Episode Transcript
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Microphone (Logitech USB He (00:25):
Hi, good morning, good afternoon, or
good evening whenever you arelistening in.
I am glad to connect with youtoday and have a fun episode on
is Hippotherapy SensoryIntegration.
Two things that I absolutelylove to talk about and I think
before, maybe I jump right inthere.
(00:45):
Just wanna touch base on wherethings are and where we're going
with the podcast.
This podcast is called Animalsand Aquatics, and we've been
touching a lot on the animalside of things.
And my co-host, Mr.
Ryan, also known as my husband,will be jumping in with some
episodes on aquatics coming upshortly.
We've been having a lot ofreally good sessions at the pool
(01:07):
lately and have been reallyexcited to share some of what
we've been seeing, what's beengoing on, and looking at that
aquatic therapy from theoccupational therapy lens.
So we're excited to be bringingin some of those episodes as we
move forward.
But also to keep sharing somegreat interviews.
I have some great interviewslined up that I'm excited to get
(01:29):
shared and get out to you.
And some information like ourepisode today about hippotherapy
and sensory integration.
Again, two things that I'mreally passionate about and
excited to speak about, and I'min the process with some
colleagues of mine of updating.
The Sensory Connections courseas a member of the American
Hippotherapy Associationfaculty, and as I've been going
(01:53):
through some of the material andseeing the updates that need to
be done, it made me think of areally good way to share some of
this information.
and as I was looking around and,and kind of gathering my
thoughts together, how often didI see that Hippotherapy provides
sensory integration?
(02:14):
Hippotherapy is a form ofsensory integration, kind of a
whole lot of differentterminology thrown around on
different websites, and it wassomething that made me really
stop and want to address thisspecific question and how I look
at it both from uh, facultystandpoint as well as from a
(02:36):
clinical standpoint, and themore I work with OTR and OTA
students, the more I think aboutanswering these types of
questions and explaining maybewhere my thought processes are
on this.
And I think the best place tostart with is what is sensory
integration?
(02:57):
And there's lots of differentways to look at it.
So it's a neurobiologicalprocess, it's a theory and it's
an intervention.
So sensory integration involvesperceiving, modulating
organizing and interpretingsensations to optimize
occupational performance andparticipation.
(03:17):
So we can think about a littlebit as like the neurological
neurobiological process, then weknow that Anna Jean Ayres
created the sensory integrationtheory that was really of her
genesis.
And neuroscience really remainsa cornerstone of that theory.
So sensory integration asoriginated by Jean Ayres is both
(03:43):
a theory and a practice.
So that's the practice and theintervention part.
And it's really targeting aperson's ability to process and
integrate information from theirbody and from the environment.
And I think in occupationaltherapy, we're seeing more and
more attention on the sensoryinformation from the body in the
(04:09):
form of interoception.
And I know some of the clientsthat I work with certainly
struggle with the interoceptionpiece, so that's a component of
it.
The sensory information might bevisual, auditory, could be
tactile, proprioceptive orvestibular in nature, and here
I'm going to refer to AyresSensory Integration, the, the
(04:33):
trademarked name because that'swhat I was trained in.
So Ayres Sensory Integrationuses individually tailored
activities that are reallylooking for that just right
challenge.
So with our clients, we'relooking for both a just right
challenge, but then also to seean adaptive response.
(04:53):
So that just right challenge isreally going to look at how the
client is typically processingsensory information, how they
are motor planning or the praxispiece, and then we're going to
encourage them by setting up theenvironment, by creating the
activities and presenting themto the client.
(05:17):
To help them be more organizedand to integrate the sensory
information into more usableforms.
Ayres sensory integrationincorporates specialized
equipment.
So when we think about a sensorygym, we think about our
suspended equipment and that isto give the client an
(05:37):
opportunity to explore a varietyof different movement patterns
for it to be client led.
So when we are using thisequipment or the materials, it's
purposeful for our client.
It's playful.
And so there is a relationshipbased component to it, and we're
looking to again, improve thatadaptive behavior or an adaptive
(06:00):
response from the client.
And a lot of times we can seethis.
even within a session when aclient is using an approach
avoidance type of behavior withthe equipment and as they become
more regulated, as they're ableto integrate that information
more effectively, then suddenlythey're able to engage with a
(06:21):
swing or a slide or they're ableto dual task so they can go down
the side holding a toy.
And we're able to to see thisadaptive response evolve
throughout the session.
Ayres sensory integration isimplemented by therapist with
specialized training.
Again, I did go through one ofthe earlier certification
(06:42):
programs for Ayres sensoryintegration.
It's most often used byoccupational therapists, but
even in my cohort there were afew PTs and SLPs.
So it can be delivered by OT,PT, or speech with specialized
training, and it takes place ina specially designed clinical
(07:03):
setting.
