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    Analysis of hippotherapy outcome measures Analysis of hippotherapy outcome measures Document Transcript

    • Analysis Of Hippotherapy Outcome Measures Login Login Signup Advertise HOME GO PRO CHANNELS EVENTS BROWSE UPLOAD Search × Job Openings-PT,OT,SLP Therapeutic Partners Login or Signup toBCBA Jobs start uploading Immediate Openings-w/Stable Therapy for adults, children, & The Benefits You Want The Company Great Benefits & Login with Facebook couples in Raleigh, Apex, Cary, etc Rewards You Never Expected Pay,Supportive Mgt www.therapeuticpartners.com www.MayInstitute.org www.heritage-healthcare.com Dont have a Facebook Account? Join SlideShare Analysis Of Hippotherapy Outcome Measures 7 months ago Email Favorite Download Already have a SlideShare account? Please Login Embed More… lacygardner + FOLLOW 505 views, 0 favs, 0 embeds more Related Recommended More by user Meta Analysis Of Hippotherapy Sites 74 views Evidence Table 47 views Intro to Valley Therapeutic Equestrian Association VTEA 340 views Pediatric Occupational Therapy San Diego Autism Masters Degree Earn a Degree in Behavioral Intervention & Autism 100% Online! www.UMassOnline.net Occupational Therapy Info Occupational Therapy Degree at a School Near You. Get Started Today! Colleges.CampusCorner.com Child Autism Expert, Cary × Aspergers Syndrome & Autistic Spectrum Testing, Children & Teens WynnsFamilyPsychology.com www.WGU.edu Ads by Google About this document Do you like this presentation? You like this. Unlike · Admin Page · Error USAGE RIGHTS Like You like thisBe the first of your friends to like © All Rights Reserved hi lik d i 0 comments STATS 0 0 0 Favorites Comments Downloads Post a comment 505 0 505 Views on Views on Total View SlideShare Embeds ACCESSIBILITY View text version Embed Video  Subscribe to comments ADDITIONAL DETAILS Post Comment Uploaded via SlideShare Uploaded as Adobe PDF Flag as inappropriate File a copyright complaint Want to Teach Special Ed?http://www.slideshare.net/lacygardner/analysis-of-hippotherapy-outcome-measures?from=share_email[9/28/2010 12:11:27 AM]
    • Analysis Of Hippotherapy Outcome Measures NCATE Accredited Bachelor or Master in Special Categories Education. Apply Today! Health & Medicine www.WGU.edu Cypress Therapy Software Follow SlideShare Rehab EMR software for OT/PT/SLP Outcomes, Documentation, Scheduling Twitter www.accu-med.com/Cypress.asp Facebook Speech, PT, OT Therapy SlideShare Blog Pediatric Therapy Free Evaluations www.raleights.com Alkalize & Heal - eBook In This Free eBook, Learn About Alkalizing & Healing Your Body! www.pHDrinkingWater.com Analysis Of Hippotherapy Outcome Measures - Document Transcript 1. Analysis of Hippotherapy Outcome Measures 1 Analysis of Hippotherapy Outcome Measures OTD-E Capstone Lacy Lee Gardner University of St. Augustine for Health Sciences November 25, 2009 2. Analysis of Hippotherapy Outcome Measures 2 Abstract This paper describes the use of hippotherapy with children who have autism spectrum disorders (ASD). It details the rationale, frames of references and a review of the literature. Furthermore, descriptions of a capstone project are provided on the investigation of hippotherapy outcome measures being used by current occupational therapists. Five hippotherapy sites were visited and at least one full day of sessions was observed at each. Occupational therapists were also interviewed about current practices. Findings support the use of non-standardized testing for measuring outcomes of children with ASD. Also noted are the various methods for delivering hippotherapy services. Keywords: Hippotherapy, Autism Spectrum Disorders, Outcome Measures 3. Analysis of Hippotherapy Outcome Measures 3 Introduction Autism Spectrum Disorders (ASD) are estimated to affect approximately 1 in 150 children in the United States yet it is still unclear as to what causes ASD. This developmental disorder affects numerous aspects of a child’s daily functioning, including communication, social interaction, cognitive functioning, motor functioning and sensory integration (CDC, 2009). A wide variety of treatments are available, including behavior and communication approaches, dietary approaches, medication, and complementary and alternative approaches (CDC, 2009); however there is currently no consensus as to which treatment strategies are most effective (Bass, Duchowny, & Llabre, 2009). Some families have participated in traditional therapies without much success and are seeking complementary and alternative approaches to trial. “Current research shows that as many as one third of parents of children with an ASD may have tried complementary or alternative medicine treatments” (CDC, 2009). Therefore, it is not surprising that hippotherapy is in demand and on the rise (AHA, 2009). Hippotherapy originates from the Greek word hippos meaning horse and literally translates to treatment with the help of a horse. “Hippotherapy is a physical, occupational, and speech-language therapy treatment strategy that utilizes equine movement as part of an integrated intervention program to achieve functional outcomes” (AHA, 2009). The horse’s movement provides a multi-sensory environment that facilitates active responses in the client. Movements are directed and graded by the therapist, allowing the client to participate in motivating activities to develop transferable skills (Byam & Simmons, 