Healing by horseback: Hippotherapy provides results

Hippotherapy offers rhythmic motion
December 16th, 2015

“Hippotherapy refers to the incorporation of equine movement by physical therapy, occupational therapy, or speech language pathology professionals in treatment.” – American Hippotherapy Association (AHA).

Tim Miller laughs and waves his hands with excitement as a physical therapist and volunteers strap him into a rock-climbing harness. He knows what comes next: He’ll be hoisted onto a horse.

Tim, 28, has cerebral palsy and spends most of his life in a wheelchair. Other than swimming, riding a horse is one of the few chances he gets for exercise.

Once mounted on Ally, a brown and white mare with a gentle disposition, Tim sits more erect and gains better control of his body.

Therapists say there’s something about being on horseback that takes patients beyond what they could achieve with traditional physical therapy methods.

“Good job,” said Sage Littleboy, his physical therapist from the Rehabilitation Patient Care Unit at Memorial Hospital at UCHealth Colorado Springs.

Littleboy and her supervisor, Kristen Zelenbaba, have earned Level 2 therapist certification from the AHA. Littleboy, who has been doing this for four years at Memorial, originally became involved in hippotherapy when she volunteered in a program while in graduate school.

Tim’s mom said that after he spent three years in the program (offered at the Pikes Peak Therapeutic Riding Center), she could see a big difference.

“Oh, my gosh, it’s been wonderful for him,” said Sheri Miller. “It’s been good for his balance, for upper body strength and for relaxing his muscles. It’s very soothing.

“It gives him a sense of being able to do something other people can do. He loves it. He’s just the happiest kid anyway, but this makes him especially happy.”

Littleboy also sees improvement in Tim’s physical abilities.

“Most recently, our big focus is trying to get him to verbalize more. But from a PT standpoint, it’s more about his standing balance and his ability to walk. At home now, he walks to the bathroom and to the car, instead of riding in a wheelchair,” she said. “He’s gaining more mobility.”

More success stories

Ashley Whitead, also 28, follows Tim into the shady indoor arena.

Anita Azare, Ashley’s mom, said her daughter has been diagnosed as intellectually developmentally delayed. Learning basic concepts can be difficult for her.

When she arrived for a recent Monday session, Ashley was overly excited and repeating several phrases over and over. Once mounted on the horse, however, she calmed down and seemed to gain control over both her body and her mind. Her speech became more focused, and she carefully followed directions while sitting atop the gentle Ally.

Littleboy had Ashley identify colors, name the days of the week, and do small tasks, like tossing a red beanbag into a slot in a ladybug painted on the wall.

“She likes being around people, being observed by people,” her mom said. “She is in a dance troupe, a drama group, and anything that involves performing. She likes all that.”

Ashley has been riding since she was about 15 or 16. Once she did it, she was hooked, her mom said. “Her first session, it took us about 40 minutes to get her off the horse.”

On days after Ashley has ridden, “She’s more independent and expressive in her language, and she’s able to construct language instead of just parroting things or repeating things,” Azare said.

The fact that Memorial offers this, “Well, it’s just thinking outside the box.  And because it’s a hospital program, insurance pays for it. That’s a big deal for us.”

Ashley tends to have a crouched walk, Littleboy said. “We’re trying to give her more of an upright gait. She has issues controlling her excitement. The horse helps her control that.”

Tonya Bauer had a car accident that resulted in a serious spinal injury in 2011. A horse lover, she has been doing hippotherapy for more than a year. She rides Dylan, a big brown gelding. Although she and her husband have horses on their own place east of town, those animals are not trained to handle someone with an injury. But the horses at the riding center are specifically chosen for their placid demeanor.

“It has opened new vistas for me,” Bauer said. “It gives me more flexibility, and more confidence in my walking,” which she does with the aid of two high-tech crutches.

“We are working on Tonya’s core stability and leg strength to allow her to be more independent in her home with the Lofstrand crutches,” said therapist Zelenbaba. “When she first started, Tonya required assistance to sit upright on the horse. [But] now she has incorporated the use of the reins, which decreases the ability for her arms to help her with balance. [As a result], Tonya walks more fluidly following treatment then she does before and reports increased ease at home for several days following hippotherapy.”

Tonya said she looks forward to her weekly sessions.

“It’s a bright spot in my week,” she said. “And the people are so nice here.”

How it works

According to the AHA, the therapists “use evidence-based practice and clinical reasoning in the purposeful manipulation of equine movement to engage the sensorimotor and neuromotor systems to create functional change in their patients. Used with other neuromotor and sensorimotor techniques, hippotherapy is part of a patient’s integrated plan of care.”

Nancy Beers, director for the Pikes Peak Therapeutic Riding Center, said Memorial has used their facility at Latigo for its hippotherapy program for many years.

“It started as a program for children but has been taking adults for a long time, at least a decade.”

horseback balanceHippotherapy is all about improving or regaining control of your body, from balance to confidence.  Riding, even at a slow pace, “helps normalize muscle tone,” she said. “Some patients have low muscle tone and others have way too much. Riding seems to resolve both issues.”

She also thinks that it’s good for a patient like Tim, who must turn his head and look up any time someone speaks to him. When he’s on a horse, he can sit erect and look down at the speaker for a change.

The whole premise of hippotherapy “is that the gait of the horse runs in a perpendicular fashion to the human pelvis,” Littleboy said. So it replicates normal human gait.

It’s also about posture,” she said. “[Tim] can sit up in an upright posture and it allows his diaphragm to be in a more appropriate position – he can literally breathe easier.”

Another important aspect hippotherapy offers is the rhythmical motion that only a horse can provide. The patient receives what is called vestibular, proprioceptive and visual input – which is different with every horse’s gait – and so some horses work better with certain people, she said.

“You have to analyze what the patient needs and what horse can provide that for them,” Littleboy said.  “That’s why it’s important for the therapist to be certified to provide that service.”

Insurance does cover some patients at Memorial, particularly cerebral palsy or multiple sclerosis patients, but, she admitted, “It can be tough to get insurance to pay for any of this.”

In order to get into the program, patients need to be evaluated by therapist Zelenbaba, who is the supervisor of Memorial’s Scarborough Outpatient Rehabilitation Clinic.

She typically gets referrals from physicians or requests from patients or their families for the program.  Patients need a prescription for the program, and she checks to see if their insurance will cover it. It’s billed as physical therapy – “And that is exactly what it is. We just use the movement of the horse to facilitate it.” The constant movement of the horse is far better than, say, sitting on an exercise ball, she added.

“Our main concern is the safety of the rider, volunteers and horse,” she said. “If a patient has enough sitting balance and is behaviorally appropriate, then the program can be very beneficial.”

Anyone interested in the program may contact Zelenbaba at the Scarborough center, 719-365-5742.

About the author

Erin Emery is editor of UCHealth Today, a hub for medical news, inspiring patient stories and tips for healthy living. Erin spent years as a reporter for The Denver Post, Colorado Springs Gazette and Colorado Springs Sun. She was part of a team of Denver Post reporters who won the 2000 Pulitzer Prize for breaking news reporting.

Erin joined UCHealth in 2008, and she is awed by the strength of patients and their stories.