1. A Review of Animal Assisted Therapy
Hippotherapy and Dolphin Therapy
Antonia Giannakakos
Paula Gaglioti
Erin Stutz

2. Animal Assisted Therapy
Involves animals as a form of treatment
Goal = improve social, emotional and cognitive functioning
Research shows that the relationship between humans and companion animals are generally favorable
Methodological concerns about the poor quality of data show a need for improved experimental studies

3. What is Hippotherapy? http://www.americanhippotherapyassociation.org/
“The American Hippotherapy Association defines hippotherapy as a physical, occupational, and speech-language therapy treatment strategy that utilizes equine movement as part of an integrated intervention program to achieve functional outcomes.”
Video

4. What is Hippotherapy?
Using a horse as a treatment tool to accomplish therapeutic objectives:
Improved balance
Strength
Motor coordination
For children with Autism:
Promoting communication
Sensory regulation
Creating a bond between horse and student
Bond motivates student to complete skill building tasks

5. Hippotherapy History
Hippocrates mentions riding in his writing “Natural Exercises”
1780
Tissot wrote of the beneficial qualities of a horse’s walk. Also mentioned ill effects of too much riding.

6. Hippotherapy History
1875
Chassaign, a French physician, began conducting the first systematic study of therapeutic riding
Beneficial therapy for certain types of neurological paralysis
Noted improvements in posture, balance and joint movement
Striking increases in morale

7. Hippotherapy History 1960s 1980s Germany, Austria, and Switzerland
An adjunct to physical therapy
Performed by a physiotherapist, trained horse and horse trainer
Gait, tempo, cadence and direction
Influence neuromuscular changes in the patient
1980s
First hippotherapy curriculum was formed by Canadian and American therapists

8. Hippotherapy History 1992 1999 American Hippotherapy Association
Established standards and educational curriculum for occupational, physical and speech therapists
1999
First Hippotherapy Clinical Specialists were being certified in the United States.
Traveled to Germany to learn about hippotherapy to bring it to North America (wikipedia)

9. American Hippotherapy Association
Has evolved over 30 years.
MISSION: to educate and promote excellence in the field of Equine Assisted Therapy
VISION: AHA is recognized as part of the international community that provides education, facilities research and promotes Equine Assisted Therapy as an effective treatment strategy that improves the quality of life for individuals with disabilities.

10. AHA Core Values Integrity Accountability Accessibility Innovation
Excellence
Collaboration

11. AHA Curriculum Level I – Treatment Principles 2 1/2 day course
Entry level therapists
Hands on practicum
Can be attended by graduate occupational, speech and physical therapists.
Curriculum may be utilized only under conditions set forth by AHA, Inc.

12. AHA Curriculum Level II Treatment Principles 2 1/2 day course
Provides and facilitates a problem solving treatment approach
Uses actual patients currently involved in Hippotherapy
Practical applications to NDT, SI and Motor Learning Theory and Clinical Reasoning will be applied
Video taping and group discussions
Attendees
licensed, Speech, Physical and Occupational Therapists and assistants (PTA, COTA). The curriculum may be used only under conditions set by AHA, Inc.
The AHA Education Committee requires 30 treatment  hours of experience of 1:1 patient treatments incorporating hippotherapy as a treatment strategy before this course

13. Therapeutic Strategies
Sensory stimulation to muscles and joints
Proprioception
Impacts balance
Varied tactile experiences
Communication
Receptive
Expressive
Social cues

14. Importance of the Horse
Walk
Pelvis
Provides sensory input
Graded for each student
Gait change = input change
Creates reaction in student’s pelvis
Improves neurological functioning and sensory processing
Horse’s walk is similar to human’s 3 dimensional walk
Gait – change or no change helps achieve therapy goal
Reaction – generalizes to daily routines and functional outcomes of therapy goals

15. What Hippotherapy Claims To Do:
Professional treatment to improve neurological functioning in the areas of:
1) Cognition
2) Body movement
3) Organization
4) Attention (

16. Also Claims to Address:
1) Vestibular system: client is facing backward while horse is moving forward.
2)Proprioceptive: heavy touch pressure through the hip, knee, wrist, elbow and shoulder joints in the quadruped position. [Quadruped position is when client is on all fours]
3)Tactile: touching the warm soft coat of the horse.

