Animals and Aquatics

Is hippotherapy sensory integration?

March 28, 2023 gina taylor
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Hi, good morning, good afternoon, or good evening whenever you are listening in. I am glad to connect with you today and have a fun episode on is Hippotherapy Sensory Integration. Two things that I absolutely love to talk about and I think before, maybe I jump right in there. Just wanna touch base on where things are and where we're going with the podcast. This podcast is called Animals and Aquatics, and we've been touching a lot on the animal side of things. And my co-host, Mr. Ryan, also known as my husband, will be jumping in with some episodes on aquatics coming up shortly. We've been having a lot of really good sessions at the pool lately and have been really excited to share some of what we've been seeing, what's been going on, and looking at that aquatic therapy from the occupational therapy lens. So we're excited to be bringing in some of those episodes as we move forward. But also to keep sharing some great interviews. I have some great interviews lined up that I'm excited to get shared and get out to you. And some information like our episode today about hippotherapy and sensory integration. Again, two things that I'm really passionate about and excited to speak about, and I'm in the process with some colleagues of mine of updating. The Sensory Connections course as a member of the American Hippotherapy Association faculty, and as I've been going through some of the material and seeing the updates that need to be done, it made me think of a really good way to share some of this information. and as I was looking around and, and kind of gathering my thoughts together, how often did I see that Hippotherapy provides sensory integration? Hippotherapy is a form of sensory integration, kind of a whole lot of different terminology thrown around on different websites, and it was something that made me really stop and want to address this specific question and how I look at it both from uh, faculty standpoint as well as from a clinical standpoint, and the more I work with OTR and OTA students, the more I think about answering these types of questions and explaining maybe where my thought processes are on this. And I think the best place to start with is what is sensory integration? And there's lots of different ways to look at it. So it's a neurobiological process, it's a theory and it's an intervention. So sensory integration involves perceiving, modulating organizing and interpreting sensations to optimize occupational performance and participation. So we can think about a little bit as like the neurological neurobiological process, then we know that Anna Jean Ayres created the sensory integration theory that was really of her genesis. And neuroscience really remains a cornerstone of that theory. So sensory integration as originated by Jean Ayres is both a theory and a practice. So that's the practice and the intervention part. And it's really targeting a person's ability to process and integrate information from their body and from the environment. And I think in occupational therapy, we're seeing more and more attention on the sensory information from the body in the form of interoception. And I know some of the clients that I work with certainly struggle with the interoception piece, so that's a component of it. The sensory information might be visual, auditory, could be tactile, proprioceptive or vestibular in nature, and here I'm going to refer to Ayres Sensory Integration, the, the trademarked name because that's what I was trained in. So Ayres Sensory Integration uses individually tailored activities that are really looking for that just right challenge. So with our clients, we're looking for both a just right challenge, but then also to see an adaptive response. So that just right challenge is really going to look at how the client is typically processing sensory information, how they are motor planning or the praxis piece, and then we're going to encourage them by setting up the environment, by creating the activities and presenting them to the client. To help them be more organized and to integrate the sensory information into more usable forms. Ayres sensory integration incorporates specialized equipment. So when we think about a sensory gym, we think about our suspended equipment and that is to give the client an opportunity to explore a variety of different movement patterns for it to be client led. So when we are using this equipment or the materials, it's purposeful for our client. It's playful. And so there is a relationship based component to it, and we're looking to again, improve that adaptive behavior or an adaptive response from the client. And a lot of times we can see this. even within a session when a client is using an approach avoidance type of behavior with the equipment and as they become more regulated, as they're able to integrate that information more effectively, then suddenly they're able to engage with a swing or a slide or they're able to dual task so they can go down the side holding a toy. And we're able to to see this adaptive response evolve throughout the session. Ayres sensory integration is implemented by therapist with specialized training. Again, I did go through one of the earlier certification programs for Ayres sensory integration. It's most often used by occupational therapists, but even in my cohort there were a few PTs and SLPs. So it can be delivered by OT, PT, or speech with specialized training, and it takes place in a specially designed clinical setting. It is meant to be, again, client led. So safety is a big factor and obviously it's a sensory rich experience. There is a lot of variety put together when the clinician is setting up that environment. And some of the core tenants of air sensory integration include. Um, addressing physical safety. So if we want to be client led, we