All for One and One for All: The Hippotherapy Team Approach

 In this episode, we explore the essential roles of the hippotherapy team in achieving therapeutic goals for clients. As a hippotherapy clinical specialist, our host explains the key players of the team, including the therapist, horse, horse handler, and therapy aide, and how they work together to support the client. We discuss the importance of communication and collaboration among team members, as well as ongoing assessment and evaluation of the client's progress. Listeners will gain an understanding of how the horse's movement can be used to achieve occupational therapy goals, the importance of selecting the right horse for hippotherapy, and proper techniques for horse handling and side walking. Join us as we dive into the power of teamwork and the role of the hippotherapy team in promoting safe and effective occupational therapy sessions. 

Transcript

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hi, I'm Gina host of animals and aquatics. And your guy today, learning all about the hippotherapy team. I am a hippotherapy clinical specialist, which means that I have sat for the American hippotherapy certification board exam as an HPCs, which demonstrates ability and education in understanding the role of the therapist in hippotherapy. Safety. Horse history. There's a lot of components that go into the hypnotherapy clinical specialist exam and it designates a level of confidence in understanding how the movement of the horse can be used as a therapeutic tool. It is open to occupational therapists, physical therapists and speech language pathologists. The American hippotherapy certification board. Registered therapist exam is also open to therapy assistance. So today I'm going to be talking about how use hippotherapy as a treatment tool within the context of the hippotherapy team. So a lot of times as therapists, we are used to working one-on-one with our clients. And setting up her environment, getting everything ready and then jumping right into our treatment session. But one of the really unique. Components. Of using hippotherapy is the fact that we are working in a team, no matter how we look at it, there's a team approach here. And it's really something that needs, support and education to be really effective. And I've seen therapist who are expert clinicians and are very good working with the patient population that they work with. But when put into the team setting, they really start to struggle either. They have difficulty with communicating with other team members. Or they have difficulty dividing their attention and they are either, you know, completely focused on what's going on with the horse in the movement. And they're losing that interaction piece with their client. Or they're very, very into their client, into handling or communicating with their client. And they're really leaving their horse handler out to dry. And that. Ends up, meaning that the horse handler starts making a lot of the decisions and that can really leave to an unbalanced team and team roles. So it's extremely important that when we decide to incorporate hippotherapy into our patient's plan of care, that we can ensure that we have the appropriate team available to support us and to support our clients. So. The hippotherapy team is typically thought of to be comprised of. The therapist. The horse. The horse handler. And there may be an additional, an additional therapy aid such as a sidewalker and we call them the sidewalker because they walk along the side. We may also in some teams have a horse handler that is long lining the horse. In which case we would have an additional team member called a header. There are forward safety person and they're responsible for the horses. Well, So our hippotherapy team can be comprised of a number of different people. With my horse handler. I'm defining that as the person who is in charge of handling the horse during the therapy session. But in some cases, we may also have another member of our team and that may be our horse expert or equine expert or our horse trainer. And so we also need to be able to communicate with them as well. That's an additional person, you know, much like your patients, doctor. Maybe another person that's on your patient's team. You know, when we may not be working closely with them, but we do need to communicate with them. So. Each role on the team is important. As the therapist, my role on the team is really to be the leader. So there's a big component of leadership that comes along with using hippotherapy and. If you are you. A new clinician. That maybe a little role that's a little bit harder to step into, but even experienced clinicians when they start using a new treatment tool or a new treatment strategy. A lot of times you have those feelings of like, am I doing it right? What do I need to be doing in this situation? And when it comes into stepping into the role of a leader in hippotherapy, we really need to be able to be confident. We need to be able to communicate well, we need to kind of have, you know, all our ducks in a row, so to speak because once we're, we're going. We need to know that everybody on that team is able to work together. So as the team leader, we're responsible for. Everything. Yes. Everything. Ultimately it is our license that is on the line. It is our treatment session that we are in charge of. It is our client that we are seeing. So ultimately we are responsible for everything, which if that doesn't give you pause, I don't know what will, but whenever I stop and think about it, it does give me pause to think about how important it is that I'm communicating with all the other members on my team that I feel like they are competently trained. And if I don't feel like they have enough training, that I'm either able to provide the training or make sure that they get the training that they need, that I can find resources to share with them. I can get them. You know, up to speed, so to speak where I feel comfortable with that. Our next member of the team would be the horse. So we are partnering with the horse and we are able to use the movement that the horse provides to reach the goals that our client and I have set together. So one of the things, when I think about this partnership is is this horse able, physically able to do what I need it to do? And this is an important component because if the horse is not physically able to do what I need them to do, it doesn't matter how great of a temperament they have or the other components, you know, that they're willing to work or that they're available for me. I really need to know physically that they have medical quality movement and they're able to provide that input that I need for this specific patient. So that match. Would