Equine-assisted therapy

Hippotherapy has been used to treat people with physical or mental challenges.

Equine-assisted therapy (EAT) encompasses a wide range of treatments that includes equine (i.e., horse) activities or an equine environment to promote physical, occupational, and emotional growth in persons with attention deficit hyperactivity disorder (ADHD), anxiety, autism, cerebral palsy, dementia, depression, developmental delay, genetic syndromes (such as Down's syndrome), traumatic brain injuries, behavioral issues, abuse issues, post traumatic stress disorder (PTSD), drug and alcohol addiction, and other mental health problems. This type of modality does not replace more commonly used therapies, it is predominantly used to assist other forms of ''in clinic'' therapy .

This field is not to be confused with adaptive sports activities involving horsemanship. Riders with disabilities have demonstrated accomplishments in national and international Para-equestrian competitions.

Terminology

Terminology within the field is not standardized, and the lack of clear definitions and common terminology presents problems in reviewing medical literature on these therapies. An overall term that encompasses all forms of equine therapy is Equine-Assisted Activities and Therapy (EAAT). Within that framework the more common therapies are:

• Therapeutic horseback riding uses a therapeutic team, usually including a certified therapeutic riding instructor, two or more volunteers, and a horse, to help an individual ride a horse and work with it on the ground.
• Hippotherapy usually involves an occupational therapist, a physiotherapist, or a speech and language therapist working with a client and a horse. Different movements of the horse present challenges to the rider to promote different postural responses of the rider. In essence, the horse influences the rider rather than the rider controlling the horse. The word "Hippotherapy" is also used in some contexts to refer to the entire realm of equine therapies.
• Equine-assisted psychotherapy (EAP) often does not involve riding, but instead may include grooming, feeding and ground exercises. Mental health professionals work with one or more clients and one or more horses in an experiential manner to help the clients learn about themselves and others, while processing or discussing the client's feelings, behaviours, and patterns. The goal is to help the client in social, emotional, cognitive, or behavioral ways. Other variants on equine psychotherapy include Equine-facilitated psychotherapy (EFP), equine-assisted therapy (EAT), and equine-assisted learning (EAL).
• Interactive vaulting involves vaulting activities in a therapeutic milieu.
• Therapeutic carriage driving involves controlling a horse while driving from a carriage seat or from a wheelchair in a carriage modified to accommodate the wheelchair.

Application

See also: Animal-assisted therapy

Physical therapy, occupational therapy, recreation therapy and speech-language therapy strive to assist the individual with many of the same goals with EAT. However, physical therapy focuses more on gross motor movement and ability, occupational therapy focuses on fine motor ability, and speech-language therapy on the physiological systems associated with speech and language. Equine Assisted Therapy is used by these professionals to provide these benefits without giving the individual a feeling that they are in therapy.

Therapeutic Horseback Riding

Therapeutic horseback riding is the use of horses and equine-assisted activities with the goal of enhancing physical, emotional, social, cognitive, behavioral and educational skills for people in recovery or with disabilities, which include autism, cerebral palsy, and mental health disabilities. The therapeutic approach not only focuses on riding skills but also on the development of a relationship between horse and rider that proponents claim provide the greatest therapeutic benefit. Advocates also propose that a team approach with the guidance of a riding instructor is the best for providing treatment.

Most research has focused on physical benefit of therapeutic work with horses, though the most rigorous studies have only been subject to systematic review since about 2007. Claims made as to the efficacy of equine therapies for mental health purposes have been criticized as lacking proper medical evidence due in large part to poor study design. Ethical questions relating to its expense and its continued promotion have been raised in light of this lack of evidence, but such therapies are not iatrogenic; they appear to cause no harm. Reviews agree there is a lack of quanitative data and inadequacy of study design to date, but some reviews note that there is promising preliminary evidence supporting of the effectiveness of equine therapies.

Horses provide a unique neuromuscular stimulation when being ridden through their movement. Horses move in a rhythmic motion that mimics the human movement of walking. While riding, the horses stride acts to move the rider's pelvis in the same rotation and side-to-side movement that occurs when walking. The horses' adjustable gait promotes riders to constantly adjust the speed to achieve the desired pelvic motion while promoting strength, balance, coordination, flexibility and confidence.

Hippotherapy

Today, hippotherapy is defined a kind of therapy which uses horses in an attempt to improve some types of brain function by providing motor and sensory inputs. Physical and occupational therapists, physical and occupational therapy assistants, and speech and language pathologists practicing hippotherapy incorporate the horse's movement into the total care plan for their patients.

