Therapeutic riding: Does it make a difference

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Therapeutic riding Does it make a difference?

• Lana Kaiser MD, DVM
• and a cast of thousands
• College of Nursing
• College of Human Medicine
• Michigan State University

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THERAPEUTIC RIDING Is it good for the rider?
Is it good for the horse? Is it good for the
researcher?
3

• Kate Smith, Camie Heleski, Bonnie DePue, Janice
  Siegford, William Purcell, Linda Spence, Adroaldo
  Zanella, Christine Kaiser, Megan Townsend, Dawn
  Mace, Kari Rogers, Kellie Anderson, Kerrie Vanden
  Bosch, Amy Bowden, John Buckler, Mary Grace Ash,
  Tootles, Amy Shelle, Diane Detore
• 123 Riders
• 25 Horses
• 50 volunteers
• One rural school system

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Overview

• Definition
• History
• Scientific evidence
• Rider
• Horse
• MSU-CHUM Therapeutic Riding Research Project
• At risk
• Special ed
• Horse

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What is therapeutic riding?

• Therapeutic riding is the use of equine related
  activities to positively contribute to the
  cognitive, physical, emotional, and social well
  being of the individual

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What is therapeutic riding?

• Partnership between horse and rider
• Relationship is used to improve specific issues
  of the rider
• The knowledge skills of the instructor are an
  integral component
• Therapeutic riding is NOT just riding lessons or
  getting on the horse and going!

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History of therapeutic riding

• Horseback riding as therapy began in 1952, when
  Liz Hartel of Denmark, despite being handicapped
  by polio, won an Olympic silver medal for
  dressage in the Helsinki games.

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History of therapeutic riding

• 1960s - Therapeutic riding came to the United
  States
• Today - gt700 centers in the US accredited by the
  North American Riding for the Handicapped
  Association (NARHA)
• Hundreds of smaller programs

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History of therapeutic riding

• Despite the proliferation of centers, the
  research documenting the benefits has not kept
  pace with their development, there is little
  empirical documentation of its benefits in
  able-bodied individuals.

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Documenting the benefits

• Anecdotes and case studies
• Many studies not peer reviewed
• Little scientific documentation of benefit for
  rider
• Less documentation of the effect on the horse

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Scientific evidence for benefits of therapeutic
riding the rider

• Studies have focused on the physical effects of
  riding for physically handicapped children and
  adults.
• Cerebral palsy (Benda et al, 2003 Sterba et al.,
  2002 McGibbon et al, 1998 Bertoti 1988)
• Developmentally delayed children (Winchester et
  al, 2002)

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Scientific evidence for benefits of therapeutic
riding- the rider

• The psychosocial outcomes of therapeutic riding
  programs for able-bodied children have not been
  investigated

• Psychosocial outcomes have only begun to be
  investigated
• Adults with psychiatric disability (Bizub
  Davidson, 2003)
• Children with sensory modulation disorder
  (Candler, 2003)
• Psychological effects on children with cerebral
  palsy (Sokolov et al, 2002)

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Evidence for benefits of therapeutic riding in
children?

• 5 days of therapeutic riding day camp resulted in
  a significant decrease in anger
• (Kaiser et al 2004)

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Evidence for benefits of therapeutic riding
able-bodied children?

• Tucker (1997) - No effect of riding on
  self-concept, locus of control, hopelessness
  impulsitivity
• Pearson (1997) More frequent riding was
  associated with fewer antisocial behaviors

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Is therapeutic riding good for at risk children?
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Do at-risk children cause more stress to the
horse?

• At-risk children may display inappropriate
  behavior toward the animal they are working with
• Behavior may range from impulsive to antisocial
  to violent,
• We wondered if therapeutic riding with at-risk
  individuals is more stressful to the horse than
  other work the horse does.

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Scientific evidence that therapeutic riding is
good for the horse?

• Although therapeutic riding programs have
  proliferated and interest in animal welfare has
  increased, there has been very little work done
  on the effect of therapeutic riding programs on
  the horse

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Scientific evidence that therapeutic riding is
good for the horse?
                                             

• Purpose Determine useful methods for screening
  horses for therapeutic riding programs
• Population 76 therapy horses 27 non-therapy
  horses
• Study Temperament survey, personality traits,
  hormone levels, reactivity tests
• Results Little agreement between observers on
  horses temperament
• No correlation between temperament, hormone
  levels, and reactivity
• Author conclusion It is very difficult to
  objectively determine the suitability of horses
  for therapeutic riding (Anderson, et al 1998)

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Scientific evidence that therapeutic riding is
good for the horse?

