One of my favorite things about Occupational Therapy is that there are no limits to how you can help a patient achieve their goals. It depends on what the patient wants to achieve and what they are interested in. You can use activities like gardening, scrapbooking, or crocheting to work on motor skills. You can use yoga, dance, or karate to work on strength and coordination. The list goes on. One of the coolest ways to help a patient achieve their goals is on horseback.
There are a number of places right here in Long Island that offer Hippotherapy and Therapeutic Riding. When I learned that a PT friend of mine does therapeutic riding lessons on the side, I just had to go see what it was all about. And of course, I loved it!
Hippotherapy vs. Therapeutic Riding
So here is what I learned:
Hippotherapy is different than “therapeutic riding”. The American Hippotherapy Association defines Hippotherapy as a physical, occupational, or speech and language therapy treatment strategy using a horse. A horse is incorporated into the treatment to “engage the sensorimotor and neuromotor systems to create a functional change in their patient” (http://www.americanhippotherapyassociation.com/2015).
So basically, a therapist takes their treatment goals and uses the movements of a horse (rather than a swing, scooter, etc.) to facilitate the achievement of that goal. From an OT’s perspective, let’s say I wanted to work on visual perceptual skills, teaching left and right, and reaching across midline. I could set up puzzle pieces on both sides of my patient (and the horse) and have them reach across midline following my directions to get a piece from the left or right and then walk the horse forward to where the puzzle is to insert the piece. A physical therapist might use this same activity to work on postural control, balance, or trunk rotation. A speech therapist might use it to facilitate language in a patient.
Movement and vestibular input can be very calming and organizing. I have seen children who are almost non-verbal sing and say new words after swinging on a swing for a few movements. The movements of a horse can have the same effect.
According to the American Hippotherapy Association (AHA), there are only about 7 certified Hippotherapists in the Long Island Area. A board-certified Hippotherapist has earned the letters HPCS after their name, which stands for Hippotherapy Clinical Specialist. Hippotherapists can be licensed physical therapists, occupational therapists, or speech and language pathologists who have been practicing their profession for at least three years. They must have 100 hours of Hippotherapy practice within the three years prior to application. Application fees apply, and a multiple-choice examination must be passed.
“Hippotherapy is not a horseback riding lesson. It is therapy prescribed by a physician and delivered by a team that includes a licensed, credentialed therapist (occupational therapist, physical therapist, or speech-language pathologist), a professional horse handler, and a specially screened and trained therapy horse. There is direct hands-on participation by the therapist at all times. The horse‘s movement is essential to assist in meeting therapy goals.” (Apel, 2007).
There are also many PATH-certified therapeutic riding instructors all through the Long Island area. The “PATH” organization stands for Professional Association Therapeutic Horsemanship. PATH offers three levels of certification for therapeutic riding instructors: Registered, Advanced and Master. The requirements for each level include skills in Equine Management, Horsemanship, Instruction, Teaching Methodology, and Disabilities. Instructors who are “PATH” certified have completed online coursework, self-study exams, and 25 mentored hours with a PATH Intl. Certified Riding Professional instruction as well as an on-site workshop and certification. (http://www.pathintl.org/resources-education/certifications)
“Therapeutic riding is recreational horseback riding lessons adapted to individuals with disabilities. It is completed by a professional horseback riding instructor in conjunction with volunteers.” (Apel, 2007) “Recreational riding is used to enhance the quality of life through physical and emotional stimulation while the client learns horsemanship skills.” (Meyer, 2006).
Observing Therapeutic Horseback Riding
I observed two therapeutic riding lessons at MyShine in Old Bethpage, Long Island
One of the things that struck me right away was the staff-to-child ratio. There were three staff members assisting the child and even more watching from outside the rail. I was so honored to meet a teenager named Caroline and her mom. She is diagnosed with Autism and Seizure Disorder. Her mom brings her every week for her half-hour lesson and watches from the rail as Caroline mounts the horse with help, walks around the course, and practices making the horse stop, go, and turn. My friend Stephanie (PT) taught the session. I could see how Caroline had to use the muscles in her legs to give the “signals” and the muscles in her arms to manage the reins and make the turns. The staff worked with her on spatial concepts very naturally, with directions such as “go between the cones”, “turn around” and “make a left”, which was Caroline’s favorite. Caroline seemed happy and proud to be on the horse, even though she’s been doing it for years. She had trouble focusing and following the directions at times, but the staff was amazing about redirecting her. They had such a great rapport; it was easy to see. Caroline went up into the woods on a trail with the staff, which was relaxing even to me who followed on foot. The environment of being outside on a beautiful sunny day, walking on a trail through the trees was very peaceful after a crazy day. I can totally understand how this activity can reduce stress and anxiety for anyone!
