Meet the Hippotherapy Team: Part 1 – Introduction

According to the American Hippotherapy Association, The term hippotherapy refers to how physical therapy, occupational therapy and speech-language pathology professionals apply best practice to create functional change in the patient by skillfully directing equine movement imparted to the patient to engage the patient’s neuro, sensory and movement systems. Integrated with other neuro/sensorimotor techniques, hippotherapy is part of the patient’s plan of care.

Hippotherapy is a physical, occupational, and speech-language therapy treatment strategy which utilizes equine movement as part of an integrated intervention program to achieve functional outcomes.  Equine movement provides multidimensional movement, which is variable, rhythmic and repetitive.  Hippotherapy is an effective treatment strategy used by occupational therapists, physical therapists and speech language pathologists to address a wide variety of therapy goals and objectives.

Therapy using equine movement can only be provided by physical, occupational and speech therapy professionals, and should not be confused with adaptive riding (sometimes refereed to as therapeutic riding).

A hippotherapy team in action

Hippotherapy requires a team.  The team is made up of specially trained people and horses.  In order produce the best results, each member of the hippotherapy team plays an important role.  The team is made up of:

  • The therapist (must be a licensed physical, occupational or speech therapist)
  • The horse
  • The horse handler
  • The side walker

Staff/volunteers tend to horses before and after therapy sessions

Hippotherapy is a labor intensive treatment strategy.  In addition to the members of the hippotherapy team, many other people are also involved in:

  • The training of the horse
  • The care of the horse
  • The grooming of the horse
  • Warming up the horse
  • Preparing the horse for the session
  • Taking care of the horse following a session
  • The training of the horse handlers and side-walkers
  • The scheduling of the team
  • The preparation and maintenance of the facility

Because of this, most therapists using hippotherapy as a treatment strategy have strict cancellation policies to ensure that all members of the team are given sufficient notice when a session is canceled.

Speech Language Pathology in Motion, located in Hauppauge and Islandia NY offers hippotherapy as a speech therapy treatment strategy.  Visit our website to learn more: www.speechinmotion.com

This blog is part of a 5 part series on the hippotherapy team.  The hippotherapy team is led by the therapist.  Look for part 2 of this series to learn about what makes a good therapist for hippotherapy.

Posted in Equine Assisted Therapy, Hippotherapy, Speech Language Pathology in Motion, The Hippotherapy Team | 1 Comment

Valentine’s Day Speech and Language Home Practice Ideas

Every February 14,  men, women and children across the United States and around the world, exchange valentines, candy, flowers and gifts all in the name of St. Valentine as an expression of friendship and love.  The holiday is often decorated with pink, red and purple hearts.

We hope that you will enjoy these Valentine’s Day activities with a speech and language twist from Speech Language Pathology in Motion:

  • Compare and Contrast Hearts: Valentine’s’ Day is filled with hearts.  Hearts that are different sizes, shapes, textures and colors can be seen everywhere!  You can use this as an opportunity to encourage children to use attributes (color, size, shape, texture, etc.) and to compare and contrast using their language.  Ask your child to tell you something that is the same about 2 hearts and then something that is different about them.  If your child has difficulty with this, see if your he/she can identify the hearts that are the same and the hearts that are different receptively on this free worksheet from ABC Teach.  You can model the expressive task by explaining to your child how the hearts are the same/different.
  • Valentine’s Day Pudding:  Cooking activities are a great hands on way to work on speech and language goals.  Use a box of vanilla flavored pudding mix and add some red food coloring to make a tasty pink Valentine’s day treat!  While making the pudding take the opportunity to work on requesting, problem solving, and following directions.  Practice the concepts wet/dry, empty/full, some/all/rest.  Some sample questions to ask are: “Is the bowl empty or full?”, “Is the pudding mix wet/dry?”, “What do we need to do with the box?” (open).  Be sure to encourage turn taking skills while mixing and pouring in the ingredients (“You pour some, then let me pour the rest”).  For some added fun serve this treat in a heart shaped container!  You can also add red fruit to this snack such as raspberries or strawberries or some candy hearts or red sprinkles.  **This activity can be modified and done with red Jello!  If doing this activity with Jello, use different size heart shape cookie cutters to cut out hearts and practice size concepts.  You can also practice following directions containing the location concepts top, bottom and middle while cutting out the hearts.
  • I like you because…:  This is a great activity to include while writing Valentine’s Day cards with your child.  This activity can help children who are working on social skills and children who are working on using attributes.  While making Valentines with your child, have them come up with a reason that they like the person they are making the Valentine for and say or write something positive about that person.  Suggest that they think of kind things about how their friend acts, thinks, plays, works or looks.   You may have to help your child think of ideas.  If this is difficult have them do it for a few friends or family members only rather then for the whole class.  Have your child deliver the Valentine’s on Valentine’s day!  **This activity can be modified to be done in a group or classroom setting.  Each child can come up with a reason why the like the child next to them.  The children can share what they came up with at the end of the activity.
  • Hunt for Hearts: This is a fun activity that can be used to work on many different speech and language goals.  The idea is simple.  Hide hearts around the house and have your child go on a treasure hunt to find them!  You can make the hunt simple or more challenging depending on your child.  Items can be peeking out from their hiding spot, or they can be completely hidden and have messages with clues attached to them that will lead them to the next item.  You can put pictured on the hearts that target a certain articulation sound (i.e. for the /t/ sound add pictures such as turtles, tiger, tie, cat, gate, butter etc).  You can use a search engine such as Google images to find your pictures.   When your child finds the hearts, have your child say the name of the item 3-5 times each or say them in a sentence when they find them.  If your child is not working on articulation, you can also use this activity to work on language skills.  Select items targeting the vocabulary words that your child is working on to help them learn the new words.  You can make this more challenging by having your child follow directions on how to find the items (i.e. to find this treasure you need to look: left, right, above, below, next to, across from, between etc).  You can make the directions simple or more difficult depending on your child and their goals.
Posted in Articulation and Phonology, Expressive Language, Feeding Skills, Home Practice Ideas for Speech and Language, Pragmatic Language and Social Skills, Receptive Language, Speech and Language Development, Speech and Language Therapy | 1 Comment