2005). The American Hippotherapy Association (2009) states that this method of treatment delivery is appropriate for any child or adult with “mild to severe neuromusculoskeletal dysfunction.” Specific medical 4. Analysis of Hippotherapy Outcome Measures 4 conditions include autism spectrum disorders (ASD), cerebral palsy (CP), developmental delay, genetic syndromes, learning disabilities, sensory integration disorders, speech-language disorders, traumatic brain injury, and stroke (AHA, 2009). “Occupational therapists can use the technique of hippotherapy as part of their intervention to deign functional and occupation-based treatment plans to meet specific client goals” (Byam & Simmons, 2005, p.14). They use hippotherapy to address physical impairments, social participation, behavior modification, psychosocial issues, and cognition. Benefits can include improved posture, muscle tone, flexibility, endurance, sensory processing, motor planning skills, body awareness, motivation, self-confidence and problem-solving skills. (See Appendix A for examples of hippotherapy benefits, intervention techniques, and generalizations to other skills). These benefits can be explained through the Person-Environment-Occupation (PEO) Model, which was designed to reveal the complex relationships among these three factors. “Occupational performance results from an individual’s engagement in purposeful tasks and activities within an environment” (Byam & Simmons, 2005, p. 14). With hippotherapy, clients can achieve their goals through interaction with the unique horse environment and activities performed while on horseback. People are generally attracted to horses; therefore, this unique relationship and interaction often motivates clients to engage in intervention activities (Byam & Simmons, 2005). Hippotherapy for children with ASD is also represented in the Sensory Integration model. The Sensory Integration model was developed by Ayers with a central principle of providing planned and controlled sensoryhttp://www.slideshare.net/lacygardner/analysis-of-hippotherapy-outcome-measures?from=share_email[9/28/2010 12:11:27 AM]
    • Analysis Of Hippotherapy Outcome Measures input in order to facilitate a related adaptive 5. Analysis of Hippotherapy Outcome Measures 5 response and enhance the brain’s organization. Occupational therapists can use the horse to deliver this controlled sensory input, including proprioceptive, vestibular, and tactile. The therapist can manipulate the horse’s movement, direction, speed and gait or even change the horse itself, as each moves differently, in order to control the sensory input (Bracher, 2000). “Each time the equine takes a step there is a concussive force transmitted to the patient giving them proprioceptive input (the sense of where the body is in relation to other body parts). By moving through space the patient receives vestibular input (the sense of movement or orientation in space)” (NARHA, 2008, p.44). And tactile input is received just through touching the horse. These systems play a key role in the patient’s arousal level, which impacts the ability to attend to a given task and follow directions (NARHA, 2008). “It has been noted from teachers and parents that autistic children have improved in most areas of sensory processing and their reaction to the world around them much more completely after riding” (Stoner, 2004). Countless testimonials support the outlined benefits of hippotherapy, however anecdotal evidence is not enough. Insurance companies still consider hippotherapy to be “experimental and investigational” due to insufficient scientific data in the peer reviewed medical literature to support its efficacy (Aetna, 2009). Furthermore, the minimal amount of research available is focused on changes in motor control with diagnoses such as cerebral palsy, spinal cord injuries and multiple sclerosis. Studies involving children with ASD are extremely rare. Upon further analysis, it is hypothesized that outcome measures might be one cause for the scarcity of evidence available. “Because children with autism have difficulties with interaction and communication, they rarely comply with standardized administration of test 6. Analysis of Hippotherapy Outcome Measures 6 items. Most of the measures used in autism research have been scales completed by teachers and parents based on observation of behaviors or structured observations of children in natural settings from videotapes” (Miller-Kuhaneck, 2004, p.406-7). This limits the possible measurement tools to be used, eliminating several of the more sensitive tests. Another issue affecting the quality of available studies is the lack of randomized clinical trials. It is difficult to obtain randomized samples that are comparable, because children with ASD present with varied levels of disability and characteristics. Likewise, interventions are individualized to meet each unique child’s needs and goals. This makes standardization and replication of interventions very difficult, again presenting a limitation of research (Miller- Kuhaneck, 2004). From this it was determined that a need exists for investigation of commonly used assessments among therapists currently practicing in hippotherapy settings. “Measurement of behavior and performance is not the only issue in regard to children with autism; identifying which variables to measure is also important to consider. The behaviors of children with autism