be a great topic for a whole nother podcast episode, because as an occupational therapist, there's a lot that goes into making the match. There's physical sensory. There's a social aspect and depending on what my client's schools are, I may be focusing on one of those areas more, but really to keep it on target today as a therapy team. Member. That horse. I need to know the horse well enough to know what they have to offer me. And that will help me make a selection. That's going to work for me and for the horse, because if I select the horse to do something that they're not really good at. It's not going to be a great match. It's going to be a struggle for the horse handler. And it's not going to get the kind of outcomes that I'm looking for. So. I want to make sure you know, that the horses going to be able to provide the type of movement or the type of experience that I'm looking for. That they have a temperament that suitable for working with me in therapy. And I want to make sure that that specific day that I'm coming out to treat that the horses ready and prepared. That means. That they've been groomed. They don't have any wounds or injuries that would impact their ability to work. That they're in a good mindset to come out and work with me for that day, because I've seen all of the situations where those things aren't in place and the horse really can't do their job the way that they want to be able to perform. And my client, isn't going to have the experience that I want or need them to have to reach their goals. So for the horse, obviously they're a crucial member to the hippotherapy team. But there's also some key components to the horse that they need to have. Now my horse handler is, you know, my trusted buddy in this team, they are the one that is responsible for communicating with the horse. For ensuring safety that the horse is able to move and perform in a safe way. They are in charge of letting me know if something is happening with the horse that I haven't picked up on. And, you know, something needs to change quickly. They're responsible for all that. They're the person that I'm going to count on in an emergency, whether that's a horse emergency or a client emergency, they're the person I'm counting on. So I need to feel really confident with my horse handler. I can be a bit picky with my horse handlers. I don't like them to change. I like to know who I'm working with. I like them to know my language or communication style. Because I have a particular language or communication style that I like to use with my horse handler. That's a little bit of a shorthand. Because I like to work on a lot of feedback skills with my clients and I don't want them necessarily to know what's coming. So I do have a bit of a shorthand language that I like to use. With my horse handlers and. You need to have worked with me and know that it's, I can't even like print out a cheat sheet, so to speak. Of that shorthand to give to somebody who's new. So it's really important that my horse handlers and I have a good working relationship that they feel confident with me as the leader. And they really understand what I'm asking them for. When I asked for a serpent teen or circle or change direction across the diagonal. Now those are all typical horse. Schooling terms, but not every horse person knows them or uses them in the same way. So I have a very specific idea in mind when I say to do a serpentine, I mean, a three loop serpentine that uses the entire arena. And that's the way I want it done. If I have to take additional time to explain that. That's both my own cognitive power and, and time taking away from my session, but also that's interrupting the flow that I have with my client. So with my horse handler, they have a very important role to play both to the horse as the horse leader, or again, they may be long lining, even if they're long lining, they're still the horse handler. And then also, you know, communicating with me and communicating with the horse. So. In the event that we are long lining, then I want to have a horse header. So that's my forward safety person. And that header is going to be at the head of the horse during any transfers. So in the mounting ramp, as we do our transfer on, as we do our transfer off, if we're stopped for an extended period of time, or if we're going to be outside of an enclosed arena, that header is in place. And they're taking an active role in the team. If we're in an enclosed arena and my horse handlers long lining, then they're just close by so they can hear if they're needed and they can help us in other ways during that time period where they're not. Active with the horse. Some. The head or sometimes is there, but isn't always there, but the horse handler is always there. They may be doing skilled leading, or they may be doing long lining. Then we have the sidewalker or therapy aid. So not all clients need to have a sidewalker. They may have balance that. You know, it doesn't require that extra person. Or they may have sensory or social skills that that other person could interfere with, especially early on in the therapeutic relationship. Sometimes it can be hard for our clients to kind of tune out a second person. And if that second person is touching them or talking to them, that can be challenging. So depending on the patient population that you work with, that therapy aid. Is going to need to have a different set of skills. So this person can be really important to us in. They're handling skills, how they're going to touch the client. And, you know, it's up to us as a therapist, both be able to train and communicate that to them. And then also that social and sensory impact, if they are talking with the client, you know, what are my therapeutic goals? What am I working towards? And the sensory aspect, if they're touching what type of touch that they're using, where are they going to be touching? Those are all really important things for that therapy aid to know. Now my therapy aides are often fieldwork students or interns, and that's great in a lot of ways. The nice thing about fieldwork students and interns is they're super motivated to be there. They're learning about the occupational therapy process. They may have already had some clinical field work rotation. So they may be ahead of the curve as far as some early on clinical skills or handling skills. Those are all things that I can use to my benefit. That therapy aid position on the team can also mean things like helping us get set up. Helping us design pre and post activities. Getting equipment during the session. And bringing it to us or retrieving equipment that has been dropped or equipment that may be needed at the start of the session for positioning. But then as the client becomes more activated