HIPPOTHERAPY and sensory processing EN

1. Specialised VET training on Hippotherapy for professionals working with
children with intellectual, emotional, physical and psychomotor disabilities
2019-1-TR01-KA202-074547

2.  "Hippo" is a Greek word for horse.
 According to the American Hippotherapy
Association, hippotherapy is an equestrian
therapy in which the movements of the horse are
directed by experts to stimulate the sensory,
neurological and movement systems of the person
to create changes in the person's functions.

3.  Hippotherapy is applied together with the rehabilitation team and horse trainer.
 Occupational therapists or physiotherapists know that the movements of the horse are
a treatment tool while practicing hippotherapy, and they use the appropriate method
in this direction.
 In addition, it is aimed to develop the child's functions by organizing a work plan
according to the child's needs.

4.  The horse's movement is rhythmic, smooth,
precise and in definite patterns, which is the
basis of hippotherapy.
 The person on the horse is in the role of
participants who respond to the movements
that the horse changes during the therapy, and
the movements of the horse are symmetrical
and bilateral.

5. • Horse movement offers vestibular, proprioceptive, tactile and visually well modulated
sensory input.
• At the same time, equine movement can be used to facilitate the neurophysical systems
that support our functional daily living skills.
15.2. Hippotherapy and Sensory Integration

6.  In hippotherapy, a session with an occupational therapist, physical therapist, or speech
language therapist continually modifies the movement of the horse to meet the needs of the
individuals for functional goals.
 Active participation in therapy activities has been shown to lead to improvements in adaptation
and increased willingness to participate in daily activities.

7.  Because each stride of the horse is a challenge in
maintaining posture, hippotherapy offers unique
opportunities to improve postural control.
 The horse takes about 100 steps per minute. Thus, in a
45-minute hippotherapy session, the horse takes about
4,500 steps.
 As a result, children must repeatedly respond to
variability in the horse's movement to maintain posture.

8.  The positive physical effects of hippotherapy on
coordination, muscle tone, postural balance,
flexibility, endurance, correction of abnormal
movement patterns, and improvement of gait and
balance have been demonstrated in many studies.
 Also, contact with animals, including horses,
stimulates physiological, psychological and social
responses in children and adolescents.

9.  Horse vitality and body temperature also provide a
sensory input to children participating in therapy.
 Due to the lack of this vitality of horse simulations, its
effect is not like hippotherapy.

10.  Physiotherapist- Occupational therapists; can place a variety of motor tasks on the horse's
movement to promote functional outcomes in skill areas related to gross motor ability such
as sitting, standing, and walking.
 The therapist may gradually combine the effects of equine movement with other standard
intervention strategies to work on fine motor control, sensory integration, nutrition,
attention and daily living skills.

11.  Speech-language therapists can use equine movement to facilitate speech and the
physiological systems that support language.
 When combined with other standard speech-language strategies, the speech-language
therapist can provide effective correction of communication disorders.

12. Additionally, hippotherapy is an excellent activity used to assess and treat sensory
processing skills.
Hippotherapy, which provides sensory input to the vestibular, tactile, visual and
auditory systems, is used for the individual's sensory modulation to reach treatment
goals and to reveal functional activity.

13.  Hippotherapy applications provide sensory feedback using horse movements and thanks
to this feature, these applications are used in different neurological conditions.
 Hippotherapy covers not only the work done on the horse, but also the practices in the
processes such as the environment in which the horse lives, its participation in the care of
the horse, and the feeding of the horse. And these environments contain many visual,
auditory, tactile and physical sensory richness for children.

14.  Physiotherapists use the horse's movement patterns to treat
the patient, while psychologists and mental health
therapists use the horse's mobility to induce or increase
patient compliance.
 The horse's pelvis exhibits a 3-axis movement pattern while
walking, just like the human pelvis. These variable rhythmic
and repetitive movements provide physical and sensory
feedback to the patient.

15.  In a therapy session, sensory
processes can simultaneously
stimulate the vestibular,
proprioceptive, tactile, visual and
auditory systems.

16. Sensory processing disorders are known as neurological-based problems
caused by the inability of the brain to integrate sensory input from sensory
systems and to convert the input into effective responses.
Sensory processing difficulties have also been described as a 'disorder'
and a 'cluster of symptoms associated with other neurodevelopmental
disorders'
Deficiencies in the interpretation of sensory stimuli coming from the body
and the environment cause difficulties in academic or motor learning.

