The Angry Biller
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A show where we explore the people and the businesses behind-the-scenes of healthcare, those men and women that are the catalysts that allow providers to concentrate on delivering exceptional patient care.
The Angry Biller
Ep 35 - Community and Compassion: Transformative Horse Therapy with Denise Panariello
Discover the transformative power of horse therapy with Denise Panariello, the passionate Executive Director of Bit by Bit Therapeutic Riding Center. Denise's journey from a mental health career to the forefront of hippotherapy reveals the incredible physical and emotional benefits horses offer to children with disabilities. From mimicking the human gait to facilitating speech development, horse therapy provides a dynamic, engaging alternative to traditional therapies. Listeners will learn how this innovative approach is changing lives, offering renewed hope and joy to families across the community.
Our conversation also uncovers the heartwarming success stories that highlight the impact of Bit by Bit's work. As the center grows in Davie, Florida, with plans to expand facilities, Denise shares how the support from dedicated therapists and volunteers fuels this vital mission. We delve into the logistics of therapeutic horseback riding, addressing the thoughtful considerations in equipment and horse selection to ensure comfort and progress for each child. As a nonprofit, Bit by Bit thrives on community involvement and support, with upcoming events and opportunities for listeners to engage and help expand their reach. Tune in to feel the inspiration and learn how to be part of this exceptional journey towards healing and empowerment.
Denise Panariello
Bit-By-Bit Medical Therapeutic Riding Center
Website: http://www.bitbybittherapy.org
LinkedIn: https://www.linkedin.com/in/denise-panariello-ms-otr-l-ctri-63608959/
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Phone: (954) 544-2706
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Production of Podcast: VISUALS BY MOMO
Josh Fertel
00:04
Welcome to the Angry Biller, a show where we explore the people and the businesses behind the scenes of healthcare, those men and women that are the catalysts that allow providers to concentrate on delivering exceptional patient care. Welcome to the Angry Biller. My name is Josh Fertel, I'm the owner of J3 Medical Billing and I am your host. We are here at the Visuals by Momo studio in Fort Lauderdale, florida. You know I like to have nonprofits on. I think that the work that they do just it eases some of the things that a provider has to take care of, and they're doing it for such a great cause and very excited today. Denise Panariello, bit by Bit Therapy. They have a great take on, a nice way that they handle things. We're going to learn about the word hippotherapy, like I promised. I'm going to find out exactly what it is, but thank you so much for coming, denise.
Denise Panariello
00:55
Thank you for having me. I'm excited to be here today.
Josh Fertel
00:57
Yeah, and I want to hear everything they do, but I want to hear about you. First, tell us your story.
Denise Panariello
01:03
Oh sure, my name's Denise. I'm with Bit by Bit Therapeutic Writing Center. I'm the executive director there. I've been the executive director for about the past year and a half, but I've been with them since 2011.
Josh Fertel
01:15
They've been around for a while.
Denise Panariello
01:17
They have been. They've been in existence since 2002. Wow, I started my career in mental health.
Josh Fertel
01:26
Okay.
Denise Panariello
01:27
I have my master's degree in counseling psychology, nice, and later in life I went back to school for occupational therapy.
Josh Fertel
01:34
Okay.
Denise Panariello
01:34
And I did my student fieldwork at Bit by Bit. I had never been around a horse a day in my life before that Right. And I started as a student and never left.
Josh Fertel
01:46
What made you want to go into occupational therapy?
Denise Panariello
01:49
So I had always worked with children and families and I at one point found myself working in a residential treatment facility a long-term residential facility with kids with special needs and developmental delays. And when I had moved to Florida with my degree in counseling I could not get licensed right away. I had to go back for more classes. Interesting I didn't transfer over and at that point I just decided if I needed to go back to school, then I was going to go back for occupational therapy.
Josh Fertel
02:24
No, that's great. So let's go back a little bit further. What got you into the whole health field? Is there something? That sparked it.
Denise Panariello
02:32
You know, I've always loved working with people and have wanted to help people, and then I just was always drawn to working with kids. So, starting, I worked in a daycare. I started babysitting when I was 12 years old, so it just stayed with me.
Josh Fertel
02:52
Okay, so tell us about Bit by Bit.
Denise Panariello
02:54
So at Bit by Bit, we're a nonprofit organization and we provide therapy, healing with the help of a horse, and so we do much needed therapy occupational therapy, physical therapy and speech therapy with individuals with disabilities and special needs. And we use a horse and its movement in our therapy sessions.
