“Walk on,” Paul instructs confidently as he signals for his horse to move forward thus beginning his lesson. As the horse and rider move toward the arena a gleeful, “Whoopie!” is heard from the nearly 70-year-old equestrian. All the bystanders within earshot couldn’t help but share in a grin. It is not the age of the man that stirs emotion this day, but rather the reality that three years ago he suffered a stroke that left him paralyzed on his left side. Almost immediately after his stroke, Paul began riding at the Fran Joswick Therapeutic Riding Center in San Juan Capistrano, California. Today, he credits a large portion of his astounding recovery to therapeutic riding.
Within months, Paul found that the therapy sessions on horseback were having profound physical results as he began noticing that he was becoming stronger and his balance was improving dramatically. Results similar to what Paul has attained from this unique form of therapy are being witnessed around the world at therapeutic riding centers. Therapeutic riding, which became a medically recognized form of therapy over 47 years ago. offers an exercise that simulates the three-dimensional qualities of the human walk.
Hippotherapy is a term that literally means “treatment with the horse,” and can be part of an overall treatment plan for a broad range of children and adults with diverse needs. In hippotherapy, the client is positioned on-and actively responds to the movement of the horse. The therapist directs the movement of the horse. analyzes the client’s responses and adjusts the treatments accordingly. As opposed to many traditional therapies, hippotherapy has a system-wide impact including: arousal, balance, posture, respiration, speech/language, timing, circulation, strength, self-esteem, sensory input. perception coordination, muscle tone, cognition processing, impulsivity, emotions and behavior bond Ing, compassion.)
One success story is 4 year-old Trevor who has apraxia. A child with apraxia of speech has difficulty sequencing the motor movements necessary for volitional speech. The most important factor is the root word “praxis,” which is the ability to execute skilled movement. Many children with apraxia of speech also have fine motor difficulties with their hands as well as sensory integration difficulties which cause them to oftentimes be awkward or uncoordinated. At the age of 3, Trevor’s vocabulary was significantly limited in comparison with a typical child. He was unable to stabilize the area of his body between his hips and his shoulders. Regular movements such as walking up or down stairs using reciprocal feet or swinging a leg over a bicycle were far from being mastered. On the advice of a friend, the family visited the Fran Joswick Therapeutic Riding Center where Trevor began receiving hippotherapy sessions, and they never stopped coming.
After only a year with the program, Trevor has shown an amazing surgency in all aspects of his progress, both physically and psychologically. His mother, Jennifer, says that it took close to two months to start seeing the changes. At first the changes were minimal, a new word here or there, and then the changes began cascading and every day brought new landmarks in Trevor’s progress. “As far as the many therapies that Trevor receives, this is by far the best one,” Jennifer notes. “Since coming to the center, he has become stronger and shown more dramatic results faster than from any of his other therapies. He’s developed confidence and started trying things that he would have never tried before like climbing ladders and trees.” Looking up towards the arena where Trevor is lead by a therapist and two “side walkers,” she recalls some of the emotional moments they have had over the past year. “We take for granted the simple things. With Trevor’s apraxia, he has to focus and concentrate 100 percent on every moment in order to take a step. Because of this concentration, it becomes increasingly difficult for him to even do something so fundamental as talk while engaged in any other activity, and look at him now.” There is Trevor, standing backwards atop a moving horse with his arms spread out like an eagle, After ten counts of the exercise, the therapist instructs Trevor to pass a small stuffed animal she hands him to the side walker on the opposite side. This display of fundamental multi-tasking is thrilling to those that have followed his progress from the beginning.
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Chet Cooper, Editor-in-Chief of ABILITY Magazine, had the opportunity to meet with Janelle Robinson, registered physical therapist on staff with the Fran Joswick Therapeutic Riding Center.
Chet Cooper: Hippotherapy is a very unique physical therapy tool that few people have ever heard of how did you get involved with it?
