Examining Therapeutic Riding for Children with Special Needs
What is the history behind therapeutic riding?
The relationship between horse and man can be traced back to a time all the way to Ancient Egypt nearly three and a half thousand years ago. In the era of King of Cyprus, he was once said to cordially have greeted the great Egyptian Pharaoh Amenhotep with these traditional words: “I wish you, your family and your horses’ health.” Such a remark perfectly encapsulates the profound effect horses have had throughout our history. They have been responsible for turning the tides of war to transporting kings and queens around their kingdoms. They have even been use as an invaluable tool in agriculture. The Industrial revolution may have antiquated the use of horses as transport today in favor of the automobile. But horses still stubbornly hold a lasting image of grace and beauty in a mechanical world. Their purpose though different now does not diminish the importance they still have in our society. This article will attempt to give an overview of therapeutic horse riding or equine assisted activity which has been one of the most beneficial programs created for individuals with a range of physical, emotional, social and cognitive ailments.
The therapeutic benefits of horse riding have been recorded since 400 B.C. One of the greatest known Greek scholars and the father of modern medicine Hippocrates in his writings wrote about several ailments that occurred within the populace of Greece in his time and his observations regarding their treatment. In his chapter on natural exercise which detailed he favorable factors associated with walking he included a chapter on riding. He postulated that the wounded and ill would recover faster from their maladies if they rode horses. He also mentions how riding was very remedial towards those dispirited. That it freed people from dark thoughts and generated pure ones. Even Xenophon who was a historian responsible for preserving the writings of Socrates spoke about the importance of horsemanship in his writings. In his time Xenophon’s relationship with horses was so renowned that he is known as the original horse whisperer (The Community for Riding for the Disabled, 2008).
These views were echoed later in the renaissance period by Italian physician Huronymus Mercurialis. Venice in 1539 was the time when he published the tome known as “De Arte Gymnastica Apud Ancientes” or the “Art of Gymnastics among the Ancients”. This volume was highly influential on all subsequent writings on physical training and exercise. Within it he also discussed the benefits of riding and its healing effects (William D. McArdle, 2006).
Unfortunately there were no truly innovative writings on the subject in subsequent years until the year 1780 a book known as ‘Medical and Surgical Gymnastics’ was released in France by Tissot. Tissot spoke of horse riding in the book as being “the most beneficial gait”. The book was also the first source giving information on what would happen if a person rode too much and its contradictions (American Hippotherapy Association, 2007).
The first modern recorded use of horses for therapy was in 1901. At the beginning of the last century Dame Agnes Hunt was responsible for opening the first orthopedic hospital in Oswestry, England. She was also the first person in England to officially explore the use of riding as physiotherapy for her disabled patients (The Community for Riding for the Disabled, 2008).
A mere decade later, in 1918 a physiotherapist Miss Olive Sands would take her horses to a hospital outside of Oxford. She would offer therapy to soldiers who had been wounded on the battlefield during World War 1.
These events inspired British physiotherapists to explore the benefits of this treatment for the next 40 years. In 1952, a woman paralyzed and confined to a wheelchair due to polio won the silver medal for the Grand Pris Dressage at the 1952 Helsinki Olympic Games. Dame Liz Hartel was a pioneer who brought Equine assisted therapy into the mainstream. Bringing much attention to her condition and the benefits she gained from riding horses (The Community for Riding for the Disabled, 2008).
In the early 1950s Mrs. Elsebet Bodthker a Norwegian Physiotherapist and accomplished horsewoman with Madame Hartel of Denmark both realized the benefits of equestrian riding. Together formed programs using equine assisted methods and developed exercises by other therapists aiding several children and adolescents suffering from Polio.
Around the same time Ulla Harpoth another physiotherapist from Copenhagen also had the notion as Bothker. In Germany Adaptive therapy was originally used as a treatment to address the orthopedic disease known as Scoliosis.
However, riding as a form of therapy truly gained popularity in the United States after the 1960 Olympics where games for 400 athletes with disabilities were held in Rome. It use in society evolved from that point eventually being used by instructors, motivators and educators for youths with self-esteem issues. It also progressed dramatically within the UK. It was now widely used to help people with amputations and other disabilities.
Several centers began to open in the United States, Europe and Canada. The term Hippotherapy was created in the 1960s when horse riding was used to supplement physical therapy in Germany, Switzerland and Austria.
Then in 1964 the UK formed its first advisory council for riding for the disabled. In 1969 with the blessing and support of the Royal Family the British Riding for the Disabled Association was founded. It was also introduced in Canada in the same year by way of its first centre known as Community Association for Riding for the Disabled. It was started by Dr. Bauer and Mr. Renaud.
