An Analysis of the Models of Equine Assisted Therapy

Published on February 2017 | Categories: Documents | Downloads: 37 | Comments: 0 | Views: 290
of 11
Download PDF   Embed   Report

Comments

Content

An Analysis of RUNNING HEAD: Equine Assisted Therapy

1

An Analysis of the Models of Equine Assisted Therapy Angela Lenz Rocky Mountain College

Abstract: Horses have been used therapeutically for centuries, but only in the 20th century did equine assisted therapies become widespread in the west. Scientifically speaking, there is little evidence in support of these theories. The studies that exist have positive results, but they also have their faults, mostly involving controls and sample sizes. Hippotherapy, as a physical therapy has more scientific support than equine-facilitated psychotherapy, equine experiential

An Analysis of learning, or equine assisted personal development. Although equine assisted therapies have enormous potential, more study is needed for each branch of this developing field.

2

An Analysis of the Models of Equine Assisted Therapy Horses and other animals have, throughout history, been used therapeutically. According to the American Hippotherapy Association (2003), people as far back as Hippocrates recommended horseback riding as a therapeutic exercise. In the 20th century, the use of equineassisted physical therapy became more prominent, especially after 1952 Olympic equestrian silver-medalist, Liz Hartel, claimed that riding horses had assisted her recovery from polio (Casady & Nichols-Larsen, 2004). In the 1960's and 1970's, therapeutic riding became established in Europe and America; in the 1980's and 1990's, the standardization processes began, and associations like the American Hippotherapy Association (2003) and the North American Riding for the Handicapped Association (NARHA) began to certify therapists. These were strictly for physical therapy and it

An Analysis of was not until the late 1990's that anyone began considering the use of horses in psychotherapy (Kohanov, 2001; Irwin, 2001). Equine assisted therapies should be distinguished from therapeutic horseback riding which has the sole purpose of providing a means of recreation for handicapped individuals and is not meant to rehabilitate those individuals (Casady & NicholsLarsen, 2004).

3

There has always been a considerable lack of research on the equine assisted therapies as effective modalities for psychiatric or physical treatment. Hippotherapy as a physical therapy has been tested more rigorously than has equine facilitated psychotherapy, but that does not necessarily mean there have been many reliable experiments performed on it and most of what is known about either model is clinical in nature, rather than experimental. There are certain physical disorders that have been tested rather extensively. For example, equine assisted physical therapy was shown, in a controlled experiment, to improve muscle activity in children with cerebral palsy (Benda, McGibbon, & Grant, 2003). Casady and Nichols-Larsen (2004) also noted a change in functioning for individuals with cerebral palsy after only ten weeks of hippotherapy sessions. A Swedish group of researchers (Hammer, Nilsagard, Forsberg, Pepa, Skargren & Oberg, 2005) performed a single-subject design to study hippotherapy's effectiveness on multiple sclerosis patients. They found statistically significant improved sense of balance levels and roleemotional levels and variable benefits depending on the patient. Another Swedish study (Lechner, Feldhaus, Gudmundsen, Hegemann, Michel, Zach & Krecht, 2003) found that hippotherapy was beneficial to reduce spasticity in patients with spinal cord injuries. They hypothesized that the positioning while riding the horse – hip flexion and abduction, rotation, and three-dimensional movements (Lecher et al, 2003) – were responsible for the loss of spasticity. Psychologically, little has been studied in depth. One of the existing studies examined hippotherapy's impact on children who have suffered a loss (Glazer, Clark & Stein, 2004). They analyzed data with open-coding procedures, which turn qualitative documents into quantitative data. This qualitative study showed an increase in self-esteem and self-confidence, as well as improved trust and communication skills (2004). A study using therapeutic vaulting (gymnastics

An Analysis of on horseback) also demonstrated a different technique that could be used with a degree of success for equine-facilitated psychotherapy (Vidrme, Owen-Smith, & Faulkner, 2002). Macauley and Gutierrez (2004) did a pilot study with three individuals using

4

hippotherapy for language and learning disabilities. The results of the study were positive, which indicated that there could be potential for studies of hippotherapy on children with Attention Deficit/Hyperactive Disorder or other learning disorders. However no conclusion can be drawn from this study because so few participants were used. This study should be looked at as a pilot study only and not as actual evidence that the model works on these cases.

