Hippotherapy and Dolphin Therapy Antonia Giannakakos Paula
Gaglioti Erin Stutz
Slide 2
Animal Assisted Therapy Involves animals as a form of treatment
Goal = improve social, emotional and cognitive functioning Research
shows that the relationship between humans and companion animals
are generally favorable Methodological concerns about the poor
quality of data show a need for improved experimental studies
Slide 3
What is Hippotherapy? The American Hippotherapy Association
defines hippotherapy as a physical, occupational, and speech-
language therapy treatment strategy that utilizes equine movement
as part of an integrated intervention program to achieve functional
outcomes. http://www.americanhippotherapyassociation.org/ Video
http://www.youtube.com/watch?v=1E7zLeDZ-kc
Slide 4
What is Hippotherapy? Using a horse as a treatment tool to
accomplish therapeutic objectives: Improved balance Strength Motor
coordination For children with Autism: Promoting communication
Sensory regulation Creating a bond between horse and student
Slide 5
Hippotherapy History Hippocrates mentions riding in his writing
Natural Exercises 1780 Tissot wrote of the beneficial qualities of
a horses walk. Also mentioned ill effects of too much riding.
Slide 6
Hippotherapy History 1875 Chassaign, a French physician, began
conducting the first systematic study of therapeutic riding
Beneficial therapy for certain types of neurological paralysis
Noted improvements in posture, balance and joint movement Striking
increases in morale
Slide 7
Hippotherapy History 1960s Germany, Austria, and Switzerland An
adjunct to physical therapy Performed by a physiotherapist, trained
horse and horse trainer Gait, tempo, cadence and direction
Influence neuromuscular changes in the patient 1980s First
hippotherapy curriculum was formed by Canadian and American
therapists
Slide 8
Hippotherapy History 1992 American Hippotherapy Association
Established standards and educational curriculum for occupational,
physical and speech therapists 1999 First Hippotherapy Clinical
Specialists were being certified in the United States.
Slide 9
American Hippotherapy Association Has evolved over 30 years.
MISSION: to educate and promote excellence in the field of Equine
Assisted Therapy VISION: AHA is recognized as part of the
international community that provides education, facilities
research and promotes Equine Assisted Therapy as an effective
treatment strategy that improves the quality of life for
individuals with disabilities.
Slide 10
AHA Core Values Integrity Accountability Accessibility
Innovation Excellence Collaboration
Slide 11
AHA Curriculum Level I Treatment Principles 2 1/2 day course
Entry level therapists Hands on practicum Can be attended by
graduate occupational, speech and physical therapists. Curriculum
may be utilized only under conditions set forth by AHA, Inc.
Slide 12
AHA Curriculum Level II Treatment Principles 2 1/2 day course
Provides and facilitates a problem solving treatment approach Uses
actual patients currently involved in Hippotherapy Practical
applications to NDT, SI and Motor Learning Theory and Clinical
Reasoning will be applied Video taping and group discussions
Attendees licensed, Speech, Physical and Occupational Therapists
and assistants (PTA, COTA). The curriculum may be used only under
conditions set by AHA, Inc. The AHA Education Committee requires 30
treatment hours of experience of 1:1 patient treatments
incorporating hippotherapy as a treatment strategy before this
course
Slide 13
Therapeutic Strategies Sensory stimulation to muscles and
joints Proprioception Impacts balance Varied tactile experiences
Communication Receptive Expressive Social cues
Slide 14
Importance of the Horse Walk Pelvis Provides sensory input
Graded for each student Gait change = input change Creates reaction
in students pelvis Improves neurological functioning and sensory
processing
Slide 15
What Hippotherapy Claims To Do: o Professional treatment to
improve neurological functioning in the areas of: o 1) Cognition o
2) Body movement o 3) Organization o 4) Attention
(http://www.rightsteptherapy.com/hippo.htm#more)http://www.rightsteptherapy.com/hippo.htm#more
Slide 16
1) Vestibular system: client is facing backward while horse is
moving forward. 2)Proprioceptive: heavy touch pressure through the
hip, knee, wrist, elbow and shoulder joints in the quadruped
position. [Quadruped position is when client is on all fours]
3)Tactile: touching the warm soft coat of the horse. Also Claims to
Address:
Slide 17
4)Cognitive: higher level motor planning skills required to
execute the transition. 5)Motor: stability of hips and pelvis
required to maintain position while reaching forward with one hand.
