August 4, 2016

Hippotherapy for the Aging Adult

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by Roy Lee Aldridge, Jr., PT, EdD
Hippotherapy is the use of natural movements of a horse for a treatment tool in individuals with disabilities utilized by occupational therapists, physical therapists, and speech therapists. The word hippos is derived from the Greek word meaning “horse”; giving therapy on a horse the name, Hippotherapy. The history of Hippotherapy dates back to before the 1900’s. In ancient Greece there was a chapter written on ‘Natural Exercise’ and it mentions riding a horse. In the late 1960’s therapeutic riding centers had developed throughout Europe, Canada, and the USA.1

Hippotherapy has many indications for use in children, adults, and older adults. These indications include: abnormal muscle tone, impaired balance, abnormal reflexes, impaired coordination, impaired communication, poor oral motor functioning, impaired sensorimotor function, postural asymmetry, poor postural control, impaired mobility, and delayed speech and language.1 It has been hypothesized that Hippotherapy can enhance the balance and functions of older adults and, therefore, prevent falls. All of the impairments listed manifest in some or all of the following medical conditions: autism, chromosomal abnormalities or deletions, cerebral palsy, cerebral vascular accident or stroke, developmental delay, functional spine curvature (scoliosis, kyphosis, and lordosis), multiple sclerosis/neuromuscular dysfunction, sensory integrative dysfunction, and brain injury.1

Horses and humans have very similar pelvic movements during gait. Aging adults having poorer balance ability than younger adults and have a higher risk of falls. During gait of older adults, temporary instability can occur when the body is supported by one foot and balance recovery occurs on the stepping foot to restore the center of gravity to within the base of support. During a walking gait of a horse there is a 4 beat rhythm that is symmetrical. Horses have a vertical and lateral pelvic shift, and pelvic rotation just like humans do. Lateral pelvic shifts in the horse are about 6 to 7 degrees whereas in the human it is about 1 to 2 degrees. There are no data found on vertical pelvic shifts in the horse but the human has 2 inches of vertical pelvic shift. Pelvic rotation in the horse is 7 to 9 degrees and in the human it is normally 4 degrees forward and 4 degrees backwards for a total of 8 degrees.1, 2 When mounted on a horse during gait, a human being is close to a normal gait pattern due to the movements the horse manifests during its gait.

These movements are what make up the use of Hippotherapy for therapists. During certain gait cycles, cadences, and directions that the horse is in determines the outcome of motions in the human while riding. A forward swing of the horse’s hind leg promotes rotation of the horse’s pelvis and therefore causing a lateral pelvic tilt in the rider. A lateral pelvic tilt in the rider further causes elongation of that side and shortening of the opposite side. A lateral flexion of the horse’s barrel (midsection) during forward swing and reach of the hind leg promotes pelvic rotation in the rider. To accomplish a posterior pelvic tilt in the rider the horse accelerates movement of the hind leg during swing phase. To promote an anterior pelvic tilt; the horse does the opposite. The center of gravity with each step the horse takes is shifted side to side to promote a lateral shift of the rider’s pelvis.1

The benefits of all of these components together include improved balance by making the rider constantly maintain balance on the horse due to movement. Coordination, reflexes, and motor planning are improved through repetition of patterned movements required in controlling a horse; this quickens the reflexes and aids in motor planning. In the aging adult, increases in step length and step speed increase the ability to cope with the risk of falls when balance has been lost. In some studies, step length has increased significantly and step time decreased indicating a decrease in fall risk with Hippotherapy. Grooming can help with decreased range of motion in the upper extremities. Decreased spasticity accomplished by lowering the amount of abnormal movement patterns can also improve range of motion. Sensory integration plays a major role with Hippotherapy. Through changes in the horse’s speed/direction, barn smells, controls of the horse, sounds, and receptors in human muscles, tendons, ligaments, and joints the following are stimulated: tactile, vestibular, olfactory, vision, auditory, and proprioceptive.3 Other benefits found in the older adult include lessening of depression, fears, and anxiety while gaining self-confidence, as well as improving non-verbal communication.

References:
1. American Hippotherapy Association. Treatment principles level 1: workshop manual 1st ed. 2006:2-18.
2. Magee DJ. Assessment of gait. Orthopedic physical assessment 5th ed. Saunders Elsevier. 2008:940-971.
3. Riding for the Disabled Association (Malaysia). 2001-2008. Available at: http://www.rda-malaysia.org/physical.html. Accessed March 12, 2009.