Models of Equine Assisted Therapy There are currently in existence four models of equine assisted therapy. The physical model, which is supported by NARHA and the AHA (2003), is the oldest and most common model. Equine facilitated psychotherapy, which utilizes forms of cognitive-behavioral therapy, is a newer model with less literature to support it. This model is supported in part by NARHA while the two final models are smaller and independent of NARHA. Equine assisted personal development (Irwin, 2005) is a holistic combination of the physical and psychological model, and is used more rarely than either of the parent models. It was developed to help people with self confidence and emotions more than to cure psychiatric disorders. The final model is equine experiential learning, used by Epona (Kohanov, 2000) and by its very nature that it promotes spiritualism, Taoism, and shamanism, it is least supportable by scientific evidence. Hippotherapy Equine assisted physical therapy, more commonly known as hippotherapy, has been shown to aid in improvement of coordination, posture control, and balance (Casady & NicholsLarsen, 2004). The mechanism of hippotherapy is the use of the horse's movement to teach neuromuscular compensation to the rider. Therapists generally prefer a horse whose walking pace is similar to the human pace, at about 80-100 strides per minute so that the compensation required more closely simulates a human walk. Hippotherapy stimulates multiple systems (2004) so that individuals with below-average functioning have stimulation to those systems in which they are deficient. These systems include but may not be limited to the sensory, musculo-

An Analysis of

5

skeletal, vestibular, and ocular systems. Casady & Nichols-Larsen (2004) suggested that the lack of balance when riding a horse demands similar compensation efforts to the therapy ball used by physical therapists. A hippotherapy session like those above (Casady & Nichols-Larsen, 2004) usually involves the rider, usually with the support of side-walkers, being directed by the therapist to walk or jog the horse, navigate obstacles, and perform other tasks that require use of cognitive and motor functioning. Studies such as the Swedish multiple sclerosis study (Hammer et al, 2005) usually outline the particular exercises used in their methodology sections. Hippotherapy seems to be effective with other neurological and physiological disorders such as multiple sclerosis (Hammer et al, 2005) but there still is a lack of research in the area. Until more research is completed, little can be concluded about its efficacy in treating other disorders. It can, however, be considered moderately effective; especially with multiple sclerosis, cerebral palsy, and similar physical disabilities. Equine Facilitated Psychotherapy Equine facilitated psychotherapy (EFP), as the more scientific of the psycho-emotionally oriented models, uses horses as facilitators for therapy. The therapeutic model that best fits the clinical use of EFP is cognitive-behavioral therapy as described by Corsini & Wedding (2005) as viewing mental disorders as incorrect views of self, experience, and future. Cognitive therapy is known to be a solid method for treating many disorders as it attempts to change habitual thought patterns by helping a patient to recognize dichotomous thoughts, personalization, overgeneralization, and other faulty thought patterns (Corsini & Wedding, 2005). Robert and Williams (2004) describe techniques used in the riding aspects such halting the horse by breathing deeply and sitting back, which would reduce stress and anger. Roberts and Williams (2004) describe horses as biofeedback machines which can sense emotions like anxiety and react, so that the rider can notice those emotions and deal with them. Kohanov (2000) cited resonance theory when describing how EFP works. Resonance is an effect similar to biofeedback, and horsemen have used it for years in training (Irwin, 2000). It is said that if one is fearful of their horse or their environment, the horse will become fearful, to the point of danger of those around that horse. An exercise in many horsemanship programs is twofold. First, the rider or handler simply recognizes the horse's nervousness when it tosses its

An Analysis of head, prances, shies, or behaves dangerously. Second, the rider or handler will relax one's own demeanor and handle the horse calmly and firmly. This is what Irwin (2000) calls “being the better horse” and when a horse feels that the one in control of it is not afraid, the horse will be able to behave more calmly. Few know why or how this works the way it does, but some theorize that this is because of pheromones released (Irwin, 2004). In a therapeutic setting, resonance would be useful to help a handler or rider learn to recognize their own cognitive emotions. Someone who is trying to no avail to pull a stubborn thousand-pound horse forward may realize that he is in a losing argument and could easily find

