Hippotherapy and Cerebral Palsy

Hippotherapy and rational paralyseIntervention AnalysisBackgroundJane Walters is a pentad class old girl and has a diagnosis of left sided convulsive hemiplegia, a form of Cerebral Palsy. Jane has two older sisters who attend sawbuck climb on lessons at their local stables. Jane has recently posited an interest in link them to her p atomic number 18nts. However her parents are worried that because of her diagnosis she testament non be able to keep up with her siblings. However Jane is very independent kid and she doesnt believe that she is any different from other peasantren of her age.DiagnosisCerebral Palsy (CP) refers to non-progressive conditions characterised by impaired voluntary action or posture, and dissolventing from prenatal break dancemental malformations or postnatal CNS damage (Reed, 2013, pp. 38-47).According to the National base of neurological Disorders and Stroke (2008), it is highly likely that a pip-squeak with CP exit devour other medical di sorders such as cognitive impairments, seizures, slow growth and study. Spastic syndromes such as Janes occur in more than than 70 percent of CP fonts.Spastic hemiplegia is a cause of CP that typically affects the arm and hand on one side of the body, but push aside likewise include the leg. . The spasticity creates a state of resistance against any guide of motion, this resistance ultimately en astronomics with increasing speed of that elbow grease (Reed, 2013, pp. 38-47). Children with spastic hemiplegia will more often than not walk later and on topple because of high heel tendons. Often the arm and leg on the boors affected side are shorter and thinner (National Institute of Neurological Disorders and Stroke 2008).Impact of Right Hemisphere Brain DamageThe primary winding cause of CP is damage to white matter of the headspring this is often caused by ab blueprint point build upment, a bleed on the brain, or brain damage caused by a lack of oxygen in the brain, generally caused by a difficult birth.Jane has left sided spastic hemiplegia, indicating that damage to the brain has occurred on the right hemisphere. It was felt important to consider additional complications colligate to right sided brain damage to ensure we are aware of Ellies level of functioning visiblely, cognitively and behaviourally. Those that whitethorn relate to Ellies case are listed below, however, it is important to recognise that each case moldiness be treated individually the symptoms and severity will vary for each individual. concern difficultness concentrating on a task or tensioning on what is said or seen.PerceptionVisual perception deficits causing a person to have difficulty perceiving and processing any information on the left visual field (left-sided neglect). For example, individuals with right hemisphere damage may have difficulty with reading words on the left side of a page, eating food on the left side of their plate, or acknowledging the left sid e of their bodyReasoning and problem solving bar identifying that there is a problem and generating solutions.MemoryDifficulty recalling previously well- groomd information and schooling new information.Social communicationDifficulty reading abstract language such as metaphors, reservation inferences, and dispo tantaliseion jokes and problems understanding nonverbal cues and pursuit the rules of communicationOrganisationDifficulty with systematically transcription information and be afterning, which is often reflected in communication difficulties, such as about(prenominal)eration telling a story with events in the right order, asserting a takings during conversation.InsightDifficulty recognizing problems and the impact on daily functioning.OrientationDifficulty recalling the date, time, or place. The individual may likewise be disoriented to ego (ASHA 2014).medical Considerations for Therapeutic travelPeople with rational paralyze have difficulty coordinating and pr oducing purposeful, functional trends. Some people have too much muscle tone, such as those with spasticity. Their muscles hold their limbs in earlier stiff postures and it is difficult to relax these muscles. Thus, the rider sightnot move his limbs easily besides in the direction the spastic muscles pull. Other types of tone subnormalities include fluctuate tone, as seen in athetoid noetic palsy and hypotonia, or too petite tone.Tone is an elusive thing to quantify. Using treatment techniques to temporarily submit tone more normal does not suddenly result in normal, coordinated movement patterns. In fact, change magnitude tone may be the result of pathologic weaknesses in other muscle groups coupled with the normal human desire to move. Muscle fibers are know to change everyplace time, resulting in increasing, age-related difficulty in maintaining posture. It may be true that abnormal tone, especially spasticity, is an abnormal response to normal sensation, such as tie in and movement sensation.Orthopedic problems occur in people with rational palsy, peradventure partly because of the interaction of the abnormal neurologic system with the muscles, joints and soft tissues. The abnormal, commonly asymmetrical pull of spastic muscles coupled with lack of normal movement and weightbearing notify result in progressive scoliosis and dislocating renal pelviss. Other joints, such as wrists, elbows, knees and ankles, move lose flexibility and range of motion.Despite these factors, the rhythmic motion, shape, lovingness and inherently motivating quality of the gymnastic supply can be right-hand to people with cerebral palsy throughout their lives. Therapeutic equitation can facilitate cognitive and sensori go development in tykehood, help develop a sense of responsibility, self-confidence and fair play in adolescence and return life-long recreation and sport. It can do all this while stimulating the slap-up posture, balance and flexibility neede d for functional independence off the sawbuck.equitation works best for maintaining range of motion and joint flexibility if a well-aligned, correct posture on the buck is always a goal. in that location is no substitute for a ply with good, symmetric movement. Many riders with cerebral palsy can achieve normal balance, posture and movement on a horse if the instructor takes a long, slow