Photograph by Jacqueline Ramseyer
Mounting Effort: Blake Tanis, 5, gets a kick out of riding Harley during his hippotherapy treatment at the National Center for Equine Facilitated Therapy in Woodside. Occupational therapist Claudia Vicas keeps a rein on Blake, while he enjoys his ride.
Physical therapy on horses can help disabled learn how to walk
Willow Glen family says hippotherapy helps son who has cerebral palsy
By Kate Carter
Five-year-old Blake Tanis holds his mother's hand as he walks toward his friends by the horse arena. His face breaks into an irresistible grin and he pushes at his glasses and energetically points to the horses. Blake is small for his age and his short legs move haltingly, but he lets go of his mom and shows no fear as he heads straight for the large beasts, the animals that helped him learn to walk.
"Don't you want to get your helmet, Blake?" asks his occupational therapist, Claudia Vicas, as she guides him toward a storage box.
Blake and his mother, Nikki Tanis, his 18-month-old brother, Corey--who's asleep in the car--and his nanny, Mimi Mascaras, have all made the trek from their Willow Glen home to Woodside. They come to the 12-acre outdoor horse facility, nestled among large private estates, every Wednesday afternoon for Blake's half-hour of hippotherapy at the National Center for Equine Facilitated Therapy.
Hippotherapy--a Greek word meaning "treatment with the help of a horse"--is a form of physical therapy that uses the horse as a therapy tool. It is designed for people who, because of disabilities, have difficulty using their abdominal or trunk muscles. Riding a horse can help such people build the strength, coordination and balance they need to sit up, move their arms and legs and even stand and walk, because the motion of a walking horse mimics the motion of a walking person.
Hippotherapy is just one of a variety of therapies Blake uses to help control the symptoms of his cerebral palsy, a neuromuscular condition that limits his ability to use his muscles. He receives more than four hours of physical, occupational and speech therapy every week, and attends a special education preschool every weekday.
Blake receives so many therapies that it's impossible to say which of his many improvements were caused by which therapy. But Nikki Tanis credits the hippotherapy program, which Blake has participated in since he was 18 months old, with helping him take his first unaided steps about a year ago.
And, as Blake beams down from astride a tall horse named Harley, there's no denying that he loves it.
Human Motion
Many people are familiar with images of developmentally and physically disabled people using physical aids that allow them to ski, swim or do other activities their bodies won't let them do. At first glance, hippotherapy seems like another version of the same type of thing.
But hippotherapy is more than just helping disabled people have fun riding horses, says Steve McKenzie, the center's hippotherapy program director.
"That impression is something we constantly have to fight against," he says.
Hippotherapy is different from therapeutic horse riding--riding to achieve some kind of physical, mental or emotional benefit. The classic form of hippotherapy was developed in Europe in the mid-1900s and involves a passive experience by a person of a horse's movement. A horse moves as a human does--front-to-back, side-to-side and rotationally--and, by feeling the motion, a person can learn how to move their own muscles in similar ways.
Later on, hippotherapy evolved to include doing activities while riding a horse, instead of just sitting or lying on it. People change positions, from facing forward to facing backward to facing sideways. They balance on the horse on their hands and knees and move their hands to reach below or across their bodies. They throw balls or pass rings or even stand up, all while trying to remain on top of the horse as it walks in circles or figure eights.
An experienced physical, occupational or speech therapist oversees the hippotherapy and makes adjustments in the horse's movement and the participant's activities, based on his or her needs and skill level. Physical therapy focuses on developing the ability to make large movements, called gross motor skills, and mobility. Occupational therapy focuses on fine motor skills, such as hand-eye coordination. Speech therapy helps develop oral muscles.
A hippotherapy session is a five-person effort. Each participant is accompanied by a therapist, as well as two volunteers walking on either side and preventing the disabled person from falling off. Finally, a horse handler guides the horse and changes direction and speed at the therapist's instruction.
Woodside's National Center for Equine Facilitated Therapy, or NCEFT, is the largest nonprofit organization in the United States that provides hippotherapy, and the only program to offer hippotherapy five days a week.
NCEFT draws clients who drive as long as 2 1/2 hours to get to their weekly half-hour session. The center's clients range from 18 months to 80 years old, but usually they are young children under the age of 6, McKenzie says. The clients all deal with some kind of physical disability-- most have cerebral palsy, like Blake, but others have multiple sclerosis, spina bifida and a variety of genetic conditions, McKenzie says.
McKenzie says hippotherapy is ideal for children, who are unable to move their muscles in certain ways and who may be less motivated to do repetitious and less interesting physical therapy exercises. He says riding the horses is like play for them, yet they derive the same benefit from riding as from doing other more specific motions. And, he says, there is no other therapy tool--such as therapy balls--that as accurately replicates real three-dimensional motion in space.
