therapeutic riding

8/10/2019 Therapeutic Riding

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Mira Lessick, PhD, RNRobyn Shinaver, BIS, MT, ASCPKimberly M. Post, RNJennifer E. Rivera, ASBetty Lemon, RN, MSN, CNS


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Mary is a 43-year-old grade schoolteacher who suffered a stroke follow-ing a motor vehicle accident. She was

injured three months ago and has left-sided hemi-paresis, an unsteady gait and difficulty maintainingtrunk control. She needs assistance in walking, andcan only walk short distances. In view of her limita-tions, she often becomes frustrated and depressed.

A nurse in the womens health center whereMary receives her primary care and rehabilitationreferred her to a local therapeutic riding program.After four weeks of horseback riding Marys bal-ance improved. She was then able to bend for-ward and straighten up as the horse walked, andshe could stand in the stirrups. She could alsoswing her left arm back and forth, but she

could not get her horse to move by kickingher feet. Six months after her lessons

began, Mary rode with her back straightand can now sit to trot with improved

arm and leg strength. She is inde-pendent in walking and uses a

cane. The horseback ridingexperience also improved

her emotional outlook and self-concept.

Horses as Therapy Agents

The horse has been used as a therapeutic agentsince the time of the ancient Greeks, and Hip-pocrates once spoke of ridings healing rhythm(Bliss, 1997). Early Greeks were reported to offerhorseback rides to raise the spirits of people whohad incurable illnesses (Bizub, Joy, & Davidson,2003). The physical and emotional benefits of rid-

ing horses have been described in literature datingback to the 1600s, as riding was prescribed for suchconditions as gout and neurological disorders aswell as for low morale (All, Loving, & Crane,1999; Willis, 1997).

While scholars throughout history have rec-ognized the horse as an agent of healing forbodies and minds, modern-day usage of ther-apeutic horseback riding (also known asequine-assisted or equine-facilitated ther-

apy) began when Liz Hartel, a youngwoman from Denmark paralyzedfrom polio, won the silver medal fordressage in the 1952 OlympicGames (Benda, Fredrickson,Flanagan, Zembreski-Ruple, & McGibbon,2000).


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Although the most widespread presence of equine therapy is in Germany, where many hospitals maintain a therapeuticriding ring, riding programs have spread throughout Europeand North America (Benda et al., 2000).The first riding centersin North America began in the 1960s, and the North AmericanRiding for the Handicapped Association (NARHA) waslaunched in 1969. Currently, about 700 NARHA centers existin the U.S.and Canada, assisting more than 30,000 individualswith a broad range of disabilities (see Box 1, Types of Disabil-ities and Conditions Served by Therapeutic Horseback Rid-ing).

Therapeutic riding refers to the use of the horse andequine-oriented activities to achieve a variety of therapeuticgoals, including physical, emotional, social, cognitive, behav-ioral and educational goals. It not only encompasses variousleisure and therapeutic activities (e.g., learning riding skills)but also places emphasis on the development of the relation-ship between the rider and horse. Therapeutic riding utilizes ateam approach to providing individualized treatment, and the

riding instructor is the heart of this intervention. The trainedinstructor must have a strong equine background, a positiveapproach to diverse situations, a good understanding of thedisabilities of participants, and awareness of his or her influ-ence on the rider (All et al., 1999).

Nurses who care for women with disabilities in a variety of clinical settings are met with the ongoing challenge of usinginterventions and practices that can effectively contribute tothe health and well-being of their patients. Such interventionsinclude traditional as well as complementary and alternativetherapies. Therapeutic horseback riding is an alternative treat-ment modality that can be used to promote quality of life and

positive health outcomes. This article discusses the use of ther-apeutic riding in the treatment of persons with disabilities andthe implications that arise for nursing professionals providingcare to women clients.

The Horse as a Therapy Aid

Horses are inspirational creatures that catch our attentionand tickle our imagination.They allow us to mold them to ourneeds but yet are governed by innate flight patterns that teach

us to communicate nonverbally. They challenge us in many waysnot only physically but also mentally and emotionally.

