Hippotherapy: refers to a form of therapy that is fast growing in popularity, administered by physical therapists, occupational therapists, or speech language pathology professionals that assist and treat their patients through the incorporation of equine movement.
Horse Tales was fortunate to conduct an in-depth interview with Bonnie Cunningham at her enchanting Swamp Fox Farm on Swiss Hill, just above Jeffersonville, in upstate New York. Bonnie is a Physical Therapist who instructs other therapy professionals and practices Hippotherapy to work with children and adults with varied disabilities, ranging from the autism spectrum to strokes, cerebral palsy to multiple sclerosis; to help her patients with balance, sensory issues, motor planning and coordination.
The Beginnings of modern day Hippotherapy
Hippotherapy began in Europe, and came about thanks to Danish Dressage rider, Lis Hartel, a competitive young horsewoman who was paralyzed by polio in 1944. Remarkably, Lis rehabilitated herself by riding horseback, against medical advice. She needed help getting on and off the horse, but she persisted, and after three years began competing in Scandinavian riding championships. In 1952, despite still being paralyzed below the knees, she won the silver Olympic medal for Dressage, and became the first woman to share an Olympic Podium with men. Not long afterward, Lis and her therapist founded the first Therapeutic Riding Center in Europe, which drew the attention of the medical community as a method of treating therapy patients. By the late 1960s equine movement as medical treatment was considered a valuable therapeutic tool and began to spread in popularity around the world.
Types of treatment
There are two distinct methods of equine treatment, which Bonnie Cunningham called the two ‘divergent pathways’: Adaptive Riding and Hippotherapy.
Adaptive Riding is the educational tool, where people use a specially trained riding instructor for problems such as weakness or balance — the adaptation may require a special kind of tack — and the goal is horseback riding; Physical Therapy, Occupational Therapy or Speech Pathology professionals are never used.
Hippotherapy is a medical treatment. The goal is never horseback riding, but rather utilizing the movement of the horse to assist disabled people in many different positions; the same goal might result from treatment in a clinic; with this form of therapy, the stable and arena become the clinic.
Bringing Hippotherapy to the U.S.
Hippotherapy officially began in the United States in 1987, when 18 therapists went to Germany to be trained, returned to this country and started a curriculum. Bonnie began the same year. She was at a show barn riding hunt seat; her trainer knew she was a Physical Therapist and suggested she go to a therapy clinic to get involved. Bonnie started as a volunteer. She worked with one of original therapists as a side walker volunteer for years, and became a treating therapist in the mid-1990s.
Today Bonnie teaches courses for the American Hippotherapy Association (AHA), which are hosted by facilities all over the world. The individual facility hosts a course, and AHA supplies the faculty, which is made up of associated PTs, OTs, and Speech Language Pathologists. Contacts/requests are made through the AHA office, located in Ft. Collins, CO; others via the website, which offers bios of all the therapists. While originally Bonnie was required to travel all over the country to teach, there are now enough therapists to keep her primarily on the East coast; namely in the states of New Hampshire, Virginia, Maryland, New Jersey. She’s also taught internationally, having traveled to Portugal back in June, in addition to Beijing China, Moscow and South Africa.
Teaching course material
The Hippotherapy courses that are given for therapists are four-day hands-on, intensive courses. The first days focuses on the Equine: conformation, movement, analysis of the gaits, grooming, tacking up, leading, and safety around the barn. Bonnie explained that even though the therapist is not leading the horse, he/she needs to understand enough to know if it’s being done correctly, as her professional license is ‘on the line’ if something unexpected happens.
The following three days are geared towards treatment that matches the human movement with horse’s movement — some horses have more anterior/posterior movement; others more lateral, rotational movement. The therapists ride the horses to feel the difference. They explore walking in straight lines vs. circles, serpentines vs. figure eights, and discuss their strategies: what are your goals for the patients, why are you choosing that movement. They examine the effects of lengthening/shortening the stride and how that effects the patient, as well as why they would choose a horse that offers a particular movement for each patient. The instructor covers position changes — a lot of work is done with the patient seated forwards, as well as side sitting, modified side sitting, backwards, and even prone over the barrel — lying supine and lying prone on the horse. All positions have a therapy rationale — such as why is a patient turned backwards on the horse and asked to prop their hands on the horse’s rump (for weight bearing.)
Therapists are taught to determine how to tailor therapy to their individual patient and what they need to work on. They choose the horse according to its particular movement; and choose tack, whether a saddle with stirrups, or a bareback pad or surcingle with pad for a patient who needs to move around on the horse. They decide if the horse will be led or long-lined (ground driven) and if one or two side walkers are needed. With long lining a qualified long liner is required; the therapist might be a side walker. As the lines are along the horse’s side rather than over the horse’s back, it provides the finesse as if you were riding, which gives the horse a sense of balance, as opposed to leading the horse — where the leader is always on one side, making it harder to establish that balance.
Choosing a horse, which horses are best
One of the biggest challenges is having the therapist become knowledgeable about the horses they will be working with. Many facilities are not able to afford to purchase their stock; most lease or utilize their own, or donated horses. The therapists needs adequate knowledge about lameness issues and identifying horse movement so that when they go to a facility they are able to choose which horse will be best suited for their needs. Not all horses will tolerate people on both sides of them, especially if they don’t have good control. And above all else, the horse must have exceptionally good temperament and tolerance — to be able to endure the screaming, yelling and hand flapping of a child with autism spectrum; or the squeezing of a child with high tone cerebral palsy; or the asymmetry of someone who has had a stroke. A therapist needs to look for horses that have different abilities as to what they will tolerate — both physically and from a desensitization point of view.
Older horses tend to be the most prevalent, as they can tolerate loud noises, vehicles, opening umbrellas, bicycles — but as most Hippotherapy programs don’t generate adequate income, most horses are donated as they’ve aged out of what they’ve done before — whether hunt seat, dressage, western pleasure; and tend to be arthritic and stiff. And while much of the therapy is done at a walk, it’s actually more difficult for an older horse to stay at that pace for long periods of time, while carrying an unbalanced rider.
Therapy horses may be of any breed — save for hot blooded/highly sensitive and very tall horses. Ideal sizes tend to be 15 – 15.1 hands; ponies are also used, mostly those of 13+ hands for a smoother walk. However, some children with autism spectrum and low tone actually do well with the more concussive walk of a smaller pony. Ideally, a facility will have a selection of equines with excellent temperaments, tolerance and physical stamina to choose from in order to best match equine with patient.
Bonnie loves her job; and enjoys traveling, as she learns from every facility. What she likes best is that each is unique, with different equipment, setup, horses and patients. She constantly needs to adapt and think ‘on the fly’.
To get involved as a volunteer, or for more information, please visit the American Hippotherapy Association at www.americanhippotherapyassociation.org