It is meant to be, again, clientled.
So safety is a big factor andobviously it's a sensory rich
experience.
There is a lot of variety puttogether when the clinician is
setting up that environment.
And some of the core tenants ofair sensory integration include.
(07:27):
Um, addressing physical safety.
So if we want to be client led,we need to have an environment
that is safe for the client toexplore.
So we think about that sensorygym again, right?
We might see mats or padding.
We're gonna see crash mats undermaybe some of our bigger
equipment because we, as theclinician do not want to have to
(07:49):
be in the business where we arelike"be careful, be careful,
watch what you're doing".
Um, we want them to really beable to have a full, the client
to have a full experience ofusing the equipment and moving
through space and experiencingwhat it is like to jump or fall
or crash and not necessarilyhaving to put those words behind
(08:11):
it.
We want to have a variety ofdifferent sensory opportunities
available, so when we're settingup our sensory clinic or our
sensory space for our clients,and we're coming from that
sensory integration perspectivewe're thinking about the
affordances of the environmentand what do we need to set up?
(08:34):
So you know, if we don't, if, ifwe don't want that stable like
platform swing, we need to makesure it's put away.
Because when once the client isthere and we're following their
lead, if they're gravitatingtowards that then we're gonna be
bringing that out for them.
And maybe that isn't the mostadaptive response, um, type of
equipment.
(08:54):
Maybe we want something that isa little bit more dynamic and
maybe we want a bolster swing.
And so we're presenting thoseopportunities to the client and
then we're following their lead.
We're looking at the client'slevel of alertness and ability
to engage.
So not under aroused.
(09:15):
Not over aroused.
And I like to describe it as awindow, right?
So like a window in your houseor window in the car.
And we can have the window justa little bit open, right?
So that's that zone where theclient is really regulated or we
can have the window wide openand we have a really wide zone
of regulation and that's whatwe're looking for.
(09:36):
You know, most of us who are,are pretty well regulated.
We have a pretty wide windowwhere we're able to maintain our
regulation.
If we're not getting enoughsleep or we're hungry or hangry,
you know, that window kind ofget smaller and smaller and we
can feel some of those things.
So helping the client to get tothat just right level of
(09:56):
alertness so that they canengage most meaningfully is
important.
We want to have a variety ofequipment that's gonna challenge
the sensory systems, both from apostural perspective, but also
from a praxis.
Perspective and looking at howthe client can organize their
(10:18):
actions around the equipmentthat's provided.
We are following the child'slead, so it is child led and,
and really that kind of innerplay comes out.
We want to be able to upgradeand downgrade our activities to
get that just right challengeagain, if it's something that is
(10:38):
too hard.
Often the children that we'reworking with, they're gonna shy
away from that, or they're noteven gonna try it.
And on the opposite side ofthings, if it's something that
they've already mastered, likethe stability of a platform
swing, then we're really notgonna get an adaptive response.
So when we're looking atequipment choice and setting up
(10:59):
the environment.
It's really important in sensoryintegration when we're coming at
it from the theory perspectiveof how we're setting up this
environment, how we're puttingeverything together.
Then once the client is thereit's all about that therapeutic
interaction with the client.
With it being playful and childled and using intrinsic
(11:22):
motivation for the child.
We're not doing a this thenthat, or you know, once you sit
down and complete this puzzle,then you can swing.
It doesn't work that way, youknow that the child is able to
meet their sensory needs and ifthat gets them to the just right
level where then they can goahead and select a puzzle that's
fabulous.
(11:42):
That would be a great adaptivebehavior or organization of
behavior that we might see.
.So those are some of the keycomponents of Ayres sensory
integration when we're applyingit to our interventions or that
intervention approach.
When we think about and start tocompare that with hippotherapy,
(12:04):
going back to the just the wordright?
The term hippotherapy isreferring to how occupational
therapy, physical therapy, andspeech language pathology
professionals use evidence-basedpractice and clinical reasoning
in the purposeful manipulationof equine movement as a therapy
tool to engage sensoryneuromotor and cognitive systems
(12:28):
to promote functional outcomes.
So the sensory part is in there,right?
It's, it's how that term can bereferring to how, as an
occupational therapist, I'mgonna use the movement of the
horse and best practice isreally going to dictate that in
(12:48):
my OT sessions, thathippotherapy is one tool that
I'm integrating along with avariety of other tools or
strategies.
So when we think about it thatway, Is Hippotherapy one tool
that I'm integrating along withsome sensory integration
strategies.
Okay.
So that's one way to think aboutit.
So when we maybe think about thetwo things, we can look at some
(13:11):
of the principles of sensoryintegration and maybe compare
those to similarities withhippotherapy or maybe some
differences.
With hippotherapy, I thinkthat's a good way for a lot of
us to think about, how does thisall fit in together?