Hippotherapy as a Speech Therapy Treatment Strategy for Pragmatic Language Deficits

Hippotherapy can be used to address a wide variety of speech and language goals (see my blog on Hippotherapy as a Speech Therapy Treatment Strategy).  Virtually any goal that a Speech Therapist works on in a clinic setting can also be addressed using hippotherapy as a treatment strategy.  Addressing these goals on the moving horse often enhances the results.  Here are a few ways how a therapist may use hippotherapy to address Pragmatic language deficits:

The position of the patient, and the horses movement can be used to encourage eye contact and joint attention skills

Pragmatic language deficits can range from mildly delayed to severely impaired.  To learn more about pragmatic language click here.

Patients with pragmatic language deficits may be working on early social skills such as responding to their name, responding to social greetings, making eye contact, and joint attention.  Or, they may be working on higher level social skills such as gaining another person’s attention, initiating, maintaining terminating and shifting conversations appropriately,  understating subtle social cues, repairing communication breakdowns, using and understanding non-verbal social signals, using and understanding facial expressions and understanding what type of communication is appropriate for the situation.

Speech therapists work with patients to address pragmatic language deficits in a variety of settings.  Often group therapy and therapy in other natural social environments is recommended and is most beneficial for addressing pragmatic language deficits.

Patients have opportunities to interact with all members of the hippotherapy team including the horse.

Pragmatic language deficits can effectively be addressed using hippotherapy.  Hippotherapy is a unique speech treatment strategy in that it involves more then just the patient and the therapist.  There are typically 2-3 people and a horse working as part of the hippotherapy team.  Because the sessions are typically conducted at a farm, there are often also other children and adults who the patient may cross paths with during the session.  There are opportunities to work on a wide range of pragmatic language skills with all of these people in a naturalistic manner during a speech session using hippotherapy as a treatment strategy.

Under the guidance of the speech language pathologist, patients are encouraged to greet, introduce themselves, appropriately initiate, maintain, shift and terminate conversation topics.  Patients can develop social relationships with others in this natural setting.  They learn the names of the people who assist in the hippotherapy session and learn to thank them and their horse at the end of each session.

Patients can work on skills such as requesting help when needed.  Objects can be placed out of the patients reach and they can be encouraged to ask for help to get the items.  The patient may also need to ask for help getting on and off of the horse and with position changes.  Being able to seek out others, gain their attention, and ask them for help when needed is an important social skill.

The horse and the horses movement can be used by a speech therapist to encourage social skills such as eye contact, and joint attention.  For example, if the patient is not attending to an activity the horses movement can be modified or stopped.  Often this change will encourage the patient to orient and attend to the immediate environment.  Patients naturally make eye contact with the therapist when these changes occur.  If a patient is having difficulty paying attention to or responding to pragmatic cues the horse’s movement can be stopped to help bring the patient’s attention back to the therapist.  The therapist can reinforce eye contact by having the horse walk again after a patient makes eye contact.

Playing catch on a moving horse is a great way to work on joint attention skills and turn taking!

Patients have the opportunity to work on turn taking skills during interactions with others and during all activities.  Activities such as games, playing catch, basketball, holding a toy and many others can be incorporated into the session to address turn taking skills.

While working with a speech language pathologist, patients can work on understanding verbal and non-verbal social cues, facial expressions, and recognizing and repairing communication breakdowns.  They can also work on understanding what type of social interaction is appropriate for various situations and when interacting with different people.

All of these opportunities for social interaction make hippotherapy an excellent tool for addressing pragmatic language deficits when provided by a specially trained speech language pathologist.