relate in complex ways, and multiple behaviors should be measured and correlated to evaluate intervention effects” (Miller-Kuhaneck, 2004, p. 407). Differences between Hippotherapy and Therapeutic Horseback Riding Hippotherapy and therapeutic horseback riding are commonly interchanged terms however there is a definite distinction between the two. “Hippotherapy establishes a foundation for neurological function and sensory processing based on a therapeutic model as where therapeutic riding concentrates on teaching specific riding skills for recreational purposes based on a recreational/leisure model. In so doing, therapeutic riding gains more flexibility, balance, strength and improves posture during the sport of riding specifically rather 7. Analysis of Hippotherapy Outcome Measures 7 than establishing the foundations of occupational performance therapeutically” (Cantu, 2005, p. 52). Both require therapists or instructors to be certified, which is controlled by their respective national associations. Carriage Barn Equestrian Center’s website offers an excellent comparison chart outlining the differences between hippotherapy and therapeutic horseback riding (See Appendix C). Often times a client may begin with hippotherapy treatment and when significant progress is observed to plateau, he/she may then transfer to a therapeutic riding program. This allows for underlying functional skills, such as sensory processing, muscle strength and endurance, to be established initially through hippotherapy and then maintained through therapeutic riding. Literature Review Literature supporting the use of hippotherapy with children who have ASD was reviewed extensively. Criteria for each of the following areas were established in order to centralize focus while searching the literature. Intervention criteria included hippotherapy, therapeutic horseback riding, equine assisted therapy, and animal assisted therapy. Participants were limited to children ages 18 and under presenting with ASD or related symptoms (delayed social skills or language disabilities). Outcomes of interest included sensory processing skills, social functioning, motivation and occupational performance. Two studies investigated the effects of hippotherapy services on children with autism or related symptoms. Taylor and colleagues (2000) examined the changes in motivation and volition of three children with autism after receiving 16 weeks of hippotherapy sessions. Each 45 minute session included donning a helmet and mounting/dismounting the horse, with 20-30 minutes actually spent riding atop the horse. The children were observed after 8 sessions and 8. Analysis of Hippotherapy Outcome Measures 8 again after the conclusion of 16 sessions, using the Pediatric Volitional Questionnaire (PVQ). All three children demonstrated increased volition from baseline at differing rates. Researchers concluded that motivation is positively impacted by hippotherapy. Maccauley and Gutierrez (2004) published a study of the effectiveness of hippotherapy for children with language-learning disabilities. Hippotherapy was administered in two 60 minute sessions a week for 6 weeks, addressing speech and language goals. Participants and their parents completed a 21-item client satisfaction questionnaire both prior to and upon completion of the hippotherapy intervention. Parents reported improvements in speech and language abilities however the children reported no difference when receiving hippotherapy. Two additional studies investigated the effects of therapeutic horseback riding on children with autism spectrum disordershttp://www.slideshare.net/lacygardner/analysis-of-hippotherapy-outcome-measures?from=share_email[9/28/2010 12:11:27 AM]
    • Analysis Of Hippotherapy Outcome Measures (ASD) 4 to 10 years of age. Stoner (2004) implemented one 60 minute session weekly for 10 weeks with 20 minutes of pre-mounted activities and 30 minutes of mounted activities. Bass, Duchowny and Llabre (2009) implemented one 60 minute session weekly for 12 weeks with five minutes for mounting and dismounting, 10 minutes of warm-up activities, 15 minutes of riding skills, 20 minutes of mounted games, and 10 minutes of horsemanship and grooming tasks. Both of these studies utilized a pretest-posttest control group design with participants randomly assigned to either the experimental group or placed on a wait-list. And again, both studies reported improvements after therapeutic horseback riding. Stoner (2004) and Bass et al (2009) reported improvements in sensory processing skills as evidenced by the sensory profile. Bass also reported improvements in social functioning as evidenced by the social responsiveness scale. 