So one of the principles ofsensory integration would be the
(13:34):
inner drive, right?
We're looking at the client'sinner drive or their, internal
motivation right?
How, motivated are they toengage in the activity?
How much are they able to, tolead.
So the inner drive is playful,it's relationship.
(13:55):
Right, and that's part of thatprinciple of sensory
integration.
So some similarities tohippotherapy.
Ideally, the child should showan affinity towards animals and
the therapists.
We want to build rapport withour clients.
We want there to be some playfulinteraction or relationship
between us and the clients thatwe're working with, whether
(14:17):
those are children or teens andadolescents, or even our adults,
right?
It's based on a relationshipthat we're having with them as
well as with the horse.
But there are some differencesas well.
So when we think about innerdrive and that playful context
with sensory integration, it'soften based on following the
(14:41):
child's lead.
And often that is not the firstaspect when we are using
hippotherapy as a treatmenttool.
And that's often not possible toalways be following the child's
lead or the client's leadbecause of our safety concerns
or safety considerations thatare present when we are in the
(15:03):
equine environment, when we'reworking with horses.
Some of the things that theclient might be internally
motivated to engage and wouldnot be safe when the horse is
our partner.
So that would be one differencebetween our sensory integration
interventions and the way thathippotherapy is used as a tool
(15:24):
is.
Although we are interested infollowing the child's interest
in using internal or intrinsicmotivation, we may not be able
to follow their lead in allcontexts.
Often it's the therapist that isleading, right?
Because if we think back to whatthe term hippotherapy refers to,
(15:45):
right?
It's the purposeful manipulationof equine movement.
The child is not purposefullymanipulating the equine
movement, the therapist isright?
So that's a pretty bigdifference.
Another tenant or core principleto sensory integration is
neuroplasticity.
And hippotherapy is also basedon dynamic systems theory and
(16:07):
the belief in neuroplasticity.
So with sensory integrationtheory, we believe that there is
neuroplasticity within thecentral nervous system, and that
would be true of hippotherapy aswell.
When we think about theconceptual framework of
hippotherapy, there is asimilarity between the belief in
neuroplasticity, there are nodifferences.
(16:32):
Another key principle would bethe adaptive response.
When you think about having anadaptive response from the
client, right?
Remember we said we want tochoose equipment in sensory
integration that will facilitatean adaptive response if we stick
with what the client alwayschooses.
Oftentimes it's what they'recomfortable with and what
(16:54):
they're already skilled at, andit's up to us as the clinician
to make sure the environmentalaffordances are going to
generate that adaptive response.
So a similarity withhippotherapy would be the
movement of the horse oftenrequires an adaptive postural
response.
Some differences is that equinemovement may not require an
(17:16):
adaptive response based onongoing sensory input in
relation to the challengespresented.
When we think about equinemovement, one of the key
characteristics are that it'srhythmic, that it's symmetrical,
and that it's ongoing.
And so, We are looking atwhether that patient is
(17:37):
accommodating to the movementand also how skilled is the
therapist in the manipulation ofthe movement to generate an
adaptive response.
So in the goal may be the sameas to get an adaptive response,
and we can use the movement ofthe horse to generate that
adaptive response.
(17:57):
So we can see some similarities,but also some differences there.
Another key principle that wecan think about is that just
right challenge.
It requires constant adjustmentbased on responses and needs of
the client.
And when we think about that asa key principle of sensory
(18:18):
integration, and we look at whenwe use hippotherapy as a
treatment tool, the therapistshould be carefully considering
the task, the environment, andcreating a just right challenge
to maximize the client's game.
So there is similarities betweenrequiring or achieving that just
right challenge when we're usinga sensory integration frame of
(18:40):
reference and when we're usinghippotherapy as a treatment
tool.
Environmental affordances.
When we are, again, setting upfor our session and we're
thinking about it from a sensoryintegration frame of reference,
the way that we set things up isreally important.
So some similarities tohippotherapy is that the
(19:03):
therapists can design thetreatment environment to capture
the child's inner drive,maximize sensory input.
We can think about that from anequipment perspective.
We can think about that from ahorse selection perspective.
We can think about it from ouractual environment.
Are we in an indoor ridingarena?
Are we in an outdoor ridingarena?
(19:24):
Are we on a trail?
Right?
There's lots of differentenvironmental affordances that
we can select there, but thedifference is that the therapist
has to work within the safetyconsiderations of our equine
partners.
So some of the environmentalaffordances are constrained by
what our horses are comfortablewith, what those safety
(19:45):
considerations are.
For those of you who have workedwith children with sensory
challenges long enough, you willknow that sometimes some of the
ideas that they have in ourtreatment sessions would
definitely not be appropriate inthe equine setting or when
around or on a horse.
So those safety considerationsplay a much bigger role when we
(20:09):
are using hippotherapy asopposed to what we can do from a
safety perspective in a sensoryclinic.