Speech Language Pathology in Motion is a private practice located in Hauppauge and Islandia NY.  Visit our website to learn more about us: www.speechinmotion.com

Posted in Equine Assisted Therapy, Hippotherapy, Pragmatic Language and Social Skills, Speech and Language Development, Speech and Language Therapy, Speech Language Pathology in Motion | 2 Comments

Hippotherapy as a Speech Therapy Treatment Strategy for Oral Motor, Swallowing and Feeding Difficulties

Hippotherapy can be used to address a wide variety of speech and language goals (see my blog on Hippotherapy as a Speech Therapy Treatment Strategy).  Virtually any goal that a Speech Therapist works on in a clinic setting can also be addressed using hippotherapy as a treatment strategy.  Addressing these goals on the moving horse often enhances the results.  Here are a few ways how a therapist may use hippotherapy to address Oral Motor, Swallowing and Feeding Difficulties

Hippotherapy can be combined with traditional oral motor techniques to increase jaw stability

Traditional oral motor exercises can be incorporated into a hippotherapy session.  The movement of the horse enhances the exercises by challenging the patient in different ways.

Vibration, chewy tubes, bubbles and other materials are easily incorporated into the session.  Tasks such as lip rounding and retracting can be addressed in functional ways while a patient is on the horse.

The horses movement helps to organize the sensory systems which in turn impacts upon the motor systems.  It is believed that hippotherapy helps to improve motor planning deficits (such as those observed in apraxia of speech).   As a result of organization of the sensory systems and coordination of the musculature of the face and mouth a decrease in drooling is often noted during and following hippotherapy. 

The movement of the horse serves to increase jaw stability.  Each time the horse takes a step, the muscles of the patient’s face and mouth are challenged.  Position changes can be used on the horse to challenge the patient in different ways.   For example, these muscles are challenged in a different way when the patient is sitting backward on the horse and weight bearing on their hands vs. when they are sitting facing forward on the horse.

Children may show improvements in feeding skills resulting from improved sensory processing

As a result, feeding skills may improve after hippotherapy.  While it is not recommended that patients be fed while on the horse due to choking risks, the motor and sensory benefits from hippotherapy can have a positive effect on feeding skills.  Hippotherapy also increases trunk control and stability and head and neck control.  These functions are necessary for safe and effective swallowing.

In the case of behavior or sensory based feeding difficulties hippotherapy can be used to help organize and regulate the sensory system and to help children and adults tolerate different textures when hippotherapy is combined with a systematic desensitization to such textures as done using the S.O.S approach to feeding.

Speech Language Pathology in Motion is a private practice located in Hauppauge and Islandia NY.  Visit our website to learn more about us: www.speechinmotion.com

Posted in Equine Assisted Therapy, Feeding Skills, Hippotherapy, Oral Motor Skills, Speech and Language Development, Speech and Language Therapy, Speech Language Pathology in Motion | 4 Comments

Groundhog’s Day Speech and Language Activities

Each year, on February 2nd, people in the United States and Canada celebrate Groundhog’s day.  According to folklore, if it is cloudy when the groundhog emerges from its burrow on this day, it will leave the burrow, signifying that winter-like weather will soon end.  If it is sunny, the groundhog will supposedly see its shadow and retreat back into its burrow, and the winter weather will continue for six more weeks.

In honor of Groundhog’s Day we thought that you might enjoy these fun and free (or almost free) speech and language activities:

  • Pop up Groundhog Puppet Craft:  Use this activity for children to work on Groundhog’s Day vocabulary: “hole”, “groundhog”, “shadow”, and the concepts: up/down and in/out.  You can use a template such as this one from DLTK or this one from Enchanted Learning to make your Groundhog pop up puppet.  After making the pop up craft you can talk about the concepts in and out and up and down while playing with the puppet.  Then, for some added fun, turn off the lights and grab a flash light.  Hold the puppet a 1-2 feet away from the wall and shine the flashlight at it.  Show your child the groundhog’s shadow.  Talk about how the groundhog’s shadow looks when he pops up, and what the ground hog does when he sees his shadow.  For a challenge you can have the groundhog face the shadow and then face away from it.  See if your child is able to understand the groundhog’s perspective by asking “can he see his shadow now?”.  Understanding another’s perspective is an important social skill, and this is good practice.
  • Dirt and worms. Just add a groundhog on a stick for some Groundhog’s Day fun!