Josh Fertel
03:16
Let's break it down a little bit. Somebody comes to you, give us an example of somebody that would come to you, and then the process of getting the horse involved.
Denise Panariello
03:24
Sure. So you know we work with primarily children, but all ages. We start as young as 18 months and go all the way through the lifespan. So we you know a lot of referrals come word of mouth from other families who have been with us. A lot of doctors are becoming much more aware of the impact that the horse's movement has.
03:46
So let's say we have a child who has cerebral palsy and they are receiving traditional therapies in a clinic, and a lot of times, at a certain age, the kids start to burn out in a clinic setting, and so families are seeking an alternative, and in addition to what they might be receiving elsewhere.
Josh Fertel
04:04
So they find that's how they find us Okay, so why does this make a difference?
Denise Panariello
04:10
So many reasons.
Josh Fertel
04:11
That's what we're here for. I want to hear the reasons.
Denise Panariello
04:15
The physical impact. So the horse's movement actually mimics the human gait pattern. So just by placing somebody on the horse to sit and walk forward, you're putting their whole physical body in the natural symmetrical, multidimensional movement that they would get from walking so for someone who doesn't walk independently. That has a massive impact on them.
Josh Fertel
04:38
Yes.
Denise Panariello
04:40
And the social-emotional piece. You can't ignore that. It's fun. It's fun. These kids forget they're in therapy. They're coming for, as far as they're concerned, to ride their horse.
Josh Fertel
04:51
Right.
Denise Panariello
04:52
And so it makes it when someone is more invested in their treatment and it's more fun for them. For children, you get the maximum benefits from it because they're active participants in their therapy sessions, as well, and what?
Josh Fertel
05:07
is there a science behind this, or is it? Is it really emotional more than anything else?
Denise Panariello
05:12
No, there actually is. There's a lot of evidence-based practice that supports the use of horses movement in therapy sessions, and it's something that we you know. The American Hippotherapy Association has a lot of information on their website with all the evidence-based practices. There's been a lot of advocacy with different physicians and other community practitioners and providers to support it as well, so they're really starting to see it.
Josh Fertel
05:41
Is there example of of what, what they, uh, what they're seeing?
Denise Panariello
05:45
what they're saying.
Josh Fertel
05:45
Yes, it's improving their balance, okay coordination strength, um because and again because it is a multi-dimensional, symmetrical, rhythmic uh movement that you no piece of equipment can mimic no, and at all if somebody, and if somebody who can or has trouble walking to be able to get that freedom right.
Denise Panariello
06:09
Yes, is that the word? Yeah.
Josh Fertel
06:11
And up high right.
Denise Panariello
06:14
Oh, and it's so funny that you say that because I was just thinking about that this morning I had a child that I'd worked with for a long time who had cerebral palsy, and she was in a wheelchair Right and she did a video for us at one time and one of the things that she said were two things that were really kind of hit home, and one was one the horse is her legs, you know.
06:36
And so. But the one thing she said as a preteen who was in a wheelchair most of the day, she said when I'm on the horse, people have to look up to me.
Josh Fertel
06:46
Different perspective.
Denise Panariello
06:47
And instead of me always having to look up to talk to somebody, and it was so moving and insightful to hear that from a 12-year-old girl, it was quite remarkable. The founder of Bit by.
Josh Fertel
07:00
Bit. Can you tell us about this?
Denise Panariello
07:02
person. Sure, we have two founding members, kathleen Pegues she's an occupational therapist and Susan March, who's a physical therapist, and both currently sit on my board of directors and they're still very active in all the operations.
Josh Fertel
07:17
And what was their passion?
Denise Panariello
07:20
Pediatric therapy and I know Susan has shared her story when, um, she covered for another therapist with that was utilizing horses in their sessions and, being someone who grew up riding horses, uh, that one day changed her life forever and they started this program. Each bought a horse, so they had two horses and four children, and we now currently have nine horses and we provide over 500 therapy sessions a month 500 therapy sessions a month yes, wonderful it's amazing.
Josh Fertel
07:55
When do you think somebody discovered that like a horse was was the way? To go you know how far back does that go?