approach, digesting on posture and alignment. These are not therapy goals. Good posture, hands-free balance and a following seat are prerequi sit aroundes to riding with ease and comfort for the rider and the horse.Riding sessions for people with cerebral palsy should never result in increased tone and discomfort. Ask the rider (family member or personal assistance assistant) how he feels after the session, when hes at home. Are the muscles relaxed or tight? If spasticity is worsened after the session, decrease the amount of stimulation. Focus on less impulsion, more stretching and relaxation, more straight-line work and fewer circles. Use a horse with a wider base and a smoother walk. Offer an opportunity to sit and rest after commenceing. Try a saddle with a suede cloth or synthetic cover so the riders seat and legs will capture to the saddle better, which will increase his stability and decrease stress.Recent articles by Ruth DismukeBlakely, SLP/CCC, in AHA News and NARHA News, indicate that the movement of the horse in hippotherapy sessions can increase the quantity, quality and volume of vocalization in the rider. For children with cerebral palsy, the horse is a wonderful motivation for expression, while the horses movement can improve the coordination of breathing, sw get outing and sound production. The horse graphicly motivates children with cerebral palsy to move, research and touch. Using the horse as a large, gentle, rhytiunic and predictably moving gross- move platform, where the child is invited and assisted to explore, can be even more useful than lea rning to ride. Instructors can encourage movement and hopefully disconnect it from the fear of failure. The result is self-confidence and courage on and off the horse.The rider with cerebral palsy benefits from advance preparation in many areas. Stretching before acquiring on the horse, as recommended by a material healer, can repress the warm-up time on the horse. When practicing walk-halt transitions, the instructor or healer can use Prepare to walk, Prepare to halt, Get ready to whoa. These preparatory phrases allow the rider to prepare or set the posture needed to follow through the task.If the rider has decreased or asymmetric range of motion at the hips and knees, select the horse that accommodates the problem so the rider can sit easily in good alignment without being pulled to one side. If the hip is partially dislocated (subluxed), the type of horse is essential. The lack of range of motion, spasticity, the horses natural shape and movement can all potentially worsen the subluxation. In general, the rider with cerebral palsy who has orthopedic problems at the hips or book binding may benefit greatly from consultation with a tangible therapist who can assist the instructor in creating an appropriate riding program.-Liz Baker, PT, NARHA Medical Commitfee Chairmanhttp//www.cpparent.org/hippotherapy/articles/cp.htmBissell, C. 2015. Cerebral Palsy and Therapeutic Riding Online. accessible at http//www.cpparent.org/hippotherapy/articles/cp.htm Accessed 29 April 2015.HippotherapyHippotherapy is a form of personal, occupational and saving therapy that uses equine (horse) movement to develop and enhance neurological and physical functioning by channelling the movement of the horse. Hippotherapy is built on the concept that the individuals neuromuscular development is enhanced when their body makes adjustments to the gait, tempo, rhythm, repeating and cadence of a horses movement.What is hippotherapy?In todays world, children with cerebral palsy o ften benefit from several traditional treatments and therapies designed to greatly enhance his or her abilities, and by extension, his or her quality of life. Some therapies such as physical therapy are commonly deployed for those with mobility and function impairment. But others, like equine therapy also known as hippotherapy take an unconventional path in the effort to increase a childs physical strength and cognitive capabilities. base on the concept that humans with physical challenges can benefit from both learned and spontaneous reactions while riding a horse, hippotherapy was conceived in the sixties and used primarily in Germany, Austria, and Switzerland as a companion to more established treatments. Hippotherapy was recognized in the United States in the 1980s as a therapy that not only helps patients with neuromuscular dysfunction increase physical strength and cognitive ability, but also offers the individual a calamity to take advantage of an enjoyable activity tha t contributes to a positive remedy experience.Hippotherapy is a form of physical, occupational and speech therapy that uses equine movement to develop and enhance neurological and physical functioning by channeling the movement of the horse. Hippotherapy is not to be confused with therapeutic horseback riding, in which individuals are taught item riding skills.Hippotherapy is built on the concept that the individual and variable gait, tempo, rhythm, repetition and cadence of a horses movement can enamor human neuromuscular development in humans. Horseback riding triggers a series of complex physical and mental reactions such as making physical adjustments to maintain proper alignment on the horse. Riders must also plan movements to maintain balance on the horse, and be able to interact with the animal.Hippotherapy, through equine movement, works by further developing physical and cognitive abilities, includingStrengthControlBalancePostureEnduranceCoordination sensory(prenominal) integrationUnderstanding of visual cuesWhat are the benefits of hippotherapy?Hippotherapy can help children with cerebral palsy on several fronts. Interacting with the animal can lift a childs spirits emotionally and psychologically while also providing valuable physical exercise as the child learns how to ride the horse properly. A horses gait has trinity-dimensional movementequine movementsimilar to a human that helps a child plan physical responses to the horses movement. Horeseback riding requires subtle adjustments and positioning to maintain proper balance and posture.Physical benefits includeImproved gross motor skillsTrunk core strengthControl of extremitiesImproved postural remainderReduced abnormal muscle toneRespiratory controlcognitive benefits