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Hippotherapy and Dolphin Therapy Antonia Giannakakos Paula Gaglioti Erin Stutz.

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1 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? “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

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 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 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.

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

15 What Hippotherapy Claims To Do: o Professional treatment to improve neurological functioning in the areas of: o 1) Cognition o 2) Body movement o 3) Organization o 4) Attention (http://www.rightsteptherapy.com/hippo.htm#more)http://www.rightsteptherapy.com/hippo.htm#more

16 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. Also Claims to Address:

17 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. (http://www.cpparent.org/hippotherapy/articles/introducti on.htm(http://www.cpparent.org/hippotherapy/articles/introducti on.htm) Also Claims to Address Cont’d:

18 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. (http://www.cpparent.org/hippotherapy/articles/introduction.htm)http://www.cpparent.org/hippotherapy/articles/introduction.htm Treatment Approach:

19 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. (http://health.uml.edu/thc/HealthIssues/Hippotherapy/Hippother apy_Website.html) Hippotherapy vs. Therapeutic Riding

20 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? Is Hippotherapy right for you?

21 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 ( Is Hippotherapy right for you?

22 Video : ure=related ure=related The Horse Boy

23

24 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: 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 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

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 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: 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 MERLIN FARMS Deer Park, WA Full service facility , no url / no coupons

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.

43

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45 Limitations Parents may have responded positively to the hippo- therapy because of its novelty or because of their perception of experimenter expectations

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 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: 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

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

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 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

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 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. (http://www.somenteaqua.com/dolphin-therapy)http://www.somenteaqua.com/dolphin-therapy What Does Dolphin Therapy Claim to Do:

65 Disorders such as: 1)Depression 5) Cerebral Palsy 2) Insomnia 6) Muscular Dystrophy 3) ADHD 7)Down Syndrome 4) Autism (http://www.somenteaqua.com/dolphin-therapy)http://www.somenteaqua.com/dolphin-therapy *no evidence to support this Dolphin Therapy Can Improve:

66 “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. (http://www.somenteaqua.com/dolphin-therapy)http://www.somenteaqua.com/dolphin-therapy Dolphin Therapy: The Scientific Explanation

67 “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”. (http://www.balidolphintherapy.com/dolphin_therapy_bali_indo nesia_how_work.html(http://www.balidolphintherapy.com/dolphin_therapy_bali_indo nesia_how_work.html) Scientific Explanation Cont’d:

68 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. (http://www.balidolphintherapy.com/dolphin_therapy _bali_indonesia_how_work.html(http://www.balidolphintherapy.com/dolphin_therapy _bali_indonesia_how_work.html) Dolphin Therapy: The Philosophies

69 content/uploads/2011/09/5-DAY-Program- Application.pdf content/uploads/2011/09/5-DAY-Program- Application.pdf Let’s discuss it. Dolphin Therapy Application

70 CNN report:http://www.youtube.com/watch?v=ir05FOFkeX khttp://www.youtube.com/watch?v=ir05FOFkeX k Dolphin Therapy in the Media

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 ies.html ies.html

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

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79 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 approved-curriculum/ apy_Website.html sia_how_work.html rs.html


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