The adage time spent in the saddle is never wasted sumsup the uniqueness of the horse as a mobile therapeutic tool.Horses provide a unique neuromuscular stimulation throughtheir movement. A horses movement can be short, medium,or long, and can be measured by how smooth or choppy itfeels to a rider. Of central importance is that the three-dimen-sional rhythmic movement of the horse simulates a humanwalk; that is, a horses stride moves the riders pelvis with thesame rotation and side-to-side movement that occurs whilewalking. The horses rhythmic, dynamic gait induces a contin-uous need for the rider to adjust to the movement of the horse.Its this natural physiological response elicited in the rider thatis used to promote strength, balance, coordination, flexibility,and confidence (Borzo, 2002).

The amount of benefit an individual with a disability gainsfrom horseback riding depends on many factors, such as thetype and severity of the disability, motivation of the rider, and

match between horse and rider. In order to best benefit a rid-er, the riding instructor must be able to choose a horse thatwill fit the individuals needs. For example, a person withweakened trunk control may need a smooth, slow horse untilthe person has gained the strength to be challenged more. Incontrast, a rider with muscle degeneration or atrophy may need a horse that provides more movement in order to stimu-late the muscles.Unlike exercise machines, which tend to work only one muscle group at a time and do not require naturalbody movements, riding requires a person to use their entirebodytrunk, arms, shoulders, head, and legsto steer and con-

48 AWHONN Lifelines Volume 8 Issue 1

Box 1.

Types of Disabilities andConditions Served byTherapeutic Horseback Riding

Traumatic brain injury Spinal cord injury Stroke Multiple sclerosis Muscular dystrophy Cognitive deficits Autism Amputations Cerebral palsy Spina bifida Mental retardation Behavioral problems (including attention deficit

disorder and substance abuse) Learning disabilities Emotional problems Hearing, speech, and visual impairments Orthopedic conditions

Mira Lessick, PhD, RN, is an associate professor at the College of Health & Human Services, University of Toledo, in Toledo, OH.

She is also a member of theAWHONN Lifelines Editorial Advisory Board. Robyn Shinaver, BIS, MT, ASCP, is executivedirector of the Vail Meadows Therapeutic Riding Center in Oregon,OH. Kimberly M. Post, RN, NARHA, is a certified riding instructor at the Vail Meadows Therapeutic Riding Center in Oregon, OH. Jennifer E. Rivera, AS, is equine director and head instructor at theVail Meadows Therapeutic Riding Center in Oregon, OH. Betty Lemon, RN, MSN, CNS, is an assistant professor at the College of Health & Human Services in Toledo, OH.DOI: 10.1177/1091592304263956


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trol the speed of the horse as well as maintain balance. Learn-ing the cognitive and physical skills to achieve full communi-cation with the horse awakens awareness of ones strengthsand weaknesses.

For a person with a disability, the perception of movementand freedom on a horse can be a catalyst for therapeuticimprovement. While traditional therapies often reach aplateau where a patient may lose motivation to keep trying,the excitement of riding stimulates the rider and encouragesmany patients to work through discomfort and increasingchallenges in seeking to improve their abilities and skills.Horseback riding provides persons with disabilities an oppor-tunity to participate and succeed at something many able-bodied people are hesitant or afraid to try. The horses rhyth-mic gaits, its ability to sense and respond to the patient, andthe interactive relationship formed between horse and rider allcontribute to a variety of significant therapeutic gains (Bendaet al., 2000).

Horses can also be used in a similar manner as other ani-

mals such as dogs, cats, rabbits, donkeys, birds, and potbelly pigs who participate in treatment programs in a variety of inpatient and outpatient settings. A patient does not need toride a horse to achieve therapeutic progress. For example,grooming a horse can help to increase a persons joint range of motion, and touching and petting a horse has a calming effectand fosters relaxation.

Benefits of TherapeuticHorseback Riding

Therapeutic horseback riding influences the whole personand has a major effect on many body systems (Daly, 2000).

This type of intervention has been reported to have physical,psychosocial, and educational benefits (see Box 2, Benefits of Therapeutic Riding). The rationale explaining horseback rid-ing as a therapeutic tool is based on the concept that ridingprovides a normal sensorimotor experience for the individualwith a disability that contributes to the development, mainte-nance, rehabilitation, and enhancement of physical skills (Allet al., 1999). This sensorimotor experience involves vestibularinput that stimulates the riders righting and equilibriumresponses as constant adjustments are needed with the horsesstride, velocity, and direction (MacKinnon, Noh, Laliberty,Lariviere, & Allen, 1995).

