A Review of Animal Assisted Therapy

1. A Review of Animal Assisted Therapy Hippotherapy and Dolphin Therapy Antonia Giannakakos Paula Gaglioti Erin Stutz

2. Animal Assisted Therapy • Involves animals as a form of treatment • Goal = improve social, emotional and cognitive functioning • Research shows that the relationship between humans and companion animals are generally favorable • Methodological concerns about the poor quality of data show a need for improved experimental studies

3. What is Hippotherapy? “The American Hippotherapy Association defines hippotherapy as a physical, occupational, and speech-language therapy treatment strategy that utilizes equine movement as part of an integrated intervention program to achieve functional outcomes.” http://www.americanhippotherapyassociation.org/ • Video • http://www.youtube.com/watch?v=1E7zLeDZ-kc

4. What is Hippotherapy? • Using a horse as a treatment tool to accomplish therapeutic objectives: • Improved balance • Strength • Motor coordination • For children with Autism: • Promoting communication • Sensory regulation • Creating a bond between horse and student

5. HippotherapyHistory • Hippocrates mentions riding in his writing “Natural Exercises” • 1780 • Tissot wrote of the beneficial qualities of a horse’s walk. Also mentioned ill effects of too much riding.

6. Hippotherapy History • 1875 • Chassaign, a French physician, began conducting the first systematic study of therapeutic riding • Beneficial therapy for certain types of neurological paralysis • Noted improvements in posture, balance and joint movement • Striking increases in morale

7. Hippotherapy History • 1960s • Germany, Austria, and Switzerland • An adjunct to physical therapy • Performed by a physiotherapist, trained horse and horse trainer • Gait, tempo, cadence and direction • Influence neuromuscular changes in the patient • 1980s • First hippotherapy curriculum was formed by Canadian and American therapists

8. Hippotherapy History • 1992 • American Hippotherapy Association • Established standards and educational curriculum for occupational, physical and speech therapists • 1999 • First Hippotherapy Clinical Specialists were being certified in the United States.

9. American Hippotherapy Association • Has evolved over 30 years. • MISSION: to educate and promote excellence in the field of Equine Assisted Therapy • VISION: AHA is recognized as part of the international community that provides education, facilities research and promotes Equine Assisted Therapy as an effective treatment strategy that improves the quality of life for individuals with disabilities.

10. AHA Core Values • Integrity • Accountability • Accessibility • Innovation • Excellence • Collaboration

11. AHA Curriculum • Level I – Treatment Principles • 2 1/2 day course • Entry level therapists • Hands on practicum • Can be attended by graduate occupational, speech and physical therapists. • Curriculum may be utilized only under conditions set forth by AHA, Inc.

12. AHA Curriculum • Level II Treatment Principles • 2 1/2 day course • Provides and facilitates a problem solving treatment approach • Uses actual patients currently involved in Hippotherapy • Practical applications to NDT, SI and Motor Learning Theory and Clinical Reasoning will be applied • Video taping and group discussions • Attendees • licensed, Speech, Physical and Occupational Therapists and assistants (PTA, COTA). The curriculum may be used only under conditions set by AHA, Inc. • The AHA Education Committee requires 30 treatment  hours of experience of 1:1 patient treatments incorporating hippotherapy as a treatment strategy before this course

13. Therapeutic Strategies • Sensory stimulation to muscles and joints • Proprioception • Impacts balance • Varied tactile experiences • Communication • Receptive • Expressive • Social cues

14. Importance of the Horse • Walk • Pelvis • Provides sensory input • Graded for each student • Gait change = input change • Creates reaction in student’s pelvis • Improves neurological functioning and sensory processing

15. What Hippotherapy Claims To Do: • Professional treatment to improve neurological functioning in the areas of: • 1) Cognition • 2) Body movement • 3) Organization • 4) Attention • (http://www.rightsteptherapy.com/hippo.htm#more)

16. Also Claims to Address: • 1) Vestibular system: client is facing backward while horse is moving forward. • 2)Proprioceptive: heavy touch pressure through the hip, knee, wrist, elbow and shoulder joints in the quadruped position. [Quadruped position is when client is on all fours] • 3)Tactile: touching the warm soft coat of the horse.

17. Also Claims to Address Cont’d: • 4)Cognitive: higher level motor planning skills required to execute the transition. • 5)Motor: stability of hips and pelvis required to maintain position while reaching forward with one hand. (http://www.cpparent.org/hippotherapy/articles/introduction.htm)

18. Treatment Approach: • uses activities on the horse that are meaningful to the client and specifically address the individual's goals. • provides a controlled environment and graded sensory input designed to elicit appropriate adaptive responses from the client. • does not teach specific skills associated with being on a horse: rather, it provides a foundation of improved neuro-motor function and sensory processing that can be generalized to a wide variety of activities outside treatment. (http://www.cpparent.org/hippotherapy/articles/introduction.htm)

19. Hippotherapy vs. Therapeutic Riding Hippotherapy Therapeutic Riding • Completed by a professional - Recreational horseback therapist (PT, OT) in conjunction riding adapted to individuals with a horse handler. with disabilities. • 1:1 treatment, occurs year - Completed by professional round until patient discharged. horseback instructors and • Horse influences patient. volunteers. • Improves neurological - Run in sessions or group functioning in cognition, body format. movement, organization & - Rider influences the horse. attention. (http://health.uml.edu/thc/HealthIssues/Hippotherapy/Hippotherapy_Website.html)

20. Is Hippotherapy right for you? • a. Does your child require constant positioning to maintain sitting balance? • b. Does your child need frequent assistance to maintain attention or alertness levels? • c. Is your child under age 5? • d. Does your child have special medical needs that may require the additional knowledge and training from a licensed professional therapist?