need to have an environment that is safe for the client to explore. So we think about that sensory gym again, right? We might see mats or padding. We're gonna see crash mats under maybe some of our bigger equipment because we, as the clinician do not want to have to be in the business where we are like"be careful, be careful, watch what you're doing". Um, we want them to really be able to have a full, the client to have a full experience of using the equipment and moving through space and experiencing what it is like to jump or fall or crash and not necessarily having to put those words behind it. We want to have a variety of different sensory opportunities available, so when we're setting up our sensory clinic or our sensory space for our clients, and we're coming from that sensory integration perspective we're thinking about the affordances of the environment and what do we need to set up? So you know, if we don't, if, if we don't want that stable like platform swing, we need to make sure it's put away. Because when once the client is there and we're following their lead, if they're gravitating towards that then we're gonna be bringing that out for them. And maybe that isn't the most adaptive response, um, type of equipment. Maybe we want something that is a little bit more dynamic and maybe we want a bolster swing. And so we're presenting those opportunities to the client and then we're following their lead. We're looking at the client's level of alertness and ability to engage. So not under aroused. Not over aroused. And I like to describe it as a window, right? So like a window in your house or window in the car. And we can have the window just a little bit open, right? So that's that zone where the client is really regulated or we can have the window wide open and we have a really wide zone of regulation and that's what we're looking for. You know, most of us who are, are pretty well regulated. We have a pretty wide window where we're able to maintain our regulation. If we're not getting enough sleep or we're hungry or hangry, you know, that window kind of get smaller and smaller and we can feel some of those things. So helping the client to get to that just right level of alertness so that they can engage most meaningfully is important. We want to have a variety of equipment that's gonna challenge the sensory systems, both from a postural perspective, but also from a praxis. Perspective and looking at how the client can organize their actions around the equipment that's provided. We are following the child's lead, so it is child led and, and really that kind of inner play comes out. We want to be able to upgrade and downgrade our activities to get that just right challenge again, if it's something that is too hard. Often the children that we're working with, they're gonna shy away from that, or they're not even gonna try it. And on the opposite side of things, if it's something that they've already mastered, like the stability of a platform swing, then we're really not gonna get an adaptive response. So when we're looking at equipment choice and setting up the environment. It's really important in sensory integration when we're coming at it from the theory perspective of how we're setting up this environment, how we're putting everything together. Then once the client is there it's all about that therapeutic interaction with the client. With it being playful and child led and using intrinsic motivation for the child. We're not doing a this then that, or you know, once you sit down and complete this puzzle, then you can swing. It doesn't work that way, you know that the child is able to meet their sensory needs and if that gets them to the just right level where then they can go ahead and select a puzzle that's fabulous. That would be a great adaptive behavior or organization of behavior that we might see..So those are some of the key components of Ayres sensory integration when we're applying it to our interventions or that intervention approach. When we think about and start to compare that with hippotherapy, going back to the just the word right? The term hippotherapy is referring to how occupational therapy, physical therapy, and speech language pathology professionals use evidence-based practice and clinical reasoning in the purposeful manipulation of equine movement as a therapy tool to engage sensory neuromotor and cognitive systems to promote functional outcomes. So the sensory part is in there, right? It's, it's how that term can be referring to how, as an occupational therapist, I'm gonna use the movement of the horse and best practice is really going to dictate that in my OT sessions, that hippotherapy is one tool that I'm integrating along with a variety of other tools or strategies. So when we think about it that way, Is Hippotherapy one tool that I'm integrating along with some sensory integration strategies. Okay. So that's one way to think about it. So when we maybe think about the two things, we can look at some of the principles of sensory integration and maybe compare those to similarities with hippotherapy or maybe some differences. With hippotherapy, I think that's a good way for a lot of us to think about, how does this all fit in together? So one of the principles of sensory integration would be the inner drive, right? We're looking at the client's inner drive or their, internal motivation right? How, motivated are they to engage in the activity? How much are they able to, to lead. So the inner drive is playful, it's relationship. Right, and that's part of that principle of sensory integration. So some similarities to hippotherapy. Ideally, the child should show an affinity towards animals and the therapists. We want to build rapport with our clients. We want there to be some playful interaction or relationship between us and the clients that we're working with, whether those are children or teens and adolescents, or even our adults, right? It's