A Case Study Determining the Effects of Hippotherapy on Developmental Dysarthria

The full case study can be downloaded here: Hippotherapy-Case-Stdy.pdf

Title: A Case Study Determining the Effects of Hippotherapy on Developmental Dysarthria
Creators: Shover, Carrie
Advisor: McCauley, Rebecca
Issue Date: 2010-06
Abstract: Hippotherapy is an approach to equine assisted therapy (EAT) that uses equine movement along with physical, occupational, or speech therapy treatment strategies (Håkanson, Möller, Lindström, & Mattsson, 2009). In speech-language pathology, the few existing studies focusing on hippotherapy have primarily used subjective measurements such as questionnaires (e.g., Borton & Ogburn 2009). These studies suggested that children who participated in hippotherapy were believed (by their parents and others) to experience improved speech and language skills, increased motivation to attend therapy sessions, and improved self-concepts (Macauley & Gutierrez, 2004). Increases in vocalizations have also been noted in non-verbal participants (Lehrman & Ross, 2001). This study is a single participant case study designed to examine the immediate effects of four hippotherapy sessions on objective measures [i.e., respiratory strength, vocal intensity (loudness) and the mean length of utterance (MLU)] of a person with developmental dysarthria, where developmental dysarthria refers to speech abnormalities due to chronic weakness of the speech musculature. Because no appropriate participant was found in time for data collection to be completed, the study goals were changed to piloting of procedures.
Embargo: No embargo
Series/Report no.: The Ohio State University. Department of Speech and Hearing Science Honors Theses; 2010
Keywords: hippotherapy
developmental dysarthria
Sponsors: Department of Social and Behavioral Sciences at The Ohio State University
Department of the Arts and Sciences at The Ohio State University

Feldenkrais Articles: Feldenkrais & Dynamic Systems Theory – A technical discussion by Mark Reese

A Dynamic Systems View of the Feldenkrais Method

By Mark Reese

Different philosophical approaches have been called upon to explain or emphasize aspects of the Feldenkrais Method; phenomenology and cybernetics are two noteworthy examples. Dynamic Systems Theory, which owes its origin to ideas popularly known as chaos, is another promising avenue of approach.

The term ‘chaos’ refers to behaviors that are highly unpredictable in their fine details, but which exhibit high degrees of regularity when observed at a macro level. Chaos theory draws attention to the self-organizing properties of nature, both animate and inanimate and, indeed, has provided a theoretical language in which to discuss both. Nature’s floating clouds, swirling eddies, spiral galaxies, growing leaves and animals––all are patterns of chaotic complexity. Chaos theory can likewise give us insights about human posture, movement, cognition, emotions, and learning.

There is a historical basis for approaching the Feldenkrais Method from dynamic systems theory. Feldenkrais at times proposed his ideas in similar terms, and one of his closest friends and theoretical collaborators was Aharon Katchalsky Katzir*, one of the world’s leading chaos pioneers until his murder in 1972 by Japanese terrorists. Some of the important sources for chaos theory include, among others, Rene Thom’s "Catastrophe" Theory, and Ilya Prigogine’s theory of "Dissipative Structures." The ideas in this article derive from Hermann Haken’s theory of "Synergetics," as interpreted by scientists Scott Kelso and Esther Thelen. Most of the material in this article originally stemmed from an attempt to explain the Feldenkrais Method to the developmental psychologist, Esther Thelen, after reading her seminal book, A Dynamic Systems Approach to the Development of Cognition and Action.

* * *

It can be demonstrated in numerous instances how Moshe Feldenkrais was ahead of his time in his thinking about cognition and action. Among other forms of therapy or somatic disciplines, Feldenkrais's approach to movement education is unique in its embodiment of dynamics systems concepts. In this article I will present a number of examples.

Conventional exercise and physical education methods involve strictly following position indications for good form or posture, literal movement instructions and imitation of visual models. These methods are consistent with hierarchical motor control theories that invoke "higher centers" or a homunculus to order the body through commands to adopt new postural and movement patterns.

Feldenkrais maintained that these approaches were based upon an incorrect theory of control and that in actual practice, conscious self-direction alone is insufficient for functional learning. Rather, functional learning emerges through pursuing exploratory variations constrained and facilitated by functional demands and the environment. Feldenkrais sometimes likened his movement lessons, which he hated to be called "exercises," because of connotations of mechanical repetition, as scientific experiments, demonstrating how human beings would arrive up similar solutions to motor problems, based upon common features of structure and function, and common environment and task demands.

These emergent solutions to problems of action (to use the phrase of Nicolai Bernstein, Russian physiologist) are reminiscent of "convergent evolution," whereby living things without shared ancestry evolve common characteristics when occupying similar ecological niches. Well known examples of this phenomena include the hydrodynamic shapes of fish and porpoises, and the common appearances of desert plants belonging to different families. In learning and in evolution, common solutions will emerge without plans, instructions, or imitation, despite difference in origins. Thus Esther Thelen has described crawling as an opportunistic solution to an infant’s problem of action, a unique discovery with a unique learning trajectory, not an inevitable result of genetic or neural programming.

In contrast to explaining movement solely in terms of anatomy and kinesiology Feldenkrais lead us to understand movement’s organization, meaning its embodied, intentional, contextual nature, i.e. how one organizes an action in an environment in order to meet our needs for action. Feldenkrais recognized the seamless and coherent integration of physical, biomechanical and energetic factors, together with our goals and environments.

Feldenkrais understood well the nonlinear nature of change. Small differences in any aspect of the task or environment may trigger nonlinear changes in an action. His methods embody a way to discover empirically which control parameters might be efficacious for the learning of more advantageous movement and postural behavior. He believed that sensitivity to the requirements of learning are crucial, and that mechanical repetition, forced stretching or manipulation, cannot be primary agents for changing patterns of action.

In contrast to teaching improved posture by adopting a position specified by a visual reference such as a plumb line or grid, Feldenkrais emphasized that posture was a component of action, and must be learned in the real time situation of meeting task demands. Far from being a position, Feldenkrais's 1940's formulation of "acture" closely resembles chaos models. Posture can be well represented as an attractor* (see definition at end of article), a zone of stable variation including many positions constrained by task demands, balance, biomechanics, support surface and many other factors. The chaotic, yet highly organized movements present even in "static" posture, called "postural sway," demonstrate the impossibility of adopting a truly fixed upright position, whether it is deemed good or bad.

In order to induce the instability necessary for phase shifts in a system from one highly stable attractor to another, Feldenkrais developed many techniques including novel tasks, novel environments, novel spatial orientations and effort substitutions.

Here are a few examples of how Feldenkrais taught improved posture:

a) One series of lessons includes variations on standing and oscillating. Stand and oscillate forwards and backwards, then side to side, first with feet apart, then will feet together, sometimes with eyes open, sometimes with eyes closed, then make circular movements in one direction, then in another. In an other series of variations one leg is placed in front of the other, and in another one stands with the arms in front of behind or out to the sides in various combinations.

Exploring these movement variations destabilizes existing postural attractors and a new attractor emerges defined as a zone of easy movement in all directions further specified by the extra balancing requirements of narrow stance and omitted visual cues.

b) Standing and turning reorganizes posture in a manner compatible with the situation of turning and seeing to the side. Our habitual posture may be disposed toward primarily forward movement or static orientation.

c) In a quadrapedal posture, on hands and feet, one alternately lifts one hand and the other, one foot then the other, right hand and foot together, then left, then right hand with left foot, then the other diagonal, then both hands, both feet, and finally hopping with all four lifted at once. While the initial placements of the arms and legs will vary enormously among individuals, almost everyone will converge towards the same posture. The task demands impose a similar postural solution, despite disparate positions and movement trajectories during the destablized, highly exploratory phases.