(http://www.cpparent.org/hippotherapy/articles/introducti
on.htm(http://www.cpparent.org/hippotherapy/articles/introducti
on.htm) Also Claims to Address Contd:
Slide 18
uses activities on the horse that are meaningful to the client
and specifically address the individual's goals. provides a
controlled environment and graded sensory input designed to elicit
appropriate adaptive responses from the client. does not teach
specific skills associated with being on a horse: rather, it
provides a foundation of improved neuro-motor function and sensory
processing that can be generalized to a wide variety of activities
outside treatment.
(http://www.cpparent.org/hippotherapy/articles/introduction.htm)http://www.cpparent.org/hippotherapy/articles/introduction.htm
Treatment Approach:
Slide 19
Hippotherapy Therapeutic Riding - Completed by a professional -
Recreational horseback therapist (PT, OT) in conjunction riding
adapted to individuals with a horse handler. with disabilities. -
1:1 treatment, occurs year - Completed by professional round until
patient discharged. horseback instructors and - Horse influences
patient. volunteers. - Improves neurological - Run in sessions or
group functioning in cognition, body format. movement, organization
& - Rider influences the horse. attention.
(http://health.uml.edu/thc/HealthIssues/Hippotherapy/Hippother
apy_Website.html) Hippotherapy vs. Therapeutic Riding
Slide 20
a. Does your child require constant positioning to maintain
sitting balance? b. Does your child need frequent assistance to
maintain attention or alertness levels? c. Is your child under age
5? d. Does your child have special medical needs that may require
the additional knowledge and training from a licensed professional
therapist? Is Hippotherapy right for you?
Slide 21
e. Does your child have sensory integration dysfunction or
frequent behavioral outbursts to sensory stimulus? f. Does your
child have specific neuro-motor goals to work on? g. Would your
child benefit most from the horse's movement in private 1:1
sessions? If you answered "yes" to any of the questions above, then
Hippotherapy may be the avenue most appropriate for your child at
this time ( http://www.rightsteptherapy.com/hippo.htm#more(
http://www.rightsteptherapy.com/hippo.htm#more) Is Hippotherapy
right for you?
Slide 22
Video : http://www.youtube.com/watch?v=b7GHzselNmA&feat
ure=related http://www.youtube.com/watch?v=b7GHzselNmA&feat
ure=related The Horse Boy
Slide 23
Slide 24
Authors: Margret M. Bass, Catherine A. Duchowny, & Maria M.
Llabre Year: 2009 Journal: Journal of Autism and Developmental
Disorders
Slide 25
Purpose To see the effects of hippotherapy on social
functioning in children with autism
Slide 26
Methods Participants: Thirty-four children diagnosed with ASD
and no previous experience with hippotherapy Experimental group Two
girls, 17 boys Ages 5-10 Control group Three girls, 12 boys Ages
4-10 Setting: Good Hope Equestrian Training Center in Homestead,
FL
Slide 27
Procedure Experimental group received 12 weeks intervention
Control group no hippotherapy received ( participants were those
wait listed for hippotherapy)
Slide 28
Procedure Prior to intervention both groups were given a
pre-test Pre-test was a series of questionnaires filled out by
parents Social Responsiveness scale (SRS) Sensory Profile (SP)
Questionnaires looked at the severity of symptoms as well as the
participants skill levels Both questionnaires utilized Likert
Scales as a rating system EX questions- seems much more fidgety in
social situations then when alone and doesnt recognize when others
are trying to take advantage of him or her
Slide 29
Procedure Intervention 1 h per week for 12 weeks Activities
include Exercises (before riding) Riding skills Focused on
improving: sensory seeking, gross/fine motor skills Mounted games
Focused on improving: social and communication skills Horsemanship
activities These activities centered on caring for and identifying
key anatomical features of the horse. There appears to be no
socially significant purpose to such an activity. Reinforcement-
physical and verbal reinforcement were provided at the end of each
exercise Post test- administered to parents, same as pre test.