based on a relationship that we're having with them as well as with the horse. But there are some differences as well. So when we think about inner drive and that playful context with sensory integration, it's often based on following the child's lead. And often that is not the first aspect when we are using hippotherapy as a treatment tool. And that's often not possible to always be following the child's lead or the client's lead because of our safety concerns or safety considerations that are present when we are in the equine environment, when we're working with horses. Some of the things that the client might be internally motivated to engage and would not be safe when the horse is our partner. So that would be one difference between our sensory integration interventions and the way that hippotherapy is used as a tool is. Although we are interested in following the child's interest in using internal or intrinsic motivation, we may not be able to follow their lead in all contexts. Often it's the therapist that is leading, right? Because if we think back to what the term hippotherapy refers to, right? It's the purposeful manipulation of equine movement. The child is not purposefully manipulating the equine movement, the therapist is right? So that's a pretty big difference. Another tenant or core principle to sensory integration is neuroplasticity. And hippotherapy is also based on dynamic systems theory and the belief in neuroplasticity. So with sensory integration theory, we believe that there is neuroplasticity within the central nervous system, and that would be true of hippotherapy as well. When we think about the conceptual framework of hippotherapy, there is a similarity between the belief in neuroplasticity, there are no differences. Another key principle would be the adaptive response. When you think about having an adaptive response from the client, right? Remember we said we want to choose equipment in sensory integration that will facilitate an adaptive response if we stick with what the client always chooses. Oftentimes it's what they're comfortable with and what they're already skilled at, and it's up to us as the clinician to make sure the environmental affordances are going to generate that adaptive response. So a similarity with hippotherapy would be the movement of the horse often requires an adaptive postural response. Some differences is that equine movement may not require an adaptive response based on ongoing sensory input in relation to the challenges presented. When we think about equine movement, one of the key characteristics are that it's rhythmic, that it's symmetrical, and that it's ongoing. And so, We are looking at whether that patient is accommodating to the movement and also how skilled is the therapist in the manipulation of the movement to generate an adaptive response. So in the goal may be the same as to get an adaptive response, and we can use the movement of the horse to generate that adaptive response. So we can see some similarities, but also some differences there. Another key principle that we can think about is that just right challenge. It requires constant adjustment based on responses and needs of the client. And when we think about that as a key principle of sensory integration, and we look at when we use hippotherapy as a treatment tool, the therapist should be carefully considering the task, the environment, and creating a just right challenge to maximize the client's game. So there is similarities between requiring or achieving that just right challenge when we're using a sensory integration frame of reference and when we're using hippotherapy as a treatment tool. Environmental affordances. When we are, again, setting up for our session and we're thinking about it from a sensory integration frame of reference, the way that we set things up is really important. So some similarities to hippotherapy is that the therapists can design the treatment environment to capture the child's inner drive, maximize sensory input. We can think about that from an equipment perspective. We can think about that from a horse selection perspective. We can think about it from our actual environment. Are we in an indoor riding arena? Are we in an outdoor riding arena? Are we on a trail? Right? There's lots of different environmental affordances that we can select there, but the difference is that the therapist has to work within the safety considerations of our equine partners. So some of the environmental affordances are constrained by what our horses are comfortable with, what those safety considerations are. For those of you who have worked with children with sensory challenges long enough, you will know that sometimes some of the ideas that they have in our treatment sessions would definitely not be appropriate in the equine setting or when around or on a horse. So those safety considerations play a much bigger role when we are using hippotherapy as opposed to what we can do from a safety perspective in a sensory clinic. Another key principle is that one-on-one treatment in a specialized environment, and when we think about similarities when we're using hippotherapy, it is typically a one-on-one treatment session with an OT, a PT, or an S L P, and the specialized environment may look different. Certainly a sensory gym looks a lot different than where the equine environment is, but the equine environment does not include suspended equipment, right? Our horses aren't suspended. We're not getting that same vestibular input that we would get from suspended equipment. So there is a difference there. When we look at Ayres sensory integration as an intervention and we look at hippotherapy as a treatment tool, there is definitely a difference there in the way that some of that sensory input can be delivered to the client and what some of that equipment looks like. Although they're both specialized in their own environment, they're