In contrast to conventional physical therapy which has emphasized the primarily mechanical factors of muscle strength and flexibility, skeletal alignment and mobility, Feldenkrais saw how postural and movement problems are tied to behavioral habits, including cognitive, motor, environmental and perceptual aspects. In conventional therapies, neurological patients may be given regimes of passive stretching. In Feldenkrais work, however, to use one example, a child with cerebral palsy is never passively stretched. It can be demonstrated that an elbow which will not normally bend, except with force, may bend easily if the child is moved in an exploratory way such that she perceives the value of bending the elbow in order to lean on it while sitting up. Movements and exercises without imbedded functional values are superficial, and may represent little more than noise to a nervous system seeking multi-modal correlation between rich sources of movement and perceptual information related to value laden action trajectories toward desired goals.

Another striking example is Feldenkrais's systemic view of chronic pain. Rather than residing in some literal way "in the body" Feldenkrais understood most musculo-skeletal pain (except the pain of immediate trauma) as expressing a pattern of action, a habit embodying emotional, biomechanical, neuro-chemical and other components. Change the pattern and you can eliminate the pain, despite structural problems. Examples of how this is done include:

a) Let us say a given joint such as the shoulder is painful when raising the arm. Feldenkrais discovered that he could move the proximal side of the joint, that is, move the scapula relative to the humerus, without pain. Thus, due to contextual differences, one may obtain a kinematically isomorphic movement which is categorically not perceived as such by the person. This proximally induced movement is completely painfree to the individual and does not trigger the protective, defensive reactions of the more normal, distally evoked movement. This technique so destabilizes the system, enabling new patterns, that after a few repetitions of the proximal movement, the normal distal movement may be accomplished without pain as well.

b) Often a movement is painful in one orientation but not another. Take, for example, flexing on the back, i.e., lifting the head and bring an elbow forward toward the opposite knee, while lifting the knee toward the elbow. If a similar movement is done in the sitting position, or leaning on one's hands and knees, pain may be absent. When the initial movement is performed again on the back, it can usually be done without pain, and with greater flexibility and coordination. These variations of orientation alter the degree of anti-gravity muscular work, change spatial relations, generate new proprioceptive information and, most importantly, change the category of action, by which the nervous system organizes the motor pattern. By dissociating the movement from its habitual context, the system has an opportunity to recognize that the movement is not necessarily dangerous, and it ceases being painful.

c) In cases of orthopedic or neurological problems, novel movements are often first taught on the "better" side of the body, that is, the side that is uninjured, pain free, less stiff, and under better neuro-motor control. Many movements of the body are reciprocal, e.g., the ability to shorten and lengthen one leg is the same, with respect to the pelvis, as the lengthening and shortening of the opposite leg. It is significant that even though the movements are physically isomorphic, movements performed on the right or left sides of the body are nonetheless perceptually highly distinct. This fact is very useful for learning new patterns.

By manipulating the environment of familiar task demands, it is possible to destabilize attractors and help new ones to emerge:

a) Alteration of spatial orientation. One lesson provides a radical demonstration of the context-based nature of learning, and the importance of spatial orientation as an essential though normally tacit component of action. One is asked to perform a simple series of foot movements, including supination and pronation, dorsi and plantar flexion, and rotation, while one lies on one's stomach, with the knees bent at right angles to the ground. Although most people would have no difficulty in performing these movements in a seated position, in this altered physical position, most people are utterly incapable of doing them. Even when they can be clumsily performed, without visual feedback people are often incapable of discriminating the position of their feet in space and which movements their feet are actually doing! The lesson then proceeds with augmenting the movement by visually tracking the foot. This, interestingly enough, destabilizes the action further, making the person even more confused, disoriented and uncoordinated. This is a good example of Edelman's multi-modal reentrant processing concept* (see definition at end of article): since the person has never correlated their foot movements with visual cues in this position, the visual tracking does not refine the movement as one would expect, but adds another perceptual-action demand to the task space. Soon, however, the visual cues do help people learn the necessary coordination. Even more helpful, however, is that students are asked to perform similar movements in different positions—standing, lying on the back, etc., until they are able to transfer and generalize information to the novel position of lying on the stomach.

b) Alteration of the environment. In Functional Integration, the primarily non verbal, hands-on technique, the student may be placed upon rollers (tubes made of cardboard or plastic material or rolled blankets) of various sizes in various orientations. For example, the student may be asked to lie on a long narrow roller placed lengthwise under the spine. This environment creates novel balancing requirements, because it is easy to fall off the roller. The practitioner moves the student in a variety of ways in order to elicit the emergence of different postural and movement patterns adequate to deal with the roller's pressure and balancing requirements.

Support. One of the most significant alterations of the environment is created by the Feldenkrais practitioner providing conditions of greater support . Just as research (see EstherThelen, A Dynamics Systems Approach…") showed how infant stepping could be re-elicited in the more supportive environment of water, so too are many actions easier to learn, and previously acquired abilities easier to elicit, when greater support is provided. In Awareness through Movement, simply doing movements while lying down enables people to perform various movements they are unable to do while upright, Presumably this is due to lessened anti-gravity muscular effort, the reduction or elimination of balancing requirements, increased proprioception due to a greater surface area when contacting the floor, and heightened kinesthetic sensitivity.

Part of Feldenkrais's rationale for utilizing support was a perceptual argument that a Weber-Fechner phenomenon was at work, enhancing those discriminations needed for learning. Just as smaller changes in illumination are perceivable against lower levels of background illumination, Feldenkrais claimed that smaller changes in muscular efficiency may be registered against a background of reduced effort. For this reason Feldenkrais often advised students to use small, even minuscule, movements in the initial stages of learning. When an action is facilitated through support it reduces muscular effort thereby lowering the threshold at which differences in movement organization can be perceived and acted upon.

In Functional Integration support may be provided by lying on rollers, pillows and surfaces that lessen muscular effort, and especially through use of the practitioner's hands in ways that support the body of the student in order to relieve postural work that the system is engaged in. In a Gibsonian sense support is understood not in a purely mechanical sense, but in the ecological sense that the surface provided to the student is perceived as affording* (see definition of affordances at end of article) reliable support for action. This enables relief from postural muscular effort, and enlarges the field of action-perception possibilities.

Furthermore, in light of Fogel's concept of co-regulation* (see definition at end of article), providing support can be understood as helping establish communication within the framework of the activity. Relevant information about the activity is conveyed as participants negotiate their relative, cooperative share of the action's effort.

Of particular interest—because of their practical value and theoretical challenge—are highly sophisticated manual procedures often done while the student lies on a treatment table, involving pushing through the feet or lifting the spine or head. If performed accurately, and it takes many years of training to achieve such accuracy, it is possible to support, and therefore convey information about, enormously complex patterns of postural behavior. Feldenkrais went so far as to say that, given ideal support, you could create in the brain a tabula rasa from which to work. Obviously an overstatement, one nevertheless observes an enormous destabilization of attractors. Such an incredible degree of plasticity enables the system to enter many novel attractor states.

