Quick Personal Note: This essay on therapeutic riding is my own composition, and I sincerely hope it provides enlightenment on the subject matter. I have been a client and teacher of therapeutic riding and believe it to be an interesting and helpful activity. Though this paper is written mostly from the medical standpoint of therapeutic riding, please understand the actual day-to-day industry concentrates on bringing health, happiness, and hope to all that tough upon it. Please forgive any grammar mistakes within, for this was the first draft, and my computer informs me that the final draft can no longer be accessed.

Author: Lori
Date: Feb. 2001

Even though it is commonly thought that the close association of humans with animals can bring about positive and profound changes in human life, it is only now beginning to become clear that, specifically, the horse has a healing power and exactly what the extent of that power is. "No one would deny that farms, horses and riding are good for one's health and well being. Many human-interest stories, case studies and research projects all clearly validate that riding is an effective form of treatment for many physical and cognitive disabilities" (McDaniel). "Any riding program using horse related activities for clients with physical, mental, cognitive, social or behavioral problems" to facilitate a change in one or more of their bodily systems is a therapeutic riding program (Heine). The therapeutic riding industry encompasses many branches of therapy with the horse, and within the industry are many highly educated equestrians who work hand-in-hand with therapists, psychologists, teachers, doctors and other professionals to provide this relatively new type of therapy. Anyone wishing to enter the field of therapeutic riding as a career must have a working knowledge of horses, the branches of therapeutic riding, how specific diseases and disabilities are treated through therapeutic riding and basic pharmacotherapy that effects therapeutic riding. Through the therapeutic riding industry, lives are touched in special ways whether those involved are clients, instructors, outside professionals, volunteers or parents.

Classic hippotherapy and hippotherapy are two of the four branches of therapeutic riding. Classic Hippotherapy uses only the motion of the horse's hind quarters and pelvis to elicit physical responses from the client. To receive the greatest benefit from this movement, riders may be placed on the horse forward, backward, prone or in other positions. Forms of hippotherapy are not taught soully by therapeutic riding instructors; rather, they are mainly taught by specially trained medical professionals such as physical and occupational therapists. In contrast, hippotherapy allows for these professionals not of the equine field to apply the aspects of their disciplines to the therapeutic riding lesson where more specific concerns related to the client's condition may be addressed by the rider's interaction with the horse and through communication with the instructor. Issues addressed by hippotherapy that are not by classic hippotherapy may include behavioral, speech and social problems. The horse is to classiccal hippotherapy as the tredmill is to the exerciser, while the horse is to regular hippotherapy as an entire gym is to that exerciser. Neither type of hippotherapy riding lesson focuses on teaching the client to ride the horse; in the sessions the horse is handled by another individual, called a leader, who directs the tempo and footwork of the horse at the lesson director's instruction, while the client strictly concentrates on the movement of the horse. While on the horse, the client has a side walker to prevent falls and aid in emergency dismounts when necessary. These branches of therapeutic riding are used to improve muscle tone, coordination, posture and balance while at the same time strengthening the respiratory system and cognitive abilities making speech easier for the client (Heine).

Three examples of illnesses/disabilities that may be treated by the hippotherapies are spina bifida, multiple sclerosis and down syndrome. Spina bifida is a condition of the spinal cord caused by a birth defect. Individuals with spina bifida were born with a sac containing a portion of their spinal cord partruding from the spinal column out of reach of the protection offered by the vertebra. These individuals are more prone to receiving saddle sores due to experiencing less nerve activity from the injury downward. Clients with the above medical diagnosis should be screened for scoliosis, hydromyelia, Chiari II malformations, and tethered cord wich are complications of spina bifida that may be aggrivated by these types of therapy (Baker). Like spina bifida, multiple sclerosis is a disease affecting the myelin within the spinal cord but also simotaineously affecting the myelin within the brain. Inflamations and scarrings of these areas may be exacerbated at any point by the disease itself or by inappropriate therapy. After an acute exacerbation, the client with multiple sclerosis should be reevaluated to be certain that therapeutic riding will still be able to help this individual's physical condition ("Multiple Sclerosis"). Persons with down syndrome were born with fourty-seven chromosones rather than the normal fourty-six. This extra chromosone may cause one or more of fifty physical and psychological defects including mental retardation, a disproportionate body and slowed physical development. Atlantoaxial Instability, a misalinement of the top two vertebra of the spine, is another of these possible complications which can become life threatening if the client is subjected to strenuous neck rotation or jostling. Some clients, such as those with Atlantoaxial Instability, may not be able to ride but may find forfillment and therapy from being in the therapeutic riding atmosphere as a groomer or stable management assistant ("Down Syndrome"). If treatment with the hippotherapies is successful, a client may advance to developmental riding where personal interaction with the horse is more frequent and may bring more emotional and physical benefits. For some clients, however, this transfer from one branch to another may not be preferable due to possible injuries seriously ill or disabled persons may sustain during solo riding training.