    Groundhog’s day cooking activity: A great snack for this fun day is Groundhog’s Day Dirt.   Don’t worry…this is easy!  Use a box of chocolate pudding mix to represent dirt.  You can work on concepts wet/dry, empty/full, open/closed, and some/all and rest while making the pudding.  Some sample questions to ask are: “Is the bowl empty or full?”, “Is the pudding mix wet/dry?”, “What do we need to do with the box? (open), “Can you pour some/all of the ___/the rest of the __ into the bowl?”.   You can also work on turn taking when pouring and mixing the ingredients and following directions while making the pudding.  Once you have made the pudding you crumble up graham crackers or Oreo cookies and put it on top.  Kids usually like crushing the cookies.  Put the whole cookies into a zip-lock bag and seal it.  Have your child use a block to crush them.  See if he/she can follow directions and turn taking while doing this (i.e. “Count to five and then stop”).  Once the cookies are crushed you can pour them  on TOP of the pudding.  Put extra in the middle to make a “mound”.  To add to the dirt look, you can add some gummy worms to the bowl.  To complete Groundhog’s day theme, you can insert a Popsicle stick with a picture of a groundhog attached to make it look like a groundhog on his mound.   You may have children color their own groundhog using a template such as the one found here.  When it is finished you can enjoy a tasty treat!  **Tip for children who are picky eaters- Try encouraging your child to taste the textures separately first (present a whole cookie, some crushed cookies, plain pudding, and worms separately so your child can explore and become familiar with the different textures).  Mixing all of these different textures together at the same time may make this snack overwhelming and difficult for some children to tolerate.**

  • Make your own Groundhog Burrow:  Get a big cardboard box (either from your grocery store or a big appliance dealer, etc.).  Make sure that it is big enough so that you and your child can crawl in and out of it easily.  Using markers, stickers, paint, leaves, sticks, or cut up pieces of paper, have your child follow directions containing prepositions (i.e. top, bottom, middle, corner, front, back) to decorate the box so it resembles a burrow.  Pretend you are groundhogs and crawl in and out of your burrow!  Use a light to make a shadow.  Practice making a “surprised face” if there is a shadow, or a “happy face” if there is no shadow.  For added fun you can have your child make a Groundhog mask using this template.  Use this activity to target turn taking, Groundhogs Day vocabulary, prepositions, following directions, and understanding of the facial expressions/emotions surprised and happy.

Speech Language Pathology in Motion is a private practice located in Hauppauge and Islandia NY.  Visit our website to learn more about us: www.speechinmotion.com

Posted in Expressive Language, Feeding Skills, Home Practice Ideas for Speech and Language, Pragmatic Language and Social Skills, Receptive Language, Speech and Language Therapy, Speech Language Pathology in Motion | 2 Comments

Hippotherapy as a Speech Therapy Treatment Strategy for Receptive and Expressive Language Deficits

Hippotherapy can be used to address a wide variety of speech and language goals (see my blog on Hippotherapy as a Speech Therapy Treatment Strategy).  Virtually any goal that a Speech Therapist works on in a clinic setting can also be addressed using hippotherapy as a treatment strategy.  Addressing these goals on the moving horse often enhances the results.  Here are a few ways how a therapist may use hippotherapy to address Receptive and expressive language deficits.

Patients can answer simple or complex questions about the environment, such as this question, containing the negation concept “not”:  “How many chickens are NOT black?”

The farm environment is a language rich environment with endless possibilities.  It is easy to incorporate receptive and expressive language goals into a patient’s hippotherapy session.  There are many opportunities for working on basic to advanced receptive expressive language skills.  Targeted objectives might be early skills such as producing vocalizations.  The goals may include using gestures signs and pictures to communicate, or they might be more advanced and focus on improving the patients ability to ask and answer complex questions and follow multi-step directions.

Use of both high and low tech communication devices can be incorporated into therapy sessions.  The horse and the equine environment motivate patients to use these systems to communicate.

Patients can use communication systems while on the horse to expand receptive and expressive language skills.   In this picture, a low tech communication system in use on a horse

Goals and objectives can also be targeted using pictures and items that can be attached to the equipment on the horse using velcro.   This is a great way to work on vocabulary, basic concepts, following directions,  and a myriad of other receptive and expressive language objectives objectives.  You can hide the items around the farm and have the patient find the items while they are on the horse.  The possibilities for language and interaction are endless.

Games like “treasure hunt”, “I spy”, and “Simon Says” are easily incorporated into a hippotherapy session.  Typically in a speech session in a clinic, there is 1 patient and 1 adult.  Due to the nature of hippotherapy, the patient has opportunities to interact with an entire treatment team including a horse handler and sidewalker as well as with any other people who he or she may cross paths with during the session. This provides additional opportunities for interactions in a naturalist way.

Hippotherapy provides sensory input helping to organize and focus the patient.   Patients who are more “organized” are better communicators as they are better able to attend to speech and language.  In addition hippotherapy helps build core and trunk support which in-turn effects breath support and helps with timing and coordination.  These are important in the production of speech.

Speech Language Pathology in Motion is a private practice located in Hauppauge and Islandia NY.  Visit our website to learn more about us: www.speechinmotion.com

Posted in Equine Assisted Therapy, Expressive Language, Hippotherapy, Receptive Language, Speech and Language Development, Speech and Language Therapy, Speech Language Pathology in Motion | Leave a comment

Hippotherapy as a Speech Therapy Treatment Strategy

Speech and language development is not just about what occurs in the mouth.   Organization and integration of the sensory systems and core strength, trunk control and breath support are important parts of speech and language development.  The ability to register speech and language, attend to it, and process it is all related to these systems working.

