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Fran Joswick Therapeutic Riding Center
"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.
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 onand actively responds tothe 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 (bonding, 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 surgence 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.
Chet Cooper, Editor-in-Chief of ABILITY Magazine, had the opportunity to meet with Janelle Robinson, a 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 ofhow 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 adjoining 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 disabilities 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 backanterior 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 inaligning 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 alternativesomething 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 interdisciplinary 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, suppose 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.
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.
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