Nine-year-old Michael Torrens grins happily as he sits tall upon the back of Belle, a 12-year-old brown-and-white paint quarter horse. Steadied by stable staff walking alongside, the boy and his mount weave through blue and orange traffic cones in the indoor arena of Rocking Horse Rehab in West Orange.
Michael’s ability to hold himself erect on horseback is a remarkable achievement for the spirited fourth-grader, who was born with cerebral palsy. He began weekly half-hour therapy sessions at the stable when he was three.
“I see him on a horse and he looks so good,” says Michael’s mother, Anna Torrens, of Livingston. “He would just fall to the side in the beginning. [The staff] would hold him, obviously, but he didn’t have a lot of trunk control. Now, he just looks great up there.”
“[Belle] makes me feel good,” attests Michael. “[Riding] helps me loosen up.”
This kind of therapy on horseback is called hippotherapy (from the Greek word hippos, meaning horse), or equine-assisted therapy. Licensed physical and occupational therapists use hippotherapy to stimulate and strengthen muscles while improving balance and coordination in people with cerebral palsy, multiple sclerosis, traumatic brain injury, autism and other neurological disorders.
Through a coincidence of physiology, the equine pelvis and gait are similar to that of a human, according to the American Hippotherapy Association (americanhippotherapyassociation.org). As a rider sits astride a walking or trotting horse, his or her nervous system receives certain motor, sensory and cognitive cues from the rhythmic movement of the horse. This can benefit individuals with severely compromised or atypical nervous systems.
“Let’s use Michael as an example,” says Rocking Horse Rehab executive director and speech-language pathologist Sheri Marino Haiken. “Michael sits in a wheelchair all day. What happens to muscles when you don’t use them? They atrophy. [In a wheelchair,] Michael doesn’t have the opportunity to exercise the muscles that surround the pelvis to increase their strength and mobility. When you put him on a horse, however, every one of those muscles is activated because it’s like he is walking. The pelvis is finally moving in a three-dimensional pattern as it would if he was walking. And there isn’t another piece of [therapeutic] equipment that can replicate that.”
“Most of what many therapies do is expose patients to stimulation and get them to respond,” says pediatric neurologist Dr. Michael Goodman, chairman of pediatrics at Children’s Regional Hospital at Cooper in Camden. “With hippotherapy, the stimulus they’re being exposed to is the horse itself—the movement, the balance and gravity all at once. There’s probably sensory stimulation happening at the same time. So the child is developing reflexes and responses to balance himself or herself and to move more fluidly and more functionally.”
By improving posture and muscle tone, hippotherapy also can help overcome speech and language deficits.
“When [the rider] can sit up, the diaphragm opens. It allows a better situation for breath production and then speech production,” says Nichola Redmond, executive director of Mane Stream (formerly the Somerset Hills Handicapped Riding Center) in Oldwick. “The therapists will use different positions. They may put the person prone on the horse, laying back on the horse, to open up the back of the throat in a way that they may not be able to do any other way, so that they can get different sound production in that position.”
Hippotherapy is no walk in the park for the horse. In fact, horses at Mane Stream receive massage therapy, acupuncture and chiropractic treatments to ease the stresses of the job. Each horse is carefully screened for size, age and temperament. The horse also must have a symmetrical gait.
“Our clientele, for the most part, have atypical nervous systems, so we don’t need to be giving them more atypical movement,” says Gina Taylor, an occupational therapist at Mane Stream who is licensed to practice hippotherapy. “We need movement that is 100 percent symmetrical so that, whatever asymmetries or deficits the person may have, we’re not compounding them and making them worse by giving their nervous system all this confusing information.”
In New Jersey, 25 stables offer some form of therapeutic horseback riding, according to PATH, the Professional Association of Therapeutic Horsemanship International (pathintl.org), a nonprofit organization that certifies certain riding instructors and accredits facilities. (Some hippotherapy specialists like Taylor are certified by the American Hippotherapy Certification Board.)
For parents and other caregivers, understanding the terminology and finding the right program are not always easy.