Feldenkrais emphasized how any new movement learning always exploits previous learning and the inherent possibilities of the system. For example:

a) In an early approach to self-defense techniques he developed back in Palestine in the twenties, Feldenkrais watched the spontaneous defensive reactions of individuals to a knife attack. He then invented a defense technique that was grafted on to and tuned this already existing pattern.

b) In the teaching of a new behavior, we often tune or refine existing movement patterns, irrespective of ideas about "normalcy" that may constrain rehabilitation therapists. For example, when teaching a person to walk again after a joint injury, we might facilitate the limping pattern that emerged as the person's way of coping with the trauma. Then we may gradually enlarge the repertoire by shifting the environment or altering task demands. If, on the contrary, as some therapists do, one ignores the existing, adaptive pattern, and tries to forcibly move the person through a "normal" range, the person may defensively react––in effect, become more stable in their pain avoidance pattern–– and be unreceptive to new learning. Feldenkrais emphasized that one needs a learning theory, and not just orthopedics, to account for post-trauma, adaptive changes. And the job of rehabilitation is therefore not just mechanical but, rather, systemic. After a serious injury and healing, even under the best circumstances, one does not simply recover function and behave identically to one's previous patterns. Post-traumatic behavior is a creative solution to a unique problem of action. Furthermore, it is possible to learn better function, through new means, than one had before.

c) Intrinsic system dynamics. Feldenkrais invented many lessons that explore and utilize intrinsic system dynamics, similar in some respects to the Kelso experiments (see Kelso references below). Some of these entail oscillatory movements generated through rhythmic ankle flexion, performed while lying on one's back. Because of the pendulum features of these movements, the coordination involves finding how to push off when the kinetic energy of the previous push and return has been dissipated (like pushing a child on a swing). There is no need to specify the frequency nor the force required, because these will emerge from system dynamics. There is a great improvement in ones posture after doing these variations, presumably because one learns to perceive how efficient compression forces can be exerted through the skeleton (without the need of anti-gravity work) in a manner analogous to the upright postural demand of organizing gravitational compression. In another series of lessons, involving lifting and dropping the legs or other parts of the body, one learn inter-limb coordination that do not depend upon neural coordination but rather structural-functional joint and limb properties. As a physicist Feldenkrais greatly appreciated the fact that movement has self-organizing properties. And as a judo teacher he knew what it meant to utilize gravity, momentum and other physical forces.

Implied here is also the idea that actions contain subsidiary coordinations that when learned, may be transferred to other skills. Feldenkrais understood how to construct and deconstruct action components out of and into subsidiary coordinations. Contrast this with reductionist models of action that emphasize local muscular strength elements.

Goal and non-goal orientation. The use of goals as attractors can be a two-edged sword, and it is important for learning strategies to be flexible in how goals can operate as control parameters. Goal direction enhances learning by providing a better understanding of what is expected and desired, and can help call up memories of how similar problems of action have been solved. However, conscious attempts to achieve a goal that is perceived as impossible, can further deepen existing attractor wells. Individuals may have a long history of learning that they cannot succeed at various tasks dues to pain, poor coordination, lack of strength, etc. Conscious attempts may merely trigger effortful and unsuccessful strategies. This is another reason why Awareness through Movement sequences are as much deconstructive as they are constructive of specific skills. In order to bypass learned inabilities, Feldenkrais ingeniously invented surprise-ending lessons that bypass expectations:

a) Moving the pelvis while sitting in a chair in various ways, triggering standing up efficiently, without the thought of getting up.

b) Lying on the floor, holding one's foot and moving it towards the mouth and other directions, leading to rolling to sit up, without any conscious idea that the lesson is about learning an improved way to sit up. I watched my own son Nathan learn to roll from back to side in precisely this way at the age of three months. Rolling to the side appeared as an accidental consequence of finally putting his big toe in his mouth! This is just one example among hundreds, of how Feldenkrais was a master at utilizing early development movements as a way of furthering coordinative skills for both children and adults. Such lessons also demonstrate that the adult's conception of what the child is learning may not at all be an accurate representation of its developmental trajectories. Many actions are learnt in the course of gaining coordinations needed for satisfying other than obvious goals. This is analogous to Gould's remarks on evolutionary change (see reference below), that organic structures may be exploited for different functions then those they originally served, and so too in learning behaviors.

Due to context sensitivity, environmental familiarity or unfamiliarity is another important variable, acting to trigger or suppress the emergence of previously learned patterns. This can be advantageous or problematic, depending upon whether the patterns are desirable.

Feldenkrais induced through the introduction of novel task demands, the stage of destabilization preceding phase shifts and new learning. One of the most powerful (and quick to produce) examples involves moving the eyes opposite to the direction of the head in order to induce greater flexibility throughout the body while turning and looking to the side. According to Feldenkrais, our inflexibility resides not in our muscles and joints but, rather, in our habits of unnecessary muscular efforts. Due to the importance of vision for the control of many movements, directing one's eyes in nonhabitual deeply destabilizes normal movement patterns, and enables the emergence of more efficient patterns that are suppressed under current circumstances. This approach is incredible effective and easy, in principle, to test experimenally. Such methods stand in sharp contrast to prevalent therapeutic modes that strive to either stretch, relax, or strengthen the neck muscles, none of which addresses the dynamic systems characters of action.

Also effective in increasing the neck's range of motion without stretching, is simply to move one's eyes many times in the same direction as that of the head. Deep changes in muscular tonus are elicited such that one can turn one's head and neck much farther in the direction of one's gaze. Feldenkrais liked to explain such effects by invoking neuro-reflex pathways involving tonic adjustment. Here, a dynamic systems explanation would be that moving the eyes elicits strong attractors reflecting a long history of performing coordinated eye and head movements in visually guided behaviors.

Feldenkrais emphasized how action and perception are inextricably intertwined (see Reed below). The easily misunderstood name for his system of movement education, "Awareness through Movement," reverses the more conventional idea of movement awareness. Feldenkrais movements were intended to further knowledge and perception, and not seen as ends in themselves. Only through movement can one perceive oneself and the world, and perception makes movement possible (as Shakespeare said, "Sure you have sense, else you could not have motion."). Also, Feldenkrais emphasized many linkages between motor and cognitive processes. Some examples include:

a) In the oscillatory movements, mentioned above, one learns from the body's movement. One can neither say that one instructs the body, nor that the body instructs itself.

b) A series of counting lessons shows how in effect one counts one's own patterned eye movements as much as objects in the world. In other words, counting involves multi-modal correspondences and correlations. The learning of speed reading involves learning how to speed up and smooth out eye movements so they don't stop on individual words, as one does when subvocalizing.

c) In lessons involving visualization we learn how eye movements and other specific patterns of muscular contraction are correlated with attention shifts. For example visualizing the right side of one's body entails eye movements to the right. Exploring in one's mind the shape of one's foot elicits coordinations reflecting a history of putting on socks, getting foot massages, and walking on different surfaces. So-called "imaginary movement" draws upon our earlier experiences of movement exploration. The training of visualization, perception and action are all interrelated.

The movement variability in all Feldenkrais lessons embodies an important principle from evolutionary and ecological biology— that variation is a key to the potential required for learning and adapting to novel conditions. A well-learned skill embodies sufficient variability to meet the demands of changing environments and tasks.

Feldenkrais invented thousands of manual and active techniques in order to facilitate the unique solutions that are required by unique persons who face unique problems. He eschewed routines and mechanical exercises, and promoted an exploratory journey that can enhance the coordination and abilities fitting the goals of the individual. Implicit in this work is an attention to micro differences in learning, micro differences in muscular patterns, joint movements, postural dispositions. Many therapies ignore, trivialize or try to wipe out these differences, based upon a Platonic ideal of healthy movement or posture, technologically implemented through machine-like movements often involving the literal coupling of humans and machines. Feldenkrais was a refugee from more than one totalitarian regime and put a high value on human freedom and individual differences.

New research methods and theoretical ideas seem to support much more attention to these individual differences and provide the scientific means to learn more about such differences. It is heartening to see, perhaps for the first time, scientific interest being paid to such a "close-up" view of action and learning.

Edelman, Gerald M. (1989). The Remembered Present: A Biological Theory of Consciousness. New York: Basic Books.

Edelman, Gerald M. (1992). Bright Air, Brilliant Fire: On the Matter of the Mind. New York: BasicBooks.

Feldenkrais, Moshe. (1981). The Elusive Obvious. Capitola, CA: Meta Publications.

Fogel, A. (1993). Developing Through Relationships: Origins of Communication, Self and Culture. Chicago: University of Chicago Press.

Glick, J. (1988). Chaos: Making a New Science. New York: Viking Penguin.