that. We don't need that equipment. So our therapy aid can really be beneficial in a lot of ways, not just that like sidewalking position where they're walking beside the client. And I definitely encourage, you know, the therapist that I mentor or coach. To evaluate that position carefully. Do you need that person in that side? Walking position? Do you need a therapy aid to support you in other ways, or is that person on the team not needed for this particular client? And if they're not needed for a particular client, Is there other things that they can be doing at your facility during that time prepping for another session, sanitizing equipment. Cleaning tack, like there's a lot of different things that are involved that you may not need them for directly in that session with Johnny, but you might need them for the session with Sarah. So during the session with Johnny, again, they can be doing prep work. They can be getting stuff ready. They can be cleaning up from the previous session. But their presence in the session with Johnny May be more distracting than it is helpful. So, you know, evaluating that on a per client basis, I think is really important. So when we bring everybody together on this therapy team, What does that start to look like? Well, everybody needs to understand what their role is like, why are they there? They need to understand. What benefit that they bring to the client. They need to know how to communicate with one another. There needs to be mutual respect and understand understanding of the leadership that the therapist brings to the team. So that's really important once we get everybody together, right. And we're ready to get started in our session, we really need to think about how are we going to communicate, how are we all going to work together? And I like to do this a lot of time. So with a kind of a debrief ahead of time. So, you know, hi, we're going to be seeing Johnny today. A couple of the things that Johnny is working on as he's working on taking turns, following verbal directions and improving his body awareness. And here's the things that I need from everybody to do. To help this happen. So when we're talking about. That communication. I'm going to let you know, my horse handler know I'm probably going to be using. Kind of a short form communication because I don't want Johnny to hear all of my instructions. I might be using a couple of hand signals, such as pointing for directions. And I might be using the sign for stop. When I want you to stop if I don't want them to see it. And again, that's gonna depend a little bit. If the horse handler is in front of me and they're leading. And so they're not gonna be able to see a hand signal or if they're behind me and they have a better view. Those are all important components. So when we think about. Coming in and being the therapist on this team. And everything that comes along with that. My role obvi. As I said is as the leader, But I need to be able to collaborate with the horse handler. The sidewalker. And I need to be able to get that quality, that medical quality movement from the horse to help my client achieve their goals. I need to be facilitating. Therapeutic moments throughout the session. So even when it seems maybe like nothing is happening. I'm evaluating the whole environment. I'm evaluating how that client is processing the movement, whether they need more of a challenge or less of a challenge, because it's really important that I'm going through. That process I'm processing it in my mind. I'm communicating with the other team members to get us as close as possible to achieving the client's goals for that day or. At least providing opportunities for the client to go ahead and demonstrate where their skills are. And where their skills are lacking. I need to be having an opportunity to. Just take a breath and assess the picture or the situation. Throughout the session so much like Allen cognitive model, where the assessment and intervention go hand in hand when we're using hippotherapy as a treatment tool, it's also a lot of the same where the assessment and the intervention are going hand in hand, they are happening simultaneously. We're assessing the client's response. We're changing the movement. We're changing the input. We might be changing an activity that we're overlaying or a piece of equipment that we again started with at the beginning, because they needed some support. And we're able to fade that out as the session goes on. There's really a lot that goes to that role of the therapist when we are using hippotherapy both in the pre kind of pregame pre-planning component of communicating with the team. But then when the client is actively engaged in the session that ongoing assessment, the. Manipulation of the equine movement is really what the value of using hippotherapy is. And if we're not doing that on an ongoing basis, if we're just kind of saying, all right, you know, go around the arena two times the left two times to the right, then we're going to do two circles, a serpentine, and then I'm going to change the client's position. That's not using that ongoing assessment. And so our role is really very nuanced. Like if we take out. The interaction piece. And we just look at the interaction between the movement of the horse and the client, right. That's all happening in and amongst all of those other components that are going on. So when we go back to them, looking at selecting the right horse, right. I need to be able to be sure that the horse is going to be able to give that movement. That's going to get my client close to their goals or give those opportunities. In some cases like that midline awareness, right. That I send my client might be working on. I want a horse that is going to have the body shape. That's going to allow that client to have some challenge with midline. I'm going to select school figures. So I need to be able to know that my horse is symmetrical and that they have the lateral flexibility to do those school figures, right. To help that client weight shift across midline. I need a horse that is going to be the right match temper mentally for that client. Maybe if we're working on that midline, you know, are they fearful of moving off of midline or are they really testing it? And they're kind of intentionally moving off a midline. I need a horse that temperamentally is going to be okay with that. So all of those components are part of the horses role in my team, but they're also part of the way that the horse is helping me move towards those functional outcomes. Now, the horse handler. Again, they need to be able to get that movement from the horse. They need to be able to be communicating with the horse in a nuanced way. So it's not interfering with my treatment session. It's