Working with CP (And Other Developmental Disabilities)

By Katrina Low-Beer, PT, DPT 

A critically appraised review of the article: "Interventions Within the Scope of Occupational Therapy Practice to Improve Motor Performance for Children Ages 0–5 years: A Systematic Review" 

Tanner, K., Schmidt, E., Martin, K., & Bassi, M. (2020). Interventions Within the Scope of Occupational Therapy Practice to Improve Motor Performance for Children ages 0–5 years: A Systematic Review. American Journal of Occupational Therapy, 74, 7402180060. https://doi.org/10.5014/ajot.2020.039644

Working in the therapy field has always been my dream; ever since I was exposed to occupational therapy, I knew it was what I wanted to do.  Six years of higher education later I was able to land a job in one of my fieldwork placements in pediatrics - a dream come true! After five years of work as an occupational therapist, I finally felt like I had a handle on this being an OT thing; I knew I was ready to add in something different to continue my professional growth. Sure, I had been keeping up with my CEUs and attending some courses here and there, but I was ready for something that would really push me outside my comfort zone and help me continue to contribute to the field I love so much. Thankfully for therapists, there are so many different types of opportunities to grow. From specialty certifications to higher-level professional development courses and trainings - the possibilities seemed endless.  With so many options, I felt emboldened by the opportunities, but unsure which direction to head next. I decided to attend the American Occupational Therapy Association's national conference. I started exploring and after talking to anyone who would listen about what was out there, I landed on getting my doctorate. This was no easy feat, but one particular course asked me to find a community program and ask them to open their doors to let me evaluate what they were doing. I found myself, for the first time, completely in luck to personally know someone who was the director of a therapy program at a nonprofit organization I contacted Melanie Dominko-Richards at Mane Stream in Oldwick, NJ and set up a day and a time for me to come out and see see what Mane Stream and hippotherapy was all about. In my lifetime, I had such limited exposure to horses (we are talking about riding a pony once as a small child and one trail ride as an adult). After coming in and looking around, I had the opportunity as part of the project to interview key stakeholders. From the administrative and therapy staff, to the board of directors, parents, and volunteers, every single one of them talked about treatment sessions incorporating equine movement with an air of majesty in their voice. It felt like they all knew something special that I didn't quite understand… yet! After observing my first therapy session, I saw the magic for myself and was officially hooked. As soon as I could (even before doctoral school was halfway over) I signed up for the AHA, Inc. Hippotherapy Treatment Principles - Part I course. Seeing horses through a scientific and therapeutic lens was exciting and new. After completing the Part I, I knew I needed more direct experience with horses, so despite my super packed schedule, I signed up for the Mane Stream volunteer training program. My first time grooming and tacking to prepare to sidewalk during a therapy session was terrifying, but thankfully I was surrounded by so much care and support in the barn, those first-day jitters soon faded away. As my confidence and experience grew, I felt ready to sign up for the AHA, Inc. Treatment Principles - Part II. Completion of this course gave me the chance to learn even more, and I proceeded to take the AHA, Inc., Sensory Connection course. As an OT, this was an amazing opportunity to take what I was already doing in the clinic and understand how to not just replicate it, but enhance it using equine movement. Three courses down I was still volunteering, finishing my doctorate and working, but the time spent at the barn always kept me going. I looked forward to the drive down, the open space, the sunshine. I needed it as almost my own therapy. When doctoral school was a thing of the past (finally!), the opportunity arose to get on the proverbial "horse" and start treating! I jumped at the chance immediately) and cleared my Saturday mornings. The first day I was a bundle of nerves but thankfully I had the skilled Mane Stream volunteers and an amazing COTA who held my hand and got me ready to take the lead on her caseload. That was in January 2020 and every week since then, I have found myself becoming more and more confident in my abilities to use the horse in my sessions. I have also become more comfortable interacting with the volunteers and horses as partners in helping me deliver the best possible treatment during my occupational therapy sessions. 

Mentorship in the New Year  

A new year brings opportunities for self-improvement, including professional growth.  Finding a mentor can be an excellent way to advance your career, improve your treatment skills set, or tackle a challenge that has been waiting for you. As a professional using hippotherapy in your practice, you may find yourself wondering, how do you locate a mentor and make a good match?