Another key principle is thatone-on-one treatment in a
specialized environment, andwhen we think about similarities
when we're using hippotherapy,it is typically a one-on-one
(20:32):
treatment session with an OT, aPT, or an S L P, and the
specialized environment may lookdifferent.
Certainly a sensory gym looks alot different than where the
equine environment is, but theequine environment does not
include suspended equipment,right?
Our horses aren't suspended.
(20:53):
We're not getting that samevestibular input that we would
get from suspended equipment.
So there is a difference there.
When we look at Ayres sensoryintegration as an intervention
and we look at hippotherapy as atreatment tool, there is
definitely a difference there inthe way that some of that
sensory input can be deliveredto the client and what some of
(21:15):
that equipment looks like.
Although they're bothspecialized in their own
environment, they're definitelynot the same and there's a
definite, some limitations inthat vestibular input that we
can provide without suspendedequipment.
Now, there are some facilitiesthat do have more of a sensory
(21:36):
gym or clinic on site whenthey're using hippotherapy as a
tool and they may have suspendedequipment there, so they might
be able to incorporate that.
But when we refer back, termhippotherapy, that best practice
dictates that hippotherapy isone tool that we're using within
our treatment toolbox.
So that suspended equipment issome of our other tools and
(21:58):
strategies that we're using.
And one of the last principlesof sensory integration is that
the long range goal isefficiency of sensory
integration leading to enhancedparticipation or that functional
outcome.
And we can say that both sensoryintegration as an intervention
(22:21):
and hippotherapy as a treatmenttool are concerned with
function, with the functionaloutcomes outside of the
treatment environment.
I think that's really important.
We're not necessarily concernedwith how well the client is able
to function within thesespecialized environments, but we
are most importantly concernedwith how they're able then to
(22:42):
integrate and use thatinformation when they go home or
when they're at school.
Those other components to howthey're able to generalize those
skills and take them into theother environments, into their
daily life.
And then use them on afunctional basis.
So it's, it's not so useful ifthey have really great sessions
(23:02):
with me, but then aren't able togo ahead and take those skills
home and use them in othersettings.
So that's another similarity.
So when we think about comparingand contrasting similarities and
differences.
I hope that you can see thathippotherapy is not sensory
integration, but it does havesome similarities and we can use
(23:24):
hippotherapy as a tool to impactsensory systems.
So when I was gathering myinformation, I came across a
relatively newer research study.
It's a pilot study and it'sentitled, The effect of
hippotherapy on sensoryintegration among children with
autism spectrum disorder.
And I did a quick read over ofit and I think it's interesting
(23:48):
to share some of the findings.
So they used the sensoryprocessing measure, the home
form, and they were guided byAyres, sensory integration
therapy.
And when they looked at thequalitative data, It revealed
that the intervention, so thatwould be the use of hippotherapy
as a treatment tool, had thegreatest impact on arousal,
(24:09):
sensory discrimination andsensory modulation.
So when we're thinking about,client selection and the
clientele that we work with andwhat the most appropriate tools
are, and we're looking at itfrom an evidence-based practice
standpoint, there is someevidence using, again, that
sensory processing measure homeform at having a statistically
(24:34):
significant impact on arousal,sensory discrimination, and
sensory modulation.
And I certainly know a lot ofthe families that come to me
have concerns about that sensorymodulation piece in particular.
That their children haveproblems, with under arousal,
over arousal, beingoverstimulated and being able to
(24:57):
modulate sensory input in avariety of environments.
It's interesting to see at leasta pilot study coming out that's
supporting a lot of what we seeclinically.
So as we go to wrap things upand think about, how do you pull
all this information togetherand how do you communicate it to
the families that we work with?
(25:18):
Or how would you communicatethis on a website?
Those types of ways that werepresent ourselves as
occupational therapy providerswhen we are using hippotherapy
as one of our tools, how do weshare the information of our
skillset?
With sensory integration and ourskillset with using
(25:39):
hippotherapy, without sayingthat hippotherapy is sensory
integration.
Because when we compare andcontrast them, we can see that
hippotherapy is not sensoryintegration, but it can help
with different sensoryprocessing challenges with
sensory discrimination, thatsensory modulation piece.
So thinking about, how do wearticulate those components and
(26:03):
how do we make it in a reallyparent-friendly way because I
think a lot of times once we getinto kind of clinical speak,
it's very easy to lose parents.
Being able to break it down soparents can understand what
we're focused on and, and whatwe're doing when we have their
child on a horse and we aremanipulating that movement to
(26:25):
have a sensory impact, it'simportant that we can translate
it to them.
Or, if we have fieldworkstudents with us, we can
translate it for them in that weare changing the horse's
movement to impact the sensorysystems.