Denise Panariello
08:03
um, I'm fairly certain it goes way back and I believe that all the science behind it started in the 1960s. Um, and it started overseas in europe which hence the term hippo therapy okay hippo is the greek word for horse, so that's the answer we've been waiting for. That's the answer that you've been waiting for I didn't mean to interrupt you, no, no, go ahead.
Josh Fertel
08:33
Okay, so let's talk about the horses. Where do they come from? What kind of training has to be done? So, there's a lot of work that goes into our therapy horses.
Denise Panariello
08:44
Okay, tell us. They come from all different places.
Josh Fertel
08:45
Okay.
Denise Panariello
08:48
We've had rescue horses. We currently have two rescue horses. One in particular came from a rescue in Palm City that has a program where they specifically train horses to be therapy horses. Oh wow, he's been a great addition to our program as well. And then we do most of the training there, but we purchase them we have two ponies that were just rehomed to us.
09:17
Some are older, some are younger. Families Like I have this great horse that we can't take care of anymore we're looking for. They need a job to do Right, and so a lot of they need a job to do Right, so a lot of times they're donated or adopted. Yes, they're either donated to us or we do purchase horses as well, if they're a good fit, because they have to have the right temperament to do this job.
Josh Fertel
09:37
Right, okay, I want to take a break. But I do want to ask you about the training a little bit more when we come.
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Josh Fertel
10:00
We're back with Denise Panarello from Bit by Bit Therapy. So the assimilation, I guess, between the horse and the rider, right, tell us about how that works. I like said there's. You know we talked about training of the horse, so there are some things that I guess you have to teach them. And then you have to set expectations for the patient, right.
Denise Panariello
10:21
Absolutely, and you know, but it's very similar to just any other therapy clinic you would go to. So with the expectations, with the expectations with our clients that come in, is we do individualized treatment plans and we develop a plan of care based on their individual goals, the family's goals and their functional outcomes.
Josh Fertel
10:40
Can you give an example of?
Denise Panariello
10:41
that. Sure, we have some families that they want their children to walk better. They want their children to sit in school and attend to tasks.
Josh Fertel
10:53
That's a big one.
Denise Panariello
10:55
Improve their self-regulation ability to you know. Calm themselves self-soothe when they're upset which we see oftentimes with children on the autism spectrum and so it's just developing the plan and then we pair that child with a particular horse, based on the horse's size, with movement and temperament and to get the maximum benefit.
Josh Fertel
11:18
That was my next question. So what does that look like when you're trying to decide which horse to pair with which patient? Is it a group of people getting together, a group of providers getting together, or is it just something that you have a? You've been doing this so long, you know.
Denise Panariello
11:32
That's a big part of it. It's usually my management team, our senior staff, but with the input of the treating therapist as well. The therapist comes and says hey, next week can we try a different horse or different equipment with them? We always listen to that and we kind of go with it from there. And then sometimes a child just connects with a certain horse where that may not have been the horse I would have chosen for them, but it just works because they just decided that was the horse they wanted to work with.
Josh Fertel
12:01
Why would the change? What's the thought process between changing equipment or changing a horse? What is it that's being seen? They say well, you know, this could be a little better if we do this.
Denise Panariello
12:11
So some of it could be the child's posture and strength, that sometimes they may have difficulty sitting up on their own, and so we may need to change up the equipment that provides them with a little bit more support, and we may need to change the horse to a shorter horse where we can provide them with more support. So it could be varying reasons like that, or just that day there may be something different we want to work on, so we're going to do different equipment for that.
Josh Fertel
12:41
So I can imagine that there might be some children that are a little overwhelmed when they first see a horse. How do you get around that? We just work through it. Some children that are a little overwhelmed when they first see a horse how, how does that? Uh, how do you get around that?
Denise Panariello
12:50
We, we just work through it. Okay, you know we just a lot of times, oftentimes the first session. We keep the time on the horse very short.
Josh Fertel
12:57
Right.
Denise Panariello
12:57
Um, and we just let the horse's movement do its job.
Josh Fertel
13:02
Yeah.
Denise Panariello
13:02
And so we oftentimes we won't put any demands on the child, we won't do any major changes or quick movement patterns or anything that we would do later on in therapy. We just let them absorb the soothing, rhythmic movement of the horse.
Josh Fertel
13:19
I love the whole concept. Where is your practice? Where is it?
Denise Panariello
13:23
We are in Davie.
Josh Fertel
13:24
Okay, I know where all the horses are. We're in Cowboy Town, right we?
