Acknowledgements

Results and ConclusionsPurpose

Therapeutic Horseback Riding

Discussion – Quality of Life in Community

Methods

Participant

The Effects of 12-months of Therapeutic Exercise and

Horseback Riding on Strength, Postural Control, and

Cognitive Function in Anoxic Brain InjuryLouisa A. M. Summers¹, Ph.D. and Maria Sebastiani. B.S.2

¹Department of Exercise and Sports Science,2 Department of Occupational Therapy

Eastern Kentucky University, Richmond, KY

We would like to acknowledge the following for their help in making this research possible:Ms. Nancy Adamson, Mr. Christopher PerryMr. Codie Monhollen, & Ms. Kaitlyn KrizmanCollege of Health SciencesProvost’s Office for Academic Affairs and Students Success OfficeEKU Department of Veteran Affairs

To Examine The Effects of

Therapeutic Horseback Riding

(THR) and Therapeutic Exercise

on Muscular Strength,

Endurance, Postural Control, and

Cognitive Function in One

Veteran with Anoxic Brain Injury

One male participant, aged 28

• Active duty Army January 2005 – until injury

November 22, 2008

• 14 months in Iraq – Oct 2006-November 2007

• Specialist 11 Bravo (509th infantry - Ft. Richardson

Alaska)

Injury – Aspiration Pneumonia

• 4 hours later in the ER went into cardiac arrest

• Intubated: first 2 attempts failed, 3rd successful

• Loss of oxygen to brain caused Anoxic Brain Injury

• Two years post injury at start of THR

• Inpatient – Dec 2008-April 2009- Shepherd Center (GA)

• Inpatient - April 2009 – May 2010- Tampa Bay (FL) VA Hospital

• Home PT/OT/Speech therapy – June 2010-June 2011

• Outpatient PT/OT– July 2011-Sept. 2012- Cardinal Hill (KY)

Rehabilitation

1. Muscular Endurance

• Time on Horse

• Postural Support Needed on Horse

2. Muscular Strength

• Number of lateral steps taken with support

• Sitting time

3. Anthropometric Measures

• Forearm, Arm, Thigh circumference

4. Cognitive Function – Mini-Mental State Exam

(Copeland, Abou-Saleh, & Blazer, 2002).

Year Beginning of the season End of the season

2010 7-17-2010 11-19-2010

6 sessions 30 minute ride 45 minute ride

Needed full trunk support – 14” peanut ball

More erect over ball

2011 6-22-2011 11-16-2011

8 sessions 20 minute ride 45 minutes

Hands on 3” PVC pipe over the horn of Western Saddle

Hands on 3” PVC pipe fitted over the horn

Moderate support with side walkers on both sides

Minimal assist with side walkers

Stood in stirrups 3 times Not Standing – tremorson/off

Commands “Whoa” and “Walk on”

2012 2-17-2012 10-19-2012

10 sessions 45 minute ride 50 minute ride

Hands on 3” PVC pipe over the horn of Western Saddle

Hands on 3” PVC pipe over the horn of Western Saddle

Added Riding Vest for trunk stability

Ability to sit up straight

Moderate support with side walkers

Moderate support with side walkers

Clonus and tremors Stood in saddle 4 times

Reaching and grasp for objects Lateral movements

Commands “Walk, Whoa, Walk”

Year Beginning of the season End of the Season

2013 3-08-2013 10-13-2013

11 sessions 25 minutes 60 minute ride

Hands on 3” PVC pipe fitted over the horn of Western Saddle

Erect

Two Side walkers with minimal support

No support on Needed on Left side;Minimal support on Right side

Reach and Return without support

Legs stiff Stand in saddle 7 times

Twice per week (2 sets , 5-12 repetitions)

Once per week (2 sets , 5-12 repetitions)

Standing Squats (with support)

Bridges (on mat table)

Back Extension (in wheelchair)

Crunches (on mat table)

Shoulder Flexion (front raises)

Prone press up (on mat table)

Shoulder Abduction (side raises)

Reverse Flys

Shoulder Press (with object in hand)

Wrist Extension

Hip Flexion (standing) Hamstring Stretch (on mat table)

Crunches (in chair) Butterfly stretch (on mat table)

• Therapeutic Exercise at a local University with

Professor – 2/week for 1 hour with Professor

• October 2012 - May 2013

• Home based Therapeutic Exercise

• May 2013 – Present

• Therapeutic Horseback Riding – 1/week for 1

hour; March – November

1. Increased total sitting time from 2 minutes (with

minimal support) to 16 minutes without support.

2. Increased number of lateral steps taken from 2 to 10.

3. Mini-Mental State Exam – 14.0 in July & October 2013. .

Therapeutic Horseback Riding - Outcomes

• Increased Time on Horse

• Increased Postural Control

• Increased Ability to Stand in Stir-ups

• Increased Ability to Reach and Grasp Objects

Methods-Outcome Measures

1. “Easier to transfer”2. “He has better control of his movements”3. “More alert, laughing, very attentive on the horse”4. Improved postural control and stamina has allowed the veteran to take part in community events such as: golf, bowling, baseball games, and climbing.

Therapeutic ExerciseCircumference (cm) June 7, 2013 October 7, 2013

L Bicep 30.5 31.0

R Bicep 30.5 32.0

L Forearm 25.5 26.6

R Forearm 25.5 27.2

L Quad 46.0 47.5

R Quad 46.0 48.0

Anthropometric Measures

Other Comments