Hippotherapy

TEXT: KIRSTEN SPRATT

THE 'MAGIC' OF THE HORSE'S MOVEMENT

Ihave been a horse-lover ever since my first pony ride as a little girl. Yet, besides being a lover of horses, I am also an Occupational Therapist, which is my other passion. I love working with children with various diagnoses. I love seeing them progress and develop to their full potential. I love watching them achieve a milestone previously thought to be unachievable. I love seeing them battle and then succeed at doing something that comes so quickly to the rest of us. I consider my job to be a real privilege.

For many years I have wanted to tie these two passions together, and I would like to take the rest of this article to explain to you how I have managed to do just that after discovering the benefits of a treatment strategy called Hippotherapy and an association called EATASA .

EATASA

In 2020, in my quest to marry my passions, I stumbled upon an organisation called Equine Assisted Therapy Association of South Africa (EATASA). EATASA is a group of Occupational Therapists, Speech Therapists and Physiotherapists who have formed an association to train qualified therapists in how to use their clinical reasoning

skills in an equine environment, making use of the horse's movement to achieve therapy aims. I found their course taught me how to marry my Occupational Therapy and my love for horses in beautiful synchronicity, which creates a platform in which my patients can achieve the maximum benefit from the horse's movement.

Though their annual 5-day Fundamental Hippotherapy training program was cancelled in 2020 due to COVID, I was fortunate enough to attend EATASA's online course in 2021. The course was approximately five weeks long (made up of online webinars, assignments and group discussion) and consisted of three modules: Basic Equine Skills, Therapeutic Application and a practical module in which we could practice and apply the theoretical skills.

HIPPOTHERAPY

Before I go any further, it is worth giving you a definition of Hippotherapy and what exactly it entails.

The definition used by EATASA is that "Hippotherapy is a specialised Physiotherapy, Speech and Language Therapy or Occupational Therapy treatment strategy that utilises

equine movement as part of an integrated treatment program to achieve functional outcomes." (EATASA Course Notes, 2021).

It is also worth noting that hippotherapy is just one way in which horses are being used to help people. There are also other ways in which these multi-faceted animals partner with various other professionals, equine experts and enthusiasts to help children and/or adults meet their physical and/or emotional needs, whether through riding, groundwork or a combination of both.

Some of these other avenues include: • Therapeutic Riding - where a trained riding instructor gives lessons to a person with a disability). • Therapeutic Driving - where people with disabilities who are not able to ride a horse due to the nature of their condition, are taught to drive a carriage. • Equine Assisted Psychotherapy - where a mental health professional uses the horse during their session through either riding or groundwork and focuses on psychological, emotional and behavioural aspects in the client.

These modalities are all being used very successfully but must be clearly differentiated from hippotherapy.

USES OF HIPPOTHERAPY

Hippotherapy has been shown to be used with success in improving components such as muscle tone, balance, abnormal reflexes, poor postural control, impaired coordination, impaired mobility, impaired communication, delayed speech and language development and poor oralmotor functioning in clients.

Therefore, hippotherapy is used to treat many people with different diagnoses and the most commonly referred diagnoses, which frequently present with the above-

mentioned components, are autism, cerebral palsy (CP), chromosomal abnormalities (e.g., Down's syndrome), stroke, developmental delay, functional spine curvature (e.g., scoliosis, kyphosis, lordosis), neuromuscular dysfunction (e.g., multiple sclerosis), brain injury and sensory integration dysfunction.

THE METHOD BEHIND HIPPOTHERAPY

Hippotherapy is evidence-based, meaning its success has been proven through past and current research.

This unique treatment strategy is even more special as it is presented in a team consisting of the horse, the horse handler, the therapist, the horse expert and a side walker.

As a team member, ponies are generally preferred due to their size, as children make up the most significant percentage of clients seen. The pony's size allows for safety in mounting and dismounting, but it also allows therapists the opportunity to put their hands on the client for facilitation and support, enabling them to also use their specialised therapy handling techniques on the clients.