Janelle Robinson: Horses have always been an interest of mine. I have owned a horse since I was ten, so it was kind of in my blood. I had gone to college to become a physical therapist and while in New Mexico I visited a center like this. From the very beginning, it piqued my interest. I thought, “Wow! What a great thing to be able to do.” I never really thought I could get paid though. I always thought I would have to volunteer for the programs. In my eleven years as a therapist, I continued to volunteer at centers in both Atlanta and Maine. After transferring to California I stabled my horse [at the ad joining private stables.] Although I was aware the Fran Joswick center was here, I had come to a point in my career where I was working so many hours that I could not afford the time to volunteer. It happened that I had referred a client to the center and shortly thereafter they called me up and asked me if I was interested in a job. Really, the job found me! What has been encouraging is that in the time since I’ve joined the staff at the center it has become a more widely recognized medical treatment.
CC: Can you tell us about the center and specifically about hippotherapy?
JR: The Fran Joswick Therapeutic Riding Center is a non-profit center that has been in existence for over 23 years. We provide physical therapy to people with dis abilities using the horse as a therapy tool. In the last two years, the center has actually developed a full-time therapy program based in physical therapy. We have two therapeutic professionals who are licensed physical therapists as well as a contracted occupational therapist and a volunteer speech pathologist to volunteer. It has really become an amazing program geared to treat the whole individual.
“Hippo” is the Greek word for horse. There is no such thing as a “Hippotherapist.” I am simply a physical therapist using the horse as a tool. The unique element of a horse’s movement is that it is three dimensional. The horse’s pelvis precisely mirrors the movements of the human pelvis. When we walk our pelvis rotates side to side. It has lateral tilt to the side and it comes front and back-anterior and posterior tilt. Sitting on a horse, the rider experiences the same three types of movement. There is no piece of equipment, no swift ball, nothing in the physical therapy gym that has been proven to be able to mimic the same movement. For a person who has a disability and is unable to walk, hippotherapy is able to duplicate the motion their pelvis would move in-aligning stomach and back muscles and strengthening posterior control within a thirty-minute session. That is powerful.
A similarly unique element of hippotherapy is how much fun clients have. Many of them don’t even feel as though they are having a therapy session. Working one on-one in a standard therapy session can oftentimes be very intense, labor intensive and frustrating. Many patients are weary of doing the traditional exercises and hippotherapy offers an alternative-something different. By placing them on the back of a horse, it becomes recreational and although the therapist never forgets the goals at hand, the clients are able to have a lot of fun and still reap the benefits. The “kids” (who range in ages from ages 2 to 96) are always excited to come here. I never have a client who doesn’t choose to be here, it makes it so easy to motivate them.
Amazingly enough, speech has turned out to be one of the largest benefits that we are seeing with our clients. Children and adults with varying degrees of autism make up a large portion of our clientele and we have been receiving a very positive response from the autistic community because we have had a very high success rate. We have had children with autism come to us who are not speaking at age seven and within three weeks they speak their first word. One child in particular hadn’t spoken at the age of five when he started coming here and now we cannot shut him up!
CC: Hmm…Can you fix that? (Laughs)
JR: (Laughing) We’re working on it! As you can see, there are a wide range of benefits, and it takes an inter disciplinary approach to how we do our work to help clients get the maximum potential benefit. Obviously, there are many components to utilizing hippotherapy. One element is knowing how to choose the appropriate horse for any given rider and understanding how each horse will affect a rider differently. For example, sup pose I have a client whose muscles are very tight and is having difficulty moving. I would choose a rhythmical horse that has a flowing gait in order for the movement to mobilize their pelvis and relax them. On the other end of the spectrum, when presented with a client who has low tone and a difficulty with sitting up, I choose a bouncy horse with really straight legs to help stimulate their bodies and increase arousal.
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CC: As you are clearly working with clients with such a diverse level of ability, many of whom are unable to balance on their own, what procedures are taken to ensure their safety?
JR: All clients begin with a therapist when they enter the program. During their initial evaluation, the therapist makes a judgement as to what type of support is necessary for each individual client. In the file, it will note whether one or two “side walkers” (volunteers who walk alongside the horse and help balance the client) are needed. For example, my next session is with Michael who requires two “side walkers” to compensate for his poor balance and weak trunk control. We are working on a lot of balance, postural control and riding reactions.