Slide 30
Results Overall authors found hippotherapy to be a viable
therapeutic approach in treating learners with ASD
Slide 31
Results Analysis Analyzed data using a 2X2 mixed design
repeated measure analysis of variance (ANOVA) Results Significant
differences were found in 7 of the 10 scales There was not a
significant difference in the areas of fine motor perception,
social cognition, and social awareness. For social cognition and
social awareness the mean scores obtained from the post-tests were
actually lower than those on the pre-test
Slide 32
Results
Slide 33
Discussion The authors explanation for the results that were
not significant was that the therapeutic activities did not target
those areas.
Slide 34
Discussion Limitations Riding the horse may have acted as a
reinforcer resulting in higher levels of motivation and social
engagement Authors claim participants displayed sustained levels of
directed attention. They attribute this to their highly structured
intervention
Slide 35
Strengths Authors propose explanations for their research
Collected data Had a control group
Slide 36
Weaknesses Very objective measures qualitative data No
treatment integrity No IOA No social validity No way to determine
how much therapy each participant was receiving outside of the
experiment
Slide 37
Authors: Beth L. Macauley & Karla M. Gutierrez Year: 2004
Journal: Communication Disorders Quarterly
Slide 38
Purpose To examine the effectiveness of hippotherapy versus
traditional therapy on children with learning disabilities
Slide 39
Methods Participants: Three boys, 9, 10, 12 years old Received
speech-language therapy from age 5 All participants had LLD and one
also had ADHD Settings: Merlin Farms Equestrian Center in Deer
Park, Washington University Program in Communication Disorders
Speech and Hearing Clinic, Spokane, Washington MERLIN FARMS Deer
Park, WA Full service facility 509-275-9444, no url / no
coupons
Slide 40
Procedure Data collection done through a questionnaire
distributed to parents and participants which assessed client
satisfaction with the intervention Questionnaires distributed at
the conclusion of traditional therapy and hippotherapy Traditional
therapy took place for 1h, twice a week, during the fall academic
semester After winter break hippo therapy began for 1 h, twice a
week for 6 weeks. During hippotherapy sessions, participant sits on
the horse and participates in therapy activities Therapy activities
were those done during traditional therapy but adapted for
hippotherapy
Slide 41
Results According to parents horse therapy was more effective
than traditional According to participants the two therapies were
equally effective
Slide 42
Results Researchers make the claim that the child is learning
better when on a horse because they arent focused on improving
their speech and language, as opposed to when they are in
traditional therapy sessions and that is all they focus on.
Slide 43
Slide 44
Slide 45
Limitations Parents may have responded positively to the hippo-
therapy because of its novelty or because of their perception of
experimenter expectations
Slide 46
Strengths Admit results could be due to extraneous variables
Acknowledge the need for research with a wider range of
participants
Slide 47
Weaknesses No quantitative data Very subjective measurements No
treatment integrity No IOA
Slide 48
Authors: Taylor et al. Year: 2009 Journal: Occupational Therapy
in Mental Health
Slide 49
Purpose To study the effectiveness of a 16 week hippo-therapy
intervention on volition of children with autism.