17. Also Claims to Address Cont’d:
4)Cognitive: higher level motor planning skills required to execute the transition.
5)Motor: stability of hips and pelvis required to maintain position while reaching forward with one hand. (

18. Treatment Approach:
uses activities on the horse that are meaningful to the client and specifically address the individual's goals.
provides a controlled environment and graded sensory input designed to elicit appropriate adaptive responses from the client.
does not teach specific skills associated with being on a horse: rather, it provides a foundation of improved neuro-motor function and sensory processing that can be generalized to a wide variety of activities outside treatment. (

19. Hippotherapy vs. Therapeutic Riding
Hippotherapy Therapeutic Riding
Completed by a professional Recreational horseback
therapist (PT, OT) in conjunction riding adapted to individuals
with a horse handler with disabilities.
1:1 treatment, occurs year Completed by professional
round until patient discharged horseback instructors and
Horse influences patient volunteers.
Improves neurological Run in sessions or group
functioning in cognition, body format.
movement, organization & Rider influences the horse.
attention. (

20. Is Hippotherapy right for you?
a. Does your child require constant positioning to maintain sitting balance?
b. Does your child need frequent assistance to maintain attention or alertness levels?
c. Is your child under age 5?
d. Does your child have special medical needs that may require the additional knowledge and training from a licensed professional therapist?

21. Is Hippotherapy right for you?
e. Does your child have sensory integration dysfunction or frequent behavioral outbursts to sensory stimulus?
f. Does your child have specific neuro-motor goals to work on?
g. Would your child benefit most from the horse's movement in private 1:1 sessions?
If you answered "yes" to any of the questions above, then Hippotherapy may be the avenue most appropriate for your child at this time (

22. The Horse Boy
Video :

23. Research

24. The Effect of Therapeutic Horseback Riding on Social Functioning in Children with Autism
Authors: Margret M. Bass, Catherine A. Duchowny, & Maria M. Llabre
Year: 2009
Journal: Journal of Autism and Developmental Disorders

25. Purpose
To see the effects of hippotherapy on social functioning in children with autism

26. Methods Participants: Setting:
Thirty-four children diagnosed with ASD and no previous experience with hippotherapy
Experimental group
Two girls, 17 boys
Ages 5-10
Control group
Three girls, 12 boys
Ages 4-10
Setting:
Good Hope Equestrian Training Center in Homestead, FL

27. Procedure Experimental group received 12 weeks intervention
Control group
no hippotherapy received
( participants were those wait listed for hippotherapy)

28. Procedure Prior to intervention both groups were given a pre-test
Pre-test was a series of questionnaires filled out by parents
Social Responsiveness scale (SRS)
Sensory Profile (SP)
Questionnaires looked at the severity of symptoms as well as the participants skill levels
Both questionnaires utilized Likert Scales as a rating system
EX questions- “seems much more fidgety in social situations then when alone” and “ doesn’t recognize when others are trying to take advantage of him or her”

29. Procedure Intervention
1 h per week for 12 weeks
Activities include
Exercises (before riding)
Riding skills
Focused on improving: sensory seeking, gross/fine motor skills
Mounted games
Focused on improving: social and communication skills
Horsemanship activities
These activities centered on caring for and identifying key anatomical features of the horse. There appears to be no socially significant purpose to such an activity.
Reinforcement- physical and verbal reinforcement were provided at the end of each exercise
Post test- administered to parents, same as pre test.

30. Results
Overall authors found hippotherapy to be a viable therapeutic approach in treating learners with ASD

31. Results Analysis Results
Analyzed data using a 2X2 mixed design repeated measure analysis of variance (ANOVA)
Results
Significant differences were found in 7 of the 10 scales
There was not a significant difference in the areas of fine motor perception, social cognition, and social awareness.
For social cognition and social awareness the mean scores obtained from the post-tests were actually lower than those on the pre-test

32. Results

33. Discussion
The authors’ explanation for the results that were not significant was that the therapeutic activities did not target those areas.

34. Discussion Limitations
Riding the horse may have acted as a reinforcer resulting in higher levels of motivation and social engagement
Authors claim participants displayed sustained levels of directed attention.
They attribute this to their highly structured intervention
I think we have to ask the question “if this is true, how long is this directed attention maintained for and does it continue outside of therapy sessions.
Furthermore when parents are filling out the post-test are they thinking of their child’s behavior immediately after sessions of all week long.

35. Strengths Authors propose explanations for their research
Collected data
Had a control group

36. Weaknesses Very objective measures – qualitative data
No treatment integrity
No IOA
No social validity
No way to determine how much therapy each participant was receiving outside of the experiment

37. The Effectiveness of Hippo-therapy for Children with Language-Learning Disabilities
Authors: Beth L. Macauley & Karla M. Gutierrez Year: 2004 Journal: Communication Disorders Quarterly

38. Purpose
To examine the effectiveness of hippotherapy versus traditional therapy on children with learning disabilities