• Purpose To evaluate stress in the therapy horse
  induced by the therapy session. 
• Population 33 therapy horses
• Study Measurement of cortisol before and after a
  therapy session
• Results in 82 of horses there was no change in
  cortisol levels.
• Author conclusion Equine Assisted Therapy is not
  stressful for most horses (abstract, McCabe 2004
  )

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Our goal was to evaluate the effect of
therapeutic riding on both the horse and the
rider simultaneously
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MSU-CHUM Therapeutic Riding Research Project
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MSU-CHUM Therapeutic Riding Research Project

• The effect of therapeutic riding for at-risk
  children
• The effect of therapeutic riding for children in
  special education programs

• The effect of therapeutic riding the horse

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MSU-CHUM Riding Project Overview

• AT-RISK KID PROJECT 2003 - The effect of
  therapeutic riding for at-risk children
• SPECIAL ED KID PROJECT 2004 - The effect of
  therapeutic riding for children in special
  education programs
• HORSE PROJECT -The effect of therapeutic riding
  on the horse

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AT-RISK KID PROJECT 2003

• The purpose of this study was to determine the
  effect of an 8 week therapeutic riding program on
  childrens anger, anxiety, perceived self
  competence and motor function

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AT-RISK KID PROJECT 2003

• Children were recruited through a letter sent by
  the school system to parents/guardians of all 6th
  8th graders in a small, rural school system

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AT-RISK KID PROJECT 2003

• Sample
• 18 students in 4th to 8th grade
• 10.7 years (/- 1.3)
• 7 boys, 11 girls

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AT-RISK KID PROJECT 2003

• At-risk was defined using federal guidelines
• Exclusion criteria
• Psychotropic drugs
• Psychiatric diagnosis
• Classified as learning disabled

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AT-RISK KID PROJECT 2003Protocol

• Tests administered before and after 8 weekly
  riding sessions
•  
• Prior to the onset of this project, the protocol
  was approved by the Michigan State University
  Committee on Research Involving Human Subjects
  (UCRIHS) and the All University Committee for
  Animal Use and Care (AUCAUC)

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AT-RISK KID PROJECT 2003

• MEASURES
• Childrens Inventory of Anger (CHIA Nelson
  Finch, 2000).
• CHIA Subscales
• Frustration (11 items),
• Physical Aggression (9 items)
• Peer Relationships (9 items)
• Authority Relations (10 items)

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AT-RISK KID PROJECT 2003

•  
• MEASURES
• State-Trait Anxiety Inventory for Children
  (Spielberger, 1973).
• Self Perception Profile for Children (Harter,
  1985).
• Subscales Global Self Worth, Social Acceptance,
  Athletic Competence, Physical Appearance,
  Behavioral Conduct, and Social Competence.

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AT-RISK KID PROJECT 2003
MEASURES

• Bruininks-Oseretsky Test (Bruininks, 1978)
• Gross motor skills
• Fine motor
• Bilateral integration
• Balance

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AT-RISK KID PROJECT 2003Results

• No difference in psychological evaluations
• Balance and coordination improved

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AT-RISK KID PROJECT 2003Conclusion

• Although all the children liked the riding
  program, we could find no improvement in the
  psychosocial parameters we measured
• This suggests either
• therapeutic riding doesnt do anything for this
  group of children ..or
• we didnt measure the right thing!

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SPECIAL ED KID PROJECT 2004

• The purpose of this study was to determine the
  effect of a 4 week therapeutic riding program on
  childrens anger, assessment of behavior, and
  cheerfulness
• We also assessed the parents perception of their
  childs behavior

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SPECIAL ED KID PROJECT 2004

• Children were recruited through a letter sent by
  the school system to parents/guardians of all
  children in special education in grades 6th
  through 12th in a small, rural school system.
•  
• Special education criteria were established by
  the school system

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SPECIAL ED KID PROJECT 2004Sample

•  
• 22 children enrolled
• 14 of 22 completed the project
• 7 boys, 7 girls
• Age 14.3 yrs
• (range 10 18)
• Learning disabled 3
• Emotionally Impaired 11

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SPECIAL ED KID PROJECT 2004Protocol

• Tests administered before and after 8 riding
  sessions over 1 month
•  
• Prior to the onset of this project, the protocol
  was approved by the Michigan State University
  Committee on Research Involving Human Subjects
  (UCRIHS) and the All University Committee for
  Animal Use and Care (AUCAUC)

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SPECIAL ED KID PROJECT 2004Measures

•  
• Anger - Childrens Inventory of Anger
• 39 items
• (Nelson Finch, 2000).
• Subscales
• Frustration (11 items),
• Physical Aggression (9 items),
• Peer Relationships (9 items),
• Authority Relations (10 items).
•   

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SPECIAL ED KID PROJECT 2004Measures

• Cheerfulness STCI
• 30 items
• 3 subscales
• cheerfulness
• seriousness
• bad mood

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SPECIAL ED KID PROJECT 2004Measures