It is no coincidence that typically developing children start talking around the same time that their sensory and motor systems begin to be organized enough for them to start crawling, walking and exploring the environment.  Sensory and motor development are important in speech and language development.  Keep in mind that speech is a complex motor task requiring that numerous muscles must work together to produce different sounds all while coordinating with breath support.

Hippotherapy” is speech therapy using the movement of the horse.  (*Hippotherapy can be also be provided by a licensed occupational, or physical therapist).  The horses movement is helpful in working with children with speech and language delays and disorders for many reasons.  Please note that hippotherapy is NOT a horseback riding lesson.  It is not considered to be a form of therapeutic or adaptive horseback riding.  It is a therapy treatment strategy.  In fact the patient likley will not be sitting on a saddle, and will not be holding onto the horses reins.  The patient is working on therapy goals and objectives selected by a licensed occupational, physical of speech therapist.

During a hippotherapy session, the horses movement causes movement in the patient.  This movement is repeated each time the horse takes a step.  Approximately 3,000 facilitatory steps of movement are produced in a 20 minute session using Hippotherapy.   This translates into 3,000 opportunities to form a new motor pathway for speech and language development.

The horse’s walk provides sensory input through movement, which is variable, rhythmic, and repetitive. The sensory benefits of equine movement can last for hours or days following as little as 20 minutes of hippotherapy.

The horses walking gait moves the human body in a similar pattern to the human pelvis while walking.  The therapist is able to facilitate increased trunk control, stability and breath support through the movement of the horse.  These functions support speech and language.

The horses walk simultaneously produces the following movement in the patient:

  • Up/Down
  • Forward/Back
  • Left/Right
  • Through space

The patient receives proprioceptive input, vestibular input, tactile input, auditory input, olfactory input, and visual flow all simultaneously as the horse is moving.  The horse also provides warmth.  It is not possible to replicate this in a clinic.

The therapist carefully chooses horses for each patient based on the type of movement they produce.  The variability of the horse’s gait enables the therapist to grade the degree of sensory input to the patient and then utilize this movement in combination with other speech-language pathology treatment strategies to achieve desired results.

In addition to all of the above, the biggest draw for some patients is that horses are living beings.  They are big, yet gentle, and they accept everyone for who they are.  People are often drawn to them and want to be around them.  Many children and adults feel better when they are around animals.  Animal Assisted therapy has been shown to have many benefits.

Many patients are motivated to participate in therapy in this unique and enriching setting.  Patients who have been receiving therapy for a long time, or receive numerous therapy treatments weekly, sometimes get burnt out!  Hippotherapy is very different from traditional therapy sessions.  The therapist is able to address the same goals as they would address in a clinic setting, but to the patient they are just having  a good time with their favorite pony!

Hippotherapy is commonly used by a Speech Language Pathologist to address:

  • Receptive language delays and deficits
  • Expressive language delays and deficits
  • Pragmatic language delays and disorders
  • Articulation delays and disorders
  • Phonology delays and disorders
  • Stuttering/Fluency Disorders
  • Oral motor delays
  • Voice (breath support, volume, vocal abuse and misuse)
  • Auditory processing disorders
  • Dysarthria
  • Oral/verbal apraxia of speech
  • Swallowing/Feeding difficulty

Here is a video explaining more about hippotherapy and speech:

When used correctly, by a specially trained therapist, hippotherapy often enhances the effects of traditional therapy techniques.  Patients tend to make progress faster and are more motivated to participate.  Hippotherapy is highly effective for addressing a variety of speech and language delays and disorders.  For more information about hippotherapy please visit The American Hippotherapy Association website.

Speech Language Pathology in Motion is a private practice located in Hauppauge and Islandia NY.  We incorporate hippotherapy into speech therapy treatment plans.  Visit our website to learn more about us: www.speechinmotion.com

Posted in Articulation and Phonology, Equine Assisted Therapy, Expressive Language, Feeding Skills, Hippotherapy, Oral Motor Skills, Pragmatic Language and Social Skills, Receptive Language, Speech and Language Development, Speech and Language Therapy, Speech Language Pathology in Motion | Tagged , , , , , , , | 5 Comments

Equine Assisted Therapies and Activities: Terminology 101

Sometimes when reading information or when  speaking to professionals (both therapists and instructors) in the Equine Assisted Therapies and Activities industry I am shocked to hear how often the wrong terminology is used when talking about things like hippotherapy and adaptive riding!  For example, on the PATH international website, they write that “Therapeutic Riding provides benefits in the areas of THERAPY, education sport and recreation & leisure.”.  Yikes!  There are several things that jump out at me here.  First, using the term “Therapeutic” when speaking about a riding lesson is confusing.  Is it therapy or not?  Then to claim that the riding lesson is providing “therapy” benefits really crosses the line.  I am not even sure if that is legal.  I do know that it is illegal to practice without a license.

