The Clinical Practice of Equine-Assisted Therapy

Including Horses in Human Healthcare

Leif Hallberg

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781134793198
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

The Clinical Practice of Equine-Assisted Therapy bridges theory, research, and practical methods to fill a rapidly developing gap for physical, occupational, speech, and mental health professionals interested in incorporating horses in therapy. Extensively researched and citing over 300 peer-reviewed journal articles, it examines core issues such as terminology, scope of practice, competency recommendations, horse care ethics, and clinical practice considerations. This book is an essential resource for professionals who wish to use a best-practices approach to equine-assisted therapy.

1
Foundations of Equine-Assisted Therapy

⃞ The History of Including Horses in Human Healthcare

Myth, magic, mystery, and metaphor have surrounded the topic of horses and human healthcare for centuries. Sources suggest horses were viewed as healing or therapeutic for humans since the time of the early Greeks (DePauw, 1986; Brudvig, 1988; Meregillano, 2004; Snider, et al., 2007; Bachi, et al., 2011; Burgon, 2011; Lanning & Krenek, 2013).

Legend tells us of the centaur Chiron, half-man, half-horse, who was shot while instructing a young man in the art of hunting and nearly died. He cured himself of the grievous wound, and through that experience discovered the healing arts. He went on to care for others, and is known in Greek mythology as the creator of medicine and surgery (Howey, 1923). Chiron’s story is representative of our modern-day “wounded healer” archetype.

Horses are thought to have been domesticated around 4000 BC, on the Eurasian steppes of the Ukraine (McGreevy, 2012), and very early in history were viewed both as the terrifying tools of destruction, warfare and death, and as messengers of the Divine, capable of bringing humans into contact with the ethereal realms of the spirit world. The Hindus and the Celts believed horses traversed the space between heaven and earth, carrying their riders on the journey between life and death (McCormick & McCormick, 1997; Howey, 1923; Kohanov, 2007; Hallberg, 2008). Biblical stories of Zechariah tell of God using horses and the men who rode them to spread His message, in one instance stating “These are the four spirits of heaven, going out from standing in the presence of the Lord of the whole world” (Zechariah 6:5, New American Standard Bible). The role of horse as messenger between humans and the spirit world continues today, as many find peace and solace in their powerful presence, and use the quiet time spent with horses to pray or mediate, seeking answers to life’s challenges (Dell, et al., 2011; Wach, 2014).

Hippocrates believed horseback riding was a universal language with a healing rhythm, and physicians prescribed riding to address mental, physical, and emotional issues (Granados & Agís, 2011). Medical literature from the 15th–18th centuries gives accounts of physicians from France, Italy, and Germany documenting both the psychological and physiological benefits of riding horses (Tissot, 1964; Bain, 1965; DePauw, 1986; Willis, 1997; All, et al., 1999; Snider, et al., 2007; Berryman, 2010; Berg & Causey, 2014).

In 1870, Chassignac published the first reported study on the effects of horseback riding for human health (DePauw, 1986; Bertoti, 1988; Lanning & Krenek, 2013). In the same year a Scottish physician suggested, “Riding a spirited horse should be recognized as a treatment for depression” (Kendall, et al., 2014: 82). Eight years later, Ghislani Durant published a book on the benefits of horseback riding from a medical perspective (Berg & Causey, 2014).

During the First World War, it is reported that returning British soldiers were paired with cavalry horses for rehabilitation purposes (Brudvig, 1988; Berg & Causey, 2014; Kendall, et al., 2014). There is also an account of a Miss Olive Sands, a physiotherapist, who brought her own horses to the Oxford Hospital and provided riding for the returning soldiers (CARD, 2016).

In 1943, Lis Hartel of Denmark contracted polio and became wheel-chair bound. A competitive dressage rider before her illness, Lis rehabilitated herself through riding to not only become the first woman to ride for an Olympic equestrian team and medal, but the first person with a major physical disability to accomplish such a feat. Lis Hartel was paralyzed from the knees down, but according to reports, few people were aware of her disability as she rode to victory, claiming second place at the 1947 Scandinavian Riding Championships (Jackson, 2014). Lis went on to represent Denmark in the 1952 Helsinki Olympics, winning the silver medal. Lis lived out the rest of her life without the use of her legs, but her tenacity and courage sparked new interest in the potential of riding for rehabilitative purposes (DePauw, 1986; Ungermann & Gras, 2011; Gabriels, et al., 2012; Berg & Causey, 2014; Wanneberg, 2014).

Sources suggest that although Lis is most commonly credited with the modern advent of rehabilitative riding, it was in fact a Norwegian physical therapist, Eilset Bodther, who first organized riding as an activity for children with disabilities (Bain, 1965; DePauw, 1986; Bertoti, 1988). Shortly thereafter, Lis and Ulla Harpoth, a physical therapist from Copenhagen, went on to form the first riding center for people with disabilities in Europe (Steiger & Steigner, 2004; Jackson, 2014).

Following in the footsteps of Bodther, Hartel, and Harpoth, other rehabilitative riding programs and organizations formed throughout the United Kingdom, Scandinavia, the Netherlands, and Belgium during the 1950s and 1960s (DePauw, 1986; Granados & Agís, 2011).

In 1969, the concept that horses could be helpful for humans migrated from Europe to North America. Dr. Reginald Renaud and Mr. Joseph Bauer founded the Community Association for Riders with Disabilities (CARD) in Canada, and the North American Riding for the Handicapped Association (NARHA) was established in the United States (DePauw, 1986; Bond, 2007; Granados & Agís, 2011; CARD, 2016; PATH Intl., 2016b).