17. When the child walks barefoot on the grass, she reacts as
if she/he were pricked by a needle.
They may be afraid of falling off a low bench because it
feels like they are high.
They may cover their ears or scream at a fire alarm.
Refuses to eat a variety of foods - may find many tastes
and textures repulsive.
May have behaviors such as liking/disturbing too much
swinging on a swing.
May not like to move or change positions.

18. The vestibular system, also called the "sense of balance,"
helps children develop body awareness as they respond
to changes in their center of gravity.
The proprioceptive sense tells us where we are in space.
Impaired sensory processing makes children appear
clumsy because they may lack coordination.
Proprioception stimulation affects sensory receptors in
the muscles and joints when engaging in pushing and
pulling or experiencing deep pressure (i.e. when
wrapping a baby in a blanket or wearing a weighted
vest).

19.  Tactile stimulation affects the sensory receptors in the skin and is
the first sensory system to develop in the womb.
 Early experiences such as hugging develop the tactile system and
future discrimination abilities (identifies objects by touch).
 The tactile sensory system is also a warning system that tells us to
take our finger off the stove.
 But children with DIB can have an overactive protective tactile
system – they find almost anything they touch unpleasant. This
keeps them in a constant state of alertness and anxiety.

20. Sensory integration therapy is based on the theory that
vestibular, proprioceptive, and tactile stimulation support
sensory processing and adaptive responses (such as
coordination).
Hippotherapy provides intense vestibular, proprioceptive
and tactile stimulation as the rider experiences up and down
(vertical), lateral and diagonal movements in response to the
horse's gait.
Also, the whole body experiences deep pressure tactile
stimulation when riding and dismounting.

21.  The type of alert changes when the rider looks sideways or backwards, lies on their
back, or lies face down..
 Even when a horse is standing still, there are subtle movements to which the rider's
inner ears, joints and muscles respond.
 Riding provides a powerful sensory stimulation to the muscles and joints, giving a
tactile experience while hugging and petting the horse, hearing the horse's neighing
and smelling the barn affect other senses.

22. The therapist can control the type and intensity of
sensory input to achieve therapeutic goals by
selecting
Walking in
straight lines or
curves
Flat or sloping
land use
Rider positioning
Alternate
walking/stopping
and varying
speeds

23. Touching the horse's mane or body
Adding different activities while on the move
Singing on horse
Turning in different directions on the horse

24. Proprioceptive and tactile stimulation is provided when the rider wraps their body
around the horse to cuddle or put weight on their hands.
Children with tactile sensitivity are often motivated to overcome their reluctance to touch
and place their hands on the fur or riding pad.
Riding and dismounting provides opportunities for full-body tactile contact while the
rider slides, pushing the horse.

25. • The intensity of proprioceptive input also varies depending on the horse's gait (children on
the autism spectrum often like a jerky gait), speed, and incline.
• For example, looking back while the horse is walking uphill stimulates the shoulder, arm,
and hand muscles because the rider puts weight on the palms that are pressing on the
horse's back.

26. • Children adapt to the oscillations to stay upright on the horse and understand where the
center of gravity is, which in turn activates the vestibular system (balance,movement).

27.  The ups, downs, swings, the force of each step and the
pressure from the saddle ensure that the child receives
different sensory inputs during the hippotherapy
session.
 Having many different tactile inputs in the natural
environment, such as the horse's texture and the skin of
the saddle, is valuable to children's sensory processes.
 In addition, the sounds of the horse in different situations
and the sounds in the environment give children the
opportunity to experience different auditory inputs.

28.  The use of visually exciting, fun-sounding or vibrating materials often encourages
children to participate actively and use their hands. (auditory-visual stimuli).
 Weighted materials such as medicine balls or sandbags promote body awareness
and coordination. (proprioceptive, tactile)

29.  Riding a horse increases body awareness. For example; often asking the child to check if
he is sitting “in the middle” with his feet in the stirrups (warning).
 After children learn how to do this while the horse is still, they are ready to learn these skills
while the horse is walking.

30. • Children work on motor planning as they transition from facing forward to sideways, learning to
let go of the reins (or handle) to swing one leg over the mane by shifting their weight to the
other side.