After thinking this through, I thought that as both a therapist and a PATH Registered Instructor, that it was important to share some information about terminology (in my wordy speech therapist way!) .

Here are a few facts about hippotherapy, adaptive riding and the related terminology:

  1. Hippotherapy is not therapy for hippopotami .  Nor is it therapy done by or with the help of a hippopotamus .  The Greek word “hippos” translates to “horse”.  Hippotherapy, is loosely translated  as treatment with the help of a horse.   The term “hippotherapy” more accurately is referring to the movement of the horse as a therapy treatment strategy.  When a patient is receiving therapy (OT, PT or Speech) while ON a moving horse we call this hippotherapy.
  2. When horses and the horse’s environment are used as part of an occupational, physical or speech therapy session but the patient is not on the horses back we do not call this hippotherapy.  Remember, hippotherapy is about the movement of the horse.  There are many goals and objectives that the occupational, physical or speech therapist can work on around the horses and in the horses environment, but we now refer to the strategy as “equine assisted therapy“, not hippotherapy.
  3. Hippotherapy is not the same as nor is it a form of “adaptive” or “therapeutic” horseback riding.  They differ in many ways, the biggest being that in hippotherapy the patient is working on therapy goals and in adaptive/therapeutic riding the rider is working on learning how to ride a horse.  Hippotherapy is a treatment strategy which can be provided by a licensed Physical Therapist, Occupational Therapist or Speech Language Pathologist as part of a patients total plan of care.  When used correctly, Hippotherapy often enhances traditional therapy methods and helps patients to meet their therapy goals and objectives.  Hippotherapy is never provided by riding instructors unless that instructor is also a licensed therapist (like me.  See number 5)!
  4. The American Hippotherapy Association (AHA) refers to riding lessons for individuals with special needs as “Adaptive Riding” as it is believed that the term “Therapeutic Horseback riding” implies that the adaptive riding lessons are “therapy” and this terminology is confusing for people.  PATH International is insistent on using the term “Therapeutic Riding”.  This is a problem because using the term “Therapeutic” misleads people into thinking that it is therapy.  It confuses people and insurance companies, resulting in denied claims for people who actually are receiving therapy!  PATH Intl argues that being around and on horses is relaxing and beneficial and therefore is “therapeutic”.
  5. Don’t get me wrong, adaptive riding has many benefits as a recreational activity.  In fact, I am also a registered riding instructor with PATH and I teach Adaptive Horseback riding lessons.  I also, up until recently, managed a horse show series for riders with disabilities called “The Long Island Horse Show Series for Riders with Disabilities“.  There are many people who receive “enough” therapy and are looking to participate in an enjoyable sport rather than another therapy session.  Being a good Adaptive Riding instructor is a skill.  Adapting a horseback riding lesson and teaching someone to overcome their limitations is amazing.  It is great for self esteem and growth.  I am not sure why PATH insists on trying to stake a claim on therapy when the work they are doing is amazing itself.  I personally love teaching riding lessons and I really love preparing riders with special needs to be successful in the world of equestrian competition.  When I work as an instructor, my riders learn things like equitation, competition rules, horse anatomy, parts of the tack, and how to groom and tack their horses.   They go to horse shows.  They have a great time and they learn a lot about the sport of riding.  They learn important lessons on sportsmanship and on winning and losing.  They feel better about themselves at the end of the day.  This all has great benefits, but it is not therapy!  When I provide speech therapy using hippotherapy my session looks VERY different than when I am teaching a riding lesson.  Having the patient learn to ride is not the goal of my session when I am using the horses movement to work on speech.
  6. Because hippotherapy is provided by a therapist as part of an occupational, physical or speech therapy treatment plan, the cost may covered by insurance depending on your coverage for occupational, physical or speech therapy services.  Your coverage will also vary depending upon if the therapist if “in network” or “out of network” with your insurance company.  Therapeutic or adaptive riding is considered recreational and is NOT covered by insurance.
  7.  This one is one of my biggest pet peeves:  There is no such thing as a “hippotherapist”!  In addition, hippotherapy is NOT a type of therapy (as speech therapy is).  This is a little confusing, because of the name “hippotherapy” but it is important to understand.  Hippotherapy is a treatment strategy.  When a speech therapist uses hippotherapy as part of a patient’s treatment we are still providing speech therapy (when an occupational therapist uses hippotherapy it is still occupational therapy, same is true for physical therapy).  Just like when you go to an occupational therapy session and the treatment strategy is the use of a therapy swing for the day, the session is billed as occupational therapy, NOT swing therapy.  The therapist does not suddenly turn into a “swing therapist” (or “a swinger”…lol!).  This is an important differentiation to make.  Insurance companies pay for speech therapy (and occupational/physical therapy), not for hippotherapy (they also don’t pay for swing therapy)!  Again, when we do not use the right terms it confuses patients and the public as well as insurance companies.
  8. Since we are talking about insurance companies, let’s talk about the “S-Code” for hippotherapy.  The American Hippotherapy Association advises against using the “S-Code” for hippotherapy.  Stick with your traditional OT, PT and Speech codes.  You are providing occupational therapy, physical therapy or speech therapy.   Just because you are using a horse, you are not suddenly doing a different type of therapy.  Remember that hippotherapy is not form of therapy (see number 7).  It is a treatment  strategy.
  9. When a person is riding a horse in a riding lesson we call them a “rider“.  When a person is receiving occupational, physical or speech therapy on a horse we refer to the person as a “patient” or “client“.  When teaching someone to ride we call it a lesson.  When giving someone therapy we call it a treatment session.
  10. A horse is a horse of course of course…But in a therapy session when we are talking about using the correct terminology, the horse is a “treatment tool“, and the horse’s movement is the “treatment strategy“.  We modify the horses movement (our treatment strategy)  as needed many times throughout a hippotherapy session to affect the responses we receive from the patient.
  11. When documenting therapy sessions which incorporate hippotherapy as a strategy it is important to stay away from horseback riding terms like “rider”, “trotted”, “posting”, “walk/halt transitions” etc.  If you are a therapist, think and speak like a therapist!  The person you are treating is a patient/client.  So they didn’t “post”.  Think about it in therapy terms.  It is a “modified sit to stand’.  They didn’t “trot”.  You “provided them with increased proprioceptive and vestibular input”.  You didn’t do “walk/halt transitions”.  You worked on “righting responses and increasing arousal”.