Hippotherapy has also seen use in speech and language pathology by incorporating sensory processing strategies into the treatment to facilitate improvement in the patient's communication skills and abilities.

In the United States, the American Hippotherapy Association (AHA) offers education to therapists, promotes research in equine assisted therapy and provides continuing education courses.

Equine-assisted psychotherapy

Equine-assisted psychotherapy (EAP) or Equine Facilitated Psychotherapy is the use of equines in a mental health setting, (EFP). Both EAP and EFP involve experiential psychotherapies and work in either a group or with an individual; using sessions with horses. In the mental-health field, social workers, psychologists and mental-health providers may incorporate equine-assisted psychotherapy into their treatment sessions. This is different from hippotherapy, where the movement of the horse influences or facilitates an adaptive response in the patient. Forms of equine assisted psychotherapy may have the patient on or off the horse, and the treatment is not focused on a set of specific movements for the horse to produce an adaptive response in the patient.

While some mental health therapies may incorporate vaulting and riding, most utilize ground work with the horses, so the client does not actually have to ride the horse. Since the horse is used as a therapeutic tool, the primary focus is on the client to solve problems and form solutions and not on the horse.

History

Horses have been utilized as a therapeutic aid since the ancient Greeks used them for those people who had incurable illnesses. Its earliest recorded mention is in the writings of Hippocrates who discussed the therapeutic value of riding. The claimed benefits of therapeutic riding have been dated back to 17th century literature where it is documented that it was prescribed for gout, neurological disorder and low morale. In 1946 Equine Therapy was introduced in Scandinavia after an outbreak of poliomyelitis.

Hippotherapy as currently practiced was developed in the 1960s, when it began to be used in Germany, Austria, and Switzerland as an adjunct to traditional physical therapy. The treatment was conducted by a physiotherapist, a specially trained horse, and a horse handler. The physiotherapist gave directives to the horse handler as to the gait, tempo, cadence, and direction for the horse to perform. The movement of the horse was carefully modulated to influence neuromuscular changes in the patient. The first standardized hippotherapy curriculum would be formulated in the late 1980s by a group of Canadian and American therapists who traveled to Germany to learn about hippotherapy and would bring the new discipline back to North America upon their return. The discipline was formalized in the United States in 1992 with the formation of the American Hippotherapy Association (AHA). Since its inception, the AHA has established official standards of practice and formalized therapist educational curriculum processes for occupational, physical and speech therapists in the United States.

Therapeutic riding as a therapy started with Liz Hartel from Denmark. Her legs were paralyzed from polio but with therapy she was able to win the silver medal for dressage in the 1952 Olympic Games. At about that time, in Germany, therapeutic riding was used to address orthopedic dysfunctions such as scoliosis. The first riding centers in North America began in the 1960s and the North American Riding for the Handicapped Association(NARHA) was launched in 1969. Therapeutic riding was introduced to the United States and Canada in 1960 with the formation of the Community Association of Riding of the Disabled (CARD). In the United States riding for the disabled developed as a form of recreation and as a means of motivation for education, as well as its therapeutic benefits. In 1969 the Cheff Therapeutic Riding Center for the Handicapped was established in Michigan, and remains the oldest center specifically for people with disabilities in the United States.

The North American Riding for Handicapped Association (NARHA) was founded in 1969 to serve as an advisory body to the various riding for disabled groups across the United States and its neighboring countries. In 2011, NARHA changed its name to the Professional Association of Therapeutic Horsemanship (PATH) International.

Animals such as elephants, dolphins, dogs, and cats have also been used for therapeutic purposes. Horses become the most popular animal to use in animal therapy because they give immediate feedback to the rider’s actions. Horses also have the ability to mirror the feelings of the rider. Horses’ large and intimidating appearance forces their rider to gain trust around them.

Characteristics of horses used for equine therapy

In most cases, horses are trained and selected specifically for therapy before being integrated into a program. Horses can be of any breed but must share specific characteristics such as being calm, even-tempered and gentle. They have to be serviceably sound, though as most work is done as slow speeds, an older horse that is not in its athletic prime can be well-suited to therapy work. They must be well-trained both under saddle and on the ground. Geldings are used more often as they are considered the most even-tempered; mares can also be used. Stallions are generally not used due to the dangers inherent in their hormone-driven behavior.

A horse has to be calm but not lazy. It must also be physically suited with proper balance, structural, muscling and gaits are particularly sought. Muscling is not as important as the balance and structural correctness, but the horse needs to be properly conditioned for the work it is to do. The horse's gaits, especially the walk, must be of good quality and the horse must move freely in order to be the most beneficial for the person. The horse should be sound and not show any signs of lameness, theses horses are not suited for equine therapy since they cannot offer the optimum benefits to the patient and quality required.