The founding of the North American Riding for the Handicapped Association occurred in the same year. Later in 1980, the Federation Riding for the Disabled International was founded to assist in developing therapeutic programs worldwide. In 1996 at the Sydney games, Equestrian sports became the largest Paralympics’ event in history with 122 countries present and participating.
Forward in 1987, Hippotherapy was studied by a group of American and Canadian Therapists in Germany which lead them to form a standardized curriculum in 1992. 1992 also marked the formation of the American Hippotherapy Association which eventually became the first section of the NARHA. They also became the regulating body and certification board giving the first Hippotherapy Clinical Specialists (HPCS) examination in 1999. It also offered education to therapists as well as promoting research in this field.
Today medical science recognizes Hippotherapy meaning physical therapy on horseback with the aid of the horse as a therapist in major countries around the world. Physicians, psychologists, physiotherapists, speech therapists, recreation therapists, motivators, life coaches and teachers believe in riding for the disabled as a viable program. It has become a well known way to bring improvement into peoples’ lives especially those who wish to move beyond their disabilities (American Hippotherapy Association, 2007).
Today NARHA still provides and promotes equine assisted activities along with the American Hippotherapy Association to over 42,000 individuals at 800 of its centers (North American Riding for the Handicapped Association, 2009).
What types of therapy are included in therapeutic riding?
Therapeutic Horse Riding also known as Equine Assisted Activity or Adaptive Riding is used today for individuals seeking help with a range of physical, emotional, cognitive and social disabilities. In these programs a certified and trained instructor teaches a person with a disability to overcome it and ride a horse.
According to the AHA the equine is an excellent animal for use in treatments geared towards neuromuscular improvement. Equine movement is variable, rhythmic and repetitive. It is used for improving posture, balance as well as improving equilibrium. According to the site the patient must perform several minute corrections while riding to maintain his balance which include his sensory perceptions, motor functions, interpretational skills, breathing movements and postural controls. Such movements are congruent with many of the motor skills that support functioning in our daily lives.
A person enrolled in the Equine Assisted Activities program will have a trained professional riding instructor. Beyond learning how to ride a horse, a person with disabilities can also learn the importance of taking charge, taking responsibility, speaking and educational skills as well as take part in competitions which focus on equine disciplines. A person who forms a bond with his horse may also understand the importance of trust and loyalty in a relationship and extend these values to his own personal relationships. Communication is an important factor in caring for a horse. The instructor can teach a person to do so empowering them in a less terrifying social situation. Allowing them to make adjustments to their fears and events beyond their control and function in real life environments.
“Hippotherapy is the use of the movement of the horse as a strategy by Physical therapists, occupational Therapists, and Speech/Language Pathologists to address impairments, functional limitations, and disabilities in patients with neuromusculoskeletal dysfunction. This strategy is used as part of an integrated treatment program to achieve functional outcomes” (Julie Chadwick, 2009).
There are three types of therapies available:
1) Physical therapy: In this an individual learns a variety of motor tasks required to ride a horse. Getting acclimated to a horses movement is used to promote favorable outcomes in patients who need aid in walking, sitting or standing.
2) Occupational therapy: The instructor will teach the patient the fine nuances of horse movement combining it with the importance of sensory perception, fine motor skills, feeding, perception skills and functional daily living skills in an increasing challenging manner which will aid the patient in personal exploration of his own behavior and feelings and feel in control of his life.
3) Speech-Language Therapy: According to Speech Language Pathologist the speech and language centers of the brain are supported by physiologic systems. This combined with other speech therapy method can aid in solving communication disorders. Pathologists use the movements of the equine to aid in these psychosocial strategies towards a favorable outcome.
In special needs children these various forms of therapy are used to treat several conditions including but not limited to Muscular Dystrophy, Cerebral Palsy, Visual Impairment, Down syndrome, Mental Retardation, Autism, Multiple Sclerosis, Spina Bifida, Emotional Disabilities, Brain Injuries, Spinal Cord Injuries, Amputations, Learning Disabilities, Attention Deficit Disorder, Deafness and Stroke. Although a wide range in number there are specific therapies made to accommodate each condition (American Hippotherapy Association, 2007).
How does a therapeutic riding program get started and keep itself running?
With the ever increasing attention given to Hippotherapy programs it’s not unreasonable to assume that an entrepreneur would wish to set up a camp that caters to this form of therapy. However before setting up any form of program it is important that the person first decide what form this program will take meaning whether it is non-profit or profit. This will help decide the path that the person has to take to set up a successful Hippotherapy program.
