Cameron Elzey tries to throw a ball in a basketball goal during a hippotherapy session as Penny Winter, Nicole Walker and Ann Marie Cascio (from left) check his progress.
To the uninitiated, it seems like a risky business: putting a small child with cerebral palsy, multiple sclerosis or other neuromusculoskeletal problems on a 1,500-pound horse.
The practice — called hippotherapy, after the Greek word for horse — was started by physical therapists in Germany, Switzerland and Austria in the 1960s. American therapists have been doing it since the 1970s and established a standardized curriculum in the 1980s. In 1994, the American Hippotherapy Association began training and registering therapists in the specialty.
Nicole Walker, MS, OTR/L, who didn't grow up around horses, first encountered hippotherapy — the use of equine movement for therapeutic gain — while helping a friend start a camp for children with special needs.
"I took the course to become a registered therapist and found it so amazing," Walker said. "The kids were so motivated and didn't look on it as therapeutic work, yet there were such tremendous gains. I knew nothing about horses before, but I knew this was where I needed to go with my practice."
She started Walker Therapy Services about two and a half years ago. Walker works with private clients in her specialty of feeding and swallowing therapy and does some home-health work, but her main practice is in hippotherapy and equine-
assisted therapy, which uses the horse as a tool and motivational factor.
"Basically, if the horse isn't moving, it's equine-assisted therapy. Patients can improve motor and other skills by grooming or brushing the horse," she said.
Walker has two employees working for her: occupational therapist Nolina Varley, MS, OTR/L, and physical therapist Mike Difrakhsh, MS, PT.
Some psychologists use horses to teach social and behavioral skills and to help improve confidence.
In hippotherapy, occupational therapists, physical therapists and speech pathologists use the movement of horses to address impairments, functional limitations and disabilities in patients with neuromusculoskeletal dysfunction. While it may appear as if a child is riding a horse that is being led by a trainer and therapist — and, in most cases, enjoying it — much more is going on.
"Hippotherapy is multidimensional therapy that allows therapists to address numerous skills at the same time," Walker said. "It has complex physical, behavioral, emotional and sensory benefits."
The reason hippotherapy works is that a horse's bone structure is similar to a person's, and, when the horse is walking, it moves the rider's body in a normal gait pattern. The patient gets the same rotation of the hip and tilt of the pelvis that he or she would get by walking. The horse's movement is unique and can't be reproduced by other therapy equipment.
While riding a horse, the patient receives constant sensory input from the animal. The bouncing stimulates all muscles, including the vestibular system, which controls balance and equilibrium. The therapist can enhance sensory, tactile and other input by changing the rider's position on the horse.
"By having them concentrate on some activity while riding, the constant striving to maintain their balance is integrated into their brain at the subconscious level," Walker said.
Hippotherapy also helps the patient with proprioception — the body's ability to know where it is in space. Contact with the horse stimulates muscles and nerve endings in the skin, helping that system to function better.
"Speech pathologists find that children verbalize more on the horse. Therapists use the rhythm of the horse's gait to reinforce sounds and skills," she said.
Not every child takes to hippotherapy immediately. Some are intimidated by the size of the horses.
"Once we start moving, they get really excited, and they don't think of it as therapy at all. They think of it as getting to ride the horse," Walker said. "It's just neat to see the animal-and-child interactions. Patients who know that they are different from other children love having an activity they can talk about each week. Parents will often take photos."
Walker has been practicing hippotherapy at various locations but is building her own facility in Gainesville. The plans call for a heated, indoor riding ring; an indoor therapy pool; and a clinic for adults and children who have feeding and swallowing problems.
Research is showing more medical and emotional benefits from hippotherapy, which doesn't surprise Walker.
"The best part of doing this kind of therapy is seeing the way the kids respond to it and how motivated they are," she said. "I only see them for an hour a week, so it's really neat for parents to tell us that they are moving so much better at home. They say that they can really see a difference, and that's what a therapist wants to hear."
The cost of hippotherapy ranges from about $160 to $200 per hour, plus barn fees that can run from $25 to $200 per month. Walker Therapy Services has a suggested barn fee of $5 per session.
Because insurance won't always pay for therapy and some patients can't afford to pay the full cost, Walker founded Finding Faith, a nonprofit organization to help children get the therapy they need. It allows Walker to offer services on a sliding scale.
The group hosts fund-raisers, including a 2007 calendar that can be purchased online at the Walker Therapy Services Web site by clicking on the Finding Faith link.