We might be changing theclient's position on the horse
or the type of equipment thatwe're using to get that just
(26:46):
right challenge and that it is amulti-sensory input we have
visual proprioceptive,vestibular, tactile input.
And we're really looking forthat just right challenge as we
change the movement, change thehorse, change the equipment,
change the environment, all ofthose different components that
we're looking at when we'redeciding how to set up our
(27:09):
session to address thoseunderlying deficits that are
gonna work towards thatlong-term functional outcome.
Certainly in another episode, wecan talk a little bit about what
do some of those long-termfunctional outcomes look like,
and maybe that backwardsplanning of, when we're setting
our OT goals and then looking atthe tools and strategies that we
(27:32):
might have available to us,whether it is hippotherapy as
one of our tools or otheranimals that we might be working
with or being in the aquaticenvironment.
How do we take those functionalgoals and backwards plan in our
sessions based on theinformation and evidence that we
have?
So I hope this was helpful foryou.
(27:53):
If you have any questions, Iwould love to hear them.
If this was useful to you,please go ahead and like, or
share our podcast so that wayothers can find us.
Thanks for listening.
Hi, good morning, good afternoon, or
good evening whenever you arelistening in.
I am glad to connect with youtoday and have a fun episode on
is Hippotherapy SensoryIntegration.
Two things that I absolutelylove to talk about and I think
before, maybe I jump right inthere.
(00:45):
Just wanna touch base on wherethings are and where we're going
with the podcast.
This podcast is called Animalsand Aquatics, and we've been
touching a lot on the animalside of things.
And my co-host, Mr.
Ryan, also known as my husband,will be jumping in with some
episodes on aquatics coming upshortly.
We've been having a lot ofreally good sessions at the pool
(01:07):
lately and have been reallyexcited to share some of what
we've been seeing, what's beengoing on, and looking at that
aquatic therapy from theoccupational therapy lens.
So we're excited to be bringingin some of those episodes as we
move forward.
But also to keep sharing somegreat interviews.
I have some great interviewslined up that I'm excited to get
(01:29):
shared and get out to you.
And some information like ourepisode today about hippotherapy
and sensory integration.
Again, two things that I'mreally passionate about and
excited to speak about, and I'min the process with some
colleagues of mine of updating.
The Sensory Connections courseas a member of the American
Hippotherapy Associationfaculty, and as I've been going
(01:53):
through some of the material andseeing the updates that need to
be done, it made me think of areally good way to share some of
this information.
and as I was looking around and,and kind of gathering my
thoughts together, how often didI see that Hippotherapy provides
sensory integration?
(02:14):
Hippotherapy is a form ofsensory integration, kind of a
whole lot of differentterminology thrown around on
different websites, and it wassomething that made me really
stop and want to address thisspecific question and how I look
at it both from uh, facultystandpoint as well as from a
(02:36):
clinical standpoint, and themore I work with OTR and OTA
students, the more I think aboutanswering these types of
questions and explaining maybewhere my thought processes are
on this.
And I think the best place tostart with is what is sensory
integration?
(02:57):
And there's lots of differentways to look at it.
So it's a neurobiologicalprocess, it's a theory and it's
an intervention.
So sensory integration involvesperceiving, modulating
organizing and interpretingsensations to optimize
occupational performance andparticipation.
(03:17):
So we can think about a littlebit as like the neurological
neurobiological process, then weknow that Anna Jean Ayres
created the sensory integrationtheory that was really of her
genesis.
And neuroscience really remainsa cornerstone of that theory.
So sensory integration asoriginated by Jean Ayres is both
(03:43):
a theory and a practice.
So that's the practice and theintervention part.
And it's really targeting aperson's ability to process and
integrate information from theirbody and from the environment.
And I think in occupationaltherapy, we're seeing more and
more attention on the sensoryinformation from the body in the
(04:09):
form of interoception.
And I know some of the clientsthat I work with certainly
struggle with the interoceptionpiece, so that's a component of
it.
The sensory information might bevisual, auditory, could be
tactile, proprioceptive orvestibular in nature, and here
I'm going to refer to AyresSensory Integration, the, the
(04:33):
trademarked name because that'swhat I was trained in.
So Ayres Sensory Integrationuses individually tailored
activities that are reallylooking for that just right
challenge.
So with our clients, we'relooking for both a just right
challenge, but then also to seean adaptive response.
(04:53):
So that just right challenge isreally going to look at how the
client is typically processingsensory information, how they
are motor planning or the praxispiece, and then we're going to
encourage them by setting up theenvironment, by creating the
activities and presenting themto the client.
(05:17):
To help them be more organizedand to integrate the sensory
information into more usableforms.
Ayres sensory integrationincorporates specialized
equipment.
So when we think about a sensorygym, we think about our
suspended equipment and that isto give the client an
(05:37):
opportunity to explore a varietyof different movement patterns
for it to be client led.