Vicas is Blake's NCEFT occupational therapist. Although her work concentrates on more specific tasks, such as helping children learn to dress, feed and bathe themselves, she says there is a good reason for her to work in hippotherapy, developing larger muscles.
"You can't have any fine motor skills if you don't have good trunk control," Vicas says. "We focus on fundamental, ground-level skills to improve fine motor skills. It's a combination of everything Blake does in his life."
Blake has trouble controlling his trunk muscles and coordinating the movements of his body, she says. So she's working with him on the horse to increase his trunk strength, which overlaps with improving his ability to walk. The two also practice movements in which he moves an arm across his body, while maintaining his balance and control.
Photograph by Jacqueline Ramseyer
Horse Help: Summer Lopez, development director at the National Center for Equine Facilitated Therapy, gives hippotherapy horse Vinnie a scratch.
First Steps
On this particular Wednesday, Blake and his horse, Harley, Vicas, the horse handler Sheridan Remley and two volunteers, move slowly around the center's covered arena, getting warmed up. Then they head out to the barn--Blake's "favorite part," Nikki says--and up to an uncovered arena.
Returning to the covered arena, Vicas asks Blake to sit sideways and throw her a ball while the horse moves. He throws it and laughs, and throws it again. Nikki watches, transfixed by his enthusiasm, and perhaps just a little nervous, even though he is supported on all sides--there is little chance of him falling.
"It's terrifying at first," Nikki says of when Blake started hippotherapy about four years ago. "He was little. He's still little. But he never worried about getting up on that big horse."
Nikki and her husband, Dave, found out about NCEFT and its hippotherapy program from other parents of disabled children in support, advocacy and service-providing organizations whom they met after their son was diagnosed with cerebral palsy. They brought him to the center for an evaluation and were told that he was a perfect candidate for hippotherapy.
The program staff believed that Blake should begin receiving the therapy immediately. Blake was allowed to bypass most of the center's waiting list--which can include as many as 50 eager clients. It also accommodated his limited endurance by giving him two 15-minute sessions each week before moving up to the more common single half-hour.
Blake is developmentally delayed, Nikki says, although not everyone who has cerebral palsy has impaired mental functions. He still doesn't talk, but he can identify things and say some muffled words. Nikki says they suspect he's capable of more than he indicates. Until Blake starts speaking, it is difficult to know how much he understands.
Nikki says Blake is beginning to feed himself and is working on standing up from a sitting position without help, and bending down to pick things off the ground. His newest trick, she says, is getting in and out of the car.
She says she believes the hippotherapy has helped make Blake's new skills possible.
"I drive to Woodside once a week with the assumption that this is still a worthwhile thing to do," she says. "We're exposing him to every possible thing that could help him."
Seeing Success
Hippotherapy is not as well researched as other forms of therapy, program director McKenzie says, although its popularity may attest to the strength of anecdotal evidence.
"Hippotherapy, in general, is kind of considered a nontraditional therapy at this point," he says. "It's very important to have physical evidence."
He says the center plans to host a Stanford University research study in fall 2002, that could provide that evidence. The study will compare people, receiving more traditional forms of therapy for their disabilities, with NCEFT clients receiving traditional therapy, as well as hippotherapy. McKenzie says that, although he would like to, there is no way to use subjects receiving hippotherapy alone, because no one ever receives just one form of therapy.
Some insurance companies cover a portion of the center's half-hour sessions, which cost $120, but others do not. McKenzie says studies that provide more evidence about the effectiveness of hippotherapy could help increase the percentage of those that do.
The center's staff doesn't turn prospective clients away if they can't afford to pay the full amount, he says. The nonprofit relies on donations of both money and horses as well as grants.
NCEFT, like other nonhigh-tech service providers in the Bay Area, struggles to keep doing what it does. The center employs two full-time therapists, three therapists and two horse handlers. The program also depends a great deal on its approximately 80 volunteers, two of whom must be present at every hippotherapy session.
McKenzie says he has ideas about expanding the center's program and even establishing other satellite locations nearby, to try to meet the heavy local demand. One of the biggest challenges, he says, is finding therapists willing to work for little money in a nonprofit environment.
Blake's therapist Vicas says the low pay is why she doesn't do hippotherapy full time.
"This is the only thing I've ever wanted to do," she says. "I've always been a horse person. Horses and children are my two biggest loves."
She says the time she does spend with her clients at the center is some of her most special time, as it is for most of the people who come to the serene and welcoming place.
"Everyone here totally loves what they do," Vicas says. "It's a completely dynamic environment, because it involves living things. It's unpredictable and it's changing all the time. It's real life."
For more information about NCEFT, call 650.851.2271, or visit www.nceft.com.
Willow Glen, California Since 1992