• Conners-Wells Adolescent Self Report Scale
• 87 items measures childs perception of their
  behavior
• Conners Parent Rating Scale
• 80 items - measures parents perception of the
  childs behavior

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SPECIAL ED KID PROJECT 2004Anger - Results

• ANGER ALL KIDS
• Significant decrease in anger and all subscales
  but peer relationships
• ANGER - BOYS
• Mean anger before riding was high normal
• Decrease in anger after riding
• ANGER - GIRLS
• Mean anger was less than normal anger level
• No change after riding

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SPECIAL ED KID PROJECT 2004Results

• Cheerfulness
• No change

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SPECIAL ED KID PROJECT 2004Results
Conners-Wells Adolescent Self Report Scale

• ALL KIDS
• Decrease in cognitive problems/inattention
• BOYS
• No change
• GIRLS
• Decrease in cognitive problems/inattention

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SPECIAL ED KID PROJECT 2004Results
Conners Parent Rating Scale

• ALL MOTHERS
• Mothers perceived no differences in childs
  behavior before and after riding
• BOYS MOTHERS
• Boys mothers perceived improvement in all
  subscales
• 7 of the 14 subscales showed significant
  improvement
• GIRLS MOTHERS
• Girls mothers did not perceive any significant
  improvement

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SPECIAL ED KID PROJECT 2004Conclusions

• Girls
• Anger was lt normal and did not change
• Girls perceived improvement in cognitive problems
  / inattention
• Mothers did not perceive any improvement in
  behavior

• Boys
• Anger significantly decreased
• Boys did not perceive any improvement in behavior
• Mothers perceived boys behavior improved

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SPECIAL ED KID PROJECT 2004Implications

• Therapeutic riding might be useful for boys in
  special education programs
• Therapeutic riding might be useful for boys with
  anger issues
• Understanding the reason for the girls low anger
  level could be important in helping them achieve
  success

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HORSE PROJECT

• Hypothesis At risk children increase stress /
  irritation of the horse

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HORSE PROJECT

• Equine behavior was observed during riding from
  June of 2003 to July of 2004
• Prior to the onset of this project, the protocol
  was approved by the Michigan State University
  Committee on Research Involving Human Subjects
  (UCRIHS) and the All University Committee for
  Animal Use and Care (AUCAUC)

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HORSE PROJECTBehavioral observation

• Ethogram of all behaviors observed
• Behaviors defined
• Definitions modified from Sue McDonalds A
  Practical Field Guide to Horse Behavior (2003)
• Refinement of instrument
• 2 min observation periods
• All behaviors were noted
• Stress/irritation behaviors determined
• Confirmation of stress behaviors by observation
  of same horses at the fair

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HORSE PROJECTStress behaviors

• Behaviors included as stress/irritation behaviors
• ears back mad
• head raised
• head turned
• head toss
• head shake
• head down
• defecate

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HORSE PROJECTRiders

• 123 riders
• Riders were classified as
• None (n34)
• Physically handicapped (Physical) n35
• Psychologically handicapped (Psychological) n15
• At-risk n18
• Special education (Special ed) n22

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HORSE PROJECTHorses

• Horses
• 25 horses
• 18 of the 25 were ridden by all 5 groups of
  riders
• total of 2065 observation periods

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HORSE PROJECTHorse Care

• At CHUM, horses are viewed as partners not tools
• Physical management
• Nutritional management
• Psychological management
• Veterinary Management
•  

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HORSE PROJECTResults

•  
• At risk children caused significantly more
  stress/ irritation behaviors in the horse than
  any other group of riders
•  
• Mean stress behavior for at risk was 2.3 per 2
  min
• All others were lt 1.1 per 2 min

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HORSE PROJECT

• At the CHUM Therapeutic Riding Center,
  therapeutic riding with physically or
  psychologically handicapped individuals is no
  more stressful to the horse than riding in the
  same setting by non-handicapped individuals
• At-risk children cause more stress to the horse
• At other therapeutic riding centers, where the
  horse care and management is different, these
  results may not apply

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• Implications
• In this setting, most horses do not see their job
  as more stressful than recreational riding
• The time each horse is ridden by at-risk children
  should be limited both daily and weekly

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THERAPEUTIC RIDING Is it good for the rider?
Is it good for the horse? Is it good for the
researcher?
58

• American Veterinary Medical Foundation and FACT,
  MSU
• Kate Smith, Camie Heleski, Bonnie DePue, Janice
  Siegford, William Purcell, Linda Spence, Adroaldo
  Zanella, Christine Kaiser, Megan Townsend, Dawn
  Mace, Kari Rogers, Kellie Anderson, Kerrie Vanden
  Bosch, Amy Bowden, John Buckler, Mary Grace Ash,
  Tootles, Amy Shelle, Diane Detore
• 123 Riders
• 25 Horses
• 50 volunteers
• One rural school system