9. Analysis of Hippotherapy Outcome Measures 9 Candler (2003) published a study of therapeutic horseback riding at a one week summer day camp. The study targeted individualized occupational performance established through the Canadian Occupational Performance Measure (COPM). Twelve children with identified sensory modulation disorders ages 5 to 13 years participated in this summer camp. This one group pretest- posttest design demonstrated an improvement in both satisfaction and performance of outlined occupations after participating in therapeutic riding sessions and arts and crafts activities at camp. However, with multiple activities and interventions implemented throughout each day, Candler (2003) was unable to determine if the positive outcome can be fully attributed to the equine activities. Sams, Fortney and Willenbing (2006) reported the effects of occupational therapy incorporating various animals, including horses, on social interactions and language use in 22 children with autism. Each weekly session, averaging 28.5 minutes in length, facilitated sensory integration, language use, sensory skills, and motor skills through either traditional or animal- assisted occupational therapy. The number of behaviors for use of language and social interaction were counted and compared between the two types of treatment sessions. After 15 weeks, positive behaviors during animal- assisted treatment sessions outnumbered those during the traditional treatment sessions. This study supports the unique and natural interest children exhibit towards animals. The above articles provide support for the use of equine-assisted therapies in promoting positive occupational and behavioral outcomes in children with ASD. However, further research is needed to validate these findings. According to Sackett’s levels of evidence, these studies present evidence limited to Levels III and IV due to lack of control for internal and external 10. Analysis of Hippotherapy Outcome Measures 10 validity. Studies with increased sample size, randomized control groups and use of reliable, valid standardized assessments are needed to provide Level I evidence. Research outside the realm of physical benefits is beginning to emerge, focusing on behavioral, cognitive, and psychosocial benefits. This is merely the beginning of many efforts to close the hippotherapy literature gap. (See appendix D for Evidence Table of quantitative research studies discussed above.) Method Local hippotherapy sites within a 100 mile radius of St. Augustine Florida were found through public access, including internet and phone book searches as well as word of mouth. (See Appendix E for reference listing of local sites). Although many of the sites offered both hippotherapy and therapeutic horseback riding, this search was limited to those offering hippotherapy treatment delivered by an occupational therapist. Four hippotherapy sites in this geographical area were contacted, along with one in Gainesville, Georgia due to a prior Level II fieldwork placement at this site. Each site was visited for observation of at least one full day of sessions administered to children with autism spectrum disorders (ASD). The specific type of treatment delivery was noted at each site, classic hippotherapy vs. equine-facilitated therapy. Classic hippotherapy focuses solely on the horse’s movement and the child’s reaction. Whereas, equine-facilitated therapy additionally incorporates traditional occupational therapy activities while atop the horse. Occupational therapists at each site were also verbally interviewed about current practices and outcome measures being utilized. Questions included: 11. Analysis of Hippotherapy Outcome Measures 11 a. What diagnoses are treated at this hippotherapy facility? b. What age is this population? c. What is the cost of hippotherapy services? How are these services funded, billed, or reimbursed? d. What measurement tools are being used at initial evaluation and follow-ups? e. What measurement tools are viewed as the most effective in demonstrating improvements for children with ASD? f. How is progress monitored? g. Is there a specific child that “sticks out” as demonstrating significant improvements as a result of hippotherapy treatment sessions? Results Results indicated that therapists currently use a variety of standardized assessments primarily for billing purposes, as insurance companies request the report of standardized scores. This includes the Bruininks-Oseretsky Test of Motor Proficiency, Peabody Developmental Motor Scales, Beery-Buktenica Developmental Test of Visual-Motor Integration, and Sensory Profile to name a few. However, therapists agree that administering standardized assessments to children with autism spectrum disorders (ASD) is difficult and not often accurate. The most valuable information regarding an individual’s progress is obtained through observations and reports from family and teachers. Observations also revealed a significant difference in delivery of hippotherapy services across each site visited. Each therapist administered hippotherapy services with personal variations; some adhered strictly to classic hippotherapy guidelines, while others added more 12. Analysis of Hippotherapy Outcome Measures 12 traditional therapeutic activities to treatment sessions. While all methods appear to benefit children with ASD, this capstone project influenced the development of a personal preference for delivery of hippotherapy services in the form of equine-facilitated therapy sessions; incorporating traditional activities while on the horse adds depth to each treatment session. Equine-facilitated therapy still offers children the benefit of classic hippotherapy, improving trunk control and sensory processing skills, as well as the benefit of improving fine motor or visual motor skills, for example. This provides children with an opportune learning environment in which skills can be easily generalized to other environments. Lastly,http://www.slideshare.net/lacygardner/analysis-of-hippotherapy-outcome-measures?from=share_email[9/28/2010 12:11:27 AM]
