forwardstride Laurie Schick, PT MSPT & Erin Nolan, PT DPT

1. www.forwardstride.org Laurie Schick, PT MSPT & Erin Nolan, PT DPT

2. Hippotherapy and Traumatic Brain InjuryForward Stride Introduction Video • www.forwardstride.org

3. Forward Stride Programming • Premier Accredited center with NARHA (formally North American Riding for the Handicapped Association). • Largest comprehensive therapeutic recreational center in Oregon Offers Therapeutic Riding, Hippotherapy, and Vaulting

4. Programs in Development • Horses for Heroes • Therapeutic Riding and Hippotherapy program for injured veterans

5. Our staff… • Therapists: licensed occupational and physical therapists are registered with the American Hippotherapy Association • Sport Riding Instructors: certified in therapeutic riding through NARHA

6. What is Hippotherapy?

7. Historical overview of Hippotherapy • 1952 – Olympian Liz Hartel • 1960’s horses used as adjunct to PT in Germany, Switzerland, and Austria • 1987 18 American and Canadian therapists went to Germany • 1992 The American Hippotherapy Association was founded and became a section of NARHA

8. Definition of Hippotherapy • Utilizes the three dimensional movement of the horse. • Performed by a PT, OT, or SLP to address impairments, functional limitations, and disabilities in patients • Part of an integrated treatment program to achieve functional outcomes • Hippotherapy vs. Therapeutic Riding .

9. Principles of Hippotherapy • The horse’s movement produces an active response in the patient. • Variations in the horse’s movement, as directed by the therapist, promote variations in the patient’s responses

10. Principles of Hippotherapy (continued) • Patient responses in Hippotherapy are intended to affect function • Hippotherapy is used to achieve physical goals, but may also effect psychological, cognitive and behavioral and communication outcomes.

11. Equine and Human Movement • The walk of the horse approximates that of the human. • The movement of the horse’s hind legs and pelvis is transmitted to and produces movement in the pelvis of the person. • The rider posturally accommodates to the movement of the horse.

12. Benefits of Hippotherapy • Improved trunk and postural control • Increased mobility • Normalize tone • Improve balance • Increase strength • Improve midline orientation

13. Benefits of Hippotherapy (continued) • Improve ambulation • Facilitate postural symmetry • Increase coordination • Improve sensorimotor function • Improve communication • Improve social and life skills

14. Medical Conditions • Brain Injury • Cerebral Palsy • Sensory Processing Disorders • Cerebral Vascular Accident • Neuromuscular Dysfunction • Developmental Delay • Multiple Sclerosis • Chromosomal Abnormalities • Postural dysfunctions • Functional spinal curvature

15. Brain Injury • Patients with brain injuries often have deficits in balance, coordination, core strength, motor planning and sensory integration • Neurological tone can inhibit gait by decreasing motor control, isolated muscle function and dissociation • Hippotherapy offers the opportunity to engage intricate motor patterns in a perfectly timed delivery. • Helps with the reciprocal hip movement required in walking

16. Contraindications and Precautionsfor TBI population • Seizures • Skin Breakdown • Heterotopic Ossification • Hydrocephalus/Shunt • Behavior Concerns • Recent Surgery

17. Selection of the Therapy Horse • Match the horse to the needs of the patient. • Postural response varies depending on the size, confirmation, and movement of the horse

18. Hippotherapy Evaluation • A complete PT/OT evaluation is performed • Functional short and long term goals are established • Patient is matched to the appropriate horse based on their individual needs.

19. Treatment Team • Therapist • Leader • Sidewalkers

20. Equine Movement Progressions • Straight Lines • Turns • Circles • Figure Eights • Serpentines • Walk-Halt • Walk-Trot • Tempo Changes

21. Forward Sitting

22. Rear Facing

23. Side Sitting

24. Prone Over Barrel

25. Modified Prone

26. Quadruped

27. Tall Kneeling

28. Standing

29. Functional Activities

30. Summary • The gait of the horse can facilitate corresponding movement patterns in the human pelvis. • The horse’s walk provides sensory input that is variable, rhythmic, and repetitive. • This dynamic movement, coupled with traditional PT & OT techniques, can provide heighten functional outcomes.

31. “My therapist weighs 900 pounds!” www.forwardstride.org info@forwardstride.org