31.  Touching the horse's ears and tail.
 Touching the left foot with the right hand, touching the right foot with the left hand
 Stretching out arms like an airplane
 Making arm circles
 Reaching out to get a ball into the basket
 Trying to go with your legs wide open
 Standing with arms and legs extended like 'Superman’
 On the horse's muzzle supine, head, arms and legs hanging like a "Sack of Potatoes"

32.  Repetitive exercises provide the rider with an opportunity to practice following
directions, sequencing and counting.
 Taking and maintaining various positions, first at rest and then during walking, also
improves body awareness and motor control.

33. The key to improving dexterity is to provide activities at the "just right"
level that are not challenging enough to invite failure, yet simple enough
not to be boring.
For example, instead of using a regular stack of rings- Ask the children to
place rings on the wand, which makes a sound, has bright lights, and
vibrates at the same time.

34.  Sometimes cloth loops (made of socks stuffed with plastic bags with the ends sewn in)
are provided so children have to use both hands to open them and place them on the
pole.
 These cloth rings provide a completely different tactile experience. Sometimes cloths
are attached to the child's arms or legs to remove them before placing them on the
posts. While this game teaches the motor skills needed to undress, it also provides
tactile stimulation.

35.  Unbuckle buttons or laces
 Balancing with one hand while moving with the other
 Scanning the arena to find the required puzzle pieces
 Playing catch with a foam-filled pillowcase (easier to control than the ball)
 Improvement of the grapple clutch to pull the locating pins out of the mane
 Placing the ring on the pole encourages motor planning skills and hands-on use.

36.  Children with special needs have difficulties with sensory integration, such as
tolerating sensory stimuli, controlling their movements, and discomfort with
touching certain tissues.
 For example, for a child diagnosed with autism who has sensory pursuits that
constantly jump, swing, push and pull, the horse's movements can be regulating and
give him the input he needs.

37.  As a result of a research conducted in the literature, parents of children with autism who
were included in the hippotherapy program stated that significant improvements were
observed in their children's physical, social and sensory functions.
 In the same study, a positive effect of hippotherapy on problematic behavior was
determined. Horses are seen as the most valuable teammates in the therapy process.
The sincere and natural interaction with the horse is very important in order to ensure
maximum development in the studies.

38.  Attention Deficit and Hyperactivity Disorder:
There are benefits for children with attention
deficit and hyperactivity disorder, such as
focusing attention on horse and trainer,
improving self-confidence and supporting
teamwork.

39.  Autism Spectrum Disorder: Horse riding,
hippotherapy and equine assisted psychotherapy
trainings give good results in this patient group.
Bas, et al. found an increase in Social Responsibility
Scale and Sensory Profile (SP) scores and an
improvement in sensory integrity after horse
training given to children with autism.
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(9), 1261-1267.

40.  Cerebral Palsy: In addition to being an enjoyable
activity for these children, riding gives very good
results in the development of posture, coordination,
balance and motor control.

41.  Ward, S. C.,Whalon, K., Rusnak, K.,Wendell, K., & Paschall, N. (2013).The association between therapeutic horseback riding and the social
communication and sensory reactions of children with autism. Journal of autism and developmental disorders, 43(9), 2190-2198.
 Lindroth, J. L., Sullivan, J. L., & Silkwood-Sherer, D. (2015).Does hippotherapy effect use of sensory information for balance in people with
multiple sclerosis?. Physiotherapy theory and practice, 31(8), 575-581.
 Junior, J. R. B. G.,de Oliveira,A. G. F., Cardoso, S. A., Jacob, K. G., & Magalhães, L.V. B. (2020). Neuromuscular activation analysis of the trunk
muscles during hippotherapy sessions. Journal of Bodywork and Movement therapies, 24(3), 235-241.
 Koca,T.T., & Ataseven, H. (2015).What is hippotherapy? The indications and effectiveness of hippotherapy. Northern clinics of Istanbul, 2(3),
247.
 Martín-Valero, R.,Vega-Ballón, J., & Perez-Cabezas,V. (2018).Benefits of hippotherapy in children with cerebral palsy: A narrative
review. European Journal of Paediatric Neurology, 22(6), 1150-1160.
 Cotton, G. S. (2021).Effect of Hippotherapy on Sensory Integration Among Children With Autism Spectrum Disorder: A Pilot Study. The
American Journal of Occupational Therapy, 75(Supplement_2), 7512515368p1-7512515368p1.
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 https://tr.pinterest.com/herbmaster/hippotherapy/

42.  HIPPOTHERAPY - 2019-1-TR01-KA202-074547
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