Tuesday, December 30, 2008

Hippotherapy Candy Cane

I rescued this plastic candy cane from the trash barrel at work. It was filled with a food treat for horses. After cleaning and scaping off the label it is perfect for an eye-hand coordination activity. It is used like a ring stack, except children need to do a little bit more motor planning to fit the ring over the curve of the cane. I can either hold the bottom so that the rings don't fall off or attach some type of barrier at the bottom with tape. This candy cane is thick enough to hold a vibrating squiggle wiggle pen (throw away the pen points) so that the activity becomes even more fun. Children are rewarded with holding the cane at the end of the activity.
This is a great activity to use during hippotherapy because children can reach for the rings or reach for the cane while placing them. Work while static or while horse is moving depending on the child's abilities. I like to have the horse walk as the child reaches for the rings and then stop when placing them. The halt/go cycle often increases body awareness and focus and of course, it is much easier to place the rings while the horse stops.

Squiggle Wiggle Writer by Hart Toys, Colors may vary

Barbara Smith, M.S., OTR/L, author of The Recycling Occupational Therapist

Sunday, December 21, 2008

Can you recommend any other hippotherapy blogs?

Hey, I would love to read about other therapists and what works and doesn't work. Can anyone recommend a similar blog about hippotherapy?

Barbara Smith, M.S., OTR/L author of, The Recycling Occupational Therapist

Adapting Scratch Ball for Hippotherapy

The common scratch ball toy is easy to adapt for children who have a weak grasp and/or cognitive delays. I put the ball inside the mesh bag and tied it to the mitt. I ask clients to pull it off while riding. This is a great way to promote reaching and balance as well as hand skills. Best of all once the ball falls, it doesn't go far and its easy to set the activity up again.

Barbara Smith, M.S., OTR/L author of, The Recycling Occupational Therapist


Friday, December 19, 2008

Reaching with the Sword

I bought this foam sword at the dollar store and use it in many different ways. This boy is demonstrating great bilateral hand skills as he balances on the walking horse. Some children go into a 2 point stand to reach for the plastic pieces or while placing them on the sword. Other children hold the sword to insert it into the plastic shapes that I hold in different positions. Because the sword is a lot of fun children visually focus and are motivated to say or sign "more" or "more toys".

Barbara Smith, M.S., OTR/L author of, The Recycling Occupational Therapist

Wednesday, December 17, 2008

A Squeaky Ball to Motivate

Its amazing that something as simple as a ball that squeaks can make such a difference. A 9 year old client I have been working with for 2 years was so excited by this ball and sound it made that she stood up into two point stand (with feet in stirrups) and put her palms on the horse's withers as she attempted to reach for the ball. She reached with one hand and then needed a small amount of trunk support to lift her left hand and reach bilaterally. Children seem to be hard wired to love balls!

I had previously used many different balls with varying sizes and textures, also a small cloth bag filled with foam and bells as well as many other auditory toys to encourage her to stand up and reach. This pet ball has a very loud and easy to produce squeak that seemed to do the trick. Furthermore, the horse didn't seem to notice it.
Barbara Smith, M.S., OTR/L author of, The Recycling Occupational Therapist

Friday, December 12, 2008

Decreasing Muscle Tone

Positioning and horse movement are used to decrease muscle tone. The horse should move in a smooth, rhythmic gait. Bearing weight in forward, backward or side sitting positions can decrease muscle tone. This child is bearing weight on her left hand and also grasping the handle with her right to provide additional stability. The knee flexion breaks up the extensor tone. Childen with high tone may first be more comfortable in a modified side sitting position. This involves a position facing forward with one leg flexed and the other leg extended, hanging along the side. Other positions that relax spastic muslces include include the Sack of Potatoes(hanging prone over horse's barrel) and Cossack hang (hanging supine over horse's barrel). Trained therapists need to especially consider breathing, feeding tubes, blood pressure and gravitational insecurity in these positions.

Barbara Smith, M.S., OTR/L author of, The Recycling Occupational Therapist

Tuesday, December 9, 2008

Hippotherapy Success Using Virbrating pIllow

I found many useful ways to use this vibrating pillow during a hippotherapy session this week. A two year old girl I will call Daisy has refused (for over a year) to lie supine on the horse. She is gravitationally insecure, meaning that she is abnormally anxious or fearful when experiencing certain head positions or movement.