Research studies have documented improved conditioningof adults and children with disabilities following participationin therapeutic riding programs (Land, Errington-Povalac, &Paul, 2001; All et al., 1999; Farias-Tomaszewski, Jenkins, &Keller, 2001; Pauw, 2000). Among the reported physical bene-fits of riding are improved balance, coordination, posture, armand leg strength, and back and neck strength. For example, inone study of the effects of an eight-week therapeutic ridingprogram, participants (ages 10 to 40) with various physical

February | March 2004 AWHONN Lifelines 49

Box 2.

Benefits of Therapeutic Riding

Physical: Improved balance and muscle strength Improved coordination and faster reflexes Increased muscular control Improved postural control Decreased spasticity Increased range of motion of joints Stretching of tight or spastic muscles Increased endurance and low-level cardiovascular

conditioning Stimulates sensory integration Improved visual-spatial perception Improved gross and fine motor skills

Psychosocial: Improved self-confidence Increased self-esteem and self-image Development of patience Emotional control and self-discipline Expansion of locus of control Improved risk-taking abilities Sense of normality Socialization and improved interpersonal skills Increased perception of quality of life and life

satisfaction Stress reduction

Educational: Learning horseback riding knowledge and skills (e.g.,

horse-handling skills, animal science knowledge) Learning safe behaviors for riding


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disabilities showed significant changes in four of eight meas-ures of sitting posture (Land et al., 2001). The warmth andmovement of the horses body can also help to reduce musclespasticity, especially in the adductors of the legs (Bliss, 1997).Likewise, such activities as mounting, dismounting, saddling,unsaddling, and grooming have a beneficial effect on increas-ing joint range of motion.

An integral component of a therapeutic riding program is theapplication of a variety of exercises to meet individual needs andtreatment goals. Such exercises include stretching, strengthen-ing, relaxing, and developing skills in balance and coordina-tion (see Box 3, Examples of Therapeutic Riding Exercises).For example, standing in the stirrups can be used to strength-en knee, hip, and trunk extensor muscles and improve balance.Other exercises for the upper extremities and trunk that can becarried out on the horses back include reaching to touch thehorses ears or tail, trunk rotation with arms outstretched, andreaching down to touch the left and right stirrup.

Possibly one of the most profound benefits of horseback riding is the increased confidence and self-esteem that comesfrom being able to control and maneuver an animal thatweighs close to 1,000 pounds. The experience of riding hasalso been reported to improve risk-taking abilities, emotionalcontrol and self-discipline; enhance self-efficacy; and fosterthe development of patience (All et al, 1999; Bizub et al., 2003;Farias-Tomaszewski et al., 2001; The National Center on Phys-ical Activity and Disability, 2000).

For example, the results of a recent study involving a 10-week therapeutic riding program documented an augmentedsense of self-efficacy and self-esteem in adults (ages 26 to 46)with psychiatric disabilities (Bizub et al., 2003). Similarly,another study of 22 adults (ages 17 to 61) with a variety of physical impairments reported increased physical self-efficacy and behavioral self-confidence following a 12-week therapeu-tic riding program (Farias-Tomaszewski et al., 2001). Ridingalso provides an increased sense of normality and enablesindividuals with disabilities, who are oftentimes isolated, tosocialize with others who have similar interests. Moreover, thecommunication between human and horse can serve as a ther-apeutic outlet for stress.

Despite its broad and beneficial effects, therapeutic ridingmay not be an appropriate intervention for some people withdisabilities (see Box 4, Contraindications for Therapeutic Rid-ing). A medical history and health care providers statement of approval and recommendations are essential before an indi-vidual can participate in therapeutic riding activities. Health careinformation enables the riding instructor(s) to prepare for indi-vidual needs, plan supervision, and ensure riders safety.