Slide 50
Methods Participants: Three children with ASD- both male and
female 4 to 6 years old Setting: Riding facility in a suburb of
Chicago, IL Dependent measures: Pediatric Volitional Questionnaire
(PVQ) evaluates motivation based on child-environment interactions
Design: Single subject A-B-B design
Slide 51
Procedure Baseline Before intervention participants were
observed and video- taped using standardized play protocol to
evaluate motivation Play activities included: playing with a wind
up toy, blowing up a balloon, popping bubbles, playing peek-a-boo,
feeding and brushing a dolls hair, exploring other toys, looking
through books, and stacking rings and cups. All play sessions were
administered by an occupational therapist Videotapes of these
sessions were rated by both an occupational therapist and a trained
graduate student who were blinded to the evaluation time point (but
they knew the purpose of the study)
Slide 52
Procedure Intervention Participants were re-evaluated halfway
through HT ( 8 weeks) and at the end of treatment (16 weeks)
Posters were placed on the walls of the riding arena. These posters
were meant to increase visual scanning and to provide opportunities
for language. The therapist would refer to these posters and
encourage the participant to use language.
Slide 53
Results Visual analysis revealed that all three participants
showed increased motivation from baseline to the cessation of the
study Rate and level of progress varied among participants
Slide 54
Results It would have been interesting to see the results had
data been collected in another 8 weeks
Slide 55
Strengths Two separate individuals assessed volition Tested for
inter-rater reliability Baseline condition Therapist driven
questionnaire
Slide 56
Weaknesses No reversal back to baseline No functional
relationship demonstrated Observers blinded to time point but not
to the purpose of the study No treatment integrity
Slide 57
Overall assessment of Hippotherapy Studies in this area are
subjective They lack both internal and external control Studies
fail to demonstrate functional relationships We do not recommend
Hippotherapy as an effective treatment
Slide 58
Slide 59
What is Dolphin Therapy? An experience where the patient is
able to swim with dolphins having therapeutic benefits Healing
power of water Intimate connection with the animal
Slide 60
Dolphin Therapy History 1970s benefits of animal presence in
therapy was discovered Dr. Betsy Smith began scientific research
with dolphins and children with autism called The Dolphin Project
1978 In Florida, Dr. David Nathanson started researching dolphin
therapy with children with developmental disabilities Increased
sensory attention 4 times faster in Dr. Nathansons study
Slide 61
Dolphin Therapy History 1988 Dr. Nathanson started a therapy
program at the Dolphin Research Center in Grassy Key, Florida
called Dolphin Human Therapy (DHT) 1989-1994 More than 500 children
went to Dr. Nathansons program before it moved to Key Largo 2000
Bunbury Dolphin Therapy was formed in Bunbury, Western Australia by
Carla Henco, B. Spec. Ed.
Slide 62
Dolphin Therapy Attractions Dolphins positive attitude towards
humans Dolphins desire for contact Large size Exotic Appearance
Easily trained Healing power = multi-link system
Doctor-coach-dolphin-patient 15 20 minutes dolphin therapy for a
period of 7-10 days
Slide 63
A Dolphin Therapy Session Meetings with the doctor Health
assessments Direct physical session with a trained dolphin
Relaxation therapy Final assessment and future recommendations
Slide 64
Although no scientific evidence exists, research has shown the
positive effects that interacting with dolphins appears to have on
humans. Researchers suggest that swimming with dolphins has the
ability to: 1) reinforce the human immune system, 2) improve
awareness, 3) lengthen attention span, 4) increase self-control 5)
increase feelings of compassion and self-assurance.
(http://www.somenteaqua.com/dolphin-therapy)http://www.somenteaqua.com/dolphin-therapy
What Does Dolphin Therapy Claim to Do:
Slide 65
Disorders such as: 1)Depression 5) Cerebral Palsy 2) Insomnia
6) Muscular Dystrophy 3) ADHD 7)Down Syndrome 4) Autism
(http://www.somenteaqua.com/dolphin-therapy)http://www.somenteaqua.com/dolphin-therapy
*no evidence to support this Dolphin Therapy Can Improve:
Slide 66
dolphins' use of sonar and echolocation produces changes in the
cell structure of the patient's body; it is consequently believed
that, through the use of sound waves and echolocation, healing can
be stimulated and the state of consciousness altered. Echolocation:
a high - pitch sound sent out by the dolphin that bounces off an
object and returns. The dolphin interprets the returning echo to
determine the objects shape, direction, distance and texture.