Gould, Stephen Jay. (1980). The Panda's Thumb: More Reflections in Natural History. New York: W.W. Norton & Company.

Katchalsky, A.K., Rowland, V., & Blumenthal, R. (1974). Dynamic patterns of brain cell assemblies. Neuroscience Research Program Bulletin, 12.

Kelso, J.A. Scott. (1995). Dynamic Patterns: The Self-Organization of Brain and Behavior. Cambridge, MA: MIT Press.

Kelso, J.A. Scott. (1982). Human Motor Behavior. Hillsdale, NJ: Lawrence Erlbaum Associates. Chapters 10, 11, and 12. M.T. Turvey, Hollis L. Fitch and Betty Tuller (Authors).

Chap. 10: "The Bernstein Perspective: 1. The Problems of Degrees of Freedom and Context-Conditioned Variability."

Chap. 11: "The Bernstein Perspective: 11. The Concept of Muscle Linkage or Coordinative Structure."

Chap. 12: "The Bernstein Perspective: 111. Tuning of Coordinative Structures with Specail Reference to Perception."

Reed, E.S. (1989). Changing Theories of Postural Development (pp. 3-24). In: Woollacoot, M.H., & Shumway-Cook, A. (Eds). Development of Posture and Gait Across the Life Span. Columbia, SC: University of South Carolina.

Reed, E.S. (1988). James J. Gibson and the Psychology of Perception. New Haven, CT: Yale University Press.

Thelen, E. & Smith, L. B. (1994). A Dynamic Systems Approach to the Development of Cognition and Action. Cambridge, MA: MIT Press. (pp. 56-61)

Thelen, E. (1995). Motor Development: A New Synthesis. American Psychologist, 50 (2), 79-95.

Thelen, E., Ulrich, B.D., & Jensen, J.L. (1989). The Developmental Origins of Locomotion (pp. 25-47). In: Woollacoot, M.H., & Shumway-Cook, A. (Eds). Development of Posture and Gait Across the Life Span. Columbia, SC: University of South Carolina.

Definitions:

Affordance:

"The environment of an observer consists of the affordances of objects, places, and events for that observer…Affordances are the functional properties of objects as, for example, the affordance of a heavy stick or rock for pounding. Any particular object will probably have many affordances. An apple may be eaten, thrown, juiced, or baked, to name but a few of its affordances. Yet a given object will also lack many affordances. An apple is of no use for a brick or as kindling."

from: Reed, E.S. (1988). James J. Gibson and the Psychology of Perception. New Haven, CT: Yale University Press. (page 231)

Attractor:

"When systems self-organize under the influence of an order parameter, they 'settle into' one or a few modes of behavior (which themselves may be quite complex) that the system prefers over all the possible modes. In dynamic terminology, this behavioral mode is an attractor state, as the system–under certain conditions–has an affinity for that state…Attractors may have varying degrees of stability and instability…While some attractor states are so unstable as to almost never be observed, other attractor states are so stable that they look like they are inevitable…but they are dynamic and changeable nonetheless."

adapted from: Thelen, E. & Smith, L. B. (1994). A Dynamic Systems Approach to the Development of Cognition and Action. Cambridge, MA: MIT Press. (pp. 56-61)

Co-regulation:

"Co-regulation occurs whenever individuals' joint actions blend together to achieve a unique and mutually created set of social actions. Co-regulation arises as part of a continuous process of communication, not as the result of an exchange of messages borne by discrete communication signals. Co-regulation is recognized by its spontaneity and creativity and is thus the fundamental source of developmental change. Co-regulation, in social and mental life, allows the individual to participate in the discovery of the unknown and the invention of possibilities."

from: Fogel, A. (1993). Developing Through Relationships: Origins of Communication, Self and Culture. Chicago: University of Chicago Press. (p. 6)

Phase Transitions:

"In physics, different aggregate states of matter–solid, liquid, gaseous–are called phases, and the transitions between them are called phase transitions. When vapor changes from liquid and eventually to ice, this is an example of progressive change from disorder to order." (p. 5)

"…pattern formation and change in the human brain [takes] the form of a dynamic instability. This suggests a new mechanism–phase transitions–for the collective action of neurons in the human cerebral cortex." (p. 260)

"A crucial aspect of pattern-forming dynamics in both brain behavior and overt behavior pertains to critical instabilities. Like many complex, nonequilibrium systems in nature, at critical values of a control parameter, the brain undergoes spontaneous changes in spatiotemporal patterns…The discovery of critical instabilities in the brain highlights the importance of fluctuations–whether of stochastic or deterministic origin–in probing the stability of coherent patterns and creating new patterns when the environmental, task, or internal conditions demand it. Not only do nonequilibrium phase transitions offer a new mechanism for the collective action of neurons, they provide the brain with a switching mechanism, essential for rapidly entering and exiting various coherent states. Thus, phase transitions confer on the brain the hallmark of flexibility." (p. 284)

from: Kelso, J.A. Scott. (1995). Dynamic Patterns: The Self-Organization of Brain and Behavior. Cambridge, MA: MIT Press.

Phase Shift:

"[The] Belousov-Zhabotinskii reaction…takes place at room temperature. Imagine, however, that we assemble our components q in a very cold chamber, the temperature being a parameter in the equation. As we slowly warm the chamber, we pump thermal energy into the dish of chemicals in a continuous manner proportional to the temperature of the room. For a long time, nothing happens; q remains in one attractor in the state space (a point attractor). Then, at a critical temperature, the reaction begins and the spontaneous patterns rotate and change; q jumps to a new region of the space and into a more complex attractor regime.

The temperature changes were continuous, but the behavior of the system was dramatically discontinuous. These nonlinearities, or phase shifts or phase transitions, are highly characteristic of nonequilibrium systems, and are… the very source of new forms. The parameter change, temperature in this case, was entirely nonspecific to q. The temperature had no information whatsoever prescribing the nature of the chemical reaction…The pattern emerged strictly as a function of…the nonlinear dynamics of the system.

In dynamic terminology, temperature is the control parameter, the parameter to which the collective behavior of the system is sensitive and that moves the system through different collective states…In biological systems, any number of organismic variables or relevant external boundary conditions can act as control parameters…Energy level is a common control parameter…[An] example is the gait of horses. As the horse continuously increases its speed, its gait shifts discontinuously from a walk to a trot to a gallop with no stable intermediate pattern. The particular pattern of footfalls acts as a dynamic attractor within a speed range. The preferred gait at any speed level is also the energetically most efficient…Because the gaits are so stable at particular speed ranges, it is tempting to view them as "hard-wired." The neural connections are essential, but the gait patterns are as much a product of the energy and information flowing through the system as of the "hardware" itself…Pattern can be generated by a system seeking cooperative stability. Order is not "in there," but is created in the process of action.

Stability is what defines the collective states of the system and it can be assessed by understanding the dynamics of transitions or phase shifts, when systems lose stability. Fluctuations around the stable states are the inevitable accompaniment of complex systems. It is these fluctuations that are the source of new forms in behavior and development and that account for the nonlinearity of much of the natural world.