    • Analysis Of Hippotherapy Outcome Measures it was discovered that information about local hippotherapy sites is not easily accessible to the community. Conventional search methods utilized by most families were not successful. Therapists offering hippotherapy services are not advertised or publicized. Families in the community may not know the many ways in which hippotherapy can benefit a child with ASD. (See Appendix E for meta-analysis of hippotherapy sites). Discussion These results support the use of hippotherapy to benefit children with autism spectrum disorders (ASD). Therapists and families alike have reported children making significant gains after participating in hippotherapy. However, insurance companies continue to disregard these services as therapeutic, considering them experimental. Therapists are then forced to creatively document hippotherapy services, using phrases such as “dynamic surface” and “barrel” in order to avoid the term “horse.” Additionally, therapists are forced to use standardized assessments in reporting therapeutic gains, despite the known superior value of clinical observations and 13. Analysis of Hippotherapy Outcome Measures 13 reports from parents and teachers. Therapists value non- standardized outcome measures over standardized testing to demonstrate improvements in children with ASD. The results also suggest that the community would benefit from a publicized reference listing of all local therapy sites. Families as well as the health profession need to be informed of the incredible benefits hippotherapy has to offer. A reference list of all local hippotherapy sites within a 100 mile radius of Saint Augustine, Florida has been composed and will be submitted to local autism support groups (See Appendix D). Additionally, the knowledge gained in this capstone can be used to develop a future study supporting the use of hippotherapy with this particular population. It is hypothesized that children participating in hippotherapy will demonstrate improvements in social functioning and sensory processing skills compared to participants not receiving the treatment. The study will include at least 50 children diagnosed with ASD between 4 and 18 years of age. Each child will be randomly assigned to either the control group or experimental group, amounting to approximately 25 in each group. Children in the control group will wait-listed and will continue to receive any conventional therapies. Children in the experimental group will participate in 60 minute hippotherapy sessions once a week for 16 weeks. Outcome measures will include the Sensory Profile (SP), Sensory Responsiveness Scale (SRS), and the use of video to rate the children’s performances on a categorized likert scale. The SP and SRS will be completed by the caregivers both before and after the 16 week period. The caregiver will not be allowed to view previous completed forms when completing the assessments at the conclusion of treatment in order to prevent bias. Bass, Duchowny and Llabre (2009) utilized the SP and SRS in their study exploring the effect of therapeutic horseback 14. Analysis of Hippotherapy Outcome Measures 14 riding on social functioning in children with autism. These assessments provide information about a child’s social functioning, sensory processing skills and characteristic behaviors of children with ASD. Both the SP and SRS are considered to be highly reliable and valid standardized assessment tools. A 15 minute video will be recorded during the children’s first and last hippotherapy session and then viewed by a blinded therapist to rate the children’s performance on a categorized likert scale (based on percentage or number of occasions identified behaviors are observed). This method can be used to prevent bias and establish inter-rater reliability. This allows the therapists’ highly valued clinical observations to be quantified. After 16 weeks, the hippotherapy services will be discontinued and can resume traditional therapeutic interventions. A follow-up will be completed 8 weeks after the intervention is discontinued in order to measure the continued benefits. It is hypothesized that children participating in hippotherapy will demonstrate decreased social functioning and sensory processing skills after services are discontinued. Sometimes effects become evident when an intervention is removed, as supported by this parent’s testimonial. “Morgan had started going every other week for therapy and she missed 3 sessions which amounted to 6 weeks. Well, her teacher called me and wanted to talk about her behavior and at home I have been having a hard time with her on doing homework. She would say, ‘Mom, my head is feeling funny,’ so I would make her do some wall pushups, etc. Well, it finally dawned on me that she had missed hippo and her body was getting out of sync again! [The therapist] felt the same way so now Morgan is back to weekly 15. Analysis of Hippotherapy Outcome Measures 15 therapy sessions, but its only been 2 weeks so no major improvement yet, but I know by the end of this year she will be doing much better.” –Chante McNeal Therefore, it may be beneficial to include an interrupted time-series withdrawal design in which the treatment is removed then re-introduced (O1 X1 O2 X0 O3). The literature supporting the use of hippotherapy with children with ASD is very limited. However, therapists, parents and families of children with ASD who have participated in this unique treatment have reported the immense benefits. “More people need to understand that [hippotherapy] is helpful – I even have a hard time with Morgan’s elementary school teachers understanding the impact it has on her” (Chante McNeal). Future studies are needed in order to further assess its therapeutic benefits. After extensive research and investigation through this capstone project, I feel the above described study would provide Level IV evidence supporting the many benefits hippotherapy has on children with autism spectrum disorders. 