(http://www.somenteaqua.com/dolphin-therapy)http://www.somenteaqua.com/dolphin-therapy
Dolphin Therapy: The Scientific Explanation
Slide 67
that sound waves emitted by the dolphins in communication and
echolocation stimulate healing. Those persons who experienced the
therapeutic exposure to dolphins consistently displayed brainwaves
that transitioned from beta waves to alpha waves. Beta waves are
often an indicator of "active, energized" brainwave activity, while
alpha waves are often displayed while in a relaxed, meditative
"state of mind" that can facilitate the possibility for
improvement.
(http://www.balidolphintherapy.com/dolphin_therapy_bali_indo
nesia_how_work.html(http://www.balidolphintherapy.com/dolphin_therapy_bali_indo
nesia_how_work.html) Scientific Explanation Contd:
Slide 68
1) One of them is that the unconditional love and support a
dolphin has to offer can benefit children and people with emotional
problems. 2) A dolphin seems to have human-like emotions, so a deep
trusting bond can be developed between client and dolphin.
(http://www.balidolphintherapy.com/dolphin_therapy
_bali_indonesia_how_work.html(http://www.balidolphintherapy.com/dolphin_therapy
_bali_indonesia_how_work.html) Dolphin Therapy: The
Philosophies
CNN report:http://www.youtube.com/watch?v=ir05FOFkeX
khttp://www.youtube.com/watch?v=ir05FOFkeX k Dolphin Therapy in the
Media
Slide 71
Research No available journal articles in this area Marino
& Lilienfeld (2007) Reviewed five peer-reviewed articles on
dolphin assisted therapies published in the last eight years Found
all five lacked both internal and external validity Authors found
that there is no evidence for the effectiveness of Dolphin Assisted
therapy
Slide 72
Research contd: Tracy L. Humphries Conducted a research
synthesis in 2003 All studies failed to control for a number of
possible threats to validity or alternative explanations. study
outcomes could not be conclusively attributed to the intervention.
Claims of the effectiveness of dolphin therapy are not
supported.
Slide 73
The available research evidence, as examined in this synthesis,
does not conclusively support the claims that DAT is effective for
improving the behaviors of young children with disabilities. More
specifically, the results of the synthesis do not support the
notion that using interactions with dolphins is any more effective
than other reinforcers for improving child learning or
social-emotional development. () Parents of young children with
disabilities and their practitioners should note that the cost of
DAT is high (typically $2600 for five 40-minute sessions) and that
currently there is not enough research evidence available to
support the use of the practice.
Slide 74
Effectiveness of Dolphin-Assisted Therapy as a Behavioral
Intervention for Young Children with Disabilities Major Findings
and Outcomes Reported by Investigators Major Study Findings and
Threats to Validity
http://www.riverbendds.org/index.htm?page=humphr ies.html
http://www.riverbendds.org/index.htm?page=humphr ies.html
Slide 75
Overall Assessment of Dolphin Assisted Therapy Research in this
area lacks internal and external validity Research does not
consider alternative explanations of outcomes No scientific
evidence in support of this treatment We do not recommend Dolphin
Assisted therapy as an effective treatment.
Slide 76
Just for laughs
Slide 77
Slide 78
Slide 79
Bass, M.M., Duchowny, C.A., & Llabre, M.M. (2009). The
effect of therapeutic horseback riding on social functioning in
children with autism. Journal of Autism and Develompental
Disorders, 39, 1261-1267. Humphries, T.L. (2003). Effectiveness of
dolphin-assisted therapy as a behavioral intervention for young
children with disabilities. Bridges, 1,. Marino, L., &
Lilienfeld, S.O. (2007). Dolphin-assisted therapy: More flawed data
and more flawed conclusions. Anthrozos, 20, 239-249. Taylor, R.R.
Kielhofner, G., Smith, C., Butler, S., Cahill,S.M., Ciukaj, M.D.,
& Gehman, M. (2009). Volitional change in children with autism:
A single-case design study of the impact of hippotherapy on
motivation. Occupational Therapy in Menthal Health, 25,
192-200.