Not all changes in systems are phase shifts. Many phenomena are parametric, that is, variables increase or decrease in a continuous manner. It is common to see systems act parametrically within certain ranges of a control parameter and nonlinearly when certain threshould values are reached. Dynamic theory has specific predictions for the behavior of systems close to true transition points. These predictions are based on the assumption of inherent fluctuations which are the result of the coupled component subsystems. These fluctuations act like continuous perturbations in the form of noise on the collective behavior of the system. Within ranges of the control parameter, the system maintains its preferred behavioral pattern depite the noise. However, at critical points, the system loses its ability to maintain these patterns and the fluctuations become enhanced. At these points, the system is dominated by these fluctuations and may display transient behavior where no stable pattern can be discerned. As the control parameter is continuously scaled, the system then exhibits a new or differnent pattern with new values of the collective variable. At this point, the fluctuations are again reduced, as the system evolves into a new attractor state."

adapted from:

Thelen, Esther & Smith, Linda B. (1994). A Dynamic Systems Approach to the Development of Cognition and Action. Cambridge, MA: MIT Press. (pp. 62-63)

"Dynamic systems accounts for the appearance of new forms during development as a series of phase shifts engendered by the loss of stability of current forms. These new forms are autonomous solutions to instability in that the system does not know the solutions a priori, but discovers them through the exploration of the space–exploration which is possible, in turn, because the cooperative assembly of components is not rigidly fixed."

from:

Thelen, Esther & Smith, Linda B. (1994). A Dynamic Systems Approach to the Development of Cognition and Action. Cambridge, MA: MIT Press. (p. 86)

Re-entry:

"Re-entry is a process of temporally ongoing parallel signaling between separate maps along ordered anatomical connections. Reentrant signaling can take place via reciprocal connections between maps (as seen in corticocortical, corticothalamic, and thalamocortical radiations); it can also occur via more complex arrangements such as connections among cortex, basal ganglia, and cerebellum."

from: Edelman, Gerald M. (1989). The Remembered Present: A Biological Theory of Consciousness. New York: Basic Books. (p. 49)

Brain maps interact by a process called reentry. These maps are connected by massively parallel and reciprocal connections. Reentrant signaling occurs along these connections. As groups of neurons are selected in a map, other groups in reentrantly connected but different maps may also be selected at the same time. Correlation and coordination of such selection events are achieved by reentrant signaling and by the strengthening of interconnections between the maps within a segment of time. The selective coordination of the complex patterns of interconnection between neuronal groups by reentry is the basis of behavior. Indeed, reentry (combined with memory) is the main basis for the bridge between physiology and psychology.

adapted from:

Edelman, Gerald M. (1989). The Remembered Present: A Biological Theory of Consciousness. New York: Basic Books. (p. 49)

Edelman, Gerald M. (1992). Bright Air, Brilliant Fire: On the Matter of the Mind. New York: BasicBooks. (p. 85)

Feldenkrais Case Studies – Alissa

Alissa's Progress using Feldenkrais:

First I would like to discuss what we think our daughter, Alissa, is getting out of Feldenkrais and why we think it is working for her. Then we would like to talk about what we think are some of the limitations of Feldenkrais and other existing treatment modalities.

We were introduced to Feldenkrais by Ester Thelen, a member of our scientific advisory board and one of the leading scientists applying "Dynamic Systems Theory" to the development of children with developmental delay. To give a you quick review of "Dynamic Systems Theory", it is the leading theory to explain how humans develop motor skills. "Dynamic Systems Theory" describes the human as an open, self-organizing, thermodynamic system. In this case "Open" means that humans develop by interacting with their environment, as opposed to having their future determined by genetic programming. Self-organizing, means that common patterns such as learning to walk, can develop among all humans independently. Finally, human development must follow the basic laws of thermodynamics in that we try to optimize for minimal energy solutions.

One of the most interesting concepts of the theory for me is the idea that the brain is only one of many "system components" in human development. It is certainly a critical component but it holds no higher role in development than several other very important components such as environment, physical structure of the body, etc. An example of how a healthy brain can still produce an unhealthy child can be found in documented cases of children being neglected in war torn orphanages. In this case a healthy brain and a deprived environment produces abnormal development.

Another example of open, self-organizing, thermodynamic systems in nature can be found in weather systems. Under certain predictable and reproducible circumstances, weather systems can self organize and take on very recognizable characteristics. The best example of this the Tornado. If we think of the human in terms of this analogy then we can begin to understand how most humans develop very similar motor skills and why kids with brain injuries also tend to develop with similar motor deficiencies. Normal human motor skills develop spontaneously in the early years of life and because most humans all face a very similar set of system parameters, motor skills thus tend to develop in a very similar pattern. In fact, "Dynamic Systems Theory" says that unless the parameters change, all humans will find the optimal solution to the physical equation of motion that minimizes energy. An example of this is the fact that all humans develop the same basic walking pattern. As a rule, humans do not hop or gallop. The reason for this is that hopping and galloping may be great for Kangaroos and Horses, however for the human biped, walking is the most energy efficient equation of motion.

With this background, we can now begin to understand why kids with brain injuries develop abnormal motor patterns. Effectively the initial injury to the brain causes a change to the normal set of parameters that are critical to human development. The injured child still follows all the same laws as described above and therefore still optimizes the system for minimal energy output. Unfortunately the optimal solution results in the familiar set of abnormal movement patterns commonly known as Cerebral Palsy.

So how does Feldenkrais fit in? Moshe Feldenkrais, was an Israeli physicist who developed the methodology. He was not aware of "Dynamics Systems Theory" but being a physicist the practice of his methodology almost perfectly describes the predictions of the theory. Fundamentally it is a methodology to maximize ones awareness of movement. It is used widely by athletes and musicians. To treat children with disabilities, the methodology relies on the fact that the initial brain injury is limiting the variation of movement that is seen is an uninjured child. Feldenkrais, allows the child to experience the variation of movement. By definition, Feldenkrais defines the term Spasticity simply as a lack of variation of movement. They treat Spasticity by helping their patients to feel what is like to move in other ways. They believe that self-awareness of the alternative motions is the key to functional movement and to improvement of Spasticity. This is in direct contrast to other methods, such as patterning, that rely on passive movement. Feldenkrais argues that passive patterning, on children that are not structurally ready, will not create new neural pathways and may even lead to increased Spasticity. This seems to correlate to reports that we are receiving from parents that have spent many years on the IHAP intensive program and have children that have developed increased rigidity and structural issues. Feldenkrais also does not place nearly the emphasis on repetition and intensity as other programs such as the IAHP. This is because, although practice is important in the learning process, the actual point of learning often occurs very quickly. A good analogy is learning how to ride a bike. Learning the skill seems to just hit you all at once. You go from a feeling of wobbly discomfort to smooth balance almost like turning on a light switch. Training wheels allow a child to feel what is like to balance on two wheels but prevent scabbed knees in the learning phase. Feldenkrais hopes to be the training wheels for kids with brain injury. Feldenkrais seeks to provide the child with a few experiences of very high quality movement with the hopes that during one of those movements the desired movement pattern will take root in the brain through the brain’s natural plasticity. This desired movement pattern gives the child slightly more variation of movement and slowly allows the child to transition from abnormal functional patterns to more desirable patterns.

We saw this scenario happen with Alissa during her first series of treatments from Anat. When we brought Alissa to see Anat at 18 months she was anxious to begin sitting on her own. She had mastered the ability to sit independently at about 16 months and was trying hard sit-up on her own. Full credit needs to go to Alissa’s NDT trained therapists that had helped her achieve the massive goal of sitting independently, however her rigidity in her left leg and right arm was preventing her from initiating the needed sequence of movement to transition from supine to sitting. Anat, worked with Alissa for five one hour sessions. By the fifth lesson, Alissa had mastered the movement patterns necessary to transition to a sit, but her strength did not allow her to do it unassisted. With-in a month she had gained the strength needed and she had mastered the ability to sit on her own! We are confident that Alissa would have gained this functional skill with-out Feldenkrais, however we feel that Anat helped Alissa to gain this skill much faster. In that same five session series, Anat helped Alissa to begin combat crawling as well. Needless to say, we were impressed, as were our regular therapists.

So why did it work so well? A few things, Alissa was ready to master those movement patterns. She was age appropriate, had adequate strength, and she was internally motivated. The only thing holding her back was that her limitations of movement caused by her rigidity had not allowed her to experience and thus develop the appropriate motor plans for those complex movements. Anat, provided her with that learning opportunity and she responded. I emphasize the word ‘learning’. Anat does not see herself as a therapist, but rather as a teacher.