definitely not the same and there's a definite, some limitations in that vestibular input that we can provide without suspended equipment. Now, there are some facilities that do have more of a sensory gym or clinic on site when they're using hippotherapy as a tool and they may have suspended equipment there, so they might be able to incorporate that. But when we refer back, term hippotherapy, that best practice dictates that hippotherapy is one tool that we're using within our treatment toolbox. So that suspended equipment is some of our other tools and strategies that we're using. And one of the last principles of sensory integration is that the long range goal is efficiency of sensory integration leading to enhanced participation or that functional outcome. And we can say that both sensory integration as an intervention and hippotherapy as a treatment tool are concerned with function, with the functional outcomes outside of the treatment environment. I think that's really important. We're not necessarily concerned with how well the client is able to function within these specialized environments, but we are most importantly concerned with how they're able then to integrate and use that information when they go home or when they're at school. Those other components to how they're able to generalize those skills and take them into the other environments, into their daily life. And then use them on a functional basis. So it's, it's not so useful if they have really great sessions with me, but then aren't able to go ahead and take those skills home and use them in other settings. So that's another similarity. So when we think about comparing and contrasting similarities and differences. I hope that you can see that hippotherapy is not sensory integration, but it does have some similarities and we can use hippotherapy as a tool to impact sensory systems. So when I was gathering my information, I came across a relatively newer research study. It's a pilot study and it's entitled, The effect of hippotherapy on sensory integration among children with autism spectrum disorder. And I did a quick read over of it and I think it's interesting to share some of the findings. So they used the sensory processing measure, the home form, and they were guided by Ayres, sensory integration therapy. And when they looked at the qualitative data, It revealed that the intervention, so that would be the use of hippotherapy as a treatment tool, had the greatest impact on arousal, sensory discrimination and sensory modulation. So when we're thinking about, client selection and the clientele that we work with and what the most appropriate tools are, and we're looking at it from an evidence-based practice standpoint, there is some evidence using, again, that sensory processing measure home form at having a statistically significant impact on arousal, sensory discrimination, and sensory modulation. And I certainly know a lot of the families that come to me have concerns about that sensory modulation piece in particular. That their children have problems, with under arousal, over arousal, being overstimulated and being able to modulate sensory input in a variety of environments. It's interesting to see at least a pilot study coming out that's supporting a lot of what we see clinically. So as we go to wrap things up and think about, how do you pull all this information together and how do you communicate it to the families that we work with? Or how would you communicate this on a website? Those types of ways that we represent ourselves as occupational therapy providers when we are using hippotherapy as one of our tools, how do we share the information of our skillset? With sensory integration and our skillset with using hippotherapy, without saying that hippotherapy is sensory integration. Because when we compare and contrast them, we can see that hippotherapy is not sensory integration, but it can help with different sensory processing challenges with sensory discrimination, that sensory modulation piece. So thinking about, how do we articulate those components and how do we make it in a really parent-friendly way because I think a lot of times once we get into kind of clinical speak, it's very easy to lose parents. Being able to break it down so parents can understand what we're focused on and, and what we're doing when we have their child on a horse and we are manipulating that movement to have a sensory impact, it's important that we can translate it to them. Or, if we have fieldwork students with us, we can translate it for them in that we are changing the horse's movement to impact the sensory systems. We might be changing the client's position on the horse or the type of equipment that we're using to get that just right challenge and that it is a multi-sensory input we have visual proprioceptive, vestibular, tactile input. And we're really looking for that just right challenge as we change the movement, change the horse, change the equipment, change the environment, all of those different components that we're looking at when we're deciding how to set up our session to address those underlying deficits that are gonna work towards that long-term functional outcome. Certainly in another episode, we can talk a little bit about what do some of those long-term functional outcomes look like, and maybe that backwards planning of, when we're setting our OT goals and then looking at the tools and strategies that we might have available to us, whether it is hippotherapy as one of our tools or other animals that we might be working with or being in the aquatic environment. How do we take those functional goals and backwards plan in our sessions based on the information and evidence that we have? So I hope this was helpful for you. If you have any questions, I would love to hear them. If this was useful to you, please go ahead and like, or share our podcast so that way others can find us. Thanks for listening.