Since that time the number of therapy practices that include horses in human healthcare has grown by the thousands, with representation from over 50 countries around the world (DePauw, 1986; All, et al., 1999; PATH Intl., 2016a; HETI, 2016; EAGALA, 2016).

⃞ Why Horses?

Although history clearly demonstrates the propensity for humans to be drawn to horses, believing in their healing qualities, surprisingly little is known from a research perspective about the role of the horse as a determining factor in human change (Bachi, 2012; Kern-Godal, et al., 2015).

This may be due in part to what researchers call a “novelty effect,” which means it is hard to separate the individual factors that contribute to human change when providing therapy in a unique setting (such as a farm) with so many stimuli (Macauley & Gutierrez, 2004; Holmes, et al., 2012; Anestis, et al., 2014; Borgi, et al., 2016).

The following section organizes existing theories and corresponding research into categories that begin to address the question of “why horses?”

The Movement of the Horse

The movement of the horse is probably the most well documented of all possible theories answering the question “why horses?” (Bertoti, 1988; Debuse, et al., 2009; Honkavaara & Rintala, 2010; Kang, et al., 2012; Baik, et al., 2014; Krejčí, et al., 2015; Garner & Rigby, 2015). Specific research has been conducted to better understand the movement of the horse, its similarity to the human gait, and the possible benefits to the human body (Janura, et al., 2009; Uchiyama, et al., 2011; Garner & Rigby, 2015). Commonly, it is physical, occupational, and speech therapists who incorporate equine movement during therapy sessions.

Uchiyama, et al. (2011) demonstrated that riding a horse at the walk closely mirrors the human gait. Even though they found the acceleration of human walking was not completely consistent with that of a horse, they felt the benefits to the human were significant, stating:

Our results indicate that horse riding at a walking gait provides the stimulation of a walking exercise more easily and effectively than does human walking. Thus, horse riding is even more efficient in providing motor and sensory inputs in the treatment of individuals with physical disabilities, as well as in achieving cardiorespiratory fitness and weight control.

(p. 276)

Honkavaara & Rintala (2010) state:

In hippotherapy the horse’s walking (gait) is the basic component used to produce neurophysiologic therapeutic effects on the rider. The client has to adapt him- or herself to the altering physical forces. Horse’s swinging movements are producing three-dimensional dynamic and rhythmic impulses that are transmitted to the rider. These impulses are exposing the rider to forward and backward movements, shifts sideways, and rotations.

(p. 30)

Other researchers suggest that riding provides sensory input and stimulates both hemispheres of the human cerebrum as well as the vestibular system (Granados & Agís, 2011; Hession, et al., 2014).

Horseback riding simulators have been used because of cost and space efficiency to treat similar conditions as those addressed in hippotherapy (Sung, et al., 2013; Kim, et al., 2013; Park, et al., 2014; Lee, et al., 2014; Temcharoensuk, et al., 2015). Interestingly, Temcharoensuk, et al. (2015) found that the movement of a living horse could not be exactly replicated by the simulator, and that riding a living horse was more effective than riding the simulator for the populations they examined. They report: “The variety in horse direction and movement are believed to induce more signals from proprioceptive and vestibular receptors through various postural challenges” (p. 276). This research suggests the movement of the horse is unique, and its impact on the human body difficult to replicate in other known settings (Giagazoglou, et al., 2013; Temcharoensuk, et al., 2015).

It is important to note that these results are achieved when a trained physical, occupational, or speech therapist is providing the service who can manipulate the person’s body position, the gait of the horse, and even the selection of specific types of horses to obtain greater therapeutic benefit (Snider, et al., 2007). Along with a knowledgeable therapist who understands the biomechanics of the horse’s movement, the condition and training of the horse plays a vital role in outcome of treatment including horses. Ajzenman (2012), states, “Effective therapy occurs when a horse achieves appropriate balance. Using horses with quality training is important in order for the therapist and handler to influence the horse’s movement” (p. 2). She goes on to report:

Movement quality is influenced through the horse actively seeking the horse handler’s hands (reins, long lines). The handler promotes a flexible neck and jaw by sending the horse forward into the contact with active engagement of the hindquarters and swinging of the back.

(p. 2)

This level of training and conditioning allows horses to have the flexibility, adjustability, and focus necessary to be effective partners in helping patients to achieve their health goals.

Equine Movement and Sexual Assault Survivors

Although no empirical research exists, anecdotal reports of practitioners suggest the movement of the horse may also trigger memories and emotions, especially related to sexual assault or trauma (Kohanov, 2001; Hall-berg, 2008; Brandt, 2013). A number of research articles suggest mounted work should be considered in the treatment of trauma and sexual abuse (Porter-Wenzlaff, 2007; Meinersmann, et al., 2008; Yorke, et al., 2008; Guerino, et al., 2015). These studies make note of the physicality of riding, but do not mention the possible effects related to memory recall that such close contact with a horse might have on participants who have been sexually assaulted. For example, Yorke, et al. (2008) state, “Few other companion animals can be ridden, offering the opportunity for such close and broad body-to-body contact” (p. 19).

Guerino, et al. (2015) published a study about the effects of hippother...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Acknowledgements
• About the Author
• Acronyms
• Foreword
• Preface
• Introduction
• 1 Foundations of Equine-Assisted Therapy
• 2 Understanding Equine-Assisted Therapy
• 3 Professional Competencies in Equine-Assisted Therapy
• 4 Populations Served by Equine-Assisted Therapy
• 5 The Clinical Practice of Equine-Assisted Therapy
• 6 The Business of Providing Equine-Assisted Therapy Services
• 7 The Ethics of Appropriating Horses for Human Wellbeing
• 8 A Vision for the Future
• Index