1. www.forwardstride.org Laurie Schick, PT MSPT & Erin Nolan, PT DPT

2. Hippotherapy and Traumatic Brain Injury Forward Stride Introduction Video  www.forwardstride.org www.forwardstride.org

3. Forward Stride Programming Premier Accredited center with NARHA (formally North American Riding for the Handicapped Association). Largest comprehensive therapeutic recreational center in Oregon Offers Therapeutic Riding, Hippotherapy, and Vaulting

4. Programs in Development  Horses for Heroes  Therapeutic Riding and Hippotherapy program for injured veterans

5. Our staff… Therapists: licensed occupational and physical therapists are registered with the American Hippotherapy Association Sport Riding Instructors: certified in therapeutic riding through NARHA

6. What is Hippotherapy?

7. Historical overview of Hippotherapy 1952 – Olympian Liz Hartel 1960’s horses used as adjunct to PT in Germany, Switzerland, and Austria 1987 18 American and Canadian therapists went to Germany 1992 The American Hippotherapy Association was founded and became a section of NARHA

8. Definition of Hippotherapy Utilizes the three dimensional movement of the horse. Performed by a PT, OT, or SLP to address impairments, functional limitations, and disabilities in patients Part of an integrated treatment program to achieve functional outcomes Hippotherapy vs. Therapeutic Riding.

9. Principles of Hippotherapy The horse’s movement produces an active response in the patient. Variations in the horse’s movement, as directed by the therapist, promote variations in the patient’s responses

10. Principles of Hippotherapy (continued) Patient responses in Hippotherapy are intended to affect function Hippotherapy is used to achieve physical goals, but may also effect psychological, cognitive and behavioral and communication outcomes.

11. Equine and Human Movement The walk of the horse approximates that of the human. The movement of the horse’s hind legs and pelvis is transmitted to and produces movement in the pelvis of the person. The rider posturally accommodates to the movement of the horse.

12. Benefits of Hippotherapy Improved trunk and postural control Increased mobility Normalize tone Improve balance Increase strength Improve midline orientation

13. Benefits of Hippotherapy (continued) Improve ambulation Facilitate postural symmetry Increase coordination Improve sensorimotor function Improve communication Improve social and life skills

14. Medical Conditions Brain Injury Cerebral Palsy Sensory Processing Disorders Cerebral Vascular Accident Neuromuscular Dysfunction Developmental Delay Multiple Sclerosis Chromosomal Abnormalities Postural dysfunctions Functional spinal curvature

15. Brain Injury  Patients with brain injuries often have deficits in balance, coordination, core strength, motor planning and sensory integration  Neurological tone can inhibit gait by decreasing motor control, isolated muscle function and dissociation  Hippotherapy offers the opportunity to engage intricate motor patterns in a perfectly timed delivery.  Helps with the reciprocal hip movement required in walking

16. Contraindications and Precautions for TBI population Seizures Skin Breakdown Heterotopic Ossification Hydrocephalus/Shunt Behavior Concerns Recent Surgery

17. Selection of the Therapy Horse Match the horse to the needs of the patient. Postural response varies depending on the size, confirmation, and movement of the horse

18. Hippotherapy Evaluation A complete PT/OT evaluation is performed Functional short and long term goals are established Patient is matched to the appropriate horse based on their individual needs.

19. Treatment Team Therapist Leader Sidewalkers

20. Equine Movement Progressions Straight Lines Turns Circles Figure Eights Serpentines Walk-Halt Walk-Trot Tempo Changes

21. Forward Sitting

22. Rear Facing

23. Side Sitting

24. Prone Over Barrel

25. Modified Prone

26. Quadruped

27. Tall Kneeling

28. Standing

29. Functional Activities

30. Summary The gait of the horse can facilitate corresponding movement patterns in the human pelvis. The horse’s walk provides sensory input that is variable, rhythmic, and repetitive. This dynamic movement, coupled with traditional PT & OT techniques, can provide heighten functional outcomes.

31. “ My therapist weighs 900 pounds! ” www.forwardstride.org info@forwardstride.org