not giving me, you know, abrupt changes in movement. If that's not what I want, it's able to, the horse handler is able to maintain the movement of the horse until I asked for something different. So I need a horse handler that's tuned into. To what I'm doing that is supporting me and understands, you know, what my goals are. And is willing to take direction. So I think when we're kind of looking at the horse handler therapist match, right. I need someone for me personally, right. That's willing to take direction. That's going to let me know if maybe there's something a little bit off with the horse and it's going to speak up in those circumstances. But I also don't want a horse handler for me. Like personally, that's going to start making suggestions. Of movement in the middle of the session. That's not going to be helpful for me because a lot of times, you know, I'm, I'm doing that assessment piece and I don't want someone to kind of step up and say, oh, like, is it time to change direction? Because I might've already assessed that and be like, no, we need another time or two around before I make a change of direction. Because then my client has to like process that all over again. So. With my horse handler. You know, I want them to really be open to taking direction. And if I need a better quality movement, I want them to be able to listen to me as far as positioning, you know, where I want them to be positioned or how I want them to ask. The horse to do that. If you are not a horse person or don't have a lot of experience with horse handling or long lining like i can train someone to long line my horses if that's not your skillset, then you need to make sure that your horse handler Has those skills in place because your not going to be able to support them in the same way that i can support my horse handler you need to know that you know you can lead a horse safely and competently around the arena around the facility that you're working that you can ask for a shortening and lengthening of the horses the therapists, because you need to be able to communicate that to the horse handler so the less skill that you have in horse handling and horse training you need to know that your horse handlers. There is going to make up for that and that they can interpret your requests In a way to get that quality of movement for your client And my horse handler i want them if they're leading To be able to maintain their position between you know the horses i am kinda mid neck. i don't want them to be out in front i don't want them to be lagging behind I want them to be able to activate the horse and the horses movement in in a kind and humane way that gets the horse's attention i don't want them dragging the horse because that's going to ruin the quality of movement that i'm getting it's going to change that horses suspension bridge of their abdominal muscles it's going to change the support that my client is getting And that's a lot of nuanced information to try to communicate during a session So again i think that's a lot of times where that shorthand comes in if my horse handler is long lining You know i need to know that they're competent in handling the lines that they're competent in handling a whip That they're going to be able to drive the horse forward into the lines i always you know, tell horse handlers that i'm training like your long line shouldn't look like power lines strung between telephone poles Right it should be a nice straight line because there needs to be communication along that line And that's all part of having really safe horse handling during your session if there's anything going on where that horse handlers not being safe where they're not being effective and efficient We need to be able to step in so again you know As i As i joked at the very beginning you know we're responsible for everything That moving from our horse handler back to our therapy aid. They can fulfill a lot of roles but when they are in that sidewalking position There are second safety person They are responsible for communicating to us what might be going on with the client If we can't see What's happening on that side of the client or that side of the horse if i'm doing you know prone over the barrel And my client's head is facing the sidewalker i want them to communicate to me how does the client look are they happy You know are they starting to look a little distressed do we need to stop or even with you know body positioning i feel like they're coming a little towards my side or their foot is really turning out out on the side what do you want me to do Because it's important that they're communicating to me and then i can communicate the proper handling techniques back. So for our sidewalker like when they are in that sidewalking position there's a number of handling techniques that i might want them to do so arm over the thigh is what it sounds like but i don't want them to be mid thigh i want them to be up high towards the hip crease so that's a component if we're doing a hold over the ankle i want to make sure that they're not blocking the joint If we're doing a stabilization hold for open weightbearing open-hand weight bearing Then i want to make sure that their hand is placed appropriately i want to make sure that if we're providing input we're doing the same type of input So when i have a sidewalker It's really a lot of communication as far as what touch are we using where are we using it and Why are we using it right there has to be a purpose i don't i don't want you touching The client if there's not a purpose to it And there's a component with some of the sidewalkers that i've worked with over the years where they are just too nervous To let go And i need them to let go like i need them not to be touching the client or the client is going to transition position from forward facing to backward facing and the client can do it by themselves right they just need close supervision they need that kind of standby Maybe even contact card I need that sidewalker to be able to do that without you know, moving their leg for them and so really understanding like how much help does this person need Being able to take that hands-off approach all of that goes into that role as a sidewalker as opposed to a therapy aid where they might be assisting me in other ways So our whole team together is super important for our best client outcomes i couldn't do it without my team This is definitely One situation one treatment tool where you you can't do it alone you can't you need a treatment team And getting the best. Best possible quality treatment team is so important i need the best possible equine movement that i can get that way i can deliver medical quality movement to my patients i need a horse handler that is skilled really