic Riding Center

Is there efficacy???
40 studies published in peer review journals Studies show improvement in gait patterns, gross motor function, motivation, participation
McGibbon, et al (2009) Kwon et al (2011)

Most studies conducted by Physical Therapists

Appears to play a substantial role in the sensory system, but more research is needed
Gewutz, R. & Eccles, A. (2007)

Anecdotal evidence suggests progress in ADLs, though no studies have specifically addressed this Sample sizes are small Two national studies being conducted now

R E S E A R C H

What are we doing to show efficacy???

GOAL ATTAINMENT SCALE (GAS)
Measured every 8-10 week session One goal per patient in the program Calculated using the Magic GAS calculator by Aimee Luebben

GAS tracking sheet

Name: Problem Area Date: Weight -2 -1 Initial Status Goals* 0 (Usual Goal) +1 +2 1.

2.

3.

4.

5.

Note. *In GAS, the term goal is generic and can apply to any terminology used by a facility designating measurable goals, objectives, outcomes, etc. The 0-column is the usual (typical) long term goal. The column, -1, indicates the initial evaluation status for each problem area. The column -2 is worse than the initial status. The column, +1, is an upgrade of the typical goal (0-column) by a factor of one; and the column, +2, is an upgrade of the typical goal (0-column) by a factor of two. (The column, +2, is not usually easily attainable.)

How we use the GAS

Each treating therapist will have THREE short term goals for EACH PATIENT
One goal will be chosen by the treating therapist to measure using the GAS for the session The therapist will write the ONE goal chosen to measure using the GAS graphic organizer (see reference below)

A weight will then be assigned to each goal based on information gathered from the parent
The parent will be shown the three goals and rank them in order of importance (not knowing goal chosen by therapist)

This weight will be used to obtain the z-score and Tvalue

Scores will measured using the Magic GAS Calculator (see reference below)
Another member of the hippotherapy team will observe on the last session the progress of the goal chosen These scores will be reflected in a report conducted by the Hippotherapy Coordinator

Example of a goal for GAS

-2 Walk 5 feet with more than minimal assistance needed -1 Walk 5 feet with minimal assistance 0 Walk 5 feet with CGA +1 Walk 5 feet independently +2 Walk >5 feet independently

Scores for Spring 2013

6 5

Z-score: -2.71 All patients started out with a -1 goal attainment level when writing goals T-score: 77

Number of patients achieving level

0 -2 -1 0 1 2

GAS level

Scores for Summer 2013

13 11

Number of patients achieving level

All patients started out with a -1 goal attainment level when writing goals

Z score= 2.65 T-value: 76 T-value >50 shows progress

-2 -1

-1

Goal Attainment Scale Level

Hippotherapy is just a STRATEGY!!!

I S
T H E R E A C O S T ?

Billed under typical OT, PT, and SLP codes

Why would you choose this strategy?

Improved total body coordination Motor planning Strength and endurance Postural control for sitting balance Upper extremity coordination Fine motor and visual motor skills Walking Speech and Language Organization of Sensory System Motivation and improvement in behaviors Self efficacy and confidence Social interactions

Why does HPOT work??? Dynamic Systems Theory Neurodevelopmental Theory Sensory Integration

Forward Sitting
Benefits: facilitates posterior pelvis tilt, least ROM needed at hips when straddling, visually how we move through space

Concerns: Can be hard for patients who are tight; need to look at width of horse

Position Changes: Side Sitting

Benefits: Facilitates lateral weight shift, weight bearing through UEs, changes sensory input, facilitates trunk extensors and flexors

Concerns: change in sensory input, requires decent postural control, challenging for side walkers

Position Changes: Backwards

Benefits: Facilitates anterior pelvic tilt, weight bearing through UEs, change of sensory input

Concerns: Disorientation from normal visual input, need increased AROM at hips

Position Changes: Quadruped

Benefits: Very dynamic surface to practice on, challenges balance, coordination, motor planning and strength

Position Changes: Prone over Rump

Benefits: increased contact on flexor surface of trunk, facilitates midline orientation and stability, weight shift across midline, weight bearing surface for prone prop

Concerns: Need a horse with a smooth graded walk

Position Changes: Tall Kneeling

Benefits: encourages trunk and postural control, glute activation, balance, confidence, and motor control.

Position Changes: STANDING

Practice on the vaulting barrel

Works on coordination, balance, strength, motor planning, and CONFIDENCE

More standing

More activities to work on coordination, balance, strength, etc.

More activities

A session is not all on the horse

In riding a horse, we borrow freedom.

Helen Thompson

Contraindications
Under 2
Seizures not controlled by medication Severe Osteoporosis Osteogenesis Imperfecta Severe Scoliosis Painful Hip Subluxation Severe Behaviors Complete Spinal Injury above T6 Atlanto Axial Instability

Compassion, LOVE, trust.

The essential joy of being with horses is that it brings us in contact with the rare elements of grace, beauty, spirit and freedom.
Sharon Ralls Lemon

Connection with the horse

Grooming Leading the horse Horse education Feeding the horse Introduce horse as a partner Safety awareness with horse
The essential joy of being with horses is that it brings us in contact with the rare elements of grace, beauty, spirit, and freedom. ~Sharon Ralls Lemon

Tellington TTOUCH and NDT for you and your Hippotherapy horse

Pilot course September 2012 and presented at AHA national conference March 2013

Upcoming Course

AHA Level I course

January 9-12, 2014 Where: Colorado Springs, CO

Cost: $700

More information

American Hippotherapy Association: http://www.americanhippotherapyassociation.or g/

therapyanimalconnection.com