Developmental riding and equine facilitated mental health are the other two branches of therapeutic riding. Developmental riding broadens the scope of therapeutic riding to include therapy for persons with handicaps and diseases that may not prevent them from riding without a leader or side walker, such as certain brain injuries, visual impairments, autism, mental retardation and various learning disabilities. The emphasis of this type of therapy is not limited to the physical motions of the horse and encourages emotional bonds between the horse and rider. Actual riding skills for equestrian disciplines, such as dressage and vaulting, are taught through developmental riding and equine facilitated mental health. Developmental riding can also be a bridge into the competitive riding world for these clients. Varying further the services offered under the therapeutic riding umbrella, equine facilitated mental health caters to individuals who exhibit emotional handicaps because of sexual abuse, depression, criminal history or other negative emotional life patterns that can be remedied through companionship and love. A rider's "hopelessness, lack of ability to communicate, depression, chemical dependency, family history, behaviors, record, and abuse all add up to being every bit as confining as any wheelchair" (McDaniel). These two branches of therapeutic riding are more controlled by riding instructors with less input from medical professionals.

The use of developmental riding and equine facilitated mental health to treat a wider variety of diseases and disabilities than the hippotherapies, requires that therapeutic riding instructors have a greater understanding of the medical conditions of their clients. The instructor must know when to use intrusive or inclusive therapy and when a client is too physically or emotionally unstable to ride. Intrusion therapy is recommended for clients with autism (Brown), while intrusive therapy is recommended for those with mental retardation ("Mental Retardation"). Unfortunately, these two conditions often exist simotaineously in one client leeding to a conflict in therapy. To aid in cases such as this and to make sure that the individual needs of clients are being addressed, it is advised that each client fill out a questionaire prior to beginning lessons which may help the instructor better understand the client. Here are some sample questions from an article on Attention Deficit Disorder which can be used as a pattern for other such questionaires; questionaires may be as individualized as the client due to the variations of different diseases and disabilities. Some questions may be more appropriate for a gardian or therapist rather than the client himself.

Is the rider easily distracted by extraneous noise?
Does he have difficulty organizing tasks?
Does he fail to finish what he started?
Does he seem to "not listen" to directions?
Does he usually act before thinking?
Can he delay gratification, or does he want things now?
Is the rider excessively restless, fidgety, or squirmy?
Does he have difficulty with quiet times or quiet tasks?
Does he have difficulty adapting his behavior to the task?
Is the rider developing a pattern of underachieving?
Does he become easily frustrated?
Does he lose his temper easily?

It is likewise important for the equine facilitated health professional to have an extensive understanding of the pharmacotherapy of their clients. Knowing the difference in the symptoms of the disease and the side effects of the medicine used as treatment for the disease will aid in lesson preparation, as well as a better understanding of the client. The regiment of medicine a potential therapeutic rider has been prescribed, or a change in a current client's medication, may be accompanied by side effects of which it is vital for the instructor to have knowledge such as compromised balance, dizziness and seizures. The instructor may also discover side effects gone unnoticed by the client which could be useful for the other members of the client's health team to be aware. There are six classes of common psychotropic medication of which the equine facilitated health professional should be familiar with in an effort to promote the safety of their clients: antipsychotics, antianxiety medications, antidepressants,mood stabilizers, stimulants and anticonvulsants.