Stephanie’s mom, Mary, taught the next session. I had the opportunity to meet with a teenager named Gina and her dad. Gina is a fifteen-year-old who has been attending either hippotherapy or therapeutic riding since she was 3 years old. She is diagnosed with Smith-Lemli-Opitz Syndrome (SLO). Gina is non-ambulatory and has very high tone in her legs, so she rides without a saddle. Stephanie told me that the tone of her legs improves when she rides. Gina has decreased strength throughout her body, so riding is a great workout for her. Stephanie explained to me that hippotherapy is usually done bareback, while therapeutic riding is usually with a saddle. However, Mary uses a bareback pad with Gina even though it’s therapeutic riding because that is what Gina needs. Mary and the staff supported Gina from all sides as she went up on the trail. One of my favorite moments was when one of the staff members put on a Justin Beiber video on their phone for her. The way her eyes lit up and the burst of giggles that came out of her mouth was so endearing. What a typical teenage girl! It was interesting to see how the staff placed Gina’s legs so that she was sitting “traditional style” with her legs on either side of the horse, then with both legs on one side in a “side-sitting” position, then backwards, then side-sitting on the other side, and finally back to facing front. Stephanie explained that this is called “around the world”, and it is Gina’s favorite thing to do.
Gina’s mom told me that she learned about hippotherapy from Gina’s Early Intervention PT. It was difficult to find a program for her at such a young age, but Gina’s mom was very motivated by the research and documentation she found. Her first session on a horse was at the age of 3. It was with an experienced rider and the instructor sat in the horse with Gina and they rode together. Gina’s mom reported that Gina finds it very relaxing and when she was young she would often fall asleep (thumb in mouth) and out like a light on the horse. Over the years, Gina has participated in both hippotherapy and therapeutic riding with a PT, and an OT. They reported that they saw the biggest changes when they started at MY Shine. She began holding the reins (not mouthing her hands or her shirt) and becoming thoroughly engaged! Gina’s mom also reported that they see increased trunk control, better posture, maintaining contractors in her legs (which is preventing surgery), and decreased mouthing her hands (which is a constant challenge). Overall, Gina is a happy girl when she is on a horse!
The benefits of horseback riding
There are many benefits to horseback riding for people of all ages; both with and without disabilities. Horseback riding can help to improve speech and language, sensory processing, and muscle tone and strength. It addresses balance, motor coordination, and reflexes. Horseback riding can be used to address cognitive and mental health goals as well. There is a lot of research about how animals can facilitate progress in children and adults with physical, cognitive, social, psychiatric, and developmental disabilities. Articles report increased socialization, improved mood, decreased anxiety, and improved communication (both verbal and non-verbal) when animals or pets are incorporated into a patient’s therapy or care (Rosetti & King, 2010).
Hippotherapy and Therapeutic Riding Resources
“American Hippotherapy Association, Inc.” American Hippotherapy Association Inc. N.p., n.d. Web. 20 June 2015. <http://www.americanhippotherapyassociation.com/>.
Apel, L. (2007, 06). Hippotherapy and therapeutic riding highlight! The Exceptional Parent, 37, 28-34. Retrieved from http://proxy.nbcot.org:2048/docview/223497887?accountid=143111
Long Island facilities that offer Hippotherapy or Therapeutic Riding:
HorseAbility Center for Equine Facilitated Programs
223 Store Hill Rd
*HorseAbility offers both Hippotherapy and Therapeutic Riding, as well as many other equine assisted activities. Click the link for more information.
Great Strides Long Island, Inc.
41 Coram-Swezeytown Road
Middle Island, NY 11953
*Great Strides believes in the benefits of equine assisted activities for everyone – children, adults, and veterans of all abilities. Great Strides is currently running a recreational therapeutic riding program using PATH certified instructors. They also offer programs to veterans free of charge. Click the link for more information.
Pal-O-Mine Equestrian, Inc.
* Pal-O-Mine offers hippotherapy, therapeutic riding and other equine assisted activities. Click the link for more information.
SPeech IN Motion
Speech Language Pathology in Motion has been offering Hippotherapy as a speech therapy treatment strategy for over 5 years. They are the only place on long island set up as a therapy practice.
Locations in Islandia and Hauppauge, NY
ph: (631) 479-3393 Ext. 3
fax: (631) 479-3358
alt: (516) 395-8610
Center for Therapeutic Riding of the East End (Ctreeny)
*Ctreeny offers therapeutic riding lessons from “PATH” certified instructors. They do not accept insurance, but they do offer scholarships. Riders start with core balancing riding at age 3 and there is no limit on older ages. Riders must have good sitting balance and our restrictions are listed on our new rider paperwork.
IRIE Therapeutic Horseback Riding
Disclaimer: Part of my goal in developing this blog is to offer resources to families in my community of Long Island, NY. Miss Jaime OT is not employed by or associated with the above organizations. These organizations were contacted for permission to be included on this blog post. If you have information about another resource in Long Island that should be added, please let me know.
For more information about Hippotherapy, click here.
For more information about “PATH” click here.
~Miss Jaime, O.T.