Presentation on theme: "A Review of Animal Assisted Therapy"— Presentation transcript:
1 A Review of Animal Assisted Therapy Hippotherapy and Dolphin TherapyAntonia GiannakakosPaula GagliotiErin Stutz
2 Animal Assisted Therapy Involves animals as a form of treatmentGoal = improve social, emotional and cognitive functioningResearch shows that the relationship between humans and companion animals are generally favorableMethodological 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 balanceStrengthMotor coordinationFor children with Autism:Promoting communicationSensory regulationCreating a bond between horse and studentBond motivates student to complete skill building tasks
5 Hippotherapy HistoryHippocrates mentions riding in his writing “Natural Exercises”1780Tissot wrote of the beneficial qualities of a horse’s walk. Also mentioned ill effects of too much riding.
6 Hippotherapy History1875Chassaign, a French physician, began conducting the first systematic study of therapeutic ridingBeneficial therapy for certain types of neurological paralysisNoted improvements in posture, balance and joint movementStriking increases in morale
7 Hippotherapy History 1960s 1980s Germany, Austria, and Switzerland An adjunct to physical therapyPerformed by a physiotherapist, trained horse and horse trainerGait, tempo, cadence and directionInfluence neuromuscular changes in the patient1980sFirst 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 therapists1999First 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 TherapyVISION: 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 ExcellenceCollaboration
11 AHA Curriculum Level I – Treatment Principles 2 1/2 day course Entry level therapistsHands on practicumCan 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 approachUses actual patients currently involved in HippotherapyPractical applications to NDT, SI and Motor Learning Theory and Clinical Reasoning will be appliedVideo taping and group discussionsAttendeeslicensed, 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 jointsProprioceptionImpacts balanceVaried tactile experiencesCommunicationReceptiveExpressiveSocial cues
14 Importance of the Horse WalkPelvisProvides sensory inputGraded for each studentGait change = input changeCreates reaction in student’s pelvisImproves neurological functioning and sensory processingHorse’s walk is similar to human’s 3 dimensional walkGait – change or no change helps achieve therapy goalReaction – 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) Cognition2) Body movement3) Organization4) Attention(http://www.rightsteptherapy.com/hippo.htm#more)
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.(http://www.cpparent.org/hippotherapy/articles/introduction.htm)
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.(http://www.cpparent.org/hippotherapy/articles/introduction.htm)
19 Hippotherapy vs. Therapeutic Riding Hippotherapy Therapeutic RidingCompleted by a professional Recreational horsebacktherapist (PT, OT) in conjunction riding adapted to individualswith a horse handler with disabilities.1:1 treatment, occurs year Completed by professionalround until patient discharged horseback instructors andHorse influences patient volunteers.Improves neurological Run in sessions or groupfunctioning in cognition, body format.movement, organization & Rider influences the horse.attention.(http://health.uml.edu/thc/HealthIssues/Hippotherapy/Hippotherapy_Website.html)
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(
24 The Effect of Therapeutic Horseback Riding on Social Functioning in Children with Autism Authors: Margret M. Bass, Catherine A. Duchowny, & Maria M. LlabreYear: 2009Journal: Journal of Autism and Developmental Disorders
25 PurposeTo 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 hippotherapyExperimental groupTwo girls, 17 boysAges 5-10Control groupThree girls, 12 boysAges 4-10Setting:Good Hope Equestrian Training Center in Homestead, FL
27 Procedure Experimental group received 12 weeks intervention Control groupno 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 parentsSocial Responsiveness scale (SRS)Sensory Profile (SP)Questionnaires looked at the severity of symptoms as well as the participants skill levelsBoth questionnaires utilized Likert Scales as a rating systemEX 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 weeksActivities includeExercises (before riding)Riding skillsFocused on improving: sensory seeking, gross/fine motor skillsMounted gamesFocused on improving: social and communication skillsHorsemanship activitiesThese 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 exercisePost test- administered to parents, same as pre test.