Antipsychotics are strong tranquilizers prescribed to treat delusional thinking, hallucinations, mania or paranoia. Types of antipsychotics include Thorazine, Mellaril, Prolixin, Trilofon, Haldol, Risperdal, Zyprexa, and Clozaril. Side effects of these medications may closely resemble symptoms of Parkinson's disease. Other side effects experienced may include constipation, dry mouth, faintness when rising , greater risk of sunburn and nasal congestion. A client's constipation is often relieved because of the exercise during a riding session. A good requirement for clients that are taking this type of medication is to have them bring bottled water to the sessions to combat the dry mouth which becomes exacerbated with physical activity. Faintness and dizziness may be decreased by increasing blood flow through simple stretching exercises before the body's altitude is changed. Antipsychotics may also alter body temperature and the ability to perspire, putting the rider at a greater risk for heat stroke; it is suggested that the strenuousness of riding sessions be kept at a minimum in warm weather to avoid this particular hazard. Neuroleptic malignant syndrome and dystonic reactions are life-threatening medicinal complications associated with this group requiring immediate emergency attention.

Antianxiety agents have somewhat similar side effects to antipsychotics because they are also tranquilizers but are less potent. Antihistamines and Beta-Blockers also fall in this group. Some common and uncommon psychotropic names are found in this group: Valium, Librium, Xanax, Ativan, Benadryl, Vistaril, Atarax, Inderal, Corgard, Tenormin, BuSpar, Equanil and Klonopin. Antianxiety agents are commonly used to treat psychiatric diseases and brain injuries. It is not often that these medicines cause side effects for they are intended to be taken over short periods of time. Central nervous side effects may include clumsiness, confusion, dizziness, drowsiness, fatigue, headache and tremors. Gastrointestinal effects are also possible such as diarrhea, dry mouth, nausea and vomiting. High blood pressure, asthmatic complications, photosensitivity and ringing in the ears are not unheard of. It is advised for an instructor to assess the client's balance and coordination before any mounted activities. If other side effects appear such as uncoordination or blurred speech, it may be an indication that the client is overdosing or combining medication with other substances unwisely.

Used to control a wide variety of disorders not limited to depression, obsessive-compulsive disorders, generalized anxiety, eating disorders and childhood bed wetting, antidepressants are usually prescribed from six to twelve months or longer. Norpramin, Tofranil, Prozac, Zoloft, Paxil, Nardil, Parnate and Marplan are all in the antidepressant drug family. While side effects appear quickly after beginning these medications, the desired effects of this branch of pharmacotherapy may not be felt by the client for a few weeks. Side effects experienced vary depending on which medication is taken but may include anxiety, dizziness, dry mouth, headache, increased heart rate, light sensitivity, nervousness, sleepiness, tremors, rapid speech, restlessness, ringing in the ears and visual distortions. When decreased mental alertness and coordination result from the introduction of a new medication, the client may benefit from unmounted sessions with the horse until his/her body adjusts to the medication. Slow methodic riding sessions may help the therapeutic rider control any hyperactiveness brought on by the medication. A hypertensive crisis or cardiac arrhythmia may be another complication brought about in association with antidepressants due to drug interaction with caffeine and a chemical found in aged foods such as alcohol, cheese, pickles and soy sauce. Hypertensive crises are characterized by a dramatic rise in blood pressure and can lead to a stroke.

Variations of drugs containing Lithium are used as mood stabilizers in psychiatric patients, who may be prescribed these drugs for life. Medications of this type can prove to be toxic to the therapeutic client if that person loses a large amount of fluid during a riding session requiring heavy physical exertion or a session on a warm day. A large intake of coffee, tea, or soft drinks will also put a client in danger of Lithium toxification, so clients should attempt to replace lost fluids with water or other liquids other than those mentioned previously. Lithium toxification, also brought on by interactions with common over-the-counter drugs, causes dizziness, slurred speech, sleepiness, headache, clumsiness, confusion, pain in the area of the eyes, irregular heartbeat, ringing in the ears, shortness of breath, or seizures. Instructors noticing these symptoms should get the client medical attention immediately. Tremors, dry mouth and some gastrointestinal complaints are less serious side effects of Lithium medications.

Attention Deficit Hyperactivity Disorder is the main illness for which stimulants such as Ritalin, Cylert and Dexedrine are prescribed to control. The effectiveness of a dose of this type of medication is usually limited to three or four hours. A client may experience headache, nervous tics, stuttering, stomach ache, absence of appetite or emotional irritability during those few hours. The therapeutic riding instructor may also be helpful to other members of the client's health team by providing a working knowledge of how the medication effects the patient. Stimulants, if effective, will make a therapeutic rider more efficient, calmer and less distractible during lessons.

