Working with CP (And Other Developmental Disabilities)

Working with CP (And Other Developmental Disabilities)

 

By Katrina Low-Beer, PT, DPT 

If asked what I was interested in prior to graduating almost four years ago (how the time flies!), I would have answered that I wanted to work with the neurologic or pediatric population, probably in an acute care setting. 

Soon after getting my license, I found myself having the good fortune of working with adults and kids with developmental disabilities, ranging from cerebral palsy and spina bifida to Lesch Nyhan disease. The facility where I work is a unique setting wherein the residents live there full time and there is an in-house day program for the adults and a school for the children. I hit the jackpot, really. 

Inpatient Treatment

My first few months as a new employee showed me a whole side of the physical therapy world that was glazed over in school (positioning, wheelchairs, splints and orthotics, etc.). Amidst troubleshooting equipment needs, which allows me to work closely with occupational therapists, I began seeing a few of my clients for individual sessions, typically focusing on gait training, standing tolerance, or sitting balance and core stability. 

Here I found myself presented with the unique challenge of working with clients that had decades of movement patterns and compensation strategies. Due to this, the progress can be slow-going, but it is rewarding for all parties involved. One client in particular, I began working with a little over two years ago to improve her trunk control. This has led to improved respiratory health, the ability to participate in an adaptive cycling program, and the ability to work on supported standing and gait training.

 

Using Hippotherapy as a Treatment Tool for Inpatients

Twice each year, school children in the spring and adults in the fall, my primary employer works with a local facility to bring 5-6 clients for six sessions of what has been affectionately dubbed "horseback riding". I later learned that this is not the preferred vernacular (thanks to the AHA Part I & II courses!). As an avid animal lover, I jumped at the opportunity to participate in these trips with our adult clients. I didn't really know what I was getting into at the time, but I have never been more grateful for the experience.

I was amazed at the differences I observed following (and even during!) each session. I could see decreased tone throughout a session as the client's muscles relaxed with the body heat of the horse as well as the graded rhythmic movements. Another client showed decreased behaviors and increased use and understanding of cause-effect. Yet another demonstrated increased alertness for the rest of the day after our trip.

Not only that, but I was floored by the adaptability of the staff present to address the physical challenges of our clients, both on and off of the horse. Some clients required significant lower extremity range of motion prior to utilizing equine movement while others required assistance to inhibit their preferred positioning into flexion (or extension). They were ready with strategies that could be implemented immediately, or had an idea for the next time.

Outpatient Physical Therapy Utilizing Hippotherapy

Fast forward six months, I took the first AHA course and then spent the summer months volunteering as a side-walker. September came and I began seeing five clients for outpatient physical therapy services. Here, I had the opportunity to work with clients similar to my caseload at my primary job, as well as novel (to me) clients that had movement deficits secondary to sensory processing disorders. While nothing is ever a one size fits all strategy, putting into practice what I had learned was eye-opening. 

Pairing gait training with the horse's movement as a way to build stability on mobility led to a client going from relying on a gait trainer to being able to ambulate short distances independently. In this instance, what amazed me most was that progress was from only one session each week; admittedly, she receives additional services through school, but even so, I could see the difference in her step length and posture between the beginning and end of the session. What humbled me even more, though, was the family reporting the differences that they saw as a result. It's one thing for me, having had gait analysis ingrained into my mind, notice the changes, but for the immediate family and caregivers to also report the positive effects, was another thing entirely.

Lastly, I have found that the trust formed with these outpatients is more than what I experienced during any of my clinical rotations. This trust, in part necessitated by the movement of the horse, lends itself to making physical therapy feel less like work, for both myself and the client. I distinctly remember working with one client in side-sitting on the horse; the progression of going from static sitting to dynamic sitting in this position was amazing. I could tell that her own confidence in her abilities skyrocketed as she realized she could do it. She even went so far as to transition from both hands, to one, then none for support. Then, when we went to the clinic to work on reaching tasks while sitting at the edge of the mat table, there was no hesitation - she just did it. 

Closing Thoughts 

While I know that utilizing equine movement is not right for all clients, I have found that when used in conjunction with strategies that I already use in traditional practice, it has made a world of difference. 

About the Author

Katrina is a New Jersey licensed physical therapist. She graduated from Clarkson University in 2012 with a Bachelor of Science in Biology and Minor in Chemistry. Katrina received her Doctorate of Physical Therapy from Clarkson University in 2016, and completed internships at two outpatient facilities, a skilled nursing facility and at a pediatric burn center. After graduating, Katrina accepted a hospital position with Matheny Medical and Educational Center located in Peapack, NJ. At Matheny, she enjoys treating adults with various developmental disabilities. Katrina came with Matheny to Mane Stream in the fall of 2017 as a sidewalker and loved the experience! She completed the American Hippotherapy Association, Inc. Treatment Principles- Part I in June 2018 and Part II in June 2019 and looks forward to combining this knowledge with her love of physical therapy. Katrina is planning on sitting for the HPCS examination sometime in the near future!

Katrina grew up in Kingston, NJ. In her spare time, she enjoys hiking, yoga, and spending time with her husband and three cats, Basil, Theo, and Freya. She also does aerial yoga!!

 

 
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