Read more to learn:

Laurie Schick, MPT, HPCS

How long have you been a part of AHA, Inc. and how did you become involved?  
I have been a member of the AHA since 2003 when I took my first Level 1 course. I started to become more involved with AHA when I began regularly attending the biannual conferences in 2009. Ruth Dismuke-Blakely helped myself, and others in Oregon, remove hippotherapy as an exclusion under our state Medicaid plan in 2015. Ruth asked me to join the Reimbursement Committee in 2016. My commitment and involvement with AHA, Inc. has continued to grow considerably since then. I was asked to be on the Terminology Summit group in an effort to provide uniform terminology across multiple industries that utilize the horse to benefit people. I joined the board in Spring of 2020 and am now chairing the Ethics, Advocacy, and Reimbursement committee.

Where does one start, to enumerate all the many and varied educational and board positions  Lori has held in AHA, Inc. over so many years. Lori has served on the AHA Board of Directors at two different times, the first time when AHA became independent and in the past few years. Lori has been Chairperson of the Education Committee both times that she has been on the board and has served on the board’s Executive Committee as Vice President. When AHA was still a section of NARHA, Lori was AHA’s Region 2 representative and has served on the Ethics and Advocacy and International Education Committees. Lori is a Hippotherapy Clinical Certified Specialist and a recipient of the 2013 AHA, Inc.  Barbara Glasow International Therapist of the Year Award. 

Lori became coordinating faculty for AHA in 2000. She has taught Level I and Level II courses, The Neuro Connection Course, The Horse Handling Course and developed and taught the Business Course, being able to teach the specialty Neuro course and the Horse specific courses showcases the breadth of Lori’s therapist and equine knowledge.

Summary: AHA, Inc. Review of “Optimal Terminology for Services That Incorporate Horses to Benefit People” 

On December 1, 2020, the results of the “Optimal Terminology for Services in the United States that Incorporate Horses to Benefit People: A Consensus Document” was published in the Journal of Alternative and Complementary Medicine (click here). The terminology work that took place over the course of two years aimed to develop optimal terminology among the various stakeholders that offer services including horses. Much progress was made in clarifying terminology for consistent use and for discontinuation.

The American Hippotherapy Association, Inc. (AHA, Inc.) was pleased to have participated in an effort to develop optimal terminology among the various industries that bring horses and humans together, spearheaded by PATH Intl. AHA, Inc. was represented in the terminology working group by Joann Benjamin, PT, HPCS. Laurie Schick, PT, HPCS and Nina Ekholm Fry, MSSc., CCTP were part of the summit group. AHA Inc. is grateful for the efforts of these long standing and dedicated members who advocated for appropriate terminology on behalf of AHA Inc. members. Terminology has been a long standing challenge; misuse of terminology, unclear terms, and inconsistency of the terms utilized in published research has resulted in challenges with reimbursement for clinical services and lack of clarity and safety for consumers. 

Terms such as “Equine Assisted Activities and Therapies” (EAAT) and now “Equine Assisted Services” (EAS) are problematic as they combine the various industries together under one name despite there being vast differences between the healthcare, horsemanship, and learning industries. These terms do not clarify for the consumer what service will be provided. Healthcare professionals are held accountable by state practice acts and regulations to clearly represent the service being provided in all communication. While the convenience of a unifying term is understood by AHA, Inc. for facilities that offer multiple services, the lack of clarity that this term will bring is equivalent to the challenges seen now with the term EAAT. As stated at the PATH Intl. Virtual Conference Opening Panel on Optimal Terminology on November 6th, 2020, AHA, Inc. does not endorse the use of Equine Assisted Services (EAS) as it relates to therapy in order to avoid potential confusion; we recommend that centers indicate which services they offer (horsemanship, learning and/or therapy). 

Disclaimer: All photos included in this post were staged with the assistance of experienced horse handlers and riders. Use of these images in any context other than their use here is not permissible.

Running a physical therapy, occupational therapy, or speech-language therapy practice is hard, but running a physical therapy, occupational therapy, or speech-language therapy practice that safely and effectively uses the treatment tool of hippotherapy as part of a total plan of care is even harder. There are many more factors to be taken into consideration including horse handlers, sidewalkers, horses, equipment, as well as the terminology you use when discussing your practice both in person and online. In the spirit of Halloween, we’ve put together a list of some tricks to set you up for a safe and effective treat(ment).

White Paper:  Occupational Therapy, Physical Therapy, and Speech-Language Pathology Incorporating Hippotherapy is a Safe Therapeutic Option 

The American Hippotherapy Association, Inc (AHA, Inc.) promotes the integration of hippotherapy, or the purposeful manipulation of equine movement, into a client’s plan of care. AHA, Inc’s mission is to “improve lives by advancing education, best practices and resources for licensed healthcare professionals who incorporate horses in therapy”.1 Since its inception, licensed occupational therapy (OT), physical therapy (PT), and speech-language pathology (SLP) professionals have worked to ensure the safety of their clients during treatment.  This paper is intended to provide information on the safety of the incorporation of hippotherapy into therapy practice.  