An Exemplar Riding Program: VailMeadows Therapeutic Riding Center

Vail Meadows Therapeutic Riding Center (VMTRC), locat-ed in Oregon, Ohio, is a nonprofit organization that providestherapeutic horseback riding to children and adults with phys-ical, mental, and emotional challenges. The centers mission isto enhance the quality of life of special needs individuals of all

ages, regardless of their financial status, by utilizing a holisticapproach to life-skill development through therapeutic horse-back riding, instruction, and education. VMTRC opened inAugust 1998, with a pilot riding program of nine individuals,a handful of volunteers, and since then has continued to grow.

This 25-acre agricultural facility provides access to a cli-mate-controlled indoor arena and an outdoor arena, bothwith spectator seating. The center is home to 14 therapy hors-es. All therapy horses at VMTRC are donated and carefully selected for suitability and safety. A gentle disposition isrequired and all horses must go through a 90-day screeningprocess.

VMTRC offers a variety of programs, including therapeu-tic riding classes, summer camp, field trips, and an adult spe-


Box 3.

Examples of TherapeuticRiding Exercises

Mounting and dismounting the horse Sitting on the horse, using proper posture

Riding forward Riding backwards Extending arms overhead Extending arms outstretched to side Holding arms outstretched forward and then over-

head, with pole or stick grasped with both hands Swinging arms alternatively forward and backward

at sides Rotating the trunk with arms outstretched Standing in the stirrups Turning side to side while sitting Reaching to touch the horse's ears or tail Lying back on the horse's back, with knees bent,

and pull up to a sitting position Reaching down to touch the left and right stirrup Sitting to the trot (once the walk has been

mastered) Advanced activities: riding without stirrups; riding

independently; cantering; maneuvering the horse ina figure eight pattern on flat ground and throughpoles

Box 4.

Contra-Indications forTherapeutic Riding

Unhealed pressure sores Fragile bones Bleeding disorders (e.g., hemophilia) Epilepsy, uncontrolled by drugs Lack of desire to ride, following a trial experience Allergies


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cial needs day program (see Box 5, Vail Meadows TherapeuticRiding Center Programs). The major goal of these programs isto provide positive, enjoyable experiences that are physically,mentally, and emotionally beneficial as well as educational.

Therapeutic riding classes are offered in 10-week sessionsfour times a year. The center serves approximately 45 to 50 rid-ers each session. Riders range in age from one to 78 years, andhave such disorders as cerebral palsy, developmental delay,multiple sclerosis, neuromuscular ataxia, traumatic braininjury, autism, cancer, severe depression, and attention deficitdisorder.

The therapeutic riding team works closely with riders andtheir health professionals, families, friends, aides, special edu-cators, therapists,and others involved with the patient in orderto establish individual goals and lesson plans. This approach is

meant to enhance any traditional therapies that riders may beinvolved in outside the center.The therapeutic riding team consists of the rider, a

NARHA-certified riding instructor, volunteer side walkers andhorse leaders, family or other caregivers, and the horse itself.Riders are matched with the most appropriate horse in termsof gait, pace, size, and character. The riding team is modifiedas needs change. For instance, an individual progressing toindependent riding skills may trim the team down to a spot-

ter (a volunteer who observes rider and horse and helps withsafety as needed). A typical therapeutic riding class includespre-class grooming, tacking (saddling), mounting, open rid-ing, exercising, planned activity, dismounting, and post-classgrooming.

Therapeutic riding is an important part of the lives of many women with disabilities. For example, a 34-year-oldwoman with multiple sclerosis began riding at Vail Meadowsin the spring of 2000. Having required one to two volunteersto maintain balance in the saddle prior to one year ago, she hasnow become an independent rider.

She grooms and tacks her horse, and can trot the circum-ference of the indoor riding arena independently. This motherof two young children credits therapeutic riding for theincreased strength in her legs and arms and increase in bal-

ance, enabling her to continue to walk up and down stairswithout the use of a handrail and perform routine householdchores.Another 30-year-old woman with Brown-Squard syn-drome began at the center in the fall of 2003. After threemonths of therapeutic riding, she no longer depends on hercane constantly, and the range of motion in her shoulders hasdramatically increased. Riding has played a major role in herregaining independence and self-esteem.


Box 5.