6

more creative ways to win that argument than to continue with it. The therapist would be there to make the connection between the horse's behavior and the rider's life (Kohanov, 2000). When the rider is finally able to coax a thousand-pound animal to do what he wants, then the rider can feel a sense of accomplishment and self confidence (Irwin, 2000). Although theories abound, few scientific studies have been done in this flourishing field. Roberts' and Williams' article (2004) merely described the field and provided anecdotal evidence from nursing school students of its efficacy and discussed resonance. The best available study to date was a qualitative study on grief (Glazer, Clark, & Stein, 2004) and even that is insufficient to conclude anything about the efficacy of equine facilitated psychotherapy in general. From other studies such as the multiple sclerosis study (Hammer et al 2005) or the Casady and Nichols-Larsen (2004) cerebral palsy study, both of which noted improvements in self confidence or emotional levels, it can be concluded that equine assisted therapies are capable of boosting confidence in the riders. Until quantitative or qualitative studies are done with larger sample sizes and sufficient evidence, nothing can be concluded about EFP as an effective form of psychotherapy. Equine Assisted Personal Development Equine assisted personal development (Irwin, 2001) is a somewhat controversial approach to equine assisted therapy because it is somewhat holistic in nature. Holism is a topic with which some readily agree and against which others readily argue. This particular form of therapeutic riding has little or no scientific evidence behind it, except for the same studies that show increases of self esteem and self confidence. Supporters of this theory (Irwin, 2001) use evidence gathered from their own experiences in the field and believe that personal

An Analysis of

7

empowerment (Irwin, 2005) can be achieved by using this method. Body-mind theory uses some methodology in common with equine facilitated psychotherapy (ground work or riding interaction) as well as other techniques, such as reading a horse's body-language, to gain empowerment by learning about oneself. Horse training techniques are those most often used as this model was more used when teaching horse training. The creator of this model, Irwin (2001) was a Canadian horse trainer and clinician who noticed that those he worked with in clinics had more self esteem after they successfully taught their horses to do something. Irwin developed his methods in EAPD to teach his clients how to train horses and to learn about themselves during the process. This model is therefore probably less useful for those who have no experience handling horses. Theorists in this area, as well as in the equine experiential learning model (Kohanov, 2000), believe that there is an ancient connection of sorts between horse and human from as early as the domestication of the horse. When humans today attempt to bridge the gap and understand what the horse is telling them, this provides an avenue for self-improvement as well. This theory is probably also perpetuated by the horse whisperer craze, which was partly initiated by Monty Roberts' (1996) controversial autobiography. Monty Roberts said in his autobiography (Roberts, 1996) that he was often asked if the techniques he used with horses would also work with children, and that he often had abused women break down in clinics from hearing the stories of particular horses. Whether or not the ancient connection between horse and rider really does exist, equine assisted personal development has as little or less scientific evidence to support it as equine facilitated psychotherapy. It seems to be useful as a technique for or theory behind equine facilitated psychotherapy but research is needed on its methodology. Equine Experiential Learning The most controversial of all models cannot be discussed scientifically because there is nothing to discuss. Kohanov (2001) created her Epona equine experiential learning program not only around theories of resonance and the idea that horses can mirror thoughts and feelings, but also around the use of the horse as a shaman and spiritual guide. Epona was the name of a Celtic goddess of horses, and the model involves female empowerment and spiritual empowerment as its goals.

An Analysis of

8

Kohanov's model (2001) indicates that it is possible to communicate psychically with the horses' souls through meditation and shamanic rituals, thereby facilitating the therapy more completely. The horses will become spiritual guides in this unconscious world and give the meditator universal truths for self understanding. This model, which is religious in nature, should be treated most critically of all because of the lack of evidential support for such concepts as psychic communication and the inability to scientifically measure such things. Resonance as a theory, in spite of being new, is not essentially faulty or new-age; in fact it was introduced by a nursing theorist, Martha Rogers, and is a concept discussed in modern developmental theory (Roberts & Williams, 2004). As previously discussed, horsemen have known for ages that a horse can feel tension or smell emotions and Monty Roberts (1996) articulated what we know about equine body language and how horses read human body language. Horses use body language and probably pheromones to communicate with oneanother, and these are more provable scientifically than psychic inter-species communication. One can conclude that the efficacy of using resonance and the mechanism by which resonance works may be useful and may be valid. The fact that it uses concepts about which we know very little makes Kohanov's model weak. These concepts have not been studied and are incapable of being studied using the scientific method. Discussion We know very little about the scientific validity of certain models however one can conclude that as far as we know the physical and psychological models of Equine Assisted Therapy have some effectiveness. Hippotherapy as a model for physical therapy is already wellestablished as a therapy and only needs the scientific evidence. The organizations, NARHA and AHA (2003), have established standardization that can be used in all therapeutic riding programs and in future experiments on the field. Equine facilitated psychotherapy, equine experiential learning, and equine assisted personal development are still growing and have not yet reached any degree of standardization. Far too much reliance is still being placed on anecdotal evidence. However solid scientific studies with a high degree of validity would be difficult and costly to perform. A normal therapy session might have eight or ten riders at the most, whereas an experiment would require a minimum of twelve in the same session to control all variables and to provide some statistical

