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Horse riding helps children with cerebral palsy (2/6/98)

Six-year-old Maranda Raab of Center Point, Texas, has an understanding with Van the horse -- namely, that she's in control. For a child with the central nervous system disorder cerebral palsy, to be in control of anything is an accomplishment.

"At first she was scared to ride," said her mother, Kim Raab. "She held on as tight as she could. Now she feeds the horses and tells her friends at school that she's riding. She likes the idea of being in control."

Maranda's been riding Van for a year on Saturdays at the HHH Equitherapy stable in Pipe Creek, about 30 miles northwest of San Antonio. Her sessions are supervised by faculty and student volunteers =66rom the occupational therapy and physical therapy departments at The University of Texas Health Science Center at San Antonio.

"Hippotherapy," a specialty area of therapeutic horse riding, is provided by licensed physical, occupational or speech therapists who are trained in the technique. Hippotherapy helps patients with neurological disorders such as cerebral palsy and neurological injuries caused by stroke or head trauma. "The rhythmic movement of the horse tends to reduce the abnormal movement patterns of children with cerebral palsy, allowing the children more freedom in purposeful, goal-directed movement," said Sandra Hubbard, assistant professor of occupational therapy at the Health Science Center. She is registered in hippotherapy.

"Maranda has improved in every area, including her upper body trunk control. She can sit in a chair now without belts," Kim Raab said. "And she is walking with a different walker. The physical therapist was amazed that she was using a new walker on her own."

The first walker had belts and straps while the new one does not, Raab explained. "Before, Maranda's legs were swinging and crossing, but now she can take a more controlled step," Raab added. "She's even using crutches during therapy sessions."

"I see Maranda as being an independent horse rider someday," said Hubbard, who came to the Health Science Center from Albuquerque, N.M.

Cerebral palsy (CP) is caused by damage to the brain before, during or after birth. It may be congenital or a result of trauma to the brain. It is characterized by inability to control motor functions such as muscle coordination and speech, and occurs in varying degrees depending on the affected area of the brain and the amount of damage.

CP can result in spasticity (tight, stiff muscles), hypotonia (limp muscles), dystonia (rigid muscles with decreased movement), dyskinesia (involuntary movement) and ataxia (imbalance). People with cerebral palsy also may have other conditions such as seizures or visual impairment.

Why do children such as Maranda respond to hippotherapy?

Graduate-level physical therapy students at the Health Science Center, supervised by Theresa Nalty, assistant professor of physical therapy, are proposing to research the motion that occurs during hippotherapy and its effect on patients' balance, gait and muscle activity. Outside funding is being sought for a motion analysis device which could be used outdoors with the child on the horse.

"We hope to support popular use of hippotherapy with scientific proof of its effectiveness," said Nalty, who holds board-approved neurology certification for physical therapists. "The physical therapy students are planning a multicenter study that will involve computerized gait, balance and electromyographic (EMG) assessments of head-injured patients before and after hippotherapy.

"It is hypothesized that hippotherapy treatments will result in a decrease in the patient's spasticity, which will normalize the firing rate of the muscles as detected by EMG. Functional improvements in the patient's coordination will then be expected. Resulting improvements in gait and balance could be compared with the findings before hippotherapy treatments using computerized three-dimensional assessments."

Occasionally, a cerebral palsied child who rides horses even learns to walk, either independently or with a walker.

"The theory behind hippotherapy is that the pelvic movement of the rider on the horse is the same as the pelvic movement of human walking," Nalty said. "The horse's repetitive movement, transferred to the rider's pelvis, not only provides a three-dimensional pattern for walking but also aids in the relaxation of the patient's spasticity. This reduction in abnormal muscle tone allows the patient freedom to move his or her pelvis, trunk and extremities with better control.