So when we are using thisequipment or the materials, it's
purposeful for our client.
It's playful.
And so there is a relationshipbased component to it, and we're
looking to again, improve thatadaptive behavior or an adaptive
(06:00):
response from the client.
And a lot of times we can seethis.
even within a session when aclient is using an approach
avoidance type of behavior withthe equipment and as they become
more regulated, as they're ableto integrate that information
more effectively, then suddenlythey're able to engage with a
(06:21):
swing or a slide or they're ableto dual task so they can go down
the side holding a toy.
And we're able to to see thisadaptive response evolve
throughout the session.
Ayres sensory integration isimplemented by therapist with
specialized training.
Again, I did go through one ofthe earlier certification
(06:42):
programs for Ayres sensoryintegration.
It's most often used byoccupational therapists, but
even in my cohort there were afew PTs and SLPs.
So it can be delivered by OT,PT, or speech with specialized
training, and it takes place ina specially designed clinical
(07:03):
setting.
It is meant to be, again, clientled.
So safety is a big factor andobviously it's a sensory rich
experience.
There is a lot of variety puttogether when the clinician is
setting up that environment.
And some of the core tenants ofair sensory integration include.
(07:27):
Um, addressing physical safety.
So if we want to be client led,we need to have an environment
that is safe for the client toexplore.
So we think about that sensorygym again, right?
We might see mats or padding.
We're gonna see crash mats undermaybe some of our bigger
equipment because we, as theclinician do not want to have to
(07:49):
be in the business where we arelike"be careful, be careful,
watch what you're doing".
Um, we want them to really beable to have a full, the client
to have a full experience ofusing the equipment and moving
through space and experiencingwhat it is like to jump or fall
or crash and not necessarilyhaving to put those words behind
(08:11):
it.
We want to have a variety ofdifferent sensory opportunities
available, so when we're settingup our sensory clinic or our
sensory space for our clients,and we're coming from that
sensory integration perspectivewe're thinking about the
affordances of the environmentand what do we need to set up?
(08:34):
So you know, if we don't, if, ifwe don't want that stable like
platform swing, we need to makesure it's put away.
Because when once the client isthere and we're following their
lead, if they're gravitatingtowards that then we're gonna be
bringing that out for them.
And maybe that isn't the mostadaptive response, um, type of
equipment.
(08:54):
Maybe we want something that isa little bit more dynamic and
maybe we want a bolster swing.
And so we're presenting thoseopportunities to the client and
then we're following their lead.
We're looking at the client'slevel of alertness and ability
to engage.
So not under aroused.
(09:15):
Not over aroused.
And I like to describe it as awindow, right?
So like a window in your houseor window in the car.
And we can have the window justa little bit open, right?
So that's that zone where theclient is really regulated or we
can have the window wide openand we have a really wide zone
of regulation and that's whatwe're looking for.
(09:36):
You know, most of us who are,are pretty well regulated.
We have a pretty wide windowwhere we're able to maintain our
regulation.
If we're not getting enoughsleep or we're hungry or hangry,
you know, that window kind ofget smaller and smaller and we
can feel some of those things.
So helping the client to get tothat just right level of
(09:56):
alertness so that they canengage most meaningfully is
important.
We want to have a variety ofequipment that's gonna challenge
the sensory systems, both from apostural perspective, but also
from a praxis.
Perspective and looking at howthe client can organize their
(10:18):
actions around the equipmentthat's provided.
We are following the child'slead, so it is child led and,
and really that kind of innerplay comes out.
We want to be able to upgradeand downgrade our activities to
get that just right challengeagain, if it's something that is
(10:38):
too hard.
Often the children that we'reworking with, they're gonna shy
away from that, or they're noteven gonna try it.
And on the opposite side ofthings, if it's something that
they've already mastered, likethe stability of a platform
swing, then we're really notgonna get an adaptive response.
So when we're looking atequipment choice and setting up
(10:59):
the environment.
It's really important in sensoryintegration when we're coming at
it from the theory perspectiveof how we're setting up this
environment, how we're puttingeverything together.
Then once the client is thereit's all about that therapeutic
interaction with the client.
With it being playful and childled and using intrinsic
(11:22):
motivation for the child.
We're not doing a this thenthat, or you know, once you sit
down and complete this puzzle,then you can swing.
It doesn't work that way, youknow that the child is able to
meet their sensory needs and ifthat gets them to the just right
level where then they can goahead and select a puzzle that's
fabulous.
(11:42):
That would be a great adaptivebehavior or organization of
behavior that we might see.
.So those are some of the keycomponents of Ayres sensory
integration when we're applyingit to our interventions or that
intervention approach.
When we think about and start tocompare that with hippotherapy,
(12:04):
going back to the just the wordright?
