Equine therapy

Assessing the impact of Hippotherapy (an equine therapy) on occupational performance following brain injury: a case study Q&A.

Sarah was struggling with fatigue, poor balance and depression when our Krysalis Neuro Occupational Therapist first met her.

But the brain injury survivor wanted to socialize with friends, and she had a lot of interests she was keen to explore, including animals. 

Here is how our Krysalis Neuro OT helped.

Q: What were the initial observations of Sarah’s mobility hurdles?

A: Sarah reported that she was ‘clumsy’ and prone to falling, and she was worried she might lose her balance and fall in public, as she had at times in the past.

What made it worse for her, sometimes, was that she struggled to get back up due to weakness in her legs

She also had problems with her memory, planning, organization and attention, and had some difficulty with fine finger movement and reduced hand grip. 

Sarah had already rejected the idea of a mobility scooter and so our Neuro OT suggested she consider other outdoor mobility options in order for her to make an informed decision.

Q: What were Sarah’s vocational and leisure interests at that point?

A: Sarah had been attending college studies but was not sure whether she enjoyed college life and stated she had no particular friends there.

At the time, and despite being happy and able to use taxis, Sarah had very limited social and leisure opportunities, attending no clubs or activities outside of college.

She appeared underconfident in her abilities and yet her range of interests was broad, encompassing drama, art, animals and shopping.

Q: Why Hippotherapy?

A: Our Neuro OT needed to explore Sarah’s physical, cognitive and social skills in addition to her likes and interests to establish a better picture of what she was able to achieve functionally. 

During one exploratory discussion, Sarah revealed a desire to try horse-riding which, as a therapy, numerous research studies have shown can benefit physical and mental health in a number of ways. (1) (2) (3)

It quickly became apparent horse-riding was one of Sarah’s key goals.

To help her achieve it, our Neuro OT collaborated with Sarah’s Physiotherapist who confirmed Hippotherapy (one type of therapy involving horses) could be “extremely beneficial” to her rehabilitation.

Hippotherapy can improve balance, posture, core strength and confidence. It also requires motor planning, attention and memory. 

For example, Sarah would have to listen to verbal instruction, whilst also having to divide her attention between her physical posture and managing the horse. 

Hippotherapy is a tactile and relaxing activity, outdoors, among other people, and includes interaction with animals which, studies have shown, can prove beneficial to mental health.

However, it was important to ensure that this would be a safe therapeutic activity for Sarah, and so upper limb and risk assessments were carried out first.

Q: How did you access Hippotherapy?

A: Our Neuro OT spent some time making enquiries to ascertain an appropriate riding centre and decided to approach The Fortune Centre of Riding Therapy in Dorset which specialises in working with young people with learning or physical difficulties.

She collaborated with staff there regarding Sarah’s needs and then booked a tour of the centre for Sarah to familiarize herself with the site and ask any questions.

Sarah was reportedly “delighted” to be around the horses, stroking each one as she passed, and asking lots of appropriate questions.

And although she managed mobilizing around the site, there were challenges due to the uneven ground and sand school surface.

The site visit was very useful in identifying other occupational performance and risk areas that needed assessing, such as mobilising across uneven terrain and handling the animals.

Q: What was the outcome?

Sarah started off by attending groundwork sessions in which she learned to work with horses using her voice and gestures, and how to groom and care for them. 

She proceeded on to mounted work (positioned on the horse) which included learning to ride, stretching/balance exercises and following instruction.

Our Neuro OT attended some of these 45-minuite Hippotherapy sessions with Sarah to ensure she was enjoying it, as well as gaining therapeutic benefits.

On her first visit, she discovered it was a very busy and over-stimulating environment and yet, while Sarah inter-acted with her horse and instructor, our Neuro OT observed her:

• following instruction.
• multi-tasking.
• planning.
• dividing attention.
• remaining focused.
• bending and stretching.
• reaching outside her centre of gravity, propped appropriately.
• balancing.

Sarah was also able to project her voice, changing tone and speed effectively to achieve a positive result from the horse.

When the session ended, she expressed extreme delight for having taken part and a wish to return regularly.

Significantly, she also met some other young people who she knew and said it was “nice to see them”.

Our Neuro OT’s conclusion was that horse-riding was a very valuable activity for Sarah, incorporating physical, cognitive and emotional skills.

It would benefit her significantly by progressing her skills for the future if her performance and attendance remained consistent.

Q: How else did you support Sarah with her Hippotherapy goal?

There were further safety and administrative tasks that needed completing before Sarah continued horse-riding.

To ensure she was physically protected, she required the correct bodywear and accessories, and so our Neuro OT assisted her with decision-making on purchases and accompanied her for professional fittings to ensure items, such as boots, also met her individual, physical needs.

There were additional healthy and safety forms that needed to be completed, which our Neuro OT facilitated with The Fortune Centre.

Our Neuro OT also ensured Sarah had a good understanding of the risks horse-riding presented as an activity, and in relation to her own health.

Q: Has Hippotherapy had an impact on Sarah’s occupational performance?

A:  Our Neuro OT is continuing to monitor the impact horse-riding is having on Sarah and to consult with her in reviewing/updating her goals in relation to her progress.

Since starting Hippotherapy sessions, however, she has observed marked improvements in Sarah in the following areas:

• confidence.
• perseverance. 
• self-awareness.
• attention.
• organization.
• physical stamina. 
• mobility.
• balance. 

More about how animals can assist in occupational therapy practice here:

Animal assisted therapy-is there OT beauty in the beast?

Rebecca - case study

References

1. Leidig, Madison. An Examination of Hippotherapy as a Tool to Deliver Physical, Occupational and Speech Therapy. s.l. : Western Washington University, 2018.

2. Erdman, E. A. and Pierce, S. R. Use of Hipppotherapy with a Boy After a Traumatic Brain Injury. s.l. : Pediatric Physical Therapy, 2016.

3. Garner, B. A. and Rigby, B. R. Human pelvis motions when walking and when riding a therapeutic horse. s.l. : Human Movement Science, 2015.