includeImproved attentionVisual coordinationSensory input tactile responseImproved timing and grading of responsesImproved ability to express thoughts, needsPsychological benefits includeEnjoyable interactions with the animalOpp ortunities for social interactionImproved self-esteemWhen is hippotherapy advised?There is no specific age, or point in a childs therapy, that dictates when or if a child would benefit from hippotherapy. Children as young as two eld old, and teens, have benefitted significantly from hippotherapy.The decision to employ hippotherapy will be found on several factors, including whether a childs specific physical and cognitive challenges could be improved by this therapy, and whether mitigating physical and cognitive conditions equal that would preclude a childs interaction with a horse.Because it is not likely to be among a childs core therapies, hippotherapy is incredible to be covered by many medical insurance plans.How is hippotherapy performed?A successful hippotherapy program incorporates the multi-dimensional movement of a horse with that of a human. The therapist will likely begin any course of treatment with an sagaciousness of the childs physical, cognitive and psychologic al abilities to gage whether hippotherapy is appropriate for a child, and what accommodations should be made if a child cannot sit on the horse in a conventional manner.Once a therapist has intractable that hippotherapy is appropriate for a child, he or she will explain how sessions will unfold. Additionally, a child and his or her parents will also be attached detailed instructions regarding how to physically interact with the horse, includingHow to skillfully mount and dismount a horseHow to utilize equipment, such as saddlesWhat to expect regarding the horse movementAfter a child mounts the horse, it is the therapists billet to strictly monitor and control the horse while the child is riding horseback. The therapist will walk alongside the horse to direct equine movement and modify movement in a way that is safe for the child. As the therapist monitors the horse, he or she is also monitoring the child to watch for changing physical reactions such as balance, control, strength and range of motion skills.Changes in physical reactions from the child are considered positive because when a child responds naturally to shifts in gait from the horse, it not only builds physical strength, but also vital connectivity in the brain.Because hippotherapy is practiced by physical, occupational and speech and language therapists, activities and goals in therapy may vary. Physical therapists tend to focus on improving gross motor skills, balance, and strength occupational therapists focus on sensory processing, vestibular and proprioceptive issues, and speech therapists focus on communicationTherapists will monitor the progress of a child, and make modifications to the childs plan of treatment as needed.Where is hippotherapy performed?Hippotherapy generally takes place at specialized institutions, generally in a horse-farm setting. Because the children will eventually ride the horses, and they are encouraged to interact with the animals, special attention is paid to ens uring the surround is stress-free, friendly, and supportive for children and their families.Some programs are dedicated entirely to providing hippotherapy programs all twelvemonth to the exclusion of other activities, and others will have occasional or seasonal programming during certain times of the year. Regionally, it can be challenging to regulate nearby programs because many horse farms are located in country-style communities.Who provides hippotherapy?Those who practice hippotherapy are most often physical, occupational or speech and language therapists, and have met the rigorous educational and certification requirements to practice deep down those disciplines. See physical therapist, occupational therapist, and speech and language pathologists. In some cases, a hippotherapy practitioner may work closely with a professional person horse trainer.The American Hippotherapy Association offers a multi-level educational program that aims to educate aspiring practitioners with a foundation of knowledge regarding how to work with both patients and horses. attestation in hippotherapy is open to physical, occupational and speech therapists that have practiced for three years in their field, and 100 hours of hippotherapy, through the AHA. Hippotherapy Clinical Specialty assay-mark can be obtained after the applicant sits for the HPCS examination. More information can be obtained at the AHAs website, which also includes a list of hippotherapy educators and testify practitioners.The AHAs educational and certification program addresses several concepts, includingPhysical attributes of the horseTacking and untacking of the horseNatural gait of the horseUnsoundness of horse movementLinks between horse and human movement sine qua non procedures and safety practicesSelecting appropriate exercisesTreatment plan effectivenessCreating quality and effective movementsRelationship between treatment and functional outcomesHPCS certification is valid for five years practi tioners must then undergo a re-certification process. During this process, applicants must each retake the HPCS examination, or provide written evidence of 120 hours in additional coursework. Fifty percent of the work must be hippotherapy-based, 25 percent must be related to hippotherapy, and 25 percent must be related to the applicants professional discipline.Hippotherapy practitioners, depending on their professions, may utilize equine movement in different ways. Physical therapists may focus on cultivating strength ad balance in large muscles of the core, legs and arms occupational therapists may focus on fine motor skills, cognitive functioning and sensory integration as it relates to everyday activities and speech pathologists may focus on communication strategies that support speech and language, write or other modes of communication.http//cerebralpalsy.org/about-cerebral-palsy/treatment/therapy/hippotherapy/CerebralPalsy.org, 2015. Hippotherapy and Cerebral Palsy Horse Ce rebralPalsy.org Online. Available at http//cerebralpalsy.org/about-cerebral-palsy/treatment/therapy/hippotherapy/ Accessed 29 April 2015.