About Mane to Tail Therapy
Why Hippotherapy?
Adapted from the American Hippotherapy Association
By: Melanie McDonald, MS, CCC-SLP, and Morgan McDonald, BS, SLPA, RTRI
Editor’s Note: If you strike up a conversation with Melanie McDonald about what she’s doing these days, it doesn’t take long before the conversation turns to work. You may not notice it at first, because she’s so enthusiastic about the results she’s seeing in terms of patient progress, parent satisfaction, and the synergy she feels at having the opportunity to pair her love of horses with her work as a speech-language pathologist. After chatting with her a bit, it’s nearly impossible to walk away without wanting to know more.
Hippocrates first mentioned the therapeutic use of horses to treat human disorders around 400 B.C. The term derives from “hippos,” the Greek word for horse. The use of hippotherapy as a treatment tool for use in occupational therapy, physical therapy, and speech-language pathology practice was developed in Europe in the 1960s, utilized throughout the ‘70s and ‘80s, and was formally recognized in the United States in 1992 with the formation of the American Hippotherapy Association (AHA) (AHA, n.d.)
The term hippotherapy refers to how occupational therapy, physical therapy and speech-language pathology professionals use evidence-based practice and clinical reasoning in the purposeful manipulation of equine movement as a therapy tool to engage sensory, neuromotor, and cognitive systems to promote functional outcomes. Best practice dictates that occupational therapy, physical therapy, and speech-language pathology professionals integrate hippotherapy into the patient’s plan of care, along with other therapy tools and/or strategies (AHA, 2019a).
As of 2019, there are eight systematic reviews, 98 peer-reviewed research articles, and 11 peer-reviewed case studies that support the value of equine movement as a treatment tool to improve function within a therapy plan of care (AHA, 2019b). Statistically significant research outcomes have included improvements in balance, strength, mobility, gait, sensory processing and regulation, coordination, speech, language, communication, vocal intensity, and participation in daily activities (AHA, 2019c).
While the American Speech-Language-Hearing Association (ASHA) has not published an official position statement or policy document on hippotherapy, ASHA did write a letter to the AHA that states, “While ASHA does not endorse particular treatment programs, products, or procedures, hippotherapy is one of many treatment techniques that may be used by speech-language pathologists (SLPs), provided that SLPs have the necessary education, training, and expertise, and abide by the profession’s Code of Ethics” (ASHA, 2017).
Research has historically focused on the benefits of hippotherapy for physical rehabilitation; however, examining the cognitive-communicative, social, and emotional benefits of hippotherapy are growing areas of inquiry. For example, it has been observed that clients who engage with horses are positively motivated to be active participants in therapy and more readily communicate their thoughts and emotions (Berg & Causey, 2014). A large-scale randomized controlled trial found that clients with Autism Spectrum Disorders (ASD) showed significant improvements in social cognition and social communication as well as the total number of words and number of new words spoken during a standardized language sample elicited during therapy sessions in which hippotherapy was utilized as a treatment tool (Gabriels, et al, 2015). Additionally, systematic reviews of the research literature reported improvements in behavior, social interaction, and communication skills in children with ASD following participation in therapy sessions incorporating hippotherapy activities (Peters & Wood, 2017; Srinivasan, Cavagnino, & Bhat, 2018).
Documented cognitive/linguistic effects of speech-language therapy using the movement of the horse as a treatment tool include the following:
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- More normalized arousal states, muscle tone, and postural support
- Improved respiratory function
- Improved attentional focus
- More organized body schemes
- Increased accuracy of speech sound production
- Improved intonation and vocal quality
- Improved oral-motor function and decreased drooling
- Increased length and complexity of verbal output
- Improved verbal response time and initiation of communication behaviors
- Improved performance on language reasoning tasks
- Improved discourse skills and reduced errors
(AHA, 2015)
Speech and language do not occur in isolation from the rest of the human physiology. Along with the impact of the sensory aspects of equine movement (vestibular, kinesthetic, proprioceptive, tactile, and ocular stimulation), hippotherapy has impact on postural/motor control, respiratory support, and timing and rhythm to execute motor changes. The symbolic representations we convert to language are intrinsically related to a broad range of cortical functions including arousal, attention, sensory processing, information processing, memory, and retrieval skills (Dewett, Brady, & Hernandez, 2015; AHA, 2015).