Association-level Supports

According to the American Speech-Language and Hearing Association (ASHA), augmentative and alternative communication (AAC) includes all of the ways we share our ideas and feelings without talking. There two main types of AAC: unaided and aided. Unaided AAC refers to any nonverbal communication that does not require anything other than your own body. This includes pointing, gesturing, facial expressions, and body language. It is quite simple and natural to incorporate unaided AAC into the equine environment. In fact, most people use unaided AAC naturally in their day-to-day communication without any thought or planning. Aided AAC refers to a tool, device, or system that a person uses to augment their verbal and unaided communication.

In this time of uncertainty when seeing your clients in the clinic may not be safe, telepractice may be an option to ensure continuity of care!

1) Check your national organization website. AOTA, APTA, and ASHA have been in direct communication with the Centers for Medicare and Medicaid (CMS) and updating information regularly.
https://www.aota.org/Practice/Manage/telehealth.aspx
http://www.apta.org/PTinMotion/News/2020/3/16/TelehealthCOVID19/
https://www.asha.org/Practice-Portal/Professional-Issues/Telepractice/

Wood, W. H., & Fields, B. E. (2019). Hippotherapy: A systematic mapping review of peer-reviewed research, 1980 to 2018. Disability and Rehabilitation. DOI: 10.1080/09638288.2019.1653997

Journal Impact Factor: 2.054

What is an Impact Factor? 

Introduction:

AHA currently defines hippotherapy as the use of equine movement as a treatment tool to promote functional outcomes; occupational therapists, physical therapists, and speech-language pathologists incorporate this treatment tool as part of their plan of care. Previous reviews of hippotherapy have either been inconclusive, or established that the research supporting hippotherapy is in early stages of scientific development. In the family of review research, systematic mapping reviews are the review of choice to implement when a body of literature is in early stages of scientific development, as they are broad in scope and include literature at varying levels of rigor. This particular systematic mapping review was informed by a phased, developmental approach to understand how complex interventions are empirically advanced. That is, research on complex interventions begins with early formulation of key elements of the intervention and its underlying treatment theory, progresses to proof of concept studies, investigation of acceptability and feasibility, and finally enters into studies of treatment efficacy and effectiveness. The purpose of this systematic mapping review was to “systematically and thoroughly gather, describe, categorize, and synthesize, or map, published research of hippotherapy as a guide to future research initiatives.”

Jessica Perkins, MS, OTR/L, HPCS

How long have you been involved with AHA, Inc?

I have been a member of AHA, Inc. since 2015, but was first exposed to hippotherapy in 2006 when I began volunteering with an OT and PT who incorporated equine movement into their practice. Working alongside them and learning about their respective professions guided my decision to become an occupational therapist and go on to attain my hippotherapy clinical specialist board certification. 

What has been the biggest surprise to you as a new board member?

As I become more familiar with the Board of Directors and the various committees that serve the AHA, Inc., I am in awe of the amount of dedication, passion, time, and effort that all of the Board and committee members contribute as they strive to advance the educational and professional standards of the organization and the industry. I am honored to serve alongside them.   

It’s easier than ever to sign up for an AHA, Inc. educational course. Here are the steps to get you started

Introduction:

Have you thought about hosting a course for the AHA, Inc. but aren’t quite sure what it entails? While the process can be daunting for first time hosts, the AHA, Inc., and Faculty are here to assist you along the way. Below is some advice and insights from facilities that have hosted an AHA, Inc. course in the past. 

It is a very exciting time for AHA, Inc. as the organization begins to expand its knowledge and expertise to international waters. Currently there are six American Hippotherapy Certification Board (AHCB) certified therapists and four Hippotherapy Clinical Specialists (HPCS) internationally. To date, AHA, Inc. faculty have facilitated international courses in Spain, Greece, New Zealand, South Korea, Mexico, Portugal, Russia, China, South Africa, Turkey, and—this year—Saudi Arabia. These courses were host to a wide international presence.

What makes a champion? According to Lynch (2006), a champion has courage to risk failure. A champion also has passion, vision, and creativity. They understand their weaknesses and work to strengthen them. They enjoy what they are doing, simply for the pleasure of doing it. They likely also possess a special talent, a niche personality, charisma, and a long-term vision of goals and opportunities for future possibilities. What constitutes a professional? For that matter, what is professionalism? For some, there may be an internal drive that creates a journey into professionalism. According to Atkins (2013), “Professionalism is a responsibility to bring changes in people’s lives.” He also states that attitudes drive behaviors, behaviors drive action, and action reinforces attitudes.