"Children may be stiff when they get on the horse, but they tend to relax, improving their balance, coordination and gait," Nalty continued. "Ms. Hubbard is looking at hand function and sensory integration in children with cerebral palsy, because hippotherapy appears to improve these areas, as well as the children's respiratory base for speech and ability to pay attention. Educators have reported improvement in children's cognitive abilities following hippotherapy."

"Children with cerebral palsy are in therapy all their lives," Hubbard said. "They get 'therapied out.' Hippotherapy provides genuine motivation to participate in therapy."

Riding around an arena at HHH Equitherapy, Hubbard and Maranda played games. For example, "Farm Animals" worked on Maranda's stretching and balance. Van the horse is trained to step sideways so that the child can place a picture of a farm animal on a poster with Velcro strips.

Each time a picture was attached, Maranda sat up again and whispered for Van to walk. For a child with CP, sitting up straight can be taxing. "Our sessions with Maranda only last about 20 minutes because of the exertion required," Hubbard said.

Maranda has a somewhat mild case of CP; her legs are most affected. However, she has to whisper to the horse because the trunk muscles that control her air flow for speech are affected by CP.

Another game challenged Maranda to put rings on Van's ears (which he allowed very gracefully). This game called for Maranda to maintain her sitting balance while reaching forward for Van's ears.

The riding has increased Maranda's endurance, Kim Raab noted. At home, Maranda can go further with her walker. Mother and daughter travel 30 minutes to HHH Equitherapy from Center Point, which is in Kerr County.

Another child who rides at HHH is Stephanie Snyder, 7, who one recent day was accompanied by her foster dad, Dennis Snyder, and foster grandpa, Rue Snyder. Stephanie rode Bo, another good-natured, well-trained horse at HHH and a stable-mate of Van's.

With all her limbs impacted, Stephanie's CP is more pronounced than Maranda's. Stephanie suffered brain damage at birth due to lack of oxygen.

"Horse riding definitely helps her," said Dennis Snyder. "Emotionally it's very satisfying for her. It helps her upper body torso control and she is improving her grasp. I'm also impressed with the way she steers with her head, which is important since she steers her wheelchair in the same way."

Stephanie rides with Hubbard behind her, because she cannot sit by herself or hold her head up. With Hubbard's support, she is able to lean her head in the direction she wants to go.

The child recently received a power chair and is learning how to drive it.

Stephanie is legally blind and is hearing impaired. Lacking in finger and arm control, she cannot form the symbols of sign language. "She's non-verbal, so our main goal is communication, to develop her abilities in that area," her father said. "To be average or above average in intelligence, but trapped in an uncooperative body and unable to communicate, must be very frustrating. After all, she understands what we say."

Parent and child share this frustration. Thankfully, the hippotherapy session seemed fruitful for both Dennis and Stephanie and the child even smiled a time or two.

Kathy and Kent Harbaugh own HHH Equitherapy, a ranch of 120 acres on Buchaus Road off State Highway 46 near Pipe Creek. Kathy Harbaugh was a horse woman in England and got involved with therapeutic riding about 12 years ago, she said. The Harbaughs have eight horses including Van and Bo.

Health Science Center physical therapy students Dixie Carr-Heyn, Richard Kyle, Wendy Salome and Stacy Thornton, and occupational therapy student Pam Gregory, enrolled in a physical therapy elective course in hippotherapy. During this class, Thornton measured Maranda Raab's range of motion in the hip adductor muscles before and after the riding session. "When Maranda starts out, she's tight," said Thornton, who is computing the average difference between before and after measurements.

"Maranda, do you want to slow down?" Hubbard asked during their session together. The child shook her head no.

"Look how much stronger she is in her back," Hubbard said of her patient. "Maranda, say walk to Van."

"Walk," Maranda said in almost a whisper.

For Maranda, it was a word of triumph, for it is a breakthrough merely to be seated on a horse.

"Inside these bodies there are children who teach us so many things," Hubbard said. "We experience with them the joy of making breakthroughs."

Contact: Will Sansom, (210) 567-2570