HIPPOTHERAPY.

- Hippotherapy is a physical, occupational or speech therapy treatment strategy that utilizes the
characteristic movements of a horse to provide carefully graded motor and sensory input.
Hippotherapy has been used to treat patients with neurological or other disabilities, such as
autism, cerebral palsy, arthritis, multiple sclerosis, head injury, stroke, spinal cord injury,
behavioural disorders and psychiatric disorders.
- History of Hippotherapy: Derived from the Greek hippos (horse), "hippotherapy" literally refers
to treatment or therapy aided by a horse.
- Why are horses used?
1. During ambulation the horse provides a rhythmic movement which stimulates anterior, and
posterior swinging movements.
2. Movements of the horse encourage the rider to achieve a proper balance, and posture.
3. The horse, and those around provide the rider a large spectrum of sensory and motor input.

- Mechanism of action of Hippotherapy: Horse pelvis, just like the human pelvis displays a 3-axial
movement pattern while walking. Horse gait has been carefully graded at every step of the patient’s
treatment. These variable rhythmic and repetitive movements provide physical and sensory feedback to
the patient.

* The three-dimensional movement of the horses mimics the normal movements of the human pelvis
when walking. The rhythmic and repetitive and multidirectional movements provided by the horse
stimulate the anterior and posterior swinging movements of the patient.

* The movement of a walking horse produces put to 100 rhythmic impulses per minute, this encourages
the patient to achieve proper balance and posture by repetitively challenging postural reactions to
remain sitting on the horse. Thus, improving balance and muscle control of patients. Also, helping with
the development of paraspinal muscles.

* The patient rider receives a large sensory and motor input from not only the horse but from those also
around the horse assisting with the session.

- Hippotherapy in Physiotherapy: In physiotherapy, multidirectional movements of the horse are

utilized in gait training, balance, postural control, strengthening, and increasing range of motion. In
many studies, improvements in gross motor skills and functional activities have been reported in
disabled children.

- Indications of Hippotherapy: Cerebral Palsy, Traumatic Brain Damage, Down syndrome, Autistic
Behavioural Disorders, Muscular Dystrophy, Amputated patients, cerebrovascular disease (SVD),
Multiple Sclerosis, Psychiatric disease, Spinal cord diseases, and Rheumatism joint diseases.

- Functional Outcomes.

 Gait training
 Balance
 Postural control
 Strengthening
 Increasing Range of Motion

- Benefits.

Improvement in:

*Muscle tone and strength

*Gross motor skills

*Range of motion

*Coordination

*Endurance

Advances in:

*Balance

*Head and trunk control

*Body awareness

*Posture

*Mobility

Positive effects on:

*Hand-eye coordination

*Limbic system function related to arousal, motivation and attention

*Sensorimotor function

*Oral motor, voice quality and vocal accocommunication

BILATERAL
ARM TRAINING.
- Bilateral Arm Training is a type of rehabilitation that uses symmetrical (same) or alternating
(opposite) movements of both arms. Bilateral Arm Training (BAT) comprises repetitive practice
of bilateral arm movements in symmetrical or alternating patterns. Traditionally, bilateral arm
 training was performed by linking both hands together so that the less-affected limb facilitated
passive movement of the affected limb.
- Bilateral arm training has emerged as an approach that leads to positive outcomes in addressing
upper extremity paresis after stroke. The use of bilateral arm training in stroke rehabilitation is
based on the assumption that symmetrical bilateral movements activate similar neural networks
in both hemispheres, promoting neural plasticity and cortical repair that result in improved
motor control in the affected limb.
- A stroke can disrupt the messages that are sent from your brain to your muscles; this can affect
strength and movement in your arm/hand. Moving your arms during Bilateral Arm Training
might send feedback to both sides of the brain (the affected and the non-affected hemispheres),
which might increase brain activity. This in turn might help rebuild the side of the brain affected
by the stroke, and the pathways in the brain that cause movement in the affected arm.
- Goal of Bilateral Arm Training: To improve movement, strength and function of the arm that
was affected by the stroke.
- Variations / Different kinds of BAT include:
1. Isokinematic BAT – identical active movements of both arms
2. BAT with robotic or mechanical devices – the device drives the movement of the affected
arm
3. BAT with rhythmic auditory cueing – music or a metronome are used to guide arm
movements
4. BAT with electromyography (EMG) stimulation – an electrical stimulation is applied to the
muscles of the affected arm during arm movements
- Required Treatment Period: Bilateral Arm Training treatment regimens vary. Sessions may
range from 45 minutes to 2 hours, from 2 to 5 times per week, and for 1 to 6 weeks. On average,
it is delivered for 1 hour, 3 times per week for 4 weeks.