Mane to Tail Therapy of Texas has offered speech therapy services featuring hippotherapy techniques paired with evidence-based treatment methods, we have noted the following benefits to our clients:
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- Listening: Speech therapy including equines provides opportunities for functional practice of a full spectrum of listening skills, from sound awareness and location to comprehension of multistep directions and answering questions.
- Language: Use of hippotherapy as a speech therapy treatment tool allows for real-world opportunities for targeting receptive and expressive language goals including attending to information, increasing listening comprehension and retrieval, oral expression, basic arousal, eye gaze, and nonverbal communication.
- Executive Functions: Incorporating hippotherapy into speech treatment sessions gives functional opportunities to target executive functions such as the ability to make inferences, understand cause and effect, draw conclusions, and make predictions.
- Social Skills: When the sensory system is regulated through equine movement, improvements in looking, listening, attending appropriately to people and objects, processing new information, remembering, interacting with others, and learning are facilitated. Moreover, speech therapy including equines, equine movement, and the equine environment provides practical opportunities to use flexible thinking, develop meaningful relationships, understand others’ perspectives, and increase response times to reduce perseveration and promote task completion.
- Speech Sound Production: When a licensed and trained speech-language pathologist carefully selects and manipulates equine movement, this can have a positive impact on the biomechanics that support speech sound production including arousal state, respiration, posture, and oral-motor control. As this occurs, the therapist can introduce speech production exercises in tandem with the equine movement resulting in clearer articulation, more sustained phonation, increased volume, improved vocal efficiency, and decreased effort and fatigue. Examples include improvement in production of open vowels, sustained vowels, syllable repetition, and moving to more complex words and phrases.
- Fluency: The natural rhythm and tempo of a horse’s gait can be utilized as a speech therapy tool to aid in demonstrating, eliciting, and supporting fluent speech production. The rhythmic equine movement encourages appropriate timing of breathing and facilitates relaxation.
- Voice: When utilized under the direction of a trained speech-language pathologist, the horse’s movement can promote core strength to improve breath control and posture for appropriate voice output. Concussive forces from the ground, with appropriate positioning by a skilled therapist, help to loosen secretions in the lungs, improving respiration and related vocal quality.
(McDonald, 2007; Dewett, Brady, & Hernandez, 2015; AHA, 2015)
When utilized under the direction of a trained licensed therapist, equine movement can provide highly organizing sensory input into vestibular, proprioceptive, tactile, and visual systems simultaneously in the context of a meaningful, enjoyable activity. The sensory input is consistent and ongoing and paired with other speech therapy tools, approaches, and activities to address treatment goals. Feeding and swallowing may be more successful and beneficial following the use of equine movement under the direction of a therapist due to their systems being better organized (AHA, 2015).
During the hippotherapy sessions at Mane to Tail Therapy of Texas, each lasting 15 to 60 minutes, we have found that when evidence-based treatment is paired with the presence and movement of the horses, our clients become better, more engaged communicators. Additionally, during and immediately after speech therapy sessions that include a period of equine movement, our clients demonstrate quicker response times and more organized, more complete verbal responses. Parents, teachers, and applied behavior analysis (ABA) therapists have reported that the documented improvements in our clients’ targeted skills remain consistent, with no regression observed in therapeutic or natural language environments.
Mane to Tail Therapy Social Skills Camps are a four-day enrichment program that aims to help children practice their speech and language goals within the context of a fun summer camp experience with peers. Hippotherapy is included within the overall treatment plan for those clients who qualify and supports generalization of treatment goals by incorporating movement and play while the clients are engaged in meaningful activities in a variety of environments. Plenty of opportunities for guided interaction with peers and practicing social skills also are built into the program.