Hippotherapy has specific therapy-related goals and must be conducted by physical therapists, occupational therapists, speech-language pathologists and other licensed professionals. Riders receiving hippotherapy rarely hold the reins or sit in a saddle. A special handler leads the horse while two trained volunteers, called sidewalkers, remain on either side, often holding onto the rider.
“Hippotherapy is such a sexy word that people want to claim it, or understand it, to mean the entire field,” says Octavia Brown, professor of equine studies and director of therapeutic riding at Centenary College in Hackettstown.
By contrast, therapeutic riding (also called adaptive or recreational riding) is a means of teaching a person with a disability to ride as independently as possible by adapting the lesson and the equipment to the rider’s needs.
“Therapeutic riding is therapeutic in the sense that we certainly hope that we’re adding something to someone’s life,” says Brown, founder of Mane Stream and of the North American Riding for the Handicapped Association (now PATH). “The motion of the horse is, of course, the same as in hippotherapy. And we often achieve very similar results. But it’s not therapy and it can’t be reimbursed [by an insurance company].”
The cost of hippotherapy can be prohibitive for some families. It typically ranges from $80 to $120 for a 30-minute session; depending on the insurance carrier, the fee may be partially reimbursed. Insurance companies that do not cover hippotherapy deem it experimental, claiming there is insufficient scientific data to demonstrate its effectiveness.
“There are a lot of variables, and that’s what makes doing research so difficult,” says Rocking Horse Rehab’s Haiken. “How do you measure the effectiveness of a hippotherapy program when the child is getting traditional therapy all day long in school, then going privately the next day to another practice that does traditional therapy. You can’t say to them, ‘You know what, guys? Let’s stop doing all therapy for three months so we can baseline and do a study on hippotherapy.’”
“Do we have as much [research] as other strategies and other interventions? Absolutely not,” admits Redmond. “But we’re still a young field. When we see a client progress, we don’t know that wouldn’t have happened at some point anyway. But I think what we are all very much convinced of, including the parents, is that with the equine-assisted therapy, we see [developmental] gains more quickly.”
“I’ve had many patients report positive results from hippotherapy, especially in the areas of balance and coordination,” says Dr. Catherine Mazzola, a pediatric neurosurgeon at Morristown Medical Center and Hackensack University Medical Center. “If a parent sees an improvement in their child, and the therapists agree, then the therapeutic intervention worked.”
Betsy and Rob Naulty, of Mountainside, credit their daughter’s improvement to a combination of hippotherapy and other interventions. Caroline, 10, has been riding at Mane Stream for three years. She was diagnosed at age two with partial agenesis of the corpus callosum, a rare birth defect in which a part of the brain that connects its two hemispheres is missing.
“Her balance is much better,” says Betsy. “She’s also much more vocal. She has a lot more vowels and consonant sounds than she ever did. We also find that she’s much more able to do things on her own, like putting on her sneakers and things like that.”
Rob adds that parents of special-needs children “will do absolutely anything” to help their kids. “If something has the potential to work, we’re going to go after that,” he says. “Our ultimate goal is to have Caroline have words.”
Branchburg resident Suzanne Confer also believes in the benefits of hippotherapy. Her son, Owen, who is six and has autism, began the therapy at Mane Stream two years ago.
“The biggest change we’ve seen is in his fine- and gross-motor skills. And we’ve definitely seen better balance and coordination,” Confer says. “If he can hold his body better, then he can stand in line at school and not cause a lot of distraction. If he can reach across his midsection, then he’s better able to do handwriting, painting or any of the things that kids his age typically do without thinking about it.”
As for Michael Torrens, he now walks short distances while supported and is a veritable chatterbox.
“He started out in preschool with just 10 words; you hear him now and it’s unreal,” his mother says. “I said to someone at one point, ‘If I ever tell him to stop talking, somebody hit me.’ Because I’m just so thankful that he can speak the way he does now. He still has a ways to go, but he’s improved a lot.”
Mary Ann McGann is a frequent contributor to New Jersey Monthly.
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