16. Analysis of Hippotherapy Outcome Measures 16 References Aetna. (2009) Clinical policy bulletin: Hippotherapy. Retrieved on October 31, 2009 from http://www.aetna.com/cpb/medical/data/100_199/0151.html. American Hippotherapy Association. (2007). Retrieved on October 31, 2009 from http://www.americanhippotherapyassociation.org. 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 Developmental Disorders, 39, 1261-1267. Bracher, M. (2000). Therapeutic horse riding: What has this to do with occupational therapists?. British Journal of Occupational Therapy, 63 (6), 277-282. Byam, E., & Simmons,http://www.slideshare.net/lacygardner/analysis-of-hippotherapy-outcome-measures?from=share_email[9/28/2010 12:11:27 AM]
    • Analysis Of Hippotherapy Outcome Measures D. (2005). Environment and occupation in hippotherapy. OT Practice, 10 (7), 13-18. Candler, C. (2003). Sensory integration and therapeutic riding at summer camp: Occupational performance outcomes. Physical & Occupational Therapy in Pediatrics, 23 (3), 51-64. Cantu, C. O. (2005). Hippotherapy: Facilitating occupational performance. Exceptional Parent, 35 (3), 51-53. Latella, D., & Langford, S. (2008). Hippotherapy: An effective approach to occupational therapy intervention. OT Practice, 13 (2), 16-20. Macauley, B. L., & Gutierrez, K. M. (2004). The effectiveness of hippotherapy for children with language-learning disabilities. Communication Disorders Quarterly, 25 (4), 205-217. Miller-Kuhaneck, H. (2004). Autism: A comprehensive occupational therapy approach (2nd ed.). Bethesda, Maryland: AOTA Press. 17. Analysis of Hippotherapy Outcome Measures 17 NARHA. (2008). Humans, horses and health: Hippotherapy. Palaestra, 24 (1), 43-44. Sams, M. J., Fortney, E. V., & Willenbring, S. (2006). Occupational therapy incorporating animals for children with autism: A pilot investigation. American Journal of Occupational Therapy, 60 (3), 268-274. Stoner, J. B. (2004). Riding high. Advance for Occupational Therapy Practitioners, 20 (13), 42. Taylor, R. R., Kielhofner, G., Smith, C., Butler, S., Cahill, S. M., Ciukaj, M. D., & Gehman, M. (2000). Volitional change in children with autism: A single-case design study of the impact of hippotherapy on motivation. Occupational Therapy in Mental Health, 25, 192- 200. 18. Analysis of Hippotherapy Outcome Measures 18 Appendix A: Benefits of Hippotherapy, Intervention Techniques, and Generalization to Everyday Learning Skills Intervention Generalization to Skill Area Sample Goal Example Other Skills The rider is placed The child will play backward and side- with siblings at the Improve dynamic Motor sitting while the horse playground and with balance walks at a moderate peers at school pace without falling The rider feels the The child will be able rhythm of the horse Improve awareness of to stand in line at Sensory at a walk, a trot, and self in space school without with transitional bumping into others movements The rider receives positive, specific feedback after The child will Provide a successful achieving a simple demonstrate Emotional experience to goal such as an increased self-esteem improve confidence independent half in social and family seat, holding the situations reins, or sitting independently The child will help The rider is asked to with simple chores make the horse go around the house and Follow two- step Process/Cognition forward by squeezing demonstrate commands his or her legs and increased ability to saying “walk on” participate in classroom activities With each transitional The child will interact movement, the rider with at least one peer Increase Communication/ is asked to verbalize in school or on a play verbalizations and Social Participation commands to the date. The child will social interactions horse such as “walk verbalize his or her on,” “whoa,” or “trot” needs at home. (Latella & Langford, 2008) 19. Analysis of Hippotherapy Outcome Measures 19 Appendix B: Comparison of Therapeutic Horseback Riding and Hippotherapy A Comparison of Therapeutic Riding and Hippotherapy programs Both programs require: Qualified Equines Safe environment for humans and equines Qualified equine professionals and horse handlers Therapeutic Riding/Equine Assisted Activities Hippotherapy/Equine Assisted Therapy • Recreation/leisure • Hippotherapy (HPOT) • Sport/Education • Equine Facilitated Psychotherapy (EFP) • Vocational/Equine • Equine Facilitated Therapy (EFT) • Improvement in social skills, quality of life • Attainment of therapy based goals as per and mobility professional designation and functional • Includes riding, driving, vaulting and outcomes assessed during evaluation. ground work adapted as needed for • Goals include improved function, individual participant rehabilitation, not necessarily equine • Goals include riding ability, acquisition of related. leisure skill, self accomplishment, • HPOT - mounted use of the horse’s animal/human interaction. Goals are movement to achieve therapy