Adaptive Riding and Hippotherapy both have very different but important functions.

Adaptive Riding is a wonderful activity with all of the benefits associated with becoming an equestrian athlete.  Riders have the joy of spending time with wonderful animals in a natural environment.  They get to spend time with others who share a common interest.  They exercise.  They become stronger.  They may overcome obstacles and will learn a new sport.  Because of these benefits some may argue that riding a horse is “therapeutic”.  We just must remember though, that it is NOT therapy.  Using the term “therapeutic” confuses people.  It is misleading (sometimes intentionally) by instructors and centers.  We must be clear when explaining what adaptive (or if you must say: “therapeutic”) riding is.  Adaptive riding is valuable and needed as a recreational activity and a sport for individuals with special needs.  It is important, just as other adaptive sports are.

Hippotherapy is as a valuable treatment strategy for patients receiving occupational, physical and speech therapy.  Therapists utilizing hippotherapy as a treatment strategy must work hard to educate patients and insurance companies.  Using the right terminology is crucial.

If the therapists and riding instructors don’t use correct and clear terms about what it is we do, how can we expect the patients, clients, riders insurance companies and the medical community to understand the differences between the two?

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Fun Winter Speech & Language Activities for Kids to do at Home

Speech Language Pathology in MotionSpeech and Language home practice does not have to seem like a chore!  Try these free or almost free fun ideas for winter speech and language home practice.  Your kids will have so much fun that they won’t even realize that they are working on their speech and language goals!