One of the lessons that Anat taught us as parents was not to be too supportive of Alissa. She observed that Alissa needed to be more self-motivated as opposed to always responding to mommy or daddy’s words of encouragement. She gave Alissa the time and space to decide what she wanted to do, then she followed on that lead helping her with the correct patterns to achieve that goal. Self-motivation is one of the tenants of learning.

Another area that Anat feels strongly about is that you should not push a child to do things that they are not physically, structurally and mentally ready to do. For example, Alissa is now 19 months old. She has a strong desire to stand erect and try to walk. However, she is far from achieving that on her own structurally. Her heal cords have become very tight and her ankles are very week. Therefore, when she is put into a supported stand her feet roll inward severely. Some of our therapists and orthopedist are anxious to get Alissa standing as soon as possible. Their proposal is to use botox to weaken the rigid muscles causing the toe pointing, to use casting to stretch the tight heal cord, then to place Alissa in a standing position to allow static proprioceptive signals to be sent to the brain. The hope is that in the short period that the botox is in effect, the brain will create the appropriate neural loops between the muscles and joints and that as the botox wears off, the old rigidity will be reduced. This is a valid approach developed based on good science. Unfortunately, this approach has several things working against it. From a "Dynamics Systems Theory" perspective the introduction of botox and casting is a new parameter in the system. Also, both act to weaken the muscles. Because of this, the likely hood of the desired movement pattern becoming dominant over the established pattern is reduced.

Feldenkrais takes the conservative approach. In Alissa’s case they are urging us to allow Alissa to develop subtle but important movement patterns that will eventually build on one another and eventually allow Alissa to have the structural and physical capability to be ready to stand on her own. In my mind, it is the correct approach but a slightly dangerous approach. On of the key aspects of "Dynamics Systems Theory" is that with time, existing movement patterns become more and more dominant in the brain. In addition, with time, structural deformities caused by abnormal movement patterns also begin to play a larger role. One of the limitations of Feldenkrais is that it can not reverse structural deformities. If a child or adult with structural deformities comes to a Feldenkrais practitioner, the practitioner will help the person to move most effectively given the physical limitations of the deformity.

For Alissa, it will be a balancing act to see if the slow progression of subtle improvements can keep the rigidity and deformities from getting worse. So far it seems that we are winning the race. The same therapists that pointed out Alissa’s tight heal cords are now telling us that Alissa’s heal cords are loosening and at the very least are not getting any worse. We will keep a close watch on this area and will act quickly to prevent the physical deformity from getting worse.

Another therapy that offers a unique approach to this scenario is the Adeli Suit promoted by the Euromeds Co of Poland. The Adeli Suit is essentially a suit worn over the body, with elastic bands that mimic the major muscle groups. The tension in the elastic bands can be adjusted to offset the highest tone muscles without weakening the muscles like botox. In addition, the suit allows full movement of the muscles and thus actually allows strengthening of the muscles as well as dynamic proprioceptive input. Euromeds has produced a small amount of self-generated statistics, which seem to support that this method works very well given the correct conditions of the patient. From my analysis of the Euromeds program this specific application of the Adeli Suit is truly beneficial. However, the program in general appears to be modeled after the IAHP program with passive patterning and intensity being major components and thus these aspects of the program are not in sync with "Dynamics Systems Theory". Thus the combination of correct alignment via the structural support of the suit, along with the dynamic proprioceptive input of exercising with the suit on creates a winning combination.

Returning to the limitations of Feldenkrais, the approach relies on the hope that enough variation of movement can be introduced early enough in a child’s development to allow the brain’s natural plasticity to overcome the effects of the initial injury. When I put the specific question of the limitations of Feldenkrais to Anat she responded with a reply of the limitation being one of the student and not one of the method. My observation is that although Feldenkrais can produce fantastic results it is extremely dependent on the skills of the practitioner. Get the wrong teacher and the best student will suffer. In addition, Feldenkrais is very conservative. It relies on the subtle improvements slowly overcoming severe neural injury. In some cases I am certain that the effects of the injury will dominate and the result will be improved functionality but still severe disability.

So that leaves me still searching for the therapeutic approach with enough robustness to fully overcome the devastating effects of the initial injury. Techniques such as NDT, Feldenkrais, the IAHP approach, the NACD approach, the Euromed approach, Conductive Education, and Constraint Induced Therapy all draw their partial success on the proven fact that the brain is extremely plastic.

So if re-generation is not the answer and re-organization therapies have limitations, does that mean that the current approaches can only take a brain injured child so far? I believe the answer is yes and the data supports it. Every study that we have read, every parent that we have talked to, every young adult that has been through all the therapies has clearly shown the limitations of the existing treatments. Thus our search is to find the next evolution of approach that will take Alissa further than the current approaches allow.

Hippotherapy Locations

chum-therapy-karen-pic-300x300

AmericanHippotherapyAssociation.org

California

STRIDES…Granada Hills, CA

Saddle Pals…Grass Valley, CA

Balance In the Saddle…Sacramento, CA

Progressive Equine Assisted Therapy Physical Therapy & Rehab Services…San Francisco, CA

Colorado

The NARHA-Professional Association of Therapeutic Horsemanship International…Denver, CO

Georgia

Kids in Motion…Villa Rica, Georgia

Michigan

CHUM Therapeutic Riding…Dansville MI

Equest Center for Therapeutic Riding…Rockford MI

New York

Pal-O-Mine Equestrian…Adapted riding starts at 2 yrs old. They have other programs like Respite, Equine Assisted Learning programs, Work Program and a few others…Islandia, NY

North Carolina

Miracle Meadows…Jacksonville NC

Ohio

The Camelot Center…Southington, Ohio

Pegasus Farm…Hartville, Ohio

Pennsylvania

Sebastian Riding Associates…Collegeville, PA

Spring Brook Farm…no hippotherapy, but individualized programs for children with special needs and animals, summer camps, etc…West Chester, PA

Utah

>Freedom Riders

Therapeutic Assets…Taylor, Utah

Virginia

Horseplay Therapeutic Riding Program…Midlothian, VA

Washington

Little Bit Therapeutic Riding Center…Woodinville, WA

Mikey-hippotherapypic2-300x225

Hippotherapy-Theraputic Horsebackriding

Therapeutic Horseback Riding-Therapy done while the person is on horseback. Helps with balance and can reduce spasticity. Also is great for increasing self-esteem.

Overview of Hippotherapy-Therapeutic Horseback Riding

By Barbara Heine, PT

Reprinted from NARHA Strides magazine, April 1997 (Vol. 3, No. 2)

By its very nature, therapeutic riding influences the whole person and the effect on all the body's systems can be profound. It was, therefore, a natural progression for therapeutic riding in North America to branch into the medical application of the horse — hippotherapy. Unfortunately, the use of this overall term has led to many misconceptions among therapeutic riding professionals.

Any riding program using horse related activities for clients with physical, mental, cognitive, social or behavioral problems is a therapeutic riding program. But when does therapeutic riding become hippotherapy or classic hippotherapy, and what exactly is developmental riding therapy? The following common questions illustrate the confusion many people have about these areas:

* A physical therapist (PT) volunteers in a consulting capacity once a month. Does this mean your program offers hippotherapy?

* An occupational therapist (OT) with a solid horse background consults for your program once a week and works one-on-one with selected clients to address specific areas of motor planning and sensory integration. The horse for these clients has been selected carefully for its movement and behavioral qualities. You notice that the therapist uses a vaulting surcingle for these sessions and in each session the client assumes different positions on the horse, such as kneeling and quadruped (on all fours). Is this hippotherapy, developmental riding therapy or therapeutic riding?

