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Does Equine-Assisted therapy increase participation in meaningful activities in children with Autism Spectrum Disorder?
Importance of Topic
Children diagnosed with Autism Spectrum Disorder (ASD) often experience reduced or limited engagement in meaningful occupations due to emotional, behavioral, and motor / postural challenges. Such limited engagement in meaningful activities or relationships is detrimental to the development of children with ASD. Equestrian-Assisted Occupational Therapy, otherwise known as Hippotherapy (HPOT), is being used among the ASD population to increase social participation and increase engagement in meaningful occupations (Ajzenman, et al., 2013).
What is Hippotherapy (HPOT)
Why is it used in Occupational Therapy?
Hippotherapy (HPOT), also known as Equine-Assisted Occupational Therapy, is an intervention strategy that utilizes horses (not hippos!) and their movements as a tool for therapy sessions. The term hippotherapy comes from the word ‘hippos,’ which means horse in Greek. Pediatric occupational therapists (OTs) work with children and their families to promote independence and develop the skills children need to succeed in their daily lives. OTs work with families to collaborate and accomplish these goals in a number of different ways. You may have heard of or seen this done in an outpatient clinic’s sensory gym or incorporated into a child’s home or school environment. In reality, pediatric OT can take place anywhere so long as therapy sessions provide opportunities for enriched sensory experiences and skill development.
HPOT is a particularly fun way for pediatric OTs to offer children and their families positive, engaged experiences, while also providing effective sensorimotor challenges within the context of a therapy session (Ajzenman et al., 2013). HPOT allows children the opportunity to not only interact with animals during on-horse activities, but also to participate in a number of other off-horse activities involved with equine sports such as riding, grooming, feeding and saddling (Llambias et al., 2016). HPOT sits alongside nature-based OT in a growing pool of modern pediatric OT programs taking therapy outside of the clinic or schools and into the community. Another win for non-traditional OT!
So we know HPOT is a great new tool for pediatric OTs, but as evidence-based practitioners, we also know that OT interventions are never a one-size fits all solution. Thus, the question begs - which of our clients are best suited for HPOT, and what behaviors or functional goals can HPOT address? The best way to answer these questions is to turn to the work of our OT colleagues conducting research on such programs and their therapeutic outcomes.
HPOT for Children with Autism Spectrum Disorder
HPOT for Children with Autism Spectrum Disorder
Research on the efficacy of HPOT has mostly included children with autism spectrum disorder (ASD). Children with ASD have been found to have difficulties with sensory integration and modulation, social relationships and participation, postural stability and motor control, executive functioning, and limited engagement with meaningful activities (Ajzenman et al., 2013; Llambias et al., 2016). Research has also shown that children with ASD spend more time unengaged and show a higher preference for objects and solitary play than their typically developing peers (Llambias et al., 2016). As a result, pediatric OTs who work with children with ASD, place heavy emphasis on engagement in meaningful activities to promote development and work towards therapeutic goals.
Weekly HPOT sessions for children with ASD typically involve at least 20 minutes of gross motor or physical activity and 20 minutes of fine motor or cognitive activities. OTs can also incorporate any number of other evidence-based strategies to facilitate engagement within HPOT sessions. One approach noted in the literature is gradual reinforcement engagement, in which therapists follow the child’s lead, providing opportunities for them to show interest and explore, make choices, and initiate activities within an OT session (Llambias et al., 2016). Another evidence-based approach commonly used within HPOT sessions is sensory integration, as therapists can grade sensory input using voice tone, touch, vestibular, and proprioceptive stimulation from the horse’s movement to challenge or support a child’s sensory modulation (Llambias et al., 2016).
Benefits of HPOT
Recent literature on HPOT programs have found a host of benefits for children with ASD. Programs typically range from 10-12 weeks, with weekly sessions lasting 45-60 minutes. Children showed significant improvements in a number of areas including increased engagement and participation in daily activities, increased social motivation and receptive communication, better postural control, and reduced irritability (Ajzenman et al., 2013; Llambias et al., 2016; Peters et al., 2022). Researchers hypothesize that the use of animals in therapy sessions is a strong motivator for children with ASD, and when strategically combined with techniques such as sensory integration, can become an even more powerful tool for therapeutic change. The positive findings from the research on these programs is incredibly encouraging, and offers pediatric OTs yet another tool to serve children and families with ASD.
Since HPOT is a multi-sensory experience that actively engages clients within their environment, pediatric OTs can address a number of functional outcomes within a single session. It’s a great bang for your buck when it comes to selecting a therapeutic tool! You may remember from Motor Learning Theory (or the stroke recovery section of your physical rehabilitation courses) that repetition is one of the most important factors in experience-dependent neuroplasticity (Pendleton & Schultz-Krohn, 2018). In a single 45-minute HPOT session, a horse takes around 4,500 steps at a natural working walk. When mounted, each step of the horse is a challenge to a child’s stability, requiring them to constantly engage in righting and equilibrium reactions in response to the horse’s constant, variable movement (Ajzenman et al., 2013).
How to Find HPOT Programs in
Your Community
If you or someone you know is interested in exploring the benefits of HPOT, a simple google search will start you in the right direction. If you’re interested in trying HPOT for yourself or your child, head over to the website, Path International, which allows you to search for the closest HPOT location to you. This website is a great place to start if you’re looking for more information on what HPOT is, what sessions involve, and how it can benefit you or a loved one.
If you’re a licensed occupational therapist and want to incorporate HPOT into your practice, you may want to check out the American Hippotherapy Association’s website. Here, you can find more information about the certification process and how to become a registered HPOT.
In addition to the resources above, here are some additional links to websites of establishments that offer HPOT in Sonoma & Marin Counties:
Sonoma County Marin County
Renaissance Healing and Learning Halleck Creek Ranch
The Pony Express Wonder Equine Therapy
References
Ajzenman, H., Standeven, J., & Shurtleff, T. (2013). Effect of Hippotherapy on motor control, adaptive behaviors, and participation in
children with autism spectrum disorder: A pilot study. American Journal of Occupational Therapy, 67(6), 653-663. 10.5014/ajot.2013.008383
Halleck Creek Ranch. (n.d.). Welcome to Halleck Creek Ranch. Halleck Creek Ranch. https://www.halleckcreekranch.org/
Llambias, C., Magill-Evans, J., Smith, V., & Warren, S. (2016). Equine-assisted occupational therapy: Increasing engagement for children with autism spectrum disorder.
American Journal of Occupational Therapy, 70(6), 1-9. 10.5014/ajot.2016.020701
Panczykowski, H. (2022). Effects of a Collaborative OT Interactive Vaulting Program on Executive Function and Participation in Children With Disabilities. American
Occupational Therapy Association, INSPIRE Conference, March 31-April 3, 2022, San Antonio, Texas. American Journal of Occupational Therapy, 76, 1. 10.5014/ajot.2022.76S1-PO216
Pendleton, H. & Schultz-Krohn W. (2018) Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction. 8th Edition. Mosby Elsevier
Peters, B., Wood, W., Hepburn, S., & Moody, E. (2022). Preliminary efficacy of occupational therapy in an equine environment for youth with autism spectrum disorder.
Journal of Autism & Developmental Disorders, 52(9), 4114-4128. 10.1007/s10803-021-05278-0
Renaissance Healing and Learning. Welcome to renaissance healing and learning. http://www.reaissancehealingandlearning.com/
The Pony Express. (n.d.). Welcome to The Pony Express. The Pony Express. http://www.ponyexpress.net/
Wonder Equine Therapy. Home. Wonder Equine Therapy. https://www.wonderequinetherapy.com/
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