An Analysis of

9

significance. To have a large number of subjects would require a very large space and extra staff for safety. An experiment of this nature would be very large in scale and quite costly as such. However experiments of this scale are needed to show the validity of the different models of therapeutic riding. There also needs to be some standardization of technique, which has not yet been accomplished. Equine experiential learning and equine assisted personal development have some techniques that could be incorporated into standard equine facilitated psychotherapy and can potentially be quite useful if they can be tested scientifically. Controlling a horse generally is enough to boost self confidence levels and with the help of a licensed clinical practitioner, the potential increases. NARHA and EAGALA are currently attempting some standardization of equine facilitated psychotherapy but there still remains work to be done on it. Using standard techniques, especially similar to those of cognitive therapy (Corsini & Wedding, 2005) will allow for more scientific research in the area. As yet, there is little known about the limits of equine assisted therapies. The signs are positive so far, but it is difficult to predict what conclusions may be drawn in the future when better studies are performed.

References American Hippotherapy Association.(2003). History of hippotherapy and AHA Inc. Retrieved March 3, 2007, from http://www.americanhippotherapyassociation.org/aha_hpot_Ahistory.htm Benda, W., McGibbon, N. & Grant, K. (2003). Improvements in muscle symmetry in children

An Analysis of with cerebral palsy after equine assisted therapy (Hippotherapy). The Journal of Alternative and Complementary Medicines, 9, 817-825. Casady, R. & Nichols-Larsen, D. (2004). The effect of hippotherapy on ten children with cerebral palsy. Pediatric Physical Therapy, 16, 165-172. Corsini, R. & Wedding, W. (2005). Current Psychotherapies, 7th ed. Thomson Learning, Belmont, CA.

10

Gasalberti, D. (2006). Alternative therapies for children and youth with special health care needs. Journal of Pediatric Health Care, 20, 133-136. Glazer, H., Clark, M. & Stein, D. (2004). The impact of hippotherapy on grieving children. Journal of Hospice and Pallative Nursing, 6, 171-175. Hammer, A., Nilsagard, Y., Forsberg, A., Pepa, H., Skargren, E. & Oberg, B. (2005). Evaluation of therapeutic riding (Sweden)/hippotherapy (United States): A single-subject experimental design study replicated in eleven patients with multiple sclerosis. Physiotherapy Theory and Practice, 21, 51-77. Heimlich, K. (2001). Animal-assisted therapy and the severely disabled child: A qualitative study. Journal of Rehabilitation, 67, 48-54. Irwin, C. (2001). Horses don’t lie: What horses teach us about our natural capacity for awareness, confidence, courage, and trust. Marlowe & Company, New York, NY. Irwin, C. (2005). Dancing with your dark horse: How horse sense helps us find balance, strength, and wisdom. Marlowe & Company, New York, NY. Kohanov, L. (2001). The tao of equus: A woman’s journey of healing and transformation through the way of the horse. New World Library, Novato, CA. Lechner, H., Feldhaus, S., Gudmundsen, L., Hegemann, D., Michel, D., Zach, G. & Krecht, H. (2003). The short-term effect of hippotherapy on spasticity in patients with spinal cord injury. Spinal Cord, 41, 502-505. Lehrman, J. & Ross, D. (2001) Therapeutic riding for a student with multiple disabilities and visual impairment: A case study. Journal of Visual Impairment and Blindness, ??, 108109. Macauley, B. & Gutierrez, K. (2004). The effectiveness of hippotherapy for children with language-learning disabilities. Communication Disorders Quarterly, 25, 205-217.

An Analysis of Morgan, M. (1962). Xenophon: The art of horsemanship. Robert Hale Ltd., London, UK. Roberts M. (1996). The man who listens to horses. Balantine Publishing, New York, NY. Roberts, F & Williams, C. (2004). Equine-facilitated psychotherapy benefits students and children. Holistic Nurse Practitioners, 18, 32-35. Vidrme, M., Owen-Smith, P., Faulkner, P. (2002). Equine-facilitated group psychotherapy: Applications for therapeutic vaulting. Issues in Mental Health Nursing, 23, 587-603.

11

Sponsor Documents

Or use your account on DocShare.tips

Hide

Forgot your password?

Or register your new account on DocShare.tips

Hide

Lost your password? Please enter your email address. You will receive a link to create a new password.

Back to log-in

Close