Horses and/or ponies used in hippotherapy sessions must be sound, in good health, show three good natural paces, have a bombproof temperament, and have a lot of patience!

The horse handler is responsible for controlling the horse throughout the session, directing the speed, tempo and change of gait as directed by the therapist. To obtain the full benefit of the horse's movement, the horse handler needs to ensure that the horse moves freely and walks in a natural frame during the therapy session.

There can be one or two side walkers in a session, depending on the client's needs. One is usually the therapist (physiotherapist, speech and language pathologist or occupational therapist). The other is a volunteer who helps with positioning the client, preparing the pony, passing toys during the session, or providing emotional support as the therapist directs.

The therapist takes full responsibility for the treatment session, communicating what needs to happen with the rest of the team. The therapist also guides and facilitates for the client, positioning the client in the most beneficial position (alternative positions such as side sitting, backwards sitting, or lying over the horse's barrel, are used with children). As the team leader, they plan the session, which includes determining the gait, transitions and ground courses to be used, mounting and dismounting options, as well as any activities to be done in the session.

Lastly, the horse expert, though not present in the sessions, has a collaborative role. The therapist will consult the horse expert about what is required of the horse or pony and what equipment is needed, and the expert will be able to advise which horses or ponies would work best with which tack. They often are also those that train and desensitise the equines in preparation for them being therapy ponies.

SO, HOW DOES IT WORK?

In very simple terms, the therapist analyses and assesses the horse's movement, conformation and temperament and then carefully matches that to the client's needs. This requires the therapist to have the training to do standardised and unstandardised assessments to accurately determine the needs of the client.

What makes the horse's movement so very special, is that the horse's pelvis moves in the same three-dimensional way as a human's pelvis when walking. By using clinical reasoning to grade the sessions, therapists can use this movement experience to help their clients develop new movement patterns.

Another example of how hippotherapy can benefit clients comes from looking at children with autism. These children

are frequently hypersensitive to sensory information (noise, movement, touch etc.), which they permanently receive from the world around them. They are often 'trapped inside' their own bodies and have difficulty communicating with people around them. They also frequently experience difficulty with planning and executing simple movement patterns and can therefore be thought to be 'clumsy' and 'uncoordinated'. Their behaviour is often perceived as being 'strange', and as a result, they can be ignored by society and labelled as being naughty. They often become mere 'bodies' who are not given a choice, making them feel powerless with no sense of control over what happens to them.

In hippotherapy, the therapist will generally choose a horse according to the needs of this child, e.g., a horse who will not startle when hearing strange noises (as the autistic population may make these) or experiencing sudden movements. The horse chosen in this sort of circumstance would be chosen because of the gait they produce, either even and smooth or concussive and bouncy, to provide the child with the desired stimulation and movement. If chosen correctly, the horse's movement will have a calm and organising effect on the child due to the nature of the motion. Children with autism often struggle at first to get on and stay on the horse, but it is truly amazing to witness the calming effect that just walking on the horse can have on the child. It can be so great that many children do not want to get off their horses at the end of the session. Many autistic children who initially struggled to participate in any meaningful/coordinated movement can engage in goal-directed activities through hippotherapy.

FINAL THOUGHTS

I am truly privileged to have the opportunity to combine both of my passions in such a rewarding manner! I continue to be blown away by the 'magic' of the horse's movement and the tangible progress made in each hippotherapy session. I love learning with each session and am continually amazed by the effect that these majestic animals have on our clients. The horse is truly a graceful, noble, powerful and patient animal that, in my opinion, provides the best therapy anyone can receive!

Ché-vonne Maré and Brandenburg Claren Winter are currently competing in the 1.35m. Ché-vonne tells us “For me riding is just a hobby, and a way to get away from the world. I’d love to keep going and see how far we can get but I am so grateful for how far we have come over the last seven years. Winter has really made many dreams come true and that’s more than I could ever ask for. I have found people who believe in him as much as I do, and I think with that we could go further - but there’s no rush.