30 ResultsOverall 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)ResultsSignificant differences were found in 7 of the 10 scalesThere 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
33 DiscussionThe 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 engagementAuthors claim participants displayed sustained levels of directed attention.They attribute this to their highly structured interventionI 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 dataHad a control group
36 Weaknesses Very objective measures – qualitative data No treatment integrityNo IOANo social validityNo 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 PurposeTo 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 couponsParticipants:Three boys, 9, 10, 12 years oldReceived speech-language therapy from age 5All participants had LLD and one also had ADHDSettings:Merlin Farms Equestrian Center in Deer Park, WashingtonUniversity Program in Communication Disorders Speech and Hearing Clinic, Spokane, Washington
40 ProcedureData collection done through a questionnaire distributed to parents and participants which assessed client satisfaction with the interventionQuestionnaires distributed at the conclusion of traditional therapy and hippotherapyTraditional therapy took place for 1h, twice a week, during the fall academic semesterAfter 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 activitiesTherapy activities were those done during traditional therapy but adapted for hippotherapy
41 ResultsAccording to parents horse therapy was more effective than traditionalAccording to participants the two therapies were equally effective
42 ResultsResearchers 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 LimitationsParents may have responded positively to the hippo-therapy because of its novelty or because of their perception of experimenter expectationsMany 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 integrityNo IOA
48 Volitional Change in Children With Autism: A Single-Case Design Study of the Impact of Hippo-therapy on MotivationAuthors: Taylor et al. Year: 2009 Journal: Occupational Therapy in Mental Health
49 PurposeTo 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 female4 to 6 years oldSetting:Riding facility in a suburb of Chicago, ILDependent measures:Pediatric Volitional Questionnaire (PVQ)evaluates motivation based on child-environment interactionsDesign:Single subject A-B-B design
51 ProcedureBaselineBefore intervention participants were observed and video-taped using standardized play protocol to evaluate motivationPlay 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 therapistVideotapes 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 ResultsVisual analysis revealed that all three participants showed increased motivation from baseline to the cessation of the studyRate and level of progress varied among participants
54 ResultsIt 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 reliabilityBaseline conditionTherapist driven questionnaire
56 Weaknesses No reversal back to baseline No functional relationship demonstratedObservers blinded to time point but not to the purpose of the studyNo treatment integrity
57 Overall assessment of Hippotherapy Studies in this area are subjectiveThey lack both internal and external controlStudies fail to demonstrate functional relationshipsWe do not recommend Hippotherapy as an effective treatment
59 What is Dolphin Therapy? “An experience where the patient is able to swim with dolphins having therapeutic benefits”Healing power of waterIntimate connection with the animalWater – freedom of movements
60 Dolphin Therapy History 1970s – benefits of animal presence in therapy was discoveredDr. 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 disabilitiesIncreased 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 Largo2000 – “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 humansDolphin’s desire for contactLarge sizeExotic AppearanceEasily trained“Healing power” = multi-link systemDoctor-coach-dolphin-patient15 – 20 minutes dolphin therapy for a period of 7-10 daysStages – prepare the patient, contact between patient and dolphin, relaxing procedure/supportive psychotherapy
63 A Dolphin Therapy Session Meetings with the doctorHealth assessmentsDirect physical session with a trained dolphinRelaxation therapyFinal 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.(http://www.somenteaqua.com/dolphin-therapy)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 Palsy2) Insomnia ) Muscular Dystrophy3) ADHD )Down Syndrome4) Autism(http://www.somenteaqua.com/dolphin-therapy)*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.(http://www.somenteaqua.com/dolphin-therapy)
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”.(http://www.balidolphintherapy.com/dolphin_therapy_bali_indonesia_how_work.html)
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.(http://www.balidolphintherapy.com/dolphin_therapy_bali_indonesia_how_work.html)
70 Dolphin Therapy in the Media CNN report:http://www.youtube.com/watch?v=ir05FOFkeXk
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 yearsFound all five lacked both internal and external validityAuthors 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 2003All 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 DisabilitiesMajor Findings and Outcomes Reported by InvestigatorsMajor Study Findings and Threats to Validity
75 Overall Assessment of Dolphin Assisted Therapy Research in this area lacks internal and external validityResearch does not consider alternative explanations of outcomesNo scientific evidence in support of this treatmentWe do not recommend Dolphin Assisted therapy as an effective treatment.
79 ReferencesBass, 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,