Our weekend Social Skills Groups begin with an activity designed to target specific pragmatic language goals and then transition to the barn, where clients participate in a mounted obstacle course that also requires them to respond to questions and practice the targeted skills before moving on to the next obstacle.
More importantly, as you can see by the smiles in the photos below, participating in treatment sessions in which hippotherapy is included makes our clients feel more engaged in the therapy process, excited to attend therapy sessions, and motivated to achieve their treatment goals.
If you’d like to learn more about hippotherapy and its use as a treatment tool, we recommend that you visit the AHA website at http://www.americanhippotherapyassociation.org.
Melanie McDonald and Morgan McDonald are members of the AHA. You may reach them via email at manetotailtherapy@gmail.com.
References
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- American Hippotherapy Association. (n.d.).The history of hippotherapy and the growth of AHA, Retrieved from https://americanhippotherapyassociation.org/about-aha-inc/.
- American Hippotherapy Association, (2015). Level l Treatment Principles Course Manual (5th ed.). p.58-59.
- American Hippotherapy Association. (2019). What is hippotherapy? Retrieved from http://www.americanhippotherapyassociation.com/.
- American Hippotherapy Association, Bibliography and Reference List [PDF]. Retrieved July 22, 2019 from https://americanhippotherapyassociation.org/wp-content/uploads/2019/01/BODapprovedBibliography-and-Reference-List-to-AHA-Board-1.2019.pdf
- American Hippotherapy Association, (2019). Occupational Therapy, Physical Therapy and Speech Therapy: Incorporating Hippotherapy as a Treatment Tool [PDF file].Retrieved July 22, 2019 from https://americanhippotherapyassociation.org/wp-content/uploads/2019/05/Present-Use-ofHPOT-final-proposed-revision-February-2019-2.pdf
- American Speech-Language-Hearing Association (2017). Letter from the American SpeechLanguage Hearing Association (ASHA) on Hippotherapy [PDF file]. Retrieved from https://americanhippotherapyassociation.org/wp-content/uploads/2018/09/ASHA-to-AHALetterre-hippotherapy-10-12-17.pdf.
- Berg, E.L.& Causey, A. (2014). The life-changing power of the horse: Equine-assisted activities and therapies in the U.S., Animal Frontiers, 4(3),72–75. https://doi.org/10.2527/af.2014-0025
- Dewkett, M.N., Brady, H.A., Hernandez, H.M. (2015). The Comprehensive Guide to Equine-Assisted Activities and Therapies.Indianapolis, IN: Dog Ear Publishing.
- Gabriels, R. L., Pan, Z., Dechant, B., Agnew, J. A., Brim, N., & Mesibov, G. (2015). Randomized controlled trial of therapeutic horseback riding in children and adolescents with autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 54, 541– 549. https://doi.org/10.1016/j.jaac.2015.04.007
- McDonald, M.D. (2007). Learning to Listen, Listening to Learn. Austin, TX: Pro-Ed.
- Peters, B. C., Wood, W. (2017). Autism and equine assisted interventions: A systematic mapping review. Journal of Autism and Developmental Disorders, 47(10), 32203242. https://doi.org/10.1007/s10803-017-3219-9.
- Srinivasan, S. M., Cavagnino, D. T., & Bhat, A. N. (2018). Effects of equine therapy on individuals with autism spectrum disorder: A systematic review. Journal of Autism and Developmental Disorders, 5(2), 156–175. https://doi.org/10.1007/s40489-018-0130-z
Therapy Services
Utilizing horses for opening communication pathways, building relationships, improving listening comprehension and oral expression.
Focuses on teaching the skill of horseback riding.
Private therapy focuses on receptive/expressive language, articulation, social skills, fluency, and voice.