Although Michael will most likely always require two “side walkers,” he has made significant improvements. In the beginning, when we turned a corner he would have a startle reflex. He was so frightened as a result of his loss of balance. Today, he has graduated from a really low level horse that barely moved to a pretty rhythmical forward-moving horse that constantly changed his movement. Although the new horse is significantly more challenging, Michael is able tolerate it.
The greatest reward for everyone is when the parents start reporting of the progress that is seen at home. Throughout his sessions, I constantly create opportunities for Michael to reach up, whether it be exercises with his arms or retrieving a toy from a tall mailbox. Now, Michael has begun doing things at home like reaching up to put his shirt on and helping with a toilet transfer by reaching for the grab bar. While these things may seem insignificant to you or I, they are huge things for him.
CC: Do you ever have a child who is unable to participate because they are fearful of the horse itself?
JR: Sometimes, of course. It is not for everybody. I have some little kids who are just too young and can’t stop. themselves from crying. We always try to give them a few chances to adjust to the horse but if we don’t begin seeing progress after three or four times then we will often suggest to the parent that they return in a year or So.
CC: With such diversity in your clients’ ages, sizes and abilities, do you see a difference in the way a horse reacts to different riders?
JR: Absolutely. Every horse has his or her own personality. Some of our horses have never ceased to amaze me. When I first started working here, I would get on a horse who would act up and give me a run for my money. I could then invariably put a rider with a severe disability on the same horse and immediately there would be a submissive change of pace. Horses have an amazingly keen sense. Part of the factor is that the majority of our clients have no preconceived fear. They simply go with the movements of the horse. Whereas you can put an able-bodied rider on who becomes instantly tight and clams up and a horse can feel that energy. Somehow they connect with the energy of the rider. They are definitely cool animals!
CC: In your opinion, what is the most extreme physical disability that can benefit from hippotherapy?
JR: We do have clients who have quadriplegia. Our very first client, a young man who is now twenty-five, has been riding with us for almost his entire life. He has severe cerebral palsy, he is unable to walk and has difficulty articulating words. While he is very expressive, he can’t feed or dress himself. For a client with quadriplegia and cerebral palsy whose muscles are constantly in a state of cramping, the body heat and movement of the horse actually relaxes the muscles which relaxes his body and allows him to feel better. Unfortunately, we do see some clients who are diagnosed with quadriplegia that, for one reason or another, are not candidates for hippotherapy. We are frequently asked about Christopher Reeves. Due to the severity of Mr. Reeves’ injury and the fact that he cannot be off his ventilator, the program would not be suitable for him. On the other hand, we do have clients with spinal cord injuries, stroke survivors and all types people you would never expect to get on a horse.
CC: How extensively has hippotherapy been researched? Have their been any clinical trials?
JR: Therapeutic riding has been around for fifty years and was brought to the forefront by a woman in England [Liz Hartel, an Olympic rider who contracted polio] Studies have been done for many years in Europe and Germany and popularity has grown in the US over the last fifteen or so years. Extensive research has shown it to relax muscle tone, increase blood flow, improve digestion, improve posterior control, and the list goes on.
CC: Is there an average length of time that your clients continue in therapeutic riding or hippotherapy?
JR: The average length of time is four to six years, although as I’ve mentioned, we have some riders who have been here almost their entire life. One element of the center that differs from typical physical therapy programs is that we do not accept insurance. Because we do not work with insurance companies, we are not governed by their assessment of what treatment or physical therapy tools are best for the client and therefore covered under their insurance plan. All our clients pay only a percentage of the actual cost of a session. The center has worked with the community to do outside fundraising and because of this is able to provide scholarships for those clients that need the assistance.
CC: Just by taking a look around, you can tell there are a lot of people involved in making this operation run smoothly. How important are volunteers to the success of a program such as this?
