Just what is the vestibular system?
The human vestibular system is the underpinning of the central nervous system (brain and spinal cord). Our eyes and inner ear semicircular canals and otolith organs represent the receptors of this system. This system functions as an integration of other (touch, etc) systems and consists of numerous pathways that extend through the brainstem located above the spinal column in the lower rear portion of our brain.
In a typically developing central nervous system, the vestibular system assists us to maintain appropriate levels of arousal and attention, conduct us as we move through space, and facilitate static or dynamic balance and numerous other automatic functions. “Feeding” this system helps to smooth neurologic pathways enhancing brain development. As we like to say, “Movement and touch is the basis for neural development” hence the maternal instinct to rock and swaddle our babies. Rocking stimulates the vestibular system and innovative baby swings deliver multiple planes of movement stimulating each semicircular canal. Swaddling is a deep touch experience and modulates and calms and the central nervous system. In therapy, we use weighted blankets and deep pressure to achieve a similar outcome.
All said, the vestibular system is imperative to the emergent brain. For many years, both PTs and OTs have understood that children provided with sensory motor breaks during the school day (recess) will function, attend and learn more effectively in the classroom. Recent studies employing 4 short recesses per day have yielded improvements in classroom focus and attention and test scores. Educators are quick to call this “new” idea brain-based learning but these principles have been the basis of OT, and PT of late, since the 1960’s thanks to the theory of Sensory Integration developed by A. Jean Ayres, PhD, OTR. Dr. Ayres, a woman ahead of her time and pre-dating brain imaging, is the principle behind Sensory Integration (now called Sensory Processing) Theory and Application. With onset of imaging technology, we are now able to visualize literal evidence of brain change.
So what does this all mean and how does equine-based work impact this process? Therapists who are educated and properly trained in this theory and application can determine the relative responsiveness of vestibular and proprioceptive (deep touch) systems. Some children are over responsive to movement and touch and some are under responsive. In both scenarios, the child can present as either over or under aroused by sensory information in the environment. A child who is sensitive to movement, touch, sound or lights may be more apt to “melt down” when overstimulated. A child with a low arousal state may constantly want to sit negating his ability to interact in the environment. In either situation, the brain is not properly organized to learn new information. In our jobs as therapists, we assess the response to input during activity and grade the input during meaningful activity in an attempt to elicit that “just right” response. E.g. eye contact, following directions, communication, etc. So…therapists who are properly trained in Sensory Integration and the science behind use of the horse in PT, OT, ST (hippotherapy) have an extraordinary chance to impact neural development. Using hippotherapy, therapists use the horse as a dynamic moving treatment surface. The horse provides us with multiple movement prospects and we can grade this input by changing the child’s position on the horse, the horse’s gait, the gait transitions (from walk to trot to walk, etc. ), the ring figures (circle, figure of 8 etc.). In addition, as our auditory and language pathways lie so close to the vestibular receptors and pathways when we add auditory input (metronome or music) we amplify the experience. In therapy, use of the horse is THE PERFECT tool. Lastly, as the human to animal bond positively impacts process and connection, we are providing our children with a superior method to aid brain growth and development.
People with low muscle tone have difficulty understanding body movement due to trouble with perceiving input through their muscles, joints and tendons. This delay can disrupt the natural rhythms associated with gait, talking, breathing and eating. In addition, to changes in rhythms, they typically have low levels of arousal. Optimal arousal levels contribute to our ability to stay focus and attend to the task at hand; requisite skills for classroom performance and learning new information. Children with low muscle tone need more energy to work against gravitational forces. Fatigue and low endurance are characteristic issues for people with low muscle tone. Equine movement can help provide input that feeds muscle, joints and tendon receptors, strengthen anti-gravity muscles and provide the rider with a more “typical” movement pattern and rhythm. Adding, music with a vigorous beat that matches the horse’s rhythm increases the child’s arousal level and maximizes outcomes. Auditory pathways are next to our balance sensing pathways so music added to an equine activity or therapy stimulates the balance sensing system.