  • Build a Snowman:  You can help your child work on language concepts while out building a snowman this winter. Talk about the size concepts big, medium and small when making the 3 snowballs.  If your child already knows these concepts see if he/she can use comparatives and superlatives (i.e. “big, bigger, biggest” or “tall, taller, tallest”)  when talking about the snowballs.  Talk about the location concepts top, middle and bottom when putting them together.  While dressing the snow man see if your child can follow 1, 2 or even 3 step directions using those concepts (i.e. put the hat on the top and then put the buttons in the middle).  You can also talk about the concepts “tall” and “short” and see if the snowman is taller or shorter then you and your child.  If you are really into this activity you can build more then one snow man and work on using attributes to have your child compare and contrast how the two snowmen are the same or different.   Tip: If it is too cold or there is not enough snow you can do this activity indoors with paper as an art project.  Cut out different size circles and make the snowman with paper and glue and talk about all of the same concepts.  OR, add a tasty twist by making the snowman out of marshmallows.  Use candy for the eyes, nose, mouth and buttons, a cracker or gum drop for the top hat and pretzels for the arms.  A toothpick will help to hold the snowman’s body together.  Have fun!
  • Make an Ice Sun Catcher:Fill a flat container with water.  Put items in (we recommend environmentally friendly items such as leaves, pine cones, acorns or other lightweight natural items, but sparkles, food coloring, googly eyes and other things are a lot of fun too and are great for working on vocabulary!)  as well as a thin wire for hanging.  While making the design you can work on vocabulary words, colors, size concepts, and the concepts sink/float, wet/dry, heavy/light, and empty/full.  See if your child can use attributes to describe the items you are putting in the water.  Have your child answer “wh” questions about the items.  Once you are finished making your design, leave it outside in freezing temperatures.  Talk about the cold and have your child predict what will happen if you leave it outside.  Check back on your creation later and after it is frozen, remove the design from it’s container and hang it from a tree to enjoy while the cold lasts.   As it melts talk about what is happening and why.
  • Frozen bubbles:  If your kids like bubbles this adds an exciting twist!  Bubbles are not just for summer time.  You can use regular bubble solution and bubble wands to blow bubbles outside on a cold day.  The cold weather will turn everyday bubbles into icy spheres!  This is a great activity for children who need to practice oral motor skills and work on lip rounding.  Have your child try to round their lips while blowing bubbles.  You can work on bilabial sounds /b/, /p/ and /m/ by having your child say these words during bubble play “up”, “more”, “pop”, “bubble” and “me”.   You can also work on turn taking as well as the concepts high and low (blow the bubbles up high, blow them down low) and many, few, some and just one.  Enjoy!
  • Snowy Day Treasure Hunt: This is a fun activity that can be used to work on many different speech and language goals.  The idea is simple.  Hide items or objects outside in the snow and have your child go on a treasure hunt to find them!  You can make the hunt simple or more challenging depending on your child.  Items can be peeking out from the snow, or they can be more hidden and have messages with clues attached to them that will lead them to the next item.  You can select items that target a certain articulation sound (i.e. for the /s/ sound you can hide sun glasses, spoons, soap, a toy snake, etc) and have your child say the name of the item 3-5 times each or say them in a sentence when they find them.  You can select items targeting the vocabulary words that your child is working on to help them learn the new words.  You can make this more challenging by having your child follow directions on how to find the items (i.e. to find this treasure you need to look: left, right, above, below, next to, across from, between etc).  You can make the directions simple or more difficult depending on your child and their goals.
  • Winter Time Social Skills: Your child can invite a friend (or a few friends) over for some snow day fun.  You can work on concepts such as turn taking and cooperative play skills by having the children work together to build a fort, snowman or snow animals.  The children can take turns playing winter games such as riding a sled down a hill or pushing/pulling each other on a sled.  The kids can bundle up for a snow picnic!  Use a waterproof blanket and share some snacks picnic style.  You can also have the kids enjoy some snow bowling!  To do this, use plastic cups and fill them with water.  Color the water using food coloring.  Once frozen you can stack the ice blocks into a pyramid shape.  Have the children take turns knocking them down using snow balls.  After a fun filled day the children can talk about what they did while drinking hot coco!

We hope that you enjoy these winter speech and language ideas from Speech Language Pathology in Motion!  If you try these ideas let us know how they went.  If you have more ideas please share them below!

Speech Language Pathology in Motion is a private practice located in Hauppauge and Islandia NY.  Visit our website to learn more about us: www.speechinmotion.com

Posted in Articulation and Phonology, Expressive Language, Home Practice Ideas for Speech and Language, Oral Motor Skills, Pragmatic Language and Social Skills, Receptive Language, Speech and Language Development, Speech and Language Therapy, Speech Language Pathology in Motion | Tagged , , , , , | 4 Comments

About The Blog

Speech Language Pathology in Motion is a Speech Therapy private practice located in Islandia, NY which incorporates sensory based activities and gross motor activities including Equine Assisted Therapy, Hippotherapy and PROMPT Therapy into our speech therapy sessions to optimize results and help our patients meet their speech and language goals.  To learn more visit www.speechinmotion.com

Tina M. Rocco, M.A. CCC-SLP, HPCS is the owner of, and treating therapist at Speech Language Pathology in Motion.  She also works as a school based SLP on Long Island.

Ms. Rocco holds the following qualifications:

  • New York State License in Speech-Language Pathology
  • Certificate of Clinical Competency (CCC) from the American Speech-Language and Hearing Association (ASHA)
  • Teacher of Students with Speech and Language Disabilities (TSSLD) with the New York State Department of Education.
  • American Hippotherapy Association Board certified Hippotherapy Clinical Specialist.  One of only seven Speech Pathologists nation wide to hold this credential.
  • Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) Technique Trained
  • TEACCH (Treatment and Education of Autistic and Communication related handicapped CHildren) Trained.
  • Experience riding, training, competing and working with horses since 1993.
  • Experience in providing a variety of Equine Assisted Activities for children and adults with special needs since 2001.
  • Certified Instructor with PATH Intl.- Professional Association of Therapeutic Horsemanship International (Previously named The North American Riding for the Handicapped Association- NARHA).

Ms. Rocco is active in her field.  She is committed to continuing her education and attaining additional certifications in order to provide her patients with the most current techniques and with the highest quality of speech and language intervention.

This blog is dedicated to those interested learning more about speech and language development and treatment of speech and language disorders.  We hope that you will find the information presented here to be helpful and informative and we encourage your comments and questions!

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