10/3/2018 1 The Treatment Connection Between Occupational Therapy and Hippotherapy Karen M. Gardner, OTR MOT Hippotherapy Clinical Specialist (HPCS) 2018 Mountain Central Conference Texas Occupational Therapy Association My Goals for Presentation • To describe and discuss the relationship between occupational therapy and hippotherapy which is a movement based treatment strategy • Frames of Reference for clinical rationale • Treatment Principles for developing plan of care • Case Study Examples- compare and contrast – traditional OT with specialized OT including equines in sessions Learning Objectives I • Participants will: • be able to define hippotherapy and understand the clinical rationale for the incorporation of equine movement (hippotherapy) into a comprehensive OT Plan of Care • learn how OT treatment strategies are complementary with the principles of hippotherapy • learn to maximize functional outcomes in a patient- centered OT session including hippotherapy.
Transcript
10/3/2018
1
The Treatment Connection Between
Occupational Therapy and
Hippotherapy
Karen M. Gardner, OTR MOT
Hippotherapy Clinical Specialist (HPCS)
2018 Mountain Central Conference
Texas Occupational Therapy Association
My Goals for Presentation
• To describe and discuss the relationship between occupational therapy and hippotherapy which is a movement based treatment strategy
• Frames of Reference for clinical rationale
• Treatment Principles for developing plan of care
• Case Study Examples- compare and contrast – traditional OT with specialized OT including equines in sessions
Learning Objectives I
• Participants will:
• be able to define hippotherapy and understand the clinical rationale for the incorporation of equine movement (hippotherapy) into a comprehensive OT Plan of Care
• learn how OT treatment strategies are complementary with the principles of hippotherapy
• learn to maximize functional outcomes in a patient-centered OT session including hippotherapy.
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Learning Objectives II
• Participants will:
• learn how to maximize the benefits of equine movement
• learn how meaningful and contextually relevant activities can optimize treatment effects
• enhance their clinical reasoning in a unique environment
• learn to identify safety concerns and manage risk within this specialized treatment setting
How are OT and HPOT related?
• Hippotherapy is a treatment strategy that is incorporated into a comprehensive Plan of Care by an OT, PT or ST
• Both are based on functional activities
• Both are based on the therapeutic value of a dynamic systems model because of the holistic affect on the client
• The context of the activities has therapeutic value
• The ultimate goal is to increase participation in ADLs
Description of Hippotherapy
• According the American Hippotherapy Association:
• OT, PT and ST use clinical reasoning and evidence based practice in the purposeful manipulation of equine movement to engage sensory, neuromotor and cognitive systems to achieve functional outcomes.
• In conjunction with the affordances of the equine environment and other treatment strategies, hippotherapy is part of a patient’s integrated plan of care
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Scope of Practice
• AOTA,
• APTA
• ASHA
• have recognized that hippotherapy is a treatment strategy within the scope of practice of each of these therapy disciplines
• What does that mean to us?
Why the Horse?
• Human and Horse Movement – a unique relationship
• Human Gait occurs in 3 dimensions, in the vertical: • Anterior/posterior
• Lateral
• Rotational
• The Horse moves in the same 3 dimensions but from a horizontal perspective
Skeleton Comparison
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Skeleton Comparison
Video Example
The Science Behind It
• Humans develop in a hierarchical pattern
• Development occurs based on motor experiences coupled with sensory, neuro and cognitive inputs
• When the opportunity to experience normal movement patterns is missing or diminished, development will be delayed
• Experiencing high quality coordinated motion from a living being has potential to make changes to the person’s CNS, emotional and cognitive systems
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Benefits of HPOT
• Horse’s sensory, motor and nervous system are well-regulated and can be a model of how to adapt to challenges such as hyperarousal or low motivation
• Can help with regulation of sensory over or under responders
• Mounted posture contributes to good alignment and activates balance reactions
Benefits of HPOT
• Horse’s well regulated demeanor (calm and attentive) can be a model of positive behaviors because a horse “reads” the internal atmosphere of people rather than their words and reacts appropriately
• Intense person – horse behavior is hesitant and resistant
• Quiet, calm person – horse is attracted to them
• Why and How? Predator vs Prey
Frame of Reference 1
• Dynamic Systems Model
• Motor
• Musculoskeletal
• Nervous/limbic
• Respiratory
• Circulatory
• Sensory Processing
• Speech-language
• Cognition
• Vestibular/Proprioceptive /Kinesthestic
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Frame of Reference 2
• Hippotherapy Conceptual Framework
• Neuroplasticity
• Postural Mechanism
• Entrainment
• Rhythmicity
• Variability of Practice – motor learning
• Motivation and Arousal
The Treatment Connection
• The goals of OT intervention can be accomplished both with traditional and non-traditional therapeutically designed activities because the inclusion of equine movement is based on similar principles to human development, habilitation and re-habilitation
Client Selection
• This type of treatment has some precautions and some contraindications to consider:
• Precautions would be allergies, sun sensitivities, ability to tolerate movement and equipment like a helmet
• Contraindications would be spinal issues affected by movement, bleeding issues, potential for harm from a fall, etc.
• Source: AHA, Inc. Best Practice Guidelines
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Clinical Equipment = Horse?
• So what equipment is similar in the clinic?
• Therapy ball
• Swings
• Bolsters
• Treadmill
• Bicycle
• Scooter Board
Goals and Activities
• Gross Motor Tasks
• Walking, running, stairs, ramps,
• Kicking a ball,
• Throwing a ball – not at a target
• Doing whole body resistive work
• Pushing, pulling and carrying loads
GM – Case Study
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Goals and Activities
• Fine Motor Tasks
• Throwing an object at a target
• Manipulating objects using BUE and stable posture
• Manipulation and dexterity with small objects
• Eye Hand coordination such as writing and reading
• Using hand tools – hammer, fork, etc.
FM – Case Study
FM – Case Study
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Goals and Activities
• Psychosocial Tasks
• Shared attention
• Social skills such as greetings, appropriate social interactions, waiting your turn, good sportsmanship, empathy, sharing tools or toys
Psychosocial – Case Study
Goals and Activities
• Oral Motor skills
• Control lip closure, tongue retraction and secretions
• Using words or gestures for communication
• Eating with appropriate control of bolus and safe swallowing
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OM – Case Study
Goals and Activities
• Cognition
• Comprehension
• Problem solving
• Memory – short and long term
• Age appropriate thought processes
Cognition – Case Study
Same and Different Description
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Cognition – Case Study
Memory and Problem Solving
What’s Next? 1
• Referral:
• Be knowledgeable about the availability of services in your area and be able to refer appropriate clients
• Consult:
• Work with a local facility to help with evaluations and problem solving for therapeutic riding centers and hippotherapy facilities
What’s Next? 2
• Specialist:
• For you to continue your education to become a specialist in your field including hippotherapy as part of your treatment skills toolbox
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The AHA Inc.
• This membership organization provides courses in treatment principles for hippotherapy and specialty courses such as neuro, core development, sensory, communication and how to start a business, and treatment idea development
• It also offers courses in training horses for the specific discipline of therapy and training your horse handlers