JR: (Laughs) If you can believe it, our volunteers logged over twenty-eight thousand man hours last year alone. For one horse to go out into a single lesson it takes one volunteer, if not three. We simply would not be able to exist in the fashion in which we do, and provide services to as many clients as we do if it weren’t for our truly dedicated team of volunteers. They willingly do everything from helping with the lessons to caring for the horses. The remarkable thing about bringing together people with and without disabilities is the change that happens over time-they seem to forget that a person even has a disability. As a team, we focus on a person’s ability and help them reach their higher goals. I believe I speak for a lot of the therapeutic riding programs across the United States when I say that it is really a unique volunteer opportunity for people,
CC: What type of training do the center’s volunteers undergo?
JR: All new volunteers start by going through an orientation where they receive an overview on the center, therapeutic riding and the most important roles that our volunteers play. For those that decide they want to continue with us, they are taught how to lead the horse properly and how to “side walk” properly. If we put a poorly trained volunteer into a lesson it can compromise the integrity and quality of the service which we provide. It’s been very interesting to observe the close relationships that have developed between our professional staff, remarkable community volunteers and these wonderful animals that we have.
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A perfect example of the unique volunteer opportunities we have is with our dressage riders. Dressage is an Olympic sport of precision riding where a rider is pre scribed exact movements within the confinement of a 20 meter by 60 meter arena. Large letters are placed along the perimeter of the arena and serve as markers. John “Ziggy” Ziggler and Ken Granger are two of our top dressage riders. Both men are blind and ride independently. Because Ziggy and Ken are unable to see the letters on the perimeter, volunteers act as “audible letters.” As Ziggy and Ken are riding, they will hear a volunteer call out, “C! C! C!” Ziggy or Ken would ride in the direction of ‘C. Next, the volunteer standing behind letter H would begin calling and they again change their direction. The “Ziggy Girls,” which they have coined themselves, have come together and become his competition team. They show up and say, “Hi, I am the letter H.” or “Hi, I am letter C.” The volunteers have really come to own the experience and it is very inspiring. When I watched Ziggy compete at the Los Angeles Equestrian Center, it was incredible. To see him out there riding two perfect ten meter circles in the middle of the arena with nothing but three people to help him carve these circles. I have able-bodied students that are challenged to execute those circles and here is Ziggy, who cannot see, and he is doing it perfectly.
CC: What type of impact do you see therapeutic riding centers having on the community as a whole?
JR: Therapeutic riding has really done a lot towards creating an awareness of people with disabilities within the equestrian community. There are many riders out there who have varying disabilities but have competed in the Olympics or the Paralympics and have performed astonishing rides. It is important for us to show the equestrian community that people with disabilities can be con tenders with their typical peers. For those people with disabilities, riding has truly become a great equalizer.
I was at a show for riders with disabilities and at the end of the show, they opened the competition up to able bodied riders to compete with the riders with disabilities. Tired of playing the role of the executive, I decided to have a little fun and be in the competition. In my class, I was competing against two other women; one who wore braces on her legs and used crutches and the other used a wheelchair. As we got going, I became quite the competitor and treated it like any other competition I had been involved in. It was then that I began to understand what we do. These two ladies were just like any one of us doing the same things that the rest of us do. They were not sitting in a wheelchair or leaning on crutches, we had found a level playing field on top of a horse. It did not occur to me until I got back home that one of them beat me, I got second place!
CC: Is it true that the center is going to be expanding?
JR: Yes, and we are so excited! We have almost raised half the needed cash funds. The J.F. Shaw Company has donated an additional piece of land to the organization, a two million dollar value, and we have raised 1.3 million dollars. Our goal is to finish raising the remaining 2.3 million this next year and break ground for the new facilities within eighteen to twenty-four months.
CC: Once the expansion is completed, how many clients will the center be able to serve?
JR: The new facility is being designed to serve up to 300 weekly clients. What we are trying to do is build for the next twenty years. We are also going to continue to diversify the services we offer to our clients. Once we are in the new facility, we hope to add an interdisciplinary team so we can offer the client both occupational therapy and physical therapy. We haven’t decided how, but we are considering including a mental health com ponent. We are not set up to do that at this point nor does our mission dictate dealing with mental health issues. However, we see that as a growing need and so we will thoughtfully approach it.