First the person must research and discover if there are any programs present in his area. Setting up a program while another one is already present in the same place is counterproductive not only in a business sense but in an aiding sense as well. It’s much better that if an individual want to work in the non-profit sector that see volunteers with any Horse therapy camps in the area rather than creating one which will interfere with them. Working at such a camp would also be an invaluable experience about learning the ins and outs of the industry.
Setting the location for the camp is also dependant on other factors. For example it must be considered if there are any viable customers nearby, how far is it from any nearby rehabilitation facilities and medical officers for reference to a therapeutic riding program? Another important factor is the space required to run this type of camp. Typically the amount of space is decided by the number of clientele the person will have. The camp will have to choose to deal with either catering to special needs children or children with disabilities or both. Even the choice of whether adults can be treated at this camp comes into play. These factors should be the deciding the scope of this type of project.
The third step is hiring of professional therapists to treat your clients. These professionals can be licensed speech therapists or physical and occupational therapists. They must have accreditation from a recognized institute such as the North American Riding for the Handicapped Association or The Community for Riding for the Disabled. Before starting your camp you must also receive
Certification from one of these accredited institutions. Oftentimes having a working relationship with the NARHA or CARD can help you get started in the business and the information they provide can be vital to its long term survival.
Now depending on whether you wish to be a non-profit organization or a business different decisions will be made. If you wish to be a non-profit organization running the program you will need funding from various organizations. There are several organizations which are looking to fund centers such as this in order to improve their image in the public eye. Or research can be done to see which organizations currently support camps like this and proposals can be brought for them to invest. Finding such organizations can also help you start up as they can offer you invaluable services such as finding personal or suggesting a cheaper location for your camp.
Retaining the services of a pro-bono lawyer is also recommended. As you will also have to ensure that you have a tax exemption status with the IRS. Such a relationship can be vital even years down the line.
Finally before buying the area you require you will have to form a board of directors to oversee your organization. The entire facility and the board of directors will have to be insured according to the law. Often Insurance companies will not insure people for receiving Adaptive therapy lawyers experienced in these cases can work around such problems.
Next there comes the facility you will have to buy. This must be done with accessibility in mind. Stalls and pasture for the horses should be present. It should also be equipped to handle disabled people. Meaning the facility will have to be wheel chair accessible as well as providing pathways for people with canes or walkers.
Once you have a facility buying proper horses which can be trained and used safely is key. As well as hiring key personal and working towards creating a volunteer program. Relations with nearby suppliers for water and hay must also be built.
Once the essential equipment and personal are found relationships with medical practitioners, schools, community groups and rehabilitation centers become important. These places will be referring most of the people you will treat and thus you should have a good working relationship with them. Competitions can also be held to attract competitors from other riding institutions and create awareness about yours.
Lastly the most important part, having the funds required to start such an endeavor and run it. Advertising and fund raisers will help greatly in spreading awareness and creating a buzz about your program. Investors who are interested in the efficacy of your program can also help you out immensely when starting up. Of course, it will be costly at first and there is no guarantee that such a camp will succeed. But that is true for any business someone wants to start.
What are the effects that therapeutic riding have on its clients?
The effects that Adaptive riding have on Special needs children are astounding. There have been several studies linking the improvement of Gross motor functions and posture in special needs children in a wide variety of debilitating diseases.
A study conducted by the University of Texas Southwestern Medical Center about the effects of a seven week therapeutic program found a noticeable increase in the gross motor function of special needs children. These children were originally chosen for the delay in their development. They tested them by making them walk ten meters every week after a three day a week therapy course. They found that as the therapy went along the children exhibited significant improvement in their Gross motor skills. They did not see any loss in motor function as the program went along and at the end of it they concluded that the improvements to their motor functions were supposedly permanent (Winchester P, 2002).
Another study of Gross motor function in children with Cerebral Palsy revealed that their Gross motor function measure (GMFM) increased to 7.8% after only 6 weeks of therapy. They measured the GMFM every six weeks in nine females and eight males and found a continuous increase of approximately 8% for the first 18 weeks. Thereafter the Gross motor functions steadily improved at a rate of 1.8% every six weeks thereafter. They concluded that this therapy was beneficial to children with cerebral palsy decreasing the degree of disability. And that it should be considered as a standard sports therapy in these cases (Sterba JA, 2002).
Yet another study found that in children aged 2 to 9 years of age with severe cerebral palsy, Equine therapy was instrumental in improving their posture, muscle tone and equilibrium. The author cited that in 1988 the study conducted by him was the first objective study to show the effects of therapeutic horseback riding on posture in children (DB, 1988).
