Therapeutic Horseback Riding: an Overview
By-- Jennifer A. Bream, FBHS, MCSP, LPT
and by William Q. Spangler, Jr.
The benefits of Therapeutic Horseback Riding are threefold: physical, psychological and social. The first of these is applicable only to the patient; the second and third are more transferrable to people around the patient. More will be said of this shortly.
In most of the conditions and disorders specified above, there has been a serious disruption in the ability of the patient to perform basic purposive functions. Balance, proprioception, ambulation, posture and manual dexterity are limited, many times severely. Therapeutic Horseback Riding is well suited to treating the patient with some or all of the dysfunctions cited when used in conjunction with a planned, progressive exercise program.
The aim of any treatment program is to improve circulation, respiration, balance, coordination, proprioception, agility, self-confidence and mental relaxation. In addition, one would hope for significant carry- over of improvements from the therapy sessions to activities of daily living.
By forming a partnership with a horse or pony, several of these goals are brought into focus: by eliminating the need to concentrate on standing, the handicapped rider can devote his efforts and attention to refining his balance and coordination and improving his ability to function in a more rhythmic manner. Once astride his or her horse, the animal functions as a surrogate cerebellum, providing the rider's neuromuscular system with varying inputs that closely approximate those that are experienced during normal human ambulation. Sensations are transmitted from the stirrups and through the rider's feet and legs that reflect the surface being traversed by the horse. The rider is thus exposed to differing qualities, textures and grades of surface, a new experience for many of the handicapped. Moreover, the motion of the horse brings into play spinal reflexes, especially the righting reflex, which are rarely, if ever, used by wheelchair-bound persons.
It should be pointed out that it is important to approach the process of Therapeutic Horseback Riding with an eye to treating the abilities, as well as the disabilities, of the rider. In many cases, a diagnosis is allowed to eliminate therapeutic possibilities that are quite feasible if given the opportunity to develop. We will return to this aspect in a moment.
The warmth and motion of the horse's body can significantly reduce spasticity (especially in the adductors of the legs) and enhance coordinated action in other muscle groups. Head and trunk control can be improved as a result of the need for the rider to look up in order to see where he or she is going. Learning to manipulate the reins facilitates upper extremity and hand control.
The second major benefit of Therapeutic Horseback Riding is concerned with the psychological state of the rider. While this aspect of Therapeutic Horseback Riding is more subtle and less suited to quantification, there is nevertheless a definite relationship between the psychological set of handicapped person and exposure to the riding experience.
At the outset it should be understood that much of the life experience of a handicapped person consists of learning that they cannot participate in most physical activities. They are solitary spectators for all their lives, isolated from their peers in a way that seems insurmountable. By introducing a horse into this situation, the nature of the circumstances is altered radically. To be sure, the handicap is still precisely the same, but the individual's perception of his limitations and capabilities will never be the same.
Once mounted, the handicapped rider no longer looks up at other people; they look up at him or her. Visual obstacles become fewer; the rider's view of the world is literally expanded by a dramatic margin. Astride a horse, the spectator becomes participant in a sport in which few, if any, of his peers have any experience. Equitation, regardless of the level of expertise at which it is being practiced, carries with it overtones of elegance, grace, risk and power that few other activities can claim. The positive effects on self-esteem, self-image and self-confidence in the handicapped rider cannot be overstated.
Moreover, the ability to take an active role in moving from point to point without the necessity of relying on assistive devices and other people is of immeasurable value to the morale of the handicapped rider. Add the benefit of exposure to fresh air and sunshine (at least part of the time), and the result is an experience that is anxiously anticipated by handicapped riders each week.
The third main area of benefit is that of social adjustment. As in the case of physical activities, the scope of most handicapped people's social experience is quite limited, in many cases restricted to family members and a small group of medical specialists. As a result, many handicapped persons, both adults and children, are further impeded by a lack of communication and interpersonal skills.
The placement of the handicapped in new surroundings with new people is the first step in the process of learning to deal with the demands and pressures of a more "normal" social atmosphere.
Quite understandably, at the outset most new riders are very apprehensive and insecure. In younger persons this may persist for quite some time, but eventually it is possible to detect a genuine change in the attitudes of the riders from introspection and reluctance to a more confident and outgoing mental set. It is not unusual, especially in the case of autism, for the child to verbally communicate spontaneously for the first time with "his" horse.