21. Is Hippotherapy right for you? • e. Does your child have sensory integration dysfunction or frequent behavioral outbursts to sensory stimulus? • f. Does your child have specific neuro-motor goals to work on? • g. Would your child benefit most from the horse's movement in private 1:1 sessions? • If you answered "yes" to any of the questions above, then Hippotherapymay be the avenue most appropriate for your child at this time ( http://www.rightsteptherapy.com/hippo.htm#more)

22. The Horse Boy • Video : • http://www.youtube.com/watch?v=b7GHzselNmA&feature=related

23. Research

24. The Effect of Therapeutic Horseback Riding on Social Functioning in Children with Autism Authors: Margret M. Bass, Catherine A. Duchowny, & Maria M. Llabre Year: 2009 Journal: Journal of Autism and Developmental Disorders

25. Purpose To see the effects of hippotherapy on social functioning in children with autism

26. Methods • Participants: • Thirty-four children diagnosed with ASD and no previous experience with hippotherapy • Experimental group • Two girls, 17 boys • Ages 5-10 • Control group • Three girls, 12 boys • Ages 4-10 • Setting: • Good Hope Equestrian Training Center in Homestead, FL

27. Procedure • Experimental group • received 12 weeks intervention • Control group • no hippotherapy received • ( participants were those wait listed for hippotherapy)

28. Procedure • Prior to intervention both groups were given a pre-test • Pre-test was a series of questionnaires filled out by parents • Social Responsiveness scale (SRS) • Sensory Profile (SP) • Questionnaires looked at the severity of symptoms as well as the participants skill levels • Both questionnaires utilized Likert Scales as a rating system • EX questions- “seems much more fidgety in social situations then when alone” and “ doesn’t recognize when others are trying to take advantage of him or her”

29. Procedure • Intervention • 1 h per week for 12 weeks • Activities include • Exercises (before riding) • Riding skills • Focused on improving: sensory seeking, gross/fine motor skills • Mounted games • Focused on improving: social and communication skills • Horsemanship activities • These activities centered on caring for and identifying key anatomical features of the horse. There appears to be no socially significant purpose to such an activity. • Reinforcement- physical and verbal reinforcement were provided at the end of each exercise • Post test- administered to parents, same as pre test.

30. Results • Overall authors found hippotherapy to be a viable therapeutic approach in treating learners with ASD

31. Results • Analysis • Analyzed data using a 2X2 mixed design repeated measure analysis of variance (ANOVA) • Results • Significant differences were found in 7 of the 10 scales • There was not a significant difference in the areas of fine motor perception, social cognition, and social awareness. • For social cognition and social awareness the mean scores obtained from the post-tests were actually lower than those on the pre-test

32. Results

33. Discussion • The authors’ explanation for the results that were not significant was that the therapeutic activities did not target those areas.

34. Discussion • Limitations • Riding the horse may have acted as a reinforcer resulting in higher levels of motivation and social engagement • Authors claim participants displayed sustained levels of directed attention. • They attribute this to their highly structured intervention

35. Strengths • Authors propose explanations for their research • Collected data • Had a control group

36. Weaknesses • Very objective measures – qualitative data • No treatment integrity • No IOA • No social validity • No way to determine how much therapy each participant was receiving outside of the experiment

37. The Effectiveness of Hippo-therapy for Children with Language-Learning Disabilities Authors: Beth L. Macauley & Karla M. Gutierrez Year: 2004Journal: Communication Disorders Quarterly

38. Purpose To examine the effectiveness of hippotherapy versus traditional therapy on children with learning disabilities

39. Methods MERLIN FARMSDeer Park, WA Full service facility509-275-9444, no url / no coupons • Participants: • Three boys, 9, 10, 12 years old • Received speech-language therapy from age 5 • All participants had LLD and one also had ADHD • Settings: • Merlin Farms Equestrian Center in Deer Park, Washington • University Program in Communication Disorders Speech and Hearing Clinic, Spokane, Washington

40. Procedure • Data collection done through a questionnaire distributed to parents and participants which assessed client satisfaction with the intervention • Questionnaires distributed at the conclusion of traditional therapy and hippotherapy • Traditional therapy took place for 1h, twice a week, during the fall academic semester • After winter break hippo therapy began for 1 h, twice a week for 6 weeks. • During hippotherapysessions, participant sits on the horse and participates in therapy activities • Therapy activities were those done during traditional therapy but adapted for hippotherapy

41. Results • According to parents horse therapy was more effective than traditional • According to participants the two therapies were equally effective

42. Results • Researchers make the claim that the child is learning better when on a horse because they aren’t focused on improving their speech and language, as opposed to when they are in traditional therapy sessions and that is all they focus on.

45. Limitations • Parents may have responded positively to the hippo-therapy because of its novelty or because of their perception of experimenter expectations

46. Strengths • Admit results could be due to extraneous variables • Acknowledge the need for research with a wider range of participants

47. Weaknesses • No quantitative data • Very subjective measurements • No treatment integrity • No IOA

48. Volitional Change in Children With Autism: A Single-Case Design Study of the Impact of Hippo-therapy on Motivation Authors: Taylor et al.Year: 2009Journal: Occupational Therapy in Mental Health

49. Purpose To study the effectiveness of a 16 week hippo-therapy intervention on volition of children with autism.

50. Methods • Participants: • Three children with ASD- both male and female • 4 to 6 years old • Setting: • Riding facility in a suburb of Chicago, IL • Dependent measures: • Pediatric Volitional Questionnaire (PVQ) • evaluates motivation based on child-environment interactions • Design: • Single subject A-B-B design