Vail Meadows Therapeutic Riding Center Programs

Programs Description

Therapeutic Riding Classes This program provides one-hour weekly lessons in 10-week sessions four

times/year. Classes are offered Monday through Saturday. Each class has 2-4riders participating under the instruction of a NARHA-certified ridinginstructor. Each rider is assisted by a volunteer team consisting of a horseleader and 1-2 side walkers. The team is modified as needs change

Summer Camp This educational program offers week-long day camps for children and youngadults interested in learning about horses. Topics include: animal science,barn management, crafts, and riding class. Single-day camps are alsoprovided as an enhancement to other organizations and summer camps.

Field Trips This year-round program serves the general community population as aneducational site. A tour of the facilities and grounds is provided as well asshort lessons covering animal science, barn management, and a hands-onsegment. Tours are scheduled by appointment and custom-designed to meet

the needs of the visiting organization.

Adult Special Needs Day Program This year-round program provides vocational, recreational, and living skillsdevelopment opportunities for challenged adults. Vocational opportunities areoffered in-house and secured through local businesses in order to provide jobdevelopment and paid employment opportunities to participating adults.Recreational activities are planned on- and off-site.


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Nursing Implications

An important area of concern for women with disabilitiesis achieving the highest level of wellness possible. The nursemay be the first person that women with disabilities consultfor information and advice about alternative therapies for pro-moting, maintaining, and restoring health and well-being.Because of their holistic approach to patient care, womens

health nurses need to be aware of the positive effects on healthand social development that therapeutic horseback riding canbring to the treatment and rehabilitation process.

Numerous resources are available to assist nurses inincreasing their knowledge and awareness about this nontra-ditional form of intervention (see Box 6, A Sampling of Resources on Therapeutic Riding). Nurses awareness of equine-assisted intervention will increase their ability to pro-vide comprehensive services to their patients.

Therapeutic riding requires teamwork between health careand rehabilitation professionals, the patient, and the family.Nurses can be an integral member of the therapeutic riding

team. A riding program, such as Vail Meadows, can be incor-porated as part of the discharge planning process for many patients. The potential use of therapeutic riding in individualpatient situations must be carefully assessed for appropriate-ness and calculated benefits. Accordingly, pertinent nursinginterventions include (See Box 7, Examples of TherapeuticRiding Programs):

taking a careful history of actual and potential health prob-lems of the patient

discussing aspects of equine-facilitated therapy, includingindications, contraindications, and associated safety issues

determining the individuals level of interest and motiva-tion to participate in a riding program

collaborating with other health care and rehabilitation pro-fessionals in establishing treatment goals

locating and referring the patient to a therapeutic ridingprogram that can best meet the needs of the patient

Nurses must ensure that women clients and their familiesare given ample opportunity to discuss issues and concernsabout therapeutic riding and to have their questions answeredin an informed,meaningful, and supportive manner. They canalso help identify reliable educational resources where patientscan obtain additional information about this treatment

option.Nurses can take a leadership role and act as community

liaisons for alternative therapies such as therapeutic horseback riding. Nurses can assist individual patients or community-based programs in designing programs that incorporateequine therapy. By educating the community, patients andfamilies will have a greater understanding about equine-facilitated therapy and its health and rehabilitative benefits.

Riding centers that provide therapeutic riding and equine-related activities also offer unique employment opportunitiesfor nurses and other health care professionals with an equinebackground. Nurses are especially well suited to the therapeu-tic riding setting as they have an in-depth knowledge andunderstanding of disease processes and related assessment andmanagement considerations. Building an awareness of ortraining as a therapeutic riding instructor could also be a new area of service for nurses.

Therapeutic riding programs such as Vail Meadows Thera-peutic Riding Center are having a positive impact on the livesand health of women with disabling conditions. With theirexpertise in patient education and health promotion, nursesare in a unique position to communicate the outcomes of equine-assisted therapy in a manner that promotes informeddecisions by women regarding this intervention. With educa-tion of the community and the involvement of medical, nurs-ing, and other professional groups, the therapeutic ridingindustry will continue to evolve and many will benefit.


Box 6.