* A PT who leases your facility and horses to provide hippotherapy for several clients each week. The therapist bills each client differently. The clients sit astride the horse facing forward and backward, and occasionally are placed prone over the barrel. The therapist directs the treatment by advising the horse handler when changes in tempo and direction are required. Is this classic hippotherapy or hippotherapy?

* Your program has recently acquired a trained vaulting horse, and you plan to select several clients who could benefit from this activity. One of your volunteers has had previous vaulting experience and is willing to work closely with your instructor to develop this group activity. Will this be hippotherapy, developmental riding therapy or therapeutic riding in the area of recreation and leisure?

* Your program would like to expand to include hippotherapy because there are several clients that you believe would benefit from a more specific one-on-one approach. A PT in a local sports medicine practice is very keen to become involved and he has ridden recreationally as a child. What additional qualifications would this therapist need to provide direct hippotherapy treatment for these clients?

Questions like these highlight the often subtle differences between these various applications of the horse in a therapeutic setting. In today's litigious society, it is essential that people involved with therapeutic riding are informed not only about the role that a therapist can play, but also the requirements, qualifications and training necessary if that therapist is providing a direct service. It is the aim of this article to clarify these issues.

To begin with, we must define the word hippotherapy, which literally means treatment with the help of a horse. It originates from the Greek word "hippos" meaning horse. More specifically, it is the 3-dimensional movement of the horse's hips and pelvis as the hind legs move forward at the walk, that provides a movement challenge to the client.

Classic Hippotherapy

Classic hippotherapy reflects the German model of hippotherapy practiced widely throughout Europe since the 1960's. Since it is purely the horse's movement and the client's responses that constitute the treatment, classic hippotherapy should only be carried out by a PT, OT, or a speech language pathologist with a certificate of clinical competence (SLP/CCC), who has focused training in the following areas:

* Development of body systems and interaction with the development of movement.

* Effect of neuromuscular, musculoskeletal and cardiopulmonary dysfunction on growth and development, motor development and function.

In classic hippotherapy, it is purely the horse's movement that influences the client. The client may be positioned astride the horse facing forward, backward, prone or supine. The client passively interacts with, and responds to, the horse's movement. The therapist's responsibility is to constantly analyze the client's movement. The therapist must constantly analyze the client's responses and adjust accordingly the manner in which the horse is moving. This assumes that the therapist has sufficient understanding of the movement of the horse to direct the horse handler/instructor to alter the tempo and direction of the horse as indicated by the client's responses.

The primary focus of classic hippotherapy is the rider's posture and movement responses. However, other effects may occur in respiration, cognition and speech production. For example, if the treating therapist is a PT whose goal is to strengthen the trunk muscles and positively affect the client's posture, respiration and speech will improve due to the increased trunk strength. That is the beauty of the horse as a treatment tool — these "other" changes occur even though you are not focusing on them.

Hippotherapy

Hippotherapy, on the other hand, is a treatment approach that uses the movement of the horse based on the methodology of classic hippotherapy with the addition of the treatment principles that apply to the particular profession of the therapist providing the service. The unique combination of the horse, the horse's movement and a non-clinical environment produces an extraordinary effort on all the systems of the body. Therefore, although hippotherapy is frequently used to achieve physical goals, it also affects psychological, cognitive, social, behavioral and communication outcomes. Hippotherapy is truly a multidisciplinary form of treatment and can be applied by a PT, OT, SLP/CCC, psychologist or psychotherapist.

It is a treatment approach that uses activities on the horse that are meaningful to the client and specifically address the individual's goals. Hippotherapy provides a controlled environment and graded sensory input designed to elicit appropriate adaptive responses from the client. It does not teach specific skills associated with being on a horse — rather, it provides a foundation of improved neuromotor function and sensory processing that can be generalized to a wide variety of activities outside treatment. In other words, the client's adaptive responses to the environment and the horse's movement ultimately bring about improvements in function.

An example of a meaningful activity in which multiple systems of the body are affected could be the following: A young client may be asked to move from facing forward to facing backward and then to quadruped (on all fours). In this position, he may be asked to reach one hand down to pat the horse. This activity (the transition, the quadruped position and the reaching activity), is overlaid on the constant rhythmical 3-dimensional movement of the horse. Therefore, in addition to the facilitation of automatic postural responses and stimulation of trunk muscles, there are increases in sensory input to the following systems of the body:

* Vestibular — because the client is facing backward while the horse is moving forward.

* Proprioceptive — heavy touch pressure through the hip, knee, wrist, elbow and shoulder joints in the quadruped position.

* Tactile — touching the soft warm coat of the horse.

* Cognitive — higher level motor planning skills required to execute the transition.

* Motor (physical) — stability of hips and pelvis required to maintain position while reaching forward with one hand.

This is a meaningful activity for any client who exhibits trunk weakness, poor pelvic control, decreased gross motor skills, poor motor planning and a diminished ability to process sensory information.

Developmental Riding Therapy

Developmental riding therapy is distinguished from either classic hippotherapy or hippotherapy by its broader professional participation, more diverse client population, and equine skills/training specific to the areas of dressage, horse-handling and vaulting.

Jan Spink, M.A. developed this technique in the late 1980's to address a growing need for a more specific philosophy and methodology that focused on a multidisciplinary approach to therapeutic riding. This approach incorporates the treatment techniques and expertise of six health or education professions: PT, OT, speech therapy, rehabilitation or psychomotricity, special education and psychology. Some fundamental and distinctive elements of developmental riding therapy are:

* Individual sessions with active therapist input, a client-centered focus, and graded control of sensory stimuli during mounted and non-mounted activities.

* Use of developmental positions on the horse that directly correlate with specifically controlled movement challenges from the horse.

* Development of interrelationships among the client, therapist and horse.

* Selected components of riding and vaulting skills.

* Use of a horse that has been carefully screened for movement and behavioral qualities.

* Use of therapists or specialists who are thoroughly trained in horsemanship as well as in the philosophy and methods of equine-assisted therapy and the specific features of the system of developmental riding therapy (Spink 1987, 1990).

Developmental riding therapy can serve as an entry point for riders whose skills are not yet well enough developed for therapeutic group riding or vaulting. For the hippotherapy client who has met all long term goals, developmental riding therapy is an ideal transition to another program. The client is able to continue therapy in the motivating and pleasurable environment of the horse, but is provided with greater challenges through the use of specific riding or vaulting skills.

The Therapist's Role in Therapeutic Riding

If you currently run a therapeutic riding program and are considering expanding your services to include hippotherapy, here are some guidelines as to the qualifications, responsibilities and training requirements of therapists wishing to practice hippotherapy. Keep in mind, the use of the horse as a treatment tool does not mean that a therapist is a "hippotherapist" any more than an OT who uses sensory integration principles is a sensory integrationist (or a PT using a pool is a hydrotherapist).

Any therapist providing direct treatment services in a classic hippotherapy/hippotherapy program must meet the following qualifications:

* Is licensed or registered to practice a nationally recognized health care profession.

* Maintains current professional liability insurance.

* Has received training in the principles of classic hippotherapy, equine movement and equine psychology through attendance at a minimum of one American Hippotherapy Association (AHA) approved "Introduction to Classic Hippotherapy" course. The completion of this course is a requirement of any therapist wishing to become registered with AHA.

* Is a NARHA certified instructor (any level) and if not, has a NARHA certified instructor assisting with all treatment sessions.

Legally, a therapist must be in direct attendance to the client at all times during a session. If a therapist, operating within the scope of his professional practices act, conducts a group session, he will be actively engaged in the treatment of the whole group and focusing on each client, as and when appropriate. In such a case, treatment progress notes must be kept on each child in the group.

To practice hippotherapy, the treatment principles of a particular health profession are integrated into the hippotherapy setting. The actual treatment on the horse is only one part of a comprehensive treatment program that begins with an initial evaluation. A crucial part of this initial evaluation is the establishment of a treatment plan that incorporates both long and short term goals. Long term goals must be functional and relevant to each client's family/school/work situation. Therefore consultation with the client's family is necessary.