In contrast, people high levels of arousal (people with Post Traumatic Stress Disorder, Attention Deficit Hyperactivity Disorder, and Autism) have hyper states of arousal due chemical in the brain and subsequent disruptions in typical neural pathways. People with hyper arousal, also have difficulty with focus and attention and can be easily over stimulated by sights, sounds, movement, touch, smells and taste. An equine with slower rhythms will serve to provide more “typical” rhythms and help to calm and slow down the brain. Classical and calming music added to a riding session will help to provide, again, a more “typical” rhythm and stimulate the balance sensing system without over arousal.
Biological rhythms are a foundation of life. Whether it is our heart beat, breathing, walking or speaking, cadence in our world is based on rhythms. Our equine partners are no exception. Therapy horse essentials include a consistent gait rhythm, movement symmetry, and suppleness within gait transitions. Maintaining a consistent rhythm means that the horse’s inherent rhythm does not change through the walk, trot, and canter; and that the rhythm is maintained through a variety of movement figures such as circle, figure of eight, and serpentine. Suppleness is the horse’s ability to smoothly transition from one gait to another. Truth is, if properly matched up, equine and human rhythms are closely approximated. Horse and rider breathing and walking rhythms closely resemble those of their human- sized counterpart: the rhythms of ponies are comparable to small children with their intrinsic quicker breathing and gait rhythms.
In contrast, entrainment refers to the period of time for the horse and rider to match up movement and rhythms. These first few minutes are critical, as one assesses the other and become integrated. This period of time is quite disorganizing to the human brain, so it important to allow the rider this time to kinesthetically understand and process the equine’s movement and rhythm.
Trauma, illness, and developmental issues disrupt and negatively impact inherent bodily rhythms. As examples, cardio pulmonary disease can change the rate and efficiency of breathing, and oxygenation directly impacts a person’s talking, walking, and eating rhythms; this also decreases tissue health. As I like to say, “oxygenation is everything.” Equine-based activities or therapies can assist with facilitating some of those biological rhythms by providing gentle and graded cardio pulmonary activity.
The true “science” of equine therapies and activities is having an appreciative understanding of individual human and equine systems and their ability to “join up.” This knowledge includes a keen sense of biomechanical, neurological, and temperamental issues of both the horse and rider. Appropriately “matching” horse and rider maximizes safety and rider outcomes.
Next time, we’ll complete the picture with information on arousal.
The American Hippotherapy Association (AHA) [i] provides education for therapists interested in developing skills using hippotherapy in their treatment. This coursework provides a foundation for board certification through the American Hippotherapy Certification Board (AHCB). At present, there are two levels of board certification. Entry level AHCB certification is available for therapists as well as Certified Occupational and Physical Therapy Assistants and once they have passed the test, therapists are able to use “AHCB Certified Therapist” after their name. The second, and highest level of credentialing, requires years of experience using hippotherapy as a treatment strategy and completion of AHA coursework, while not required, is highly recommended in order to pass the test. After the advanced test, therapists are allowed to use the initials HPCS (Hippotherapy Clinical Specialist) after their name. In Maine there are two HPCS (one PT and one OT). Both are employed at Carlisle Academy Integrative Equine Therapy & Sports and they represent approximately 80 therapists world-wide. Consumers are able to view the names and contact information of credentialed therapists by going to the American Hippotherapy Association; click on “Find a Therapist” to determine credentialed therapists in their area.
In addition to therapist credentialing, therapeutic riding programs have the option to accredit their facility and hippotherapy program through the Professional Association of Therapeutic Horsemanship, Intl. (PATH, Intl.) Therapeutic riding center and specialty program accreditation is currently voluntary and this accreditation, like the accreditation process used in hospitals, schools and colleges, is designed for consumer protection and address issues such as risk management, equine care, facilities and staff credentialing. PATH, Intl Premier Accredited Centers represent the vast minority of therapeutic riding centers around the country and there are three Premier Accredited Centers in Maine.[ii] The majority of therapeutic riding centers in the US are “member” centers merely requiring the center to pay a membership fee.