Our professional education is another program that will benefit from the expansion. Part of our mission is not only to serve the disability community but also to con tribute back to the field. In the therapeutic riding industry there are approximately 850 centers in the United States. Of the 850 centers in the U.S., the Frah Joswick Therapeutic Riding Center is one of only three qualified to train instructors. Since their inception, they have trained therapeutic riding instructors from almost every state in the US as well as instructors from eleven different countries worldwide including Australia, Israel and recently, Japan. The center recently sent an instructor to Japan to develop this as a resource school to the Japan ese. Currently, we provide an instructor training once a year and we are tentatively planning to increase this course to twice a year.
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There are three levels of certification for instructors: registered, advanced and master. To become a registered instructor, you have complete a 200-hour course, after which you can test for the advanced level. For those who have spent several years in the industry, they may undergo the four-day test to become a master instructor. Training is critical as we see 70 or 80 different disabilities in a year. An instructor needs to be competent in the knowledge of how to safely get a client, who does not have control of their body, on and off the horse. It is the responsibility of the instructor to ensure the client has a safe and therapeutic session. All hippotherapy sessions are conducted by licensed medical professionals (therapy professional, physical therapist, occupational therapist or a speech pathologist) who have been additionally certified as a trained instructor.
What has been lacking in the industry up to this point is the amount of training for administrators of the therapeutic riding centers. For the first time, we are offering this course. We are currently bringing together executive directors from Canada, Connecticut, and Northern California to collaborate and share ideas and practices. Therapeutic riding is a fairly young industry. Few centers actually operate at the level to which you see here.
CC: As far as the facilities in the US, are they generally public or private? Has the government yet recognized the benefits of therapeutic riding?
JR: The majority of the centers are non-profit organizations which typically conform to 501 c(3) standards. The great, common factor of all these programs is that they are volunteer driven and they accomplish the same goal of helping people with disabilities focus on their abilities. There is a place in New York which is a residential program for youth offenders. This particular therapeutic riding center is funded by the state and federal government, whereas we are funded entirely by private donations. It varies from community to community.
CC: How many horses do you have?
JR: We have thirty horses in the program at varying states of service. All our horses are screened heavily before they come into the program because they need to be very sound. This isn’t the job for the young, nervous type of horse and some horses are still in their initial ninety-day probationary period. We have about twenty-four horses that are working in this program and anywhere from four to six on trial. Then we house a few that have been retired and are looking for the right retirement home or they are just going to stay with us.
CC. So this is more like a retirement community? (Laughs)
JR: (Laughing) No, we are not a retirement center for horses. (Laughs) Our horses work hard for a living. Some horses have been in service with us for so long that they are part of the family. Out of love and loyalty to them, they will just simply stay with us until whenever its time for them to go. We are a really passionate group and it is a deep partnership. It really is!
CC: Well Janelle, thank you for your time, we wish you all the best of luck and look forward to hearing more of the great things coming from the center in the future!
JR: It’s been my pleasure. We are just so pleased that you are giving the industry much needed recognition within ABILITY. Therapeutic riding and have become tools that are changing the lives of people with disabilities across the country. So many people have centers in their own backyards and they don’t even know they exist.
Lives across the country are being changed. Returning L from a trail ride, Paul beams as he talks about his experiences at the center and what therapeutic riding has meant for him. Since he began riding nearly three years ago, he has been a regular during the annual Swallows Day Parade. He has taken home 1st Place ribbons and Gold Medals from horse shows. As he is a rather confident rider, Paul works more independently than many of the regular clients. With a wisdom Paul probably didn’t even recognize in himself, he summed up what the program is all about, “I got thrown from a horse but I came back. You might fall down, but you have to get back up and keep on going. Walk on,” Paul says, “Walk on.”
Renamed to J.F. Shea Therapeutic Riding Center
written by Romney Snyder