based goals equine related • EFP – mounted or unmounted activities, • Implemented by trained instructor use of equine/human relationships to • Therapists as consultants achieve therapy based goals. • EFT – mounted or unmounted activities using equine skills to achieve functional goals. • Implemented by licenced/credentialed medical human service professional, PT, OT, SLP, or Phychologist Chart retrieved from The Carriage Barn Equestrian Center at http://www.carriage- barn.com/therapeutic_hippo.html#comparison 20. Analysis of Hippotherapy Outcome Measures 20 Appendix C: Evidence Table Table 1. Summary of studies: Interventions and participants Study Control Total Intervention/time Population Ages Authors Intervention n Hippotherapy: 45 min/session x None 1 session/wk x 16 wks 2000 (Each participant Children with 4-6 Session included donning 3 Taylor1 served as his/her autism yrs helmet, mounting, 20-30 mins on own control) horse, dismounting One week summer day camp: None Children with 2003 Therapeutic horseback riding (Each participant sensory 5-13 12 Candler2 Sensory integration intervention served as his/her modulation yrs Camp arts and crafts own control) disorder None Children with 2004 Hippotherapy: 60 min/session x (Each participant language- 3 9-12 Macauley3 2 sessions/wk x 6 wks served as his own learning control) disabilities Therapeutic horseback riding: 60 min/wk x 10 wks Children with 2004 4-10 Session included 30 mins pre- Wait-list autism or PDD- 12 Stoner4 yrs mounted activities and 30 mins NOS mounted activities None OT incorporating animals: (Each participant Children with 7-13 2006 Sams5 average 28.5 mins/session x 1 22 served as his/her autism yrs session/wk x 15 wks own control) Therapeutic horseback riding: 60 min/wk x 12 wks Session included 5 mins Children with 4-10 2009 Bass6 Wait-list 34 mounting/dismounting, 10 mins ASD yrs warm-up, 15 mins riding skills, 20 mins mounted games, 10 mins horsemanship/grooming 21. Analysis of Hippotherapy Outcome Measures 21 Table 2. Summary of Studies: Research methods Level of Treatment Control Rx Study Authors Research Design Rx n Evidence Duration n 2000 Taylor1 Single subject A-B-B design IV 16 wks 3 0 One-Group Pretest-Posttest 2 2003 Candler Design IV 1 wk 12 0 O1 X O2 One- Group Pretest-Posttest 2004 Macauley3 Design IV 6 wks 3 0 O1 X O2 Pretest-Posttest Control Group Designhttp://www.slideshare.net/lacygardner/analysis-of-hippotherapy-outcome-measures?from=share_email[9/28/2010 12:11:27 AM]
    • Analysis Of Hippotherapy Outcome Measures 2004 Stoner4 II 10 wks 6 6 R O1 X O2 O1 O2 One-Group Pretest-Posttest 5 2006 Sams Design IV 15 wks 22 0 O1 X O2 Pretest-Posttest Control 6 Group Design 2009 Bass III 12 wks 19 15 R O1 X O2 O1 O2 22. Analysis of Hippotherapy Outcome Measures 22 Table 3. Summary of Studies: Outcomes, measures, and results Study Outcome of Measurement Tool Result Clin Statistics Level of Authors Interest Signif Evidence 2000 Motivation/Volition PVQ + NR NS IV Taylor1 COPM (modified for NR IV 2003 Occupational summer camp setting) Candler2 performance - Performance + p=.001 - Satisfaction + p=.001 21-item questionnaire NR IV 2004 Speech and - parents + p<.000 Macauley3 language abilities - participants - p<.02 SP 2004 + Sensory processing 1 question with 3 NR NR II Stoner4 + possible answers 2006 Social interactions Number of behaviors + large p<.01 IV Sams5 Language use Number of behaviors + small p<.05 SRS + none p=.017 2009 Bass6 Social functioning III SP + small p<.01 Legend for Table 3 PVQ Pediatric Volitional Questionnaire + Result favored animal therapy COPM Canadian Occupational Performance - Result did not favor animal Measure therapy SP Sensory Profile NR Not reported SRS Sensory Responsiveness Scale ND No difference NS Not significant 23. Analysis of Hippotherapy Outcome Measures 23 List of References: 1. Taylor, R. R., Kielhofner, G., Smith, C., Butler, S., Cahill, S. M., Ciukaj, M. D., & Gehman, M. (2000). Volitional change in children with autism: A single-case design study of the impact of hippotherapy on motivation. Occupational Therapy in Mental Health, 25, 192- 200. 2. Candler, C. (2003). Sensory integration and therapeutic riding at summer camp: Occupational performance outcomes. Physical and Occupational Therapy in Pediatrics, 23 (3), 51-64. 3. Macauley, B. L., & Gutierrez, K. M. (2004). The effectiveness of hippotherapy for children with language-learning disabilities. Communication Disorders Quarterly, 25 (4), 205-217. 4. Stoner, J. B. (2004). Riding high. Advance for Occupational Therapy Practitioners, 20 (13), 42. 5. Sams, M. J., Fortney, E. V., & Willenbring, S. (2006). Occupational therapy incorporating animals for children with autism: A pilot investigation. American Journal of Occupational Therapy, 60 (3), 268-274. 6. 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 Developmental Disorders, 39, 1261-1267. 