Many significant advances in inter-personal relationships are made as a result of positive interaction with volunteer aides and instructors. Through such contact, the riders begin to experience goal-oriented behavior. The attitude of the able-bodied helper is of paramount importance in this process. It is essential that the aides and instructors be firm and consistent in their dealings with the handicapped rider; it must be made clear to him or her that a certain level of performance is expected (within, of course, the rider's limitations). The point is that the riders must learn that their abilities and capacities are greater than they think and that they must strive to improve the level of their performance just as an able-bodied rider would. Once the first goal is achieved, it becomes progressively less difficult to work toward and accomplish subsequent objectives.
An important aspect of Therapeutic Horseback Riding is the fact that it is a legitimate form of therapy "hidden," so to speak, in the process of mastering riding skills. Most physical therapy patients associate treatment with specific, repetitive and highly structured exercise regimens. Riding is seen as a recreational activity, and therefore it is not connected with therapy by the patients. In this way, many preconceived ideas and established negative attitudes toward therapy can be effectively eliminated. In many cases, the handicapped rider will be more enthusiastic, will make a greater effort and will derive more benefit from such self-motivated therapy than from more conventional modes of treatment.
Finally, the effects on the members of the handicapped person's family should be considered. A common reaction in parents to the fact of a handicapped child is a sense of being alone with a problem of unmanageable proportions. This feeling, along with feelings of guilt and helplessness, can be as emotionally crippling to the parents as the physical problem is to the child.
Therapeutic Horseback Riding, because of its intrinsic group orientation, can provide significant help to parents and other close family members on at least two important levels.
First, the sense of isolation being experienced by parents is dispelled. They are afforded the opportunity to share experiences, ideas, successes and disappointments with people who are able to lend understanding and support, particularly in times of stress. The parents are, in the final analysis, the most important source of motivation and support for the handicapped child. It is of the utmost important that they be given as much assistance as possible in fulfilling this role.
Second, by participating in the program, family members see for themselves the possibilities for improvement that Therapeutic Horseback Riding offers. In many cases, the manner in which the family perceives the handicapped member is altered substantially. As this occurs, the self- image and self-confidence of the handicapped improves, thus opening the way to more improvement and achievement. This attitudinal change is the key to a continuing process of improvement and accomplishment that can last over the course of a lifetime.
Before dealing with the specifics of the technique of Therapeutic Horseback Riding, it should be made clear that the primary concern of all involved must be safety. As has been mentioned above, one of the benefits of Therapeutic Horseback Riding is the element of risk inherent in the activity. In the case of the handicapped rider, it is significant that the risks referred to are perceived risks. Exercises and activities are designed to reduce actual risks to an absolute minimum. It is for this reason that the single most important piece of equipment used used in any program is the helmet. Under no circumstances should a rider be treated without one.
The next consideration should be the ponies and horses intended for use in a Therapeutic Horseback Riding program. The basic quality to be sought is docility and even temper. For example, the animals that are used in our program at TEC are employed on a regular basis as school horses and as such are accustomed to a wide variety of riders on all levels of skill and experience. As a result, they are very accepting of handicapped riders, whereas more high-strung, finely trained horses might not tolerate the unusual sensations handicapped riders might cause in mounting and sitting them.
Another consideration to be taken into account is the conformation of the animal. The size and build of the horse ought to be matched to the rider's size and handicap. For example, for a 4 year old child with severe scissoring spasticity of the legs, the ideal mount would be a small to medium sized pony with narrow shoulders. The small size of the pony would facilitate treating the patient, reduce the degree of apprehension in the child and reduce the amount of stress on the adductor muscles in the child's legs.
As has been pointed out above, the act of sitting astride a moving horse has an intrinsic therapeutic value. It is possible, however, to use this basic benefit as a foundation upon which can be built a progressive, planed, goal oriented program of exercise.
Our specific exercise programs are based on proprioceptive neuromuscular facilitation, which maintains that motor activity is organized into patterns of flexion-extension, abduction-adduction and rotation components. Movement in these patterns against minimal resistance guided by a trained physical therapist will enhance motor control in deficient muscles. When employing PNF, the resistance offered to muscular action should be proportional to the strength of the muscles involved in order to avoid damage to bones, joints or musculature.
In the course of a session of Therapeutic Horseback Riding the ideal objective is to bring the appropriate therapeutic exercise into play while providing effective instruction in horsemanship. As has been pointed out, a major advantage of Therapeutic Horseback Riding is that it is not perceived as a conventional session of physical therapy; therefore, the more emphasis that can be place on the horsemanship aspect of each session, the better.