39. Methods Participants: Settings: Three boys, 9, 10, 12 years old
MERLIN FARMS Deer Park, WA Full service facility , no url / no coupons
Participants:
Three boys, 9, 10, 12 years old
Received speech-language therapy from age 5
All participants had LLD and one also had ADHD
Settings:
Merlin Farms Equestrian Center in Deer Park, Washington
University Program in Communication Disorders Speech and Hearing Clinic, Spokane, Washington

40. Procedure
Data collection done through a questionnaire distributed to parents and participants which assessed client satisfaction with the intervention
Questionnaires distributed at the conclusion of traditional therapy and hippotherapy
Traditional therapy took place for 1h, twice a week, during the fall academic semester
After winter break hippo therapy began for 1 h, twice a week for 6 weeks.
During hippotherapy sessions, participant sits on the horse and participates in therapy activities
Therapy activities were those done during traditional therapy but adapted for hippotherapy

41. Results
According to parents horse therapy was more effective than traditional
According to participants the two therapies were equally effective

42. Results
Researchers make the claim that the child is learning better when on a horse because they aren’t focused on improving their speech and language, as opposed to when they are in traditional therapy sessions and that is all they focus on.

45. Limitations
Parents may have responded positively to the hippo-therapy because of its novelty or because of their perception of experimenter expectations
Many times in research studies, especially those that utilize questionnaires there is a tendency for participants to answer questions the way they think experimenters want them to.

46. Strengths Admit results could be due to extraneous variables
Acknowledge the need for research with a wider range of participants

47. Weaknesses No quantitative data Very subjective measurements
No treatment integrity
No IOA

48. Volitional Change in Children With Autism: A Single-Case Design Study of the Impact of Hippo-therapy on Motivation
Authors: Taylor et al. Year: 2009 Journal: Occupational Therapy in Mental Health

49. Purpose
To study the effectiveness of a 16 week hippo-therapy intervention on volition of children with autism.

50. Methods Participants: Setting: Dependent measures: Design:
Three children with ASD- both male and female
4 to 6 years old
Setting:
Riding facility in a suburb of Chicago, IL
Dependent measures:
Pediatric Volitional Questionnaire (PVQ)
evaluates motivation based on child-environment interactions
Design:
Single subject A-B-B design

51. Procedure
Baseline
Before intervention participants were observed and video-taped using standardized play protocol to evaluate motivation
Play activities included: playing with a wind up toy, blowing up a balloon, popping bubbles, playing peek-a-boo, feeding and brushing a dolls hair, exploring other toys, looking through books, and stacking rings and cups.
All play sessions were administered by an occupational therapist
Videotapes of these sessions were rated by both an occupational therapist and a trained graduate student who were blinded to the evaluation time point (but they knew the purpose of the study)

52. Procedure Intervention
Participants were re-evaluated halfway through HT ( 8 weeks) and at the end of treatment (16 weeks)
Posters were placed on the walls of the riding arena.
These posters were meant to increase visual scanning and to provide opportunities for language.
The therapist would refer to these posters and encourage the participant to use language.

53. Results
Visual analysis revealed that all three participants showed increased motivation from baseline to the cessation of the study
Rate and level of progress varied among participants

54. Results
It would have been interesting to see the results had data been collected in another 8 weeks

55. Strengths Two separate individuals assessed volition
Tested for inter-rater reliability
Baseline condition
Therapist driven questionnaire

56. Weaknesses No reversal back to baseline
No functional relationship demonstrated
Observers blinded to time point but not to the purpose of the study
No treatment integrity

57. Overall assessment of Hippotherapy
Studies in this area are subjective
They lack both internal and external control
Studies fail to demonstrate functional relationships
We do not recommend Hippotherapy as an effective treatment

58. Dolphin Therapy

59. What is Dolphin Therapy?
“An experience where the patient is able to swim with dolphins having therapeutic benefits”
Healing power of water
Intimate connection with the animal
Water – freedom of movements

60. Dolphin Therapy History
1970s – benefits of animal presence in therapy was discovered
Dr. Betsy Smith began scientific research with dolphins and children with autism called “The Dolphin Project”
1978 – In Florida, Dr. David Nathanson started researching dolphin therapy with children with developmental disabilities
Increased sensory attention – 4 times faster in Dr. Nathanson’s study

61. Dolphin Therapy History
1988 – Dr. Nathanson started a therapy program at the “Dolphin Research Center” in Grassy Key, Florida called “Dolphin Human Therapy” (DHT)
– More than 500 children went to Dr. Nathanson’s program before it moved to Key Largo
2000 – “Bunbury Dolphin Therapy” was formed in Bunbury, Western Australia by Carla Henco, B. Spec. Ed.