The treatment plan is developed based on the professional training and constraints of the professional practice act of the health professional providing the service. Choosing the horse whose movement best addresses the client's needs, and appropriate equipment to facilitate the desired responses is an integral part of the treatment plan. Regular documentation is provided through progress notes recorded after each treatment.

Re-evaluation of each client should be carried out at three to six month intervals (or less, depending on the reimbursement source) to ensure that the treatment plan and treatment goals remain appropriate for the client. There will be occasions when re-evaluation confirms whether a client has met the long term goals and in the therapist's professional opinion, hippotherapy can no longer address the needs of that client. In this case, the client should be discharged from hippotherapy. It is the responsibility of the treating therapist to write a discharge summary and to communicate directly with the client and/or client's family to recommend further treatment such as PT, OT or speech therapy, or a transition into another program. In the case of a client meeting all long term goals, an ideal opportunity is presented to transition that client to a therapeutic riding program where the learning of "real" riding (or vaulting) skills can add a new and exciting dimension to their lives. If the client's functional abilities and motivation are high it is quite likely that they can make the transition to able-bodied riding or vaulting classes, or competitive equine sports.

Additional Roles for Therapists

Therapists have much to offer any program and may become involved in roles other than direct client service. These can include:

* Consultation

* Staff and volunteer training in body mechanics, physical and cognitive impairments, basic handling/transfer skills, precautions and contraindications

* Community education

* Liaison with the medical community

* Recruitment of additional health care professionals

* Referral of clients

By helping in this way, a therapist has an opportunity to observe the innumerable qualities of the horse as a treatment tool. This can often be such an enlightening experience that the therapist will be motivated to gain the additional skills and training necessary to provide direct service to some of your clients. Instructors should remember that very few therapists come equipped with horse knowledge and riding skills. You can therefore help each other grow and learn.

The hippotherapy team of horse, client, sidewalkers, therapist and instructor is a wonderful example of a symbiotic relationship. No one part can operate without the other and the greater the harmony that exists between all members of the team, the greater the benefit to the client. After all, the client's safety, progress and happiness are the reasons all of us love what we do and continue to strive to be better at it.

Barbara Heine, PT, is the 1998 President of the American Hippotherapy Association. She is the executive director of the National Center for Equine Facilitated Therapy in Woodside, CA.

TheraSuit Intensive Therapy

Andy in Therapy at Movement Discoveries in San BrunoJune 2007, I was able to take Andy to Movement Discoveries located in San Bruno, CA. This was a 3 week program. Monday through Friday, 4 hours per day.

When we arrived,  it was only 8 weeks after he had foot surgery. One of the therapists was a little worried it was too soon after surgery. However, Andy was a trooper and worked through it.

He had 2 tendon transfers and an Achilles transfer on his left ankle. 2 weeks before he had his cast removed.  His foot was still recovering because it would swell up. We could tell the first week it was still pretty sore because he didn't want to put a lot of pressure on it, but through it all, he still did everything Adam and Matt asked him to do, and then some. By the end of the first week, without braces, Andy was able to walk from the hotel room to the van. This is quite a walk from the parking lot since we had a room in the courtyard.  The last week and a half, he had been learning to stand up from the ground. See the video at the end of the page….

I have to say after this 3 week program, Andy didn't have to use his wheelchair or his walker. He did need, and still does need a lot of breaks when walking long distances.

For more information about TheraSuit Intensive Therapy and finding a Provider in your area….click on the link below….

www.suittherapy.com

About Andy

Andy, Born Feb 4 2000 (Agpar Score 0,0,0,4 at 15 min, heartbeat @ 17 mins) 12 years old. HIE (Came home with G-Tube, Removed @ 14 mos.) Hypotonic, later dx'ed Mixed CP. Hydrocephalus has VP Shunt (revised 2000 & 2012) GMFM II almost Level I. Walks Independently but not well enough to play sports. Non-verbal. Uses ASL.
Parents: Kristi & Bruce Siblings: Luke/Maddie

Communication app giveaway

Passing on the information for those who need and could use the TalkTablet.
FREE

Don’t Miss Your Chance.

Communication app giveaway
It is Christmas time and we want to do our part to help families that truly need TalkTablet but simply cannot afford it. So we are gifting 50 (Fifty) copies of TalkTabletUS in time for Christmas. So spread the word as fast as possible.

We will accept nominations at admin@gusinc.com until Dec 13th. Thereafter, we will email the TalkTabletUS Redeem codes to the 50 winners. Please include a brief description of the person that needs TalkTablet and how it would benefit them.

Each of the 50 Redeem Codes will expire on January 3rd, 2013. Therefore, if you win a Redeem Code, you have until January 3rd to download/install TalkTablet onto your iPod, iPhone, or iPad.

If you win a Redeem Code but don’t have, or can’t obtain an iPod or iPad before January 3rd, 2013, simply redeem the code through your iTunes account before January 3rd, 2013 and you will be able to install it an iPod/iPad at a later date when you have an iPod/iPad. No worries.

As 2012 draws to a close, let me once again say ‘thank you’ to all of you for supporting TalkTablet and the people that bring it to you. It is an absolute privilege to create great software for people that rely on it for their day to day communication.

Have a VERY Merry Christmas!! YOU deserve it!!

Gordon Harris, President
Gus Communication Devices Inc.

https://itunes.apple.com/app/talktablet-us/id520043313?mt=8

https://www.facebook.com/TalkTablet?ref=stream

Upgrade Ideas

Tips by Roy Ellis – Father of 11

Bathing Solution:

For those not familiar with this type of bathing solution: The sling is an open mesh so we can bathe her right through the sling. We can raise or lower her to any height so no back pain from bending over for the caregiver. We can even fill the tub and lower her and suspend her in the warm water, great for relieving painful spasms. The sling spins around so we can face her in any direction. The ceiling track extends outside the tub area so we can easily get her in and out of her wheelchair.

The shower setup is part of our ceiling track lift system. The concept is similar to a hoyer lift but you lift them from a track on the ceiling instead of rolling a lift around on the floor. It came with 2 slings, a solid fabric for lifting and an open mesh for bathing.

Swing:
Emma-swingI used 2 lengths of one and a half inch square pipe and attached them to the rafters with standard joist hangars. As far as swinging in any direction, you just use one chain to attach the swing instead of two. Just make sure it’s a strong chain.

  • Make any door 2″ wider by swinging the heel of the door out of the way. Costs about $18 for a pair.
  • Bedroom has double doors and hallway is wide enough to move a hospital bed to the living room and back.
  • Bedroom now has sliding glass door for emergency exit.
  • Newer homes have temperature limiting bathtub faucets. Most are adjustable. Snap the cover off and there’s a sprocket inside you can rotate to limit the top temperature. I have mine set so I can tolerate the temp even if someone turns the handle completely to hot. That way it’s impossible for someone to get scalded and it still allows me to set the water heater hot enough for everything else in the house.

Thank you Roy Ellis for providing these tips to help make our homes accessible for our children.

 

Ella with her scooter.

Cooling Treatment for HIE

 
Rachel Claxton, mother of 2-year old Ella, talks about a potentially fatal brain damage that can happen to any newborn child during labor and an effective treatment option available now. Ella had the cooling treatment at birth to reduce the brain damage from Hypoxic Ischaemic Encephalopathy (HIE). HIE happens when due to reasons like difficult labor, twisted or compressed umbilical cord, etc. enough oxygen does not reach the brain and therefore the brain cells begin to die causing long-term damages like seizures, intellectual disability, and cerebral palsy. This video is an effort by Rachel to build awareness of the cooling treatment.


Ella’s story

Read about Ella’s story.
Ella

Ella