Denise Panariello
13:29
are near Flamingo Gardens. Okay, back in Davie. Okay, I know where all the horses are.
Josh Fertel
13:31
We're on the brand cowboy town.
Denise Panariello
13:31
right, we are near Flamingo Gardens. Okay, back in that area.
Josh Fertel
13:32
Oh, I don't know exactly where it is. What do you think the next steps are for, a bit by bit? Where do you see the next push?
Denise Panariello
13:42
So we are growing rapidly.
Josh Fertel
13:45
Okay.
Denise Panariello
13:45
We tend to run with a waiting list are growing rapidly. We tend to run with a waiting list, and so my goal is to not have a waiting list, to be able to offer more, and with that we need more, to have more horses. We're going to need more space. So those are our long-term plans. My shorter-term plan right now is we are hopefully working on towards getting a covered arena, because we run year round Nice and it's hot in Florida.
Josh Fertel
14:12
It is hot.
Denise Panariello
14:14
So you know, the weather impacts our sessions very much, but whether it's too hot, whether it's raining, we manage, we have for a long time. But we're at a point where having a covered arena would be very beneficial to all of our clients, our horses, our staff and much appreciated as well.
Josh Fertel
14:35
No, I get that. I'm trying to think if I know any place, but you did bring it up. I was thinking about staff, the caregivers that are with the patients when they're on the horses? Are they all trained? Mental or physical therapy or occupational therapy people or just sometimes it's just. Their job is just to walk around?
Denise Panariello
14:53
No, all of my staff are physical therapists, speech therapists or occupational therapists that are licensed in their prospective field. We do have some certified therapeutic riding instructors.
Josh Fertel
15:04
Okay.
Denise Panariello
15:05
That is another course and certification to get. Some of us are like myself I'm an occupational therapist but also a certified therapeutic riding instructor. And then we have volunteers. We are heavily dependent on the volunteers. We cannot run our sessions without them. So yeah, they're helping with the horse handling, leading the horse, walking with us while the therapist is doing the one-on-one therapy.
Josh Fertel
15:30
Yeah, that's kind of what I figured you were going to say. And where are the volunteers? Where are you finding them? Is this word of mouth?
Denise Panariello
15:37
Word of mouth high schools. We reach out to all the local high schools at the beginning of each school year because we are approved for their community service hours that they need to graduate. So mostly high school students is what I get, and then I have a lot of retirees who are looking for some extra things they wanted something to do, they wanted to be outside, they wanted to help, and you know we love our adult volunteers as well.
Josh Fertel
16:09
The three therapies that you said speech, physical and occupational. How does the speech therapy tie in, or is that just a separate entity where you are?
Denise Panariello
16:18
No, it still ties in just as much. So you know we have the. You know it's so much more fun to label the horse that you're seeing versus the picture of the horse and hearing the sounds the horses make. You know, I had a child one time who was getting speech therapy in another clinic and the speech therapist said what does a horse say? And she went and the therapist was very confused and her mom was like, oh, that's what her horse says bit by bit, you know, and we have cats and rabbits at the barn, so there's different things there.
16:51
But to sit on the horse they have to sit upright, and sitting upright with our shoulders back opens up our diaphragm which also helps with the airflow for fluency and speech production there. Then we have the rhythm and the cadence of the horse. That helps with articulation and fluency of speech as well, and then we can also do different positioning on the horse to get your tongue and muscles in different patterns as well.
Josh Fertel
17:16
I need to hear a really good success story. Tell me one like something just snapped, changed and this person you know flourished. Oh my goodness, I have so many. Tell me two, then I'll tell you two.
Denise Panariello
17:29
Well, we've had so many kids say their first words at the bar.
17:33
And oftentimes it was go because they wanted their horse to move Right and so it was go. But one of our biggest that I know I can openly share because the gentleman is on my board of directors and he shares his story frequently he's quite the ambassador for our program. So is his wife. Okay, in March of 2020, his wife sustained a fall in their kitchen where she ended up having a traumatic brain injury, was in a coma for a period of time, a lot of uncertainty of what the future was for her. Yeah, and it was also March of 2020, whenever the world shut down.
18:12
And so after a lot of ups and downs, you know, medically she stabilized, she was discharged, went to rehab and after a short time in doing rehabilitation and therapies in an outpatient clinic she was discharged due to lack of progress. She had kind of stagnated in her progress there. She was not motivated to continue.