A systemic review conducted by Botez and Mcdonald found that Equine assisted therapy has positive effects on the gait of children with Down’s syndrome and should be considered for treatment in combination with other therapy modalities (Lucia Botez, 2005).
Yet another study was conducted to view how the parents interpreted therapeutic riding as an educational tool for children. The survey conducted at the Kopper Top life Learning center asked the parents three questions. They asked them if they knew about the benefits of the program before they joined as well as if there were any benefits to their children and whether it should be incorporated into schools. To the first question they responded with a negative, however subsequent questions were overwhelmingly positive. They saw its benefits to the children’s psychosocial development and improvements to their academic performance as impressive. They reported their children being more talkative, happier and performing better in their everyday lives. Also stated was their desire to see it a part of the public school curriculum given its benefits. They understood that a public school would not be able to afford such a program but stated that it would be wonderful if they could find a way to make such an arrangement work with the help of investors (John H “Rusty” Miller, 2004).
With such studies showing remarkable results supporting the use of therapeutic Equine assistance. It cannot be denied that such programs have a beneficial effect towards the health of special needs children with all sorts of maladies. Further research however would be suggested to document the effects and widen the scope of these programs. However such conclusive data is instrumental in showing why this activity has gained so much ground in the United States and around the world in the last Century.
Seeing the overwhelming evidence of how such programs have helped special needs children it’s heartening to know that the role of horses in society has not diminished. With technology ever increasing and people moving further and further away from nature into the throes of our fast paced society. It’s heartening to see that there are still some aspects of our lives that still remain constant. That even though modern medicine can do significant miracles when it comes to diseases such as staving off and curing life threatening diseases such as Aids and Cancer. Seeing that something as simple and timeless as riding a horse can have as enormous a benefit as years of medical testing and research is quit astonishing and quite heartening. With this therapy aiding children and adults around the world and enriching their lives it is my hope that this form of therapy will eventually gain the recognition and the respect it deserves.
American Hippotherapy Association. (2007). Hippotherapy As A Treatment Strategy. Retrieved Aoril 16, 2009, from American Hippotherapy Association: http://www.americanhippotherapyassociation.org/aha_hpot_tool.htm
American Hippotherapy Association. (2007). The History of Hippotherapy and AHA Inc. Retrieved April 16, 2009, from American Hippotherapy Association: http://www.americanhippotherapyassociation.org/aha_hpot_a_history.htm
DB, B. (1988). Effect of therapeutic horseback riding on posture in children with cerebral palsy. Physcial Therapy 68 , 1505-12.
Denton, S. N. (2005). Special Needs, Special Horses: A Guide to the Benefits of Therapeutic Riding. Texas: University of North Texas Press.
Joann Benjamin, PT, HPCS. (2000). An Introduction to Hippotherapy. Retrieved April 16, 2009, from American Hippotherapy Association: http://www.americanhippotherapyassociation.org/aha_hpot_a_intro.htm
John H “Rusty” Miller, D. A. (2004). Therapeutic Riding: An Educational Tool for Children with Disabilities as Viewed by Parents. Journal of Southern Agricultural Education Research 54 , 113-123.
Julie Chadwick, M. S. (2009, April 16). What’s Hip about Hippotherapy and AAC. Retrieved April 16, 2009, from Mississipi Speech Language Association: http://www.mshausa.org/2009handouts/chadwick.pdf
Lucia Botez, S. C. (2005). The Effects of Therapy on the Gait of Children with Down Syndrome: A Systematic Review. Retrieved April 16, 2009, from University of British Columbia: https://circle.ubc.ca/dspace/bitstream/2429/134/1/team_Down_Syndrome.pdf
North American Riding for the Handicapped Association. (2009, March 3). About NARHA. Retrieved April 16, 2009, from North American Riding for the Handicapped Association: http://www.narha.org/WhoIsNARHA/About.asp
Sterba JA, R. B. (2002). Horseback riding in children with cerebral palsy: effect on gross motor function. Developmental medicine and Child nuerology , 301-8.
The Community for Riding for the Disabled. (2008). A History of Therapeutic Riding. Retrieved April 16, 2009, from The Community for Riding for the Disabled: http://www.card.ca/index.cfm?pagepath=About_CARD/Why_Ride_/A_History_of_Therapeutic_Riding&id=10320
William D. McArdle, F. I. (2006). Introduction. In Exercise Physiology (p. XXX). United States: Lippincott Williams And Wilkins.
Winchester P, K. K. (2002). The effect of therapeutic horseback riding on gross motor function and gait speed in children who are developmentally delayed. Physical and Occupational Therapy in Pediatrics 22 , 37-50.