"Hippotherapy is physical, occupational, and speech-language therapy treatment strategy that utilizes equine movement as part of an integrated intervention program to achieve functional outcomes (AHA website)."  The three dimensional movement of the therapy horse translates to the rider producing similar pelvic motions to those seen in ambulation.

There are several key people involved in a hippotherapy session beyond the therapist, the therapy horse, and the rider.  The horse handler is physically in control of the therapy horse and in charge of producing the desired movement in the horse at the request of the treating therapist. Additionally, side walkers walks on either side of the horse to ensure the riders safety and assist as appropriate,

In hippotherapy, the therapy horse's motion is altered in order to produce the desired reaction in the rider. For instance, by changing the length of the horse's steps the therapist can vary the type and amount of motion translated to the rider.  Additionally, changes in direction, initiation and cessation of movement and well as trotting verses walking are strategies used by therapists in order to accomplish specific movements.  These movements can be used to work on various goals including: strengthening, dynamic postural stability, motor control, sensory integration, communication, cognition, spatial awareness, and social interaction.

Therapists that practice hippotherapy also vary the position of the rider based on their desired outcomes.  A child may sit forward or backward on the horse, allowing the therapist to influence their posture through pelvic position as well as vary their sensory input.  Additional positions commonly used include: having the child lay on their tummy either along the horse's back or over their barrel, lying on their back, side sit, and quadruped (hands and knees). 

In general, hippotherapy is appropriate from age two through adults; however appropriateness is best determined by a therapist that practices hippotherapy as there are several contraindications to this form of treatment.  Many hippotherapy facilities do operate off a waitlist for services and tend not to bill health insurance, California Children's Services or Regional Center; however, some facilities are able to provide need based assistance through fundraising and donations.

Equine Assisted Therapy encompasses all forms of Intervention that use activities with a horse as part of therapeutic treatment.  Hippotherapy is just one form.  Another form is Therapeutic Riding.  The following links can provide more information on both Hippotherapy and Therapeutic Riding as well as provide a list of certified therapists and instructors.

American Hippotherapy Association
North American Riding for the Handicap Association

For more information on local programs please contact the facility directly.

 

After reading about motor learning last month, you are on your way to having a basic understanding of the puzzle of what actually takes place before a ball is kicked or before first steps are taken.  Execution of a motor skill requires several pieces of the puzzle to come together. Another piece of the puzzle is motor control.

 

Motor control is a broad term used to describe the nervous system's abilitiy to regulate the timing and amount of muscle contraction to produce smooth, coordinated, fine and gross movements.  Like motor learning, this occurs in three stages.  The first stage is stimulus indentification.  In this stage, important sesnory stimuli from the environment as well as from the body itself (input from prioprioceptors in the joints and muscles that tell our brain where our body is relative to it's space) are identified.  While several stimuli may be present, only certain ones are relevant and necessary to lead to motor production.  Previous experience, attention, motivation, and emotional state can all be factors in the ability to regulate sensory input.  Children with neurological impairments as in Cerebral Palsy or or with sensory processing difficulties as in Autism will most likely have difficulty progressing past this stage.  Initially, they may require a controlled environment along with sensory integration training in which they learn to regulate different stimuli before they can be expected to execute the desired movement appropriately.

 

The second stage is the response selection stage. During this stage, a purposeful motor plan is developed and a general decision is made.  For example, when you are driving you see a red light (visual sensory input is identified) and in response you move your foot to the brake pedal to stop your vehicle (response selection). This is an easy decision.  However, in the case of a yellow light you identify the stimulus but you may hesitate in your response between braking or continuing on but ultimately you are still able to choose an appropriate response.  Unfortunately, if your neuromuscular system is impaired, you may be unable to produce a purposeful movement in response to a stimuli or you may produce the same movement in response to every stimuli  or your responses may be too little or too much related to the stimulus.

 

The third stage is response programming.  In this final stage, control centers in our brain begin to program the sequence of muscular actions that occured in response to a certain stimuli so that we now have the response programmed in our brain to access whenever we need to.  This is why for most of us, braking and accelerating in response to traffic lights hardly requires any thought or effort.  It just happens. As pediatric therapists, we strive to help children with various types of impairments achieve this stage of motor control. 

 

The progression of motor control is very similar to that of motor learning.  However, it may help to think of motor control as the first piece to the puzzle and motor learning the second.  You must be able to produce smooth, coordinated, sequenced movements before you can truly become autonomous with any skill. 

 

Hopefully, these articles have helped you understand the processes behind motor execution.  Stay tuned in May to see how postural stability and balance play a role!