18:39
So, they had recommended that they find recreational therapy for her. So her husband they live in Weston they did some research and he came across us and he was like wait, we can do her physical and occupational therapy and she's going to think that it's recreational. And they started to come and when she started with us she didn't have a lot of speech. She was fully dependent on all of her self-care at home she used a walker to walk.
19:10
She couldn't get up off the couch by herself and within just a couple of weeks she was able to get up off the couch. Weeks, weeks Then, as time progressed. Now she's walking independently. She's independent in a lot of her self-care, she's holding full conversations. I see her and she's like hi, how are you, how are you doing? And they never thought that she would do that. And so the impact that it's had on not just her but the family as a whole. They have three, you know, young adult, teenage children that can. Now, you know, she's mom again, you know, and so it's been quite remarkable to watch her progress and move on.
Josh Fertel
19:53
That's a great success story. That's one of the best success stories that we've had before.
Denise Panariello
19:58
She's amazing, she's amazing.
Josh Fertel
20:00
And she still comes.
Denise Panariello
20:00
She still comes, yeah.
Josh Fertel
20:02
Oh, so it's been years right.
Denise Panariello
20:03
Yeah, so it's been about four years now and she just is just making gains every day right, yeah, that's awesome yeah, and some of it's the confidence. She's like I can get on this big horse and sit up and walk I I, then I can get off the couch you know, I love that.
Josh Fertel
20:21
I love that story. The uh funding for your, for the organization, is donations. Do you have events?
Denise Panariello
20:29
We do. So there's a couple of things. We are a fee-for-service program. Our program service fees are about 50% of our revenue, but then the rest is through donations and fundraising. There is a big fundraiser event coming up February 1st, which is the Megan Maranci Wild West Night, and that is an event that's held every year through. Bob and Vicki Morenci started this in honor of their daughter. Their 17-year-old daughter was a devoted horse rider who unfortunately died from injuries sustained in an equestrian event. So ever since then they started this event to honor her memory as well as to help other children heal. That's great.
21:17
And for the past eight years Bit by Bit has been the proud beneficiary of that event.
Josh Fertel
21:22
And what is it that they do? What is the event?
Denise Panariello
21:24
So the event is held at Ron Bergeron's Green Glades Ranch off of US 27. And every year we have a big country music artist. This upcoming one is Russell Dickerson. If you listen to country music, he's a phenomenal country music artist. Last year we had about 1,100 people attend. We're anticipating over 1 this year there is open buffet, premium, open bar, line dancing, silent auction, live auction and then, you know, to top off the night with a performance by Russell Dickerson.
Josh Fertel
22:01
That's February 1st and it all goes to a great cause and 100% of all proceeds go to Bit by Bit. Okay, good, I'm glad we can get that message out in time Make sure that we get it out in time. That's great. So I have one more question for you. Sure, if I had a magic wand and I gave it to you and I said, denise, do with it what you will for your organization, what would you do with it?
Denise Panariello
22:30
If I had a magic wand more space, more space covered, yeah, more space covered to grow our program. You know there are so many kids that are waiting for services. We want to be able to. You know we would need more horses and to get more horses. We would need more space. Right, and there's other programming I'd like to tap into as well. Right, and there's other programming I'd like to tap into as well offering some programs for schools and mental health programming things of that nature as well that are on the horizon.
Josh Fertel
22:55
I love the work you're doing. Thank you, thank you so much.
Denise Panariello
22:57
Thank you, you and your whole team, I mean you're doing great work with us and we invite everybody anyone to come schedule a tour and we can show you around meet the horses, see what's happening with the children and get to witness it all yourself as well. So how would somebody reach? Out to you you can visit our website at bitbybittherapy.org, or you can give us a call at the office at 754-779-7888.
Josh Fertel
23:26
Thank you for everything. I love having nonprofits. I actually you know Chris and Momo and Vigils by Momo. They're always telling me you know about different organizations and I'm glad they brought you in front of me, so I thank them for that and you know, hopefully you'll come back before.
Denise Panariello
23:45
February, so we can talk about the event again and see if we can help get some people there. Absolutely, and we're trying to plan a visitor's day in January too, that we're going to open to the public to come visit us.
Josh Fertel
23:54
Yeah, whatever we can do on our end to help make those as best they can be, we're here for you, but thank you again for coming today. Please follow us on Facebook and LinkedIn, and you can check us out at www.theangrybiller.com.