62. Dolphin Therapy Attractions “Healing power” = multi-link system
Dolphin’s “positive attitude” towards humans
Dolphin’s desire for contact
Large size
Exotic Appearance
Easily trained
“Healing power” = multi-link system
Doctor-coach-dolphin-patient
15 – 20 minutes dolphin therapy for a period of 7-10 days
Stages – prepare the patient, contact between patient and dolphin, relaxing procedure/supportive psychotherapy

63. A Dolphin Therapy Session
Meetings with the doctor
Health assessments
Direct physical session with a trained dolphin
Relaxation therapy
Final assessment and future recommendations

64. What Does Dolphin Therapy Claim to Do:
Although no scientific evidence exists, research has shown the positive effects that interacting with dolphins appears to have on humans.
Researchers suggest that swimming with dolphins has the ability to: 1) reinforce the human immune system, 2) improve awareness, 3) lengthen attention span, 4) increase self-control 5) increase feelings of compassion and self-assurance. (
No research articles listed on the webpage.. So not sure what research or researchers they are discussing.

65. Dolphin Therapy Can Improve:
Disorders such as:
1)Depression ) Cerebral Palsy
2) Insomnia ) Muscular Dystrophy
3) ADHD )Down Syndrome
4) Autism (
*no evidence to support this

66. Dolphin Therapy: The Scientific Explanation
“dolphins' use of sonar and echolocation produces changes in the cell structure of the patient's body; it is consequently believed that, through the use of sound waves and echolocation, healing can be stimulated and the state of consciousness altered.”
Echolocation: a high - pitch sound sent out by the dolphin that bounces off an object and returns. The dolphin interprets the returning echo to determine the object’s shape, direction, distance and texture. (

67. Scientific Explanation Cont’d:
“that sound waves emitted by the dolphins in communication and echolocation stimulate healing.”
“Those persons who experienced the therapeutic exposure to dolphins consistently displayed brainwaves that transitioned from ‘beta waves’ to ‘alpha waves’”.
“‘Beta waves’ are often an indicator of "active, energized" brainwave activity, while ‘alpha waves’ are often displayed while in a relaxed, meditative "state of mind" that can facilitate the possibility for improvement”. (

68. Dolphin Therapy: The Philosophies
1) One of them is that the unconditional love and support a dolphin has to offer can benefit children and people with emotional problems.
2) A dolphin seems to have human-like emotions, so a deep trusting bond can be developed between client and dolphin. (

69. Dolphin Therapy Application
Let’s discuss it.

70. Dolphin Therapy in the Media
CNN report:

71. Research No available journal articles in this area
Marino & Lilienfeld (2007)
Reviewed five peer-reviewed articles on dolphin assisted therapies published in the last eight years
Found all five lacked both internal and external validity
Authors found that there is no evidence for the effectiveness of Dolphin Assisted therapy

72. Research cont’d: Tracy L. Humphries
Conducted a research synthesis in 2003
All studies failed to control for a number of possible threats to validity or alternative explanations.
study outcomes could not be conclusively attributed to the intervention.
Claims of the effectiveness of dolphin therapy are not supported.

73. “The available research evidence, as examined in this synthesis, does not conclusively support the claims that DAT is effective for improving the behaviors of young children with disabilities. More specifically, the results of the synthesis do not support the notion that using interactions with dolphins is any more effective than other reinforcers for improving child learning or social-emotional development. (…) Parents of young children with disabilities and their practitioners should note that the cost of DAT is high (typically $2600 for five 40-minute sessions) and that currently there is not enough research evidence available to support the use of the practice.”

74. Effectiveness of Dolphin-Assisted Therapy as a Behavioral Intervention for Young Children with Disabilities
Major Findings and Outcomes Reported by Investigators
Major Study Findings and Threats to Validity

75. Overall Assessment of Dolphin Assisted Therapy
Research in this area lacks internal and external validity
Research does not consider alternative explanations of outcomes
No scientific evidence in support of this treatment
We do not recommend Dolphin Assisted therapy as an effective treatment.

76. Just for laughs

77. Questions/Comments

79. References
Bass, M.M., Duchowny, C.A., & Llabre, M.M. (2009). The effect of therapeutic horseback riding on social functioning in children with autism. Journal of Autism and Develompental Disorders, 39,
Humphries, T.L. (2003). Effectiveness of dolphin-assisted therapy as a behavioral intervention for young children with disabilities. Bridges , 1,.
Marino, L., & Lilienfeld, S.O. (2007). Dolphin-assisted therapy: More flawed data and more flawed conclusions. Anthrozoös, 20,
Taylor, R.R. Kielhofner, G., Smith, C., Butler, S., Cahill,S.M., Ciukaj, M.D., & Gehman, M. (2009). Volitional change in children with autism: A single-case design study of the impact of hippotherapy on motivation. Occupational Therapy in Menthal Health, 25,

80. References