A Sampling of Resources onTherapeutic Riding

STRIDES Therapeutic RidingP.O. Box 572455Tarzana, CA 91357-2455(818) 341-4737http://www.strides.org/what.html

American Equestrian Alliance TherapeuticRiding ProgramP.O. Box 4053Scottsdale, Arizona 85261(602) 992-1570http://www.americanequestrian.com/therapy.htm

North American Riding for the HandicappedAssociation (NARHA)P.O. Box 33150Denver, CO 80233(800) 369-RIDE (7433)http://www.narha.org

The National Center on Physical Activity andDisability Horseback RidingUniversity of Illinois at Chicago1640 W. Roosevelt RoadChicago, IL 60608-6904(800) 900-8086http://www.ncpad.org/Factshthtml/ HorseRiding.htm


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References

All, A. C., Loving, G. L., & Crane, L. L. (1999). Animals,horseback riding, and implications for rehabilitationtherapy. Journal of Rehabilitation, July/August/September, 49-57.

Benda, W., Fredrickson, M., Flanagan, S., Zembreski-Ruple,J., & McGibbon, N. H. (2000). Animal-assisted therapy:A highly versatile modality. Complementary Medicine for the Physician, 5(6), 41-48.

Bizub, A. L., Joy, A., & Davidson, L. (2003).Its like being inanother world: Demonstrating the benefits of thera-peutic horseback riding for individuals with psychiatricdisability.Psychiatric Rehabilitation Journal, 26 (4), 377-384.

Bliss, B. (1997). Complementary therapiesTherapeutichorseback riding? RN , 60(10), 69-70.

Borzo, G. (2002). Horsepower. American Medical News, 45(23), 24-26.

Daly, M. (2000). Rehabilitation in the therapeutic ridingarena. Rehabilitation Nursing, 25 (5), 167-168.

Farias-Tomaszewski, S., Jenkins, S. R., & Keller, J. (2001). Anevaluation of therapeutic riding programs for adultswith physical impairments. Therapeutic Recreation Journal, 35(3), 250-257.

Land, G., Errington-Povalac, E., & Paul, S. (2001). The effectsof therapeutic riding on sitting posture in individualswith disabilities. Occupational Therapy in Health Care,14(1), 1-12.

MacKinnon, J. R., Noh, S., Laliberte, D., Lariviere, J., & Allan,D.E.(1995).Therapeutic horseback riding: A review of the literature. Physical and Occupational Therapy inPediatrics, 15(2), 1-15.

The National Center on Physical Activity and Disability.(2000). Horseback riding. http://www.ncpad.org/Factshthtml/HorseRiding.htm

Pauw, J. (2000). Therapeutic horseback riding studies:Problems experienced by researchers. Physiotherapy , 86 (10), 523-527.

Willis, D. A. (1997). Animal therapy. Rehabilitation Nursing , 22(2), 78-81.


Vail Meadows Therapeutic Riding Center6118 Cedar Point RdOregon, Ohio 43618(419) 697-8960

Greater New Orleans Therapeutic Riding CenterP.O. Box 23284New Orleans, LA 70183-3284(504) 466-9960 or (504) 651-LADY

Riding Unlimited, Inc.Riding Unlimited, Inc.9168 T.N. Skiles RoadPonder, Texas 76259(940) 479-2016

Critter Creek Therapeutic RidingRt. 2 Box 59 DLawton, OK 73501(580) 353-5472

Fran Joswick Therapeutic Riding Center, Inc26284 Oso RoadSan Juan Capistrano, CA 92675(949) 240-8441

Colorado Therapeutic Riding Center11968 Mineral RoadLongmont, CO 80504(303) 652-9131

Thorncroft Therapeutic Horseback Riding190 Line RoadMalvern, PA 19355(610) 644-1963

Circle of Hope Therapeutic Riding, Inc.P.O. Box 463Barnesville, MD 20838-0463(301) 916-2040

Ranch+227 Rang LepageSte-Anne-des-Plaines, PQ J0N 1H0(450) [email protected]

Pacific Riding for the Disabled Association1088 - 208 StreetLangley, BC V2Z1T4(604)[email protected]

North Okanagan Therapeutic Riding AssociationP.O. Box 328 VernonBC V1T 6M3(250) [email protected]

Box 7.

Examples of Therapeutic Riding Programs

therapeutic riding

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