Daisy happens to love the feeling of this pillow and was willing to lie supine in order to feel it. I turned the pillow off and told her to sit up and then turned it back on when she lay down again. Daisy performed 5 sit-ups in this fashion, all while the horse was walking. She was also stimulated to used the words "on" and "off".

Other children have been motivated to bear weight on the pillow while sitting backwards. I also place it on the mane so that childre can position their hands on it during half seat position. Using a pillow or another visual guide to show where to place the hands during half seat appears to be helpful.

Barbara Smith, M.S., OTR/L author of, The Recycling Occupational Therapist


Monday, December 8, 2008

Child with Cerebral Palsy Slide Show

Check out this slide show of a child with cerebral palsy. I love the closing photo of his face glowing with happiness and the trunk rotation positions are fantastic.


Tuesday, December 2, 2008

Choosing a Therapy Horse

Horses used for hippotherapy are very special. They obviously need to have good temperaments and tolerate riders who make sounds, touch them and move awkwardly. The horse must be able to tolerate a busy environment filled with toys and other riders.

A good therapy horse has a rhythmic gait (regular footfalls) and is supple (bends and shifts balance smoothly). His body is symmetric and aligned straight.

A therapy horse must be able to follow the leader's directions to make transitions and change directions, tempo and speed.

Barbara Smith, M.S., OTR/L author of, The Recycling Occupational Therapist


Tuesday, November 18, 2008

How the Horse Moves the Rider

This video shows the similarity in horse and human gait! The rotation of the horses pelvis causes the rider's to move laterally-side to side. The lateral flexion of the horse's barrel resulting from the forward swing and reach of the hind leg causes pelvic rotation in the rider. The acceleration of the horse's movement during swing phase of the hind leg and deceleration of the horse's movement at strike and stance of the hind leg cause poster/anterior tilting of the rider's pelvis.

Barbara Smith, M.S., OTR/L author of, The Recycling Occupational Therapist


Sunday, November 16, 2008

Hippotherapy Precautions and Contraindications

Children should first receive clearance from a physician to be sure that there aren't health reasons that preclude hippotherapy. Contraindications may include: seizure disorders, poor head control, allergies, pain, instability of the spine (spinal fusions), skin compromise, osteoporosis, hip subluxation/dislocation. Patients with hydrocephalous may have difficutly fitting a helmet properly. Thereare other risk factors that should be cleared with the physician such as cardiac and respiratory compromise and axial instability in children with Down's Syndrome.

Another consideration is whether or not to avoid the more intense stimuation provided by trotting. This may be contraindicated in children who have spina bifida, risk of detached retina and Down's syndrome (possible axial instabiity).

Barbara Smith, M.S., OTR/L author of, The Recycling Occupational Therapist

Hippotherapy Mounting and Dismounting

An Occupational therapist shows how to mount and dismount. At the end of sessions, I tell children to hug the pony (around the withers) and bring the leg behind as shown in the video. This provides lots of deep tactile (touch) stimulation as the child slides off the side of the horse.

Barbara Smith, M.S., OTR/L author of, The Recycling Occupational Therapist

Saturday, October 25, 2008

Hippotherapy and Visual Perceptual Skills

Between 2 and 3 years of age children learn many matching skills such as identifying and matching pictures and fitting simple non-interlocking puzzle pieces into a board. These skills can be reinforced during the hippotherapy session. It is easiest for children to work on puzzles while facing backwards on the horse using the wide surface of the horse's croup. The animal puzzle shown here is placed inside a box with the puzzle pieces attached to the box lid with velcro. This makes the task easier for child and therapist to manage. Children can work on balance while naming animals and making their sounds.

The opportunity to choose which animal picture to look for is fun and promotes communication skills. I use a small photo album filled with animal pictures that match larger pictures attached to the walls in the arena.

This puzzle has the picture of each animal inside the puzzle board so that the child knows exactly what the piece looks like. Therapists can attach the puzzle pieces to walls in the arena so that children can look for them while riding. Children are encouraged to pull the reins and say "whoa" when their horses approach the needed piece. This activity develops scanning skills.

This photo album requires the child to match below the same picture. It is a relatively easy task since there will be only two choices. Children work on balance while reaching for the cards or they can work on bilateral hand skills by taking the pictures out of a small bag that they hold.

As children develop matching skills offer boards with a greater number of pictures to increase the challenge.

Barbara Smith, M.S., OTR/L author of, The Recycling Occupational Therapist