Hippotherapy and the Adult Client

Most people think of hippotherapy as an activity for kids.  We have images of small riders atop small horses with a variety of volunteer helpers and lots of giggles.

As much as we DO tend to have more kids than adults, we ALWAYS encourage adults to participate at our clinic as well.

Karen and Cory work on the ground in natural horsemanship

Reasons most adults don’t know about us:

• Hippotherapy reaches most clients through word of mouth.  There are numerous ways that parents of small children do this:  school groups, therapy centers, shared physicians, parent talk-lists.  There are FAR fewer avenues for adults with disabilities to discuss positive experiences or ‘adjunctive’ therapies that are working for them!

• Funding!  There are very few facilities providing hippotherapy that accept Medicare as a payor source.  This doesn’t mean that there is no funding available.  Many potential clients have other means of payment and we are always happy to discuss assistance with funding sources.

• Adults have usually been through lots of therapy prior to discharge from a rehab center or subacute rehab at a SNF (skilled nursing facility).  Those providing discharge planning are  typically setting up home care or out-patient therapies.  It is very rare to have a home-care therapist make additional referrals once they are finished working with a client.  This often leaves clients feeling like they’re “done”.  There is no more therapy.  They’ve finished.

This is a very big problem.

At Front Range Hippotherapy, we love adult referrals!  It gives us opportunities to work, both on and off the horse, with a client that typically participates at a different level.  Adult clients have a richer first-hand understanding of the ways we are working together toward specific goals.  Adults can often follow commands differently, understand nuance in language, and can often specifically communicate their needs.  We find working with adults challenges the way that we practice–we work very hard to provide the environment that best suits each client. With adults, we may use direct cues to elicit a physical response vs. playing games with a pediatric client to elicit a similar response.  The interaction is age-appropriate.  If astride, this is not merely “a pony ride”, but a complex treatment strategy designed to meet individual needs.

With a background in Neurorehabilitation,  I often feel like there needs to be more REHAB.  I call it “post-rehab rehab” for lack of a better term.  We discharge patients from the rehab center prematurely, based on a set of numbers generated to prove/disprove “progress”.  Often, in rehab, there are a number of factors that limit a patient’s progress.  These include (but aren’t limited to) length of time from CVA  (stroke) or TBI ( traumatic brain injury)–the patient hasn’t “woken up” yet, other medical complications such as secondary infections, poor nutrition, or limited endurance from cardiac complications.  Many patients find their participation varies day by day, according to the way they feel.  Often, when a patient is unable to fully participate, they are discharged due to a lack of substantial progress.

Sadly, there are other factors as well.  Progress is subjective.  A family member may be able to see a much more subtle change than a staff member, based on their knowledge of their loved one.  A therapist with specific experience may know a technique to use that another therapist has never tried, etc.  A physician may prescribe a treatment that is beneficial, but that another physician wouldn’t necessarily agree with.  So often, this “progress” is subjective.  Unfortunately, in these instances, it is the luck of the draw.

At Front Range Hippotherapy, we work with each individual, regardless of age, on their specific therapeutic goals.  As a PT, I feel like the portion of therapy done astride compliments the therapeutic interventions in the clinic.  We focus on the same goals that were written in rehab or in the outpatient clinic.  Strength, coordination, balance, endurance and ambulation are a few of the goal areas that we address when working with adults.
It is important to think about the contraindications for hippotherapy in this population.  They include:

• Osteoporosis (bone density sufficient for moderate stress to joints),

• Decreased hip mobility (insufficient to sit astride),

• Obesity/oversized adults (may not have a horse that can carry this size client),

• Aggressive behaviors (patients with TBI diagnoses often have episodes that may prove dangerous to the team–horse, volunteer or handler), uncontrolled seizure activity (it is difficult to manage a seizure while astride or do an emergency dismount)

• Skin breakdown in the perineal area or ischium–preventing adequate healing or causing severe pain.

If you are an adult who is recovering from an accident or illness, or a family member who is seeking out excellent PT/OT/SLP care, please consider hippotherapy. At Front Range Hippotherapy, we provide the perfect blend of horse/human interaction, age appropriate activities, and superior rehabilitation to meet all kinds of goals.

Amy

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