The term hippotherapy isreferring to how occupational
therapy, physical therapy, andspeech language pathology
professionals use evidence-basedpractice and clinical reasoning
in the purposeful manipulationof equine movement as a therapy
tool to engage sensoryneuromotor and cognitive systems
(12:28):
to promote functional outcomes.
So the sensory part is in there,right?
It's, it's how that term can bereferring to how, as an
occupational therapist, I'mgonna use the movement of the
horse and best practice isreally going to dictate that in
(12:48):
my OT sessions, thathippotherapy is one tool that
I'm integrating along with avariety of other tools or
strategies.
So when we think about it thatway, Is Hippotherapy one tool
that I'm integrating along withsome sensory integration
strategies.
Okay.
So that's one way to think aboutit.
So when we maybe think about thetwo things, we can look at some
(13:11):
of the principles of sensoryintegration and maybe compare
those to similarities withhippotherapy or maybe some
differences.
With hippotherapy, I thinkthat's a good way for a lot of
us to think about, how does thisall fit in together?
So one of the principles ofsensory integration would be the
(13:34):
inner drive, right?
We're looking at the client'sinner drive or their, internal
motivation right?
How, motivated are they toengage in the activity?
How much are they able to, tolead.
So the inner drive is playful,it's relationship.
(13:55):
Right, and that's part of thatprinciple of sensory
integration.
So some similarities tohippotherapy.
Ideally, the child should showan affinity towards animals and
the therapists.
We want to build rapport withour clients.
We want there to be some playfulinteraction or relationship
between us and the clients thatwe're working with, whether
(14:17):
those are children or teens andadolescents, or even our adults,
right?
It's based on a relationshipthat we're having with them as
well as with the horse.
But there are some differencesas well.
So when we think about innerdrive and that playful context
with sensory integration, it'soften based on following the
(14:41):
child's lead.
And often that is not the firstaspect when we are using
hippotherapy as a treatmenttool.
And that's often not possible toalways be following the child's
lead or the client's leadbecause of our safety concerns
or safety considerations thatare present when we are in the
(15:03):
equine environment, when we'reworking with horses.
Some of the things that theclient might be internally
motivated to engage and wouldnot be safe when the horse is
our partner.
So that would be one differencebetween our sensory integration
interventions and the way thathippotherapy is used as a tool
(15:24):
is.
Although we are interested infollowing the child's interest
in using internal or intrinsicmotivation, we may not be able
to follow their lead in allcontexts.
Often it's the therapist that isleading, right?
Because if we think back to whatthe term hippotherapy refers to,
(15:45):
right?
It's the purposeful manipulationof equine movement.
The child is not purposefullymanipulating the equine
movement, the therapist isright?
So that's a pretty bigdifference.
Another tenant or core principleto sensory integration is
neuroplasticity.
And hippotherapy is also basedon dynamic systems theory and
(16:07):
the belief in neuroplasticity.
So with sensory integrationtheory, we believe that there is
neuroplasticity within thecentral nervous system, and that
would be true of hippotherapy aswell.
When we think about theconceptual framework of
hippotherapy, there is asimilarity between the belief in
neuroplasticity, there are nodifferences.
(16:32):
Another key principle would bethe adaptive response.
When you think about having anadaptive response from the
client, right?
Remember we said we want tochoose equipment in sensory
integration that will facilitatean adaptive response if we stick
with what the client alwayschooses.
Oftentimes it's what they'recomfortable with and what
(16:54):
they're already skilled at, andit's up to us as the clinician
to make sure the environmentalaffordances are going to
generate that adaptive response.
So a similarity withhippotherapy would be the
movement of the horse oftenrequires an adaptive postural
response.
Some differences is that equinemovement may not require an
(17:16):
adaptive response based onongoing sensory input in
relation to the challengespresented.
When we think about equinemovement, one of the key
characteristics are that it'srhythmic, that it's symmetrical,
and that it's ongoing.
And so, We are looking atwhether that patient is
(17:37):
accommodating to the movementand also how skilled is the
therapist in the manipulation ofthe movement to generate an
adaptive response.
So in the goal may be the sameas to get an adaptive response,
and we can use the movement ofthe horse to generate that
adaptive response.
(17:57):
So we can see some similarities,but also some differences there.
Another key principle that wecan think about is that just
right challenge.
It requires constant adjustmentbased on responses and needs of
the client.
And when we think about that asa key principle of sensory
(18:18):
integration, and we look at whenwe use hippotherapy as a
treatment tool, the therapistshould be carefully considering
the task, the environment, andcreating a just right challenge
to maximize the client's game.
So there is similarities betweenrequiring or achieving that just
right challenge when we're usinga sensory integration frame of
(18:40):
reference and when we're usinghippotherapy as a treatment
tool.
Environmental affordances.