Lastly, inside and outside of our industry, there is some confusion when describing programs. The terms “therapeutic riding” or “equine therapy” and “hippotherapy” are sometimes used interchangeably. Adaptive or therapeutic riding is an adaptive and recreational service provided by certified therapeutic riding/driving instructors. This service is NOT medically necessary and is not provided by certified and licensed health care professionals. Hippotherapy and Equine Facilitated Psychotherapy may be medically necessary and are administered by certified and licensed health care professionals operating under the medical model and prescribed by a physician. There is no such thing as “equine or horse therapy” or a “hippotherapist”. A study recently published in Hippotherapy documented the rate of patient incident to therapist credentialing (decreased level of incidents to increased level of credentialing). Given the potentially dangerous nature of combining human treatment with flight animals, proper training, credentialing and accreditation serves to prevent consumer injury due to inexperience, lack of training or negligence.
For questions or for more information feel free to contact: Susan E. Grant, OTR/L, HPCS Director of Therapy and Adaptive Programs at Carlisle Academy. firstname.lastname@example.org or 207-985-0374
A good horse is the foundation for any adaptive riding program, and a solid equine partner is fundamental to delivering quality services. The devil is in the details and the definition of “good” may mean different things to different people. Sarah Armentrout, Carlisle Academy Head of School, reports that she receives calls several times a month from people trying to place their horse. Frequently, the owners report that their horse is elderly and has special care needs. Aging horses, like aging humans, do require special care and attention. Further, many have cognitive and physical rigidity as they age and may find it extremely difficult going from semi or full retirement to employment as a therapy horse. Imagine asking your retired, elderly parents to start working again to help pay the bills? Yowzaa!
Our “ideal” therapy horse looks like this:
Size, Age & Conformation
- 15-15.2 (and often taller, so they can carry adults)
- 12-15 years old with solid dressage training to at least Training Level and ideally 2nd-4th level (dressage is a great foundation for therapy work)
- Strong back (to help carry unbalanced riders)
- Supple, straight and consistent rhythm in all gaits
- Forward mover with a strong push from hind end
- Sound and close-to-correct conformation; hooves proportionate to body size
- Great temperament; loves people and other horses
- Curious and interested in new things but does not default to “flight” mode
- Solid work ethic, honest and reliable
- Good attention and willingness to follow a human leader
- Friendly face with wide eyes and good sized nostrils
- Can be lunged, ground driven, long lined and round penned
- Trailers, clips, ties, bathes
- Has competed in horse shows
- Able to do more than one discipline (driving, hippotherapy)
- Ability to learn new “occupations” (ground driving, long lining, trail riding, etc.)
- Pain-free (recent research has shown that horses with chronic pain are the first to “flunk out” of therapy programs)
- No serious underlying medical conditions
- No vices (stall weaving, cribbing, wind-sucking…)
- Owner willing to provide 30-60 day trial period with take back agreement if horse is not appropriate
- Trial and free lease option; many programs cannot afford to purchase therapy horses but can provide excellent care and meaningful work for a horse
We take our time to assess our horses using classic conformation tools: measure hip, knee and ankle angles; evaluate soft tissue pain and joint movement; evaluate horse gaits and gait transitions; and evaluate their responses to novel objects and general observations of behaviors and vices. Lastly we evaluate the influence that the horse’s movement has to the rider. All of this information is tracked and documented by our professional handling staff and summarized before final recommendations are given to Sarah. Recommendations also include ideas on training and conditioning, nutritional and supplement needs as well as dental, chiropractic, massage, farrier, etc. At Carlisle Academy, all of our horses are assessed for physical, cognitive and emotional soundness every day. All equipment is uniquely fitted to each horse, horses are stretched after working each day and workloads carefully monitored to prevent overwork. Horse vacations are a must! Our horses have one week off during each of our 5 annual sessions, and are on a light schedule or full break from the middle of December to the middle of February.
Over time, many adaptive riding programs develop specialty programs that may require unique equine skills and abilities. For example, PATH, Intl accreditation standards require that programs accept only driving horses with several years of competitive driving experience. Vaulting horses must maintain a nice forward gait and frame on the lunge and tolerate a number of students on/off their backs, while hippotherapy horses have to know how to ground drive and push from behind during the walk or trot.
Next time: How equine movement influences the rider with a disability!