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Making Strides through Hippotherapy

by Karen Dillon with Carilion Clinic


On a recent hot summer afternoon, physical therapist Lisa Belderes with Carilion Clinic Pediatric Therapy prepped for her next patient at Healing Strides of Virginia, a riding center near Boones Mill. As the dark mini-van pulled into the gravel driveway, Lisa walked out to greet her patient, 10-year-old Isabella Pate, and her mother, Petrina.


Making Strides through HippotherapyIsabella is a slender girl with shoulder length brown hair, crystal blue eyes and the thickest eyelashes you've ever seen. She greets Lisa with a shy smile. Isabella has Rett Syndrome, a neurological and developmental disorder, and is unable to communicate verbally.


Gingerly taking Isabella in her arms, Lisa placed her on a padded mat to take off her leg braces, change her shoes and get her ready for her weekly session of hippotherapy. Derived from the Greek word for horse, hippos, hippotherapy means "treatment with the help of a horse."


With a My Little Pony riding helmet strapped firmly onto her head, volunteers lifted Isabella onto Willow, an enormous, but gentle, light brown horse. After a couple of laps around a covered riding ring, Isabella's somber face began to light up.


Isabella is one of eight patients currently enrolled in the 12-week hippotherapy program, which began Aug. 20 and is presented by Carilion Clinic Pediatric Therapy and Healing Strides of Virginia. Children who may benefit from hippotherapy include those with cerebral palsy, autism, scoliosis, developmental delays, Down syndrome and traumatic brain injuries. Many of the patients have weak muscles, poor control of their posture, impaired balance responses and coordination, and decreased mobility.


For Isabella, hippotherapy is helping her strengthen her core muscles and teaching her to use her arm strength to keep her centered on the horse. This is Isabella's third session and her mother, Petrina, has seen the benefits firsthand.


"It's been key to keeping her mobile," said Petrina. "This is by far the best therapy that she does."


Because a horse's movements closely mimic the patterns of the human pelvis when a person is walking, it allows the human to experience the sensation of walking. In Isabella's case, she works to maintain balance in response to a horse's motion, which tone, stretch and strengthen the same muscle groups she would use in sitting, standing, walking and reaching on her own.


"These kids have been in therapy their whole lives," said Lisa. "We just try to make it fun and it's a great motivator for them. I feel like they must bond with the animals."


To practice hippotherapy, it takes adequate facilities, equipment, volunteers, horses, a Professional Association of Therapeutic Horsemanship (PATH) registered instructor (formerly called the North American Riding for the Handicapped Association), as well as a licensed and PATH-registered therapist trained in hippotherapy. It can be costly, too.


Petrina pays the barn fee out-of-pocket and hopes the program continues so that her daughter can get the therapy she needs.


"As long as they'll take her, we'll continue," said Petrina. "You make sacrifices to make it work."


Research shows that hippotherapy helps children improve their functional outcomes, and studies have identified an increase in their motivation, self-confidence and emotional well-being. The therapy also aims to slow the loss of abilities, improve or preserve movement and encourage communication and social contact.


In Isabella's case, "progress for her is maintenance," said Petrina. "Our goal is to work and maintain the skills that she does have."

Before the 12-week sessions begin, Lisa, who is certified as a level II therapist by the American Hippotherapy Association, and fellow physical therapist Lauren Maxwell ride all the therapy horses to ensure their movement and size are right for their patients. They also give each patient a pre-test at the beginning of the program and a post-test when they are finished to measure and track their progress. Parents are also asked to complete a questionnaire about the program.


"I think hippotherapy has been exceptionally great in strengthening core muscles and in helping her to make stepping movements. Hippotherapy is more engaging and works more muscles at once, as well as giving movement feedback," wrote one parent.

"She is so much stronger in her sitting and hands and knees," another parent wrote. "She can even stand for much longer, too! She has also gained better interaction skills and is following directions even better now!"


As her hour-long session came to a close, Lisa and the other volunteers gently lifted Isabella down from Willow's bare back. Taking Isabella's hand in hers, Lisa softly stroked the horse's nose. Isabella slowly slumped into Lisa's arms.


"She's done," said Petrina. "She's exhausted."



Healing Strides of VA | 672 Naff Road | PO Box 456 | Boones Mill, VA 24065 | 540-334-5825 | info@healingstridesofva.org