Tegretol and Depakote are two examples of anticonvulsant drugs which are used to reduce aggression or mood swings in psychiatric patients and control seizures. Dizziness, decreased coordination, clumsiness, or compromised vision may plague the client during the first weeks after beginning these medications. Constipation, dry mouth and shaking of the arms or hands may also be experienced. Use of Tegretol also heightens sensitivity to the sun. Clients with a history of seizures should have permission from their doctor to participate in the therapeutic riding program. Barn staff, volunteers and instructors should also know what to do in the event of a client's seizure and be able to identify the seriousness of that seizure (Branton).

The education needed by those working with and around therapeutic riding clients can be gained from many sources. Some therapeutic riding centers train their own instructors and volunteers while others employ persons with college degrees in equestrian science, nursing, psychology, physical therapy, physical education and therapeutic riding. It is extremely advantageous for an aspiring therapeutic riding instructor to be certified by the North American Riding for the Handicapped Association. The education requirements for volunteers are obviously less than that of instructors, but it is very important that volunteers have an understanding of the disabilities and diseases of the clients they will be in contact with. Some volunteers may attempt to be overly helpful to some clients without realizing it or may be overly concerned when seeing tremors caused by medical conditions. These problems can only be remedied by proper educaition.

There are countless stories of how therapeutic riding makes a difference in people's lives. Below are a few quotes that exemplify the reasons this industry continues to rapidly grow.

Mother of an autistic child- "I gave you a screaming, kicking, biting animal and you gave me back a little girl." (Brown)

Woman with multiple sclerosis and lyme disease after first ride- "The walk from the platform back to the car was a 400% improvement... That night my body was a bit stiff and sore but in every cell I was spiritually uplifted." (Pernicone)

Instructor from Ride on Center for Kids- "I have personally witnessed the wonderful results that are obtained when these children, many of whom have little sense of their own bodies in space, or little contact with the outside world, come in contact with the Ride On experience. The children develop special relationships with the horses that quickly generalize to increased contact and involvement with teachers, trainers and family members. The sense of confidence and competence they gain from their horsemanship is unparalleled by any other experience." (Brown)

From classic hippotherapy to equine facilitated mental health, from spina bifida to visual impairments and from antipsychotic medication to anticonvulsant medication, therapeutic riding instructors guide their clients from their own knowledge to success and enable them to reach their full potential on and off the horse. Therapeutic interactions with horses change those involved for the better including riders, parents of riders, instructors, outside professionals and volunteers. Research on the effects of therapeutic riding is greatly lacking, expecially research regarding its emotional ones. "It is hard to measure gains to use in writing grants because how can the human soul be quantified and can the rebirth of the human spirit be calibrated?" (McDaniel). More research will be done, and those who do not yet believe in the healing power of the horse will then have irrefutable proof that it exists. For some people the horse is just another farm animal; to others it is a recreational tool; to still others it is a "cool" friend. For those who have seen the healing power of the horse, the horse is considered a miracle.

Works Cited

"Attention Deficit Disorder." NARHA. 16 January 2001.

http://narha.org/features/tr_add.asp

Baker, Liz. "Therapeutic Riding: Riding with Spina Bifida." NARHA. 16 January 2001.

http://narha.org/features/t_riding.asp

Branton, Mandy. "Medication Basics for Equine Facilitated Mental Health." NARHA. 16

January 2001. http://narha.org/features/tr_efmhworkers.asp

Brown, Hana May. "'Intrusion' and 'Interaction' Therapy for Riders with Autism."

NARHA. 16 January 2001. http://narha.org/features/archives.asp

"Down Syndrome and Therapeutic Riding." NARHA. 16 January 2001.

http://narha.org/features/tr_down.asp

Heine, Barbara. "Introduction to Hippotherapy." NARHA. 16 January, 2001.

http://narha.org/features/tr_hippo.asp

McDaniel, Isabella. "What Exactly Is 'Equine Facilitated Mental Health and Equine

Facilitated Learning?'" NARAH. 16 January 2001.

http://narha.org/features/tr_mental.asp

"Mental Retardation and Therapeutic Riding." NARHA. 16 January 2001.

http://narha.org/features/tr_retard.asp

"Multiple Sclerosis and Therapeutic Riding." NARHA. 16 January 2001.

http://narha.org/features/tr_ms.asp

Pernicone, Margaret. "Riders Hip Hippotherapy Hooray." NARHA. 16 January 2001.

http://narha.org/features/riders.asp