A SYSTEMATIC REVIEW OF THE EFFECTS OF PSYCHOTHERAPY ...

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of hippotherapy, with the goal of developing a standardized curriculum; this led to the development of the American Hippotherapy Association (AHA) in 1992 and, in 1993, AHA was approved as the first subsection of NARHA. Shortly thereafter, AHA established therapist registration and standards of practice and, in 1999, subsequent to the establishment of the American Hippotherapy Certification Board, the premier Hippotherapy Clinical Specialist examination was administered (AHA). In 2004, AHA seceded from NARHA and was installed as an independent governing body for the accreditation of therapists endeavoring to employ this treatment approach. For many years the body of research on the efficacy and effectiveness of hippotherapy consisted of anecdotal reports and case studies, albeit valuable precursors and adjuncts to quantitative methods of assessment. Measurement was complicated by the lack of sensitive instruments to assess physiological improvements (Sterba, 2007). Until recently, most of the supporting evidence for the beneficial physical effects of activities involving horses consisted of single-subject designs which lacked comparison groups, studies which lacked standardized measures, and results that were frequently reported in non-peer-reviewed publications (Silkwood- Sherer & Warmbier, 2007; Snider et al., 2007). However, more rigorous research evidence has begun to accumulate, as illustrated by two systematic reviews (Snider er al.; Sterba, 2007) which demonstrated clinically significant beneficial effects of hippotherapy for children with cerebral palsy, and concluded that hippotherapy is a promising intervention. In a breakthrough study recently completed by a team of researchers at Washington University (Shurtleff, Engsberg & Standeven, in press), researchers showed large effect sizes for dynamic trunk/head stability and functional reach in children with spastic diplegia cerebral palsy, which continued at twelve weeks follow-up. These results are encouraging given that in its Clinical Policy Bulletin (2008), policy-writers for the insurance giant Aetna recommended that hippotherapy sessions not be reimbursed pending further research. Typically, hippotherapy sessions are reimbursable by third-party payers such as Harvard Pilgrim Health Care when they are part of a supervised physical or occupational therapy program provided by a contracted 9
vendor (Borzo, 2002). Interestingly, in an Administrative Hearing in California, in the Matter of Matheson W. v. North Los Angeles County Regional Center (2004/2005), it was determined that the claimant, a twelve-year-old boy with autism, should be reinstated and funded for weekly horseback riding lessons which had been discontinued by a state agency. As Glasow (2007) points out in writing for the American Hippotherapy Association (AHA), the matter of semantics in this field is very delicate. The term “hippotherapy” was derived by the Germans from the Greek word for horse, “hippos”, compounded with the word “therapy”, to mean “treatment with the help of a horse” (Glasow; Debuse, Chandler & Gibb, 2005). The use of the movement of the horse is the therapeutic tool, not the horse itself, and members of AHA are careful to denote the distinction (see Appendix B). Hippotherapy sessions are conducted by licensed physical therapists, occupational therapists, or speech and language pathologists specially trained in the principles of this treatment approach, and facilitated with a carefully trained team consisting of a horse specialist, horse leader, and sidewalkers in addition to the client and the horse (AHA; Meregillano, 2004). Therapeutic horsemanship involves any of a number of active physiotherapeutic exercises on and around the horse (Biery, 1985; Engel, 1998), which may include unmounted activities with the horse and/or in the horse environment, such as grooming and stable management experiences. In therapeutic riding, traditional riding skills are taught by a NARHA certified therapeutic riding instructor. With improvements made during the course of hippotherapy, clients can sometimes progress to therapeutic riding, where they take an active role in the control of the horse’s movement and direction. Therapeutic carriage driving is an exciting aspect of the equine tradition which offers participants who may not be able to ride the opportunity to take part in alternative mounted activities (Griffith, 1992). Interactive vaulting engages participants in horsemanship activities and movements around, on, and off the horse or barrel and ultimately in performing gymnastic exercises on the moving horse (Biery, 1985; Bracher, 2000; Frewin & Gardiner, 2005; Kroeger, 1992; Schultz, Remick-Barlow & Robbins, 2007; Vidrine, Owen-Smith & 10
Page 1 and 2: A SYSTEMATIC REVIEW OF THE EFFECTS
Page 3 and 4: ACKNOWLEDGEMENTS Some time ago I ca
Page 5 and 6: TABLE OF CONTENTS ACKNOWLEDGEMENTS
Page 7 and 8: APPENDIX 6. FUTURE DIRECTIONS .....
Page 9 and 10: LIST OF TABLES Table Page 2.1 GRADE
Page 11 and 12: The purpose of this systematic revi
Page 13 and 14: movement manifested in some neurolo
Page 15 and 16: Animals have been used for therapeu
Page 17: traumatic brain injury, attention d
Page 21 and 22: therapists address a variety of men
Page 23 and 24: interest in nature-based therapies
Page 25 and 26: their perceptions of the world. Man
Page 27 and 28: CHAPTER 2 METHODS 2.1 Literature Se
Page 29 and 30: Retrieved potentially relevant publ
Page 31 and 32: were achieved in regard to desired
Page 33 and 34: Table 2.2--Continued 24 Study Graha
Page 35 and 36: Table 2.3--Continued Study Ewing, M
Page 37 and 38: Table 2.4 Pre-Posttest Studies with
Page 39 and 40: Table 2.5--Continued 30 Study Ianno
Page 41 and 42: CHAPTER 3 RESULTS 3.1 Description o
Page 43 and 44: used to compute outcomes. In the re
Page 45 and 46: that participants with increased le
Page 47 and 48: 3.1.7.2 GRADE The results of the ap
Page 49 and 50: CHAPTER 4 DISCUSSION To date, there
Page 51 and 52: generalizability (Shambo et al), or
Page 53 and 54: CHAPTER 5 IMPLICATIONS FOR SOCIAL W
Page 55 and 56: 5.1.1 Adjunctive Uses Interventions
Page 57 and 58: CHAPTER 6 FUTURE DIRECTIONS Despite
Page 59 and 60: effects of this application on the
Page 61 and 62: Beckman-Devik, L. & Ansin, C, (Wint
Page 63 and 64: (http://www.horsesandhumans.org/Res
Page 65 and 66: handling, grooming, longeing, ridin
Page 67 and 68: APPENDIX C PRECAUTIONS AND CONTRAIN
Page 69 and 70:
An acute episode of “reactive air
Page 71 and 72:
REFERENCES Acampora, T. (2008). Not
Page 73 and 74:
Birch, A. & Hong, C. S. (2007). A l
Page 75 and 76:
Cornelius, S. (2002). An explorator
Page 77 and 78:
Fine, A., H. (2000). Animals and th
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Hansen, K., Messinger, C., Baun, M.
Page 81 and 82:
*Kaiser, L. K., Spence, L. J., Lave
Page 83 and 84:
Levinson, B. M. (1972). Man, animal
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National Association of Social Work
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Root, A. (2000). Equine-assisted th
Page 89 and 90:
Tedeschi, P. (1992). Guidelines for
Page 91 and 92:
Yorke, J. (2008). The significance
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