Effectiveness

There is some evidence that hippotherapy can help improve the posture control of children with cerebral palsy, although the use of mechanical hippotherapy simulators produced no clear evidence of benefit. A systematic review of studies on the outcomes of horseback riding therapy on gross motor function in children with cerebral palsy was concluded in 2012 with a recommendation for a "large randomized controlled trial using specified protocols" because, although positive evidence was indicated by nine high-quality studies surveyed, the studies were too limited to be considered conclusive.

According to Research Autism, "There is insufficient evidence to determine if hippotherapy provides any benefits to individuals on the autism spectrum".

There is no plausible theoretical basis for the use of equine-related treatments for people with mental health conditions, and no good medical evidence that it can help them. A 2014 review by Michael Anestis and colleagues found these treatments did no harm but strongly questioned the "meaning and clinical significance" of existing studies, and raised ethical concerns both about the marketing and promotion of the practice, and about the opportunity cost if patients in need of mental health services were "diverted" from evidence-based care. The review recommended that both individuals and organizations avoid this therapy "unless and until a strong research foundation [...] emerges".

Accreditation and certification

The Professional Association of Therapeutic Horsemanship (PATH) accredits centers providing a variety of beneficial services to people with disabilities. The Equine Assisted Growth and Learning Association (EAGALA) focuses more on the mental-health aspects of human-equine interaction, and provides certification for mental-health and equine professionals.

PATH divides these services into two general categories – "Equine-Assisted Activity" and "Equine-Assisted Therapy". Equine- assisted activities are those services provided by a trained professional and focus on recreation, leisure, sport or education. Examples of equine-assisted activities are therapeutic horseback riding, carriage driving, vaulting and equine-facilitated learning. These activities are based on an educational model; skills are taught to riders, vaulters and students. The professional guiding the experience is a specially-trained, PATH-certified instructor. The professionals’ training provides them with expertise in specialized, adaptive teaching methods which allow people with a variety of disabilities to learn horsemanship skills and experience the equine environment. Accreditation is a voluntary process that recognizes PATH Intl. The accreditation process is a peer review system in which trained volunteers visit and review centers in accordance with PATH Intl. standards. A center that meets the accreditation requirements based on the administrative, facility, program and applicable special interest standards becomes a PATH Intl. Premier Accredited Center for a period of five years. In addition to therapeutic equitation, a center may offer any number of equine-assisted activities and therapies, including Hippotherapy, equine facilitated mental health, driving, vaulting, trail riding, competition, ground work or stable management.

In Canada, centers and instructors are regulated by CanTRA, also known as The Canadian Therapeutic Riding Association.

The American Hippotherapy Association offers certification qualifications for working as a hippotherapist. Hippotherapy Clinical Specialty (HPCS) Certification is a designation indicating board certification for therapists who have advanced knowledge and experience in hippotherapy. Physical therapists, occupational therapists, and speech-language pathologists in practice for at least three years (6,000 hours) and have 100 hours of hippotherapy practice within the prior three years are permitted to take the Hippotherapy Clinical Specialty Certification Examination through the American Hippotherapy Certification Board. Those who pass are board-certified in hippotherapy, and entitled to use the HPCS designation after their name. HPCS certification is for five years. After five years the therapist can either retake the exam or show written evidence of 120 hours of continuing education distributed over the five years. Continuing education must include 50% (60 hours) in education related to equine subject matter: psychology, training, riding skills and so on; 25% (30 hours) in education related to direct service in the professional discipline and 25% (30 hours) in any other subject related to hippotherapy. An alternative is to provide written evidence of scholarly activity appropriate to the field of hippotherapy. Acceptable scholarly activity may include graduate education in hippotherapy, publication of articles on hippotherapy in juried publications, scientific research related to hippotherapy, the teaching or development of hippotherapy, or acting as AHA-approved course faculty. AHA, Inc now recognizes two different AHCB credentials: AHCB Certified Therapist and AHCB Certified Hippotherapy Clinical Specialist.

See also

• Occupational therapy
• Physiotherapy
• Para-equestrian
• Riding for the Disabled Association (UK)
• Professional Association of Therapeutic Horsemanship (PATH) (US)
• Horseback riding simulators

External links

• Federation of Riding for the Disabled International
• American Hippotherapy Association (AHA)
• Professional Association of Therapeutic Horsemanship (PATH)
• CanTRA, Canadian Therapeutic Riding Association