24. Analysis of Hippotherapy Outcome Measures 24 Appendix D: Reference List of Local Hippotherapy Sites Freedom Ride Sandra Wainman, OTR/L 1905 Lee Road Orlando, Florida 32810 (407) 293-0411 (497) 629- 9455 HOPE: HOrses helping PEople Cathi Brown, OTR/L Edi Walker, OTR/L 9814 SW 153rd Avenue Archer, Florida 32618 (352) 495-0533 (904) 961-9479 Hope Reigns Children’s Therapy Network Gina Johnson, OTR/L 3804 Pioneer Trail New Smyrna Beach, Florida 32168 (386) 428-4805 Hope Therapy Becky Davenport, OTR/L 1591 Big Branch Road Middleburg, Florida 32068 (904) 291-6784 (904) 887-8451 25. Analysis of Hippotherapy Outcome Measures 25 Appendix E: Meta-analysis of Hippotherapy Sites 26. Analysis of Hippotherapy Outcome Measures 26 Comparison of Hippotherapy Sites Children’s Freedom HOPE: HOrses Hope Walker Name Therapy Ride, Inc. helping PEople Therapy Therapy Network, Services Inc. Gina Johnson, Sandra Wainman, Cathi Brown, OTR/L Rebecca Nicole Walker, OTR/L OTR/L Edi Walker, OTR/L Davenport, OTR/L Therapist(s) OTR/L Nolina Varley, OTR/L New Smyrna Orlando, FL Archer, FL Middleburg, FL Gainesville, GA Beach, FL Location 3+ years 5-6 years 3 years to 2 years to 3 years to 7-9 years 70 years 85 years 18 years Population 10+ years autism, autism, autism, PDD, ASD, CP, ASD, CP, sensory mitochondrial oppositional/defian Down’s Down’s Diagnoses processing disorder, t behavior disorder, Syndrome, Syndrome, disorder, sanfilippo disease developmental learning Sensory cerebral palsy, disorders, sensory disability, processing multiple spine processing disorder, developmenta disorder, disorders CP, muscular l delay, ADD/ADHD, including dystrophy, brachial multiple developmenta spondylosis plexus injury, brain sclerosis, brain l delay, tumor, terminal injury, CVA, microcephaly, brain cancer (war veterans agenesis – corpus amputations) callosum, hemi- hypertrophy Classic Classic Classic Equine- Equine- Hippotherapy Hippotherapy Hippotherapy Facilitated Facilitated Method of 30 minute 45 minute weekly 60 minute weekly 60 minute 60 minute Delivery weekly sessions sessions weekly weekly sessions x 6 sessions sessions weeks OT Services: MacKay OT Services: Insurance and OT Services: Hope Reigns Scholarship (State Insurance and private pay Insurance and Cost, Billing, sponsoring, Funding), private-pay private-pay Funding Third-party Medicaid, Third- Barn Fees: Private- Barn Fees: Insurance, party Insurance, Pay, HOPE non- Private-pay, Private-pay Private-pay, profit organization Finding Faith Barn Fees: donations non-profit Hope Reigns organization sponsoring, Private-pay 27. Analysis of Hippotherapy Outcome Measures 27 Sensory Profile, VMI, BOT, SCSIT, PDMS, SP SP, MMT, SP, BOT, Great Postural clinical Primarily clinical ROM, FM/GM PDMS, VMI, Outcome Scale, clinical observations observations and skills, clinical clinical Measures observations (fine/gross motor developmental observations, observations (posture, trunk skills, imitation of milestones caregiver support/streng postures, interview th, cognition, postrotary ability to follow nystagmus, etc.) instructions, Track progress etc.) with worksheets: Arousal level at beginning and end Posture used on horse Balance (maintaining center alignment) Changing positions on horse Oral motor (Used for calming/B awareness, develop awareness of mouth, % drooling of session) Pelvis (% Active vs Passive movement) Trunk/Postur e (% upright, slight slouch, slouch) Weekly report sent home to caregivers 28. Analysis of Hippotherapy Outcome Measures 28 Susie is a 9 Aaron is a 6 year Christopher is a 9 Billy is a 9 year Morgan is a 9 year old girl old boy with year old boy with old boy with year old girl Mini-Case with autism. autism who was ASD. autism who is with ASD. Her Study Hippotherapy non-verbal prior His mother non-verbalhttp://www.slideshare.net/lacygardner/analysis-of-hippotherapy-outcome-measures?from=share_email[9/28/2010 12:11:27 AM]
    • Analysis Of Hippotherapy Outcome Measures parents and has improved to beginning reported carryover and displayed teachers her trunk hippotherapy. at home after the behaviors such reported control, After two years, first few visits, with as kicking, improvements sensory he now talks non- improvements in biting and in behaviors processing and stop! He has also dressing, grooming, pinching. After and attention communication improved sensory attention and focus. participating after skills. She has modulation skills in participating now plateaued and now hippotherapy, in after making experiences less his parents hippotherapy. significant “meltdowns.” and teachers Recently she progress and report a was unable to her therapist significant attend has referred behavior sessions for 6 her to change and weeks and therapeutic improvements Morgan’s horseback in attention teacher riding. and focus. contacted her mother regarding her changes in behavior in the classroom. Her mother also reported difficulties attending to homework. Morgan reported “Mom, my head is feeling funny.” Therapist Sessions provided Rebecca and prepares as weekly OT her mother Additional clients for session through teamed Information hippotherapy Life Skills together to sessions in Academy begin HOPE clinic by Therapy in an simulating the effort to serve horse with a those with saddle placed special needs on an egg-ball. through their Therapist love for reports this has horses. offered a smooth transition. Search LEARN ABOUT US USING SLIDESHARE SLIDESHARE OUTSIDE PRO & MORE DEVELOPERS & API WHATS NEW Introducing SlideShare About us Quick Tour Facebook App Go Pro Developers section PRO! See plans and Work with us Terms of Use LinkedIn App Capture Leads Developers Group pricing. Our Blog Privacy Policy SlideShare Mobile Advertise with us Widgets for your blog Press Copyright & DMCA Get featured on GET HELP Community Guidelines homepage © 2010 SlideShare Inc. All rights reserved.http://www.slideshare.net/lacygardner/analysis-of-hippotherapy-outcome-measures?from=share_email[9/28/2010 12:11:27 AM]