When we are, again, setting upfor our session and we're
thinking about it from a sensoryintegration frame of reference,
the way that we set things up isreally important.
So some similarities tohippotherapy is that the
(19:03):
therapists can design thetreatment environment to capture
the child's inner drive,maximize sensory input.
We can think about that from anequipment perspective.
We can think about that from ahorse selection perspective.
We can think about it from ouractual environment.
Are we in an indoor ridingarena?
Are we in an outdoor ridingarena?
(19:24):
Are we on a trail?
Right?
There's lots of differentenvironmental affordances that
we can select there, but thedifference is that the therapist
has to work within the safetyconsiderations of our equine
partners.
So some of the environmentalaffordances are constrained by
what our horses are comfortablewith, what those safety
(19:45):
considerations are.
For those of you who have workedwith children with sensory
challenges long enough, you willknow that sometimes some of the
ideas that they have in ourtreatment sessions would
definitely not be appropriate inthe equine setting or when
around or on a horse.
So those safety considerationsplay a much bigger role when we
(20:09):
are using hippotherapy asopposed to what we can do from a
safety perspective in a sensoryclinic.
Another key principle is thatone-on-one treatment in a
specialized environment, andwhen we think about similarities
when we're using hippotherapy,it is typically a one-on-one
(20:32):
treatment session with an OT, aPT, or an S L P, and the
specialized environment may lookdifferent.
Certainly a sensory gym looks alot different than where the
equine environment is, but theequine environment does not
include suspended equipment,right?
Our horses aren't suspended.
(20:53):
We're not getting that samevestibular input that we would
get from suspended equipment.
So there is a difference there.
When we look at Ayres sensoryintegration as an intervention
and we look at hippotherapy as atreatment tool, there is
definitely a difference there inthe way that some of that
sensory input can be deliveredto the client and what some of
(21:15):
that equipment looks like.
Although they're bothspecialized in their own
environment, they're definitelynot the same and there's a
definite, some limitations inthat vestibular input that we
can provide without suspendedequipment.
Now, there are some facilitiesthat do have more of a sensory
(21:36):
gym or clinic on site whenthey're using hippotherapy as a
tool and they may have suspendedequipment there, so they might
be able to incorporate that.
But when we refer back, termhippotherapy, that best practice
dictates that hippotherapy isone tool that we're using within
our treatment toolbox.
So that suspended equipment issome of our other tools and
(21:58):
strategies that we're using.
And one of the last principlesof sensory integration is that
the long range goal isefficiency of sensory
integration leading to enhancedparticipation or that functional
outcome.
And we can say that both sensoryintegration as an intervention
(22:21):
and hippotherapy as a treatmenttool are concerned with
function, with the functionaloutcomes outside of the
treatment environment.
I think that's really important.
We're not necessarily concernedwith how well the client is able
to function within thesespecialized environments, but we
are most importantly concernedwith how they're able then to
(22:42):
integrate and use thatinformation when they go home or
when they're at school.
Those other components to howthey're able to generalize those
skills and take them into theother environments, into their
daily life.
And then use them on afunctional basis.
So it's, it's not so useful ifthey have really great sessions
(23:02):
with me, but then aren't able togo ahead and take those skills
home and use them in othersettings.
So that's another similarity.
So when we think about comparingand contrasting similarities and
differences.
I hope that you can see thathippotherapy is not sensory
integration, but it does havesome similarities and we can use
(23:24):
hippotherapy as a tool to impactsensory systems.
So when I was gathering myinformation, I came across a
relatively newer research study.
It's a pilot study and it'sentitled, The effect of
hippotherapy on sensoryintegration among children with
autism spectrum disorder.
And I did a quick read over ofit and I think it's interesting
(23:48):
to share some of the findings.
So they used the sensoryprocessing measure, the home
form, and they were guided byAyres, sensory integration
therapy.
And when they looked at thequalitative data, It revealed
that the intervention, so thatwould be the use of hippotherapy
as a treatment tool, had thegreatest impact on arousal,
(24:09):
sensory discrimination andsensory modulation.
So when we're thinking about,client selection and the
clientele that we work with andwhat the most appropriate tools
are, and we're looking at itfrom an evidence-based practice
standpoint, there is someevidence using, again, that
sensory processing measure homeform at having a statistically
(24:34):
significant impact on arousal,sensory discrimination, and
sensory modulation.
And I certainly know a lot ofthe families that come to me
have concerns about that sensorymodulation piece in particular.
That their children haveproblems, with under arousal,
over arousal, beingoverstimulated and being able to
(24:57):
modulate sensory input in avariety of environments.
It's interesting to see at leasta pilot study coming out that's
supporting a lot of what we seeclinically.
So as we go to wrap things upand think about, how do you pull
all this information togetherand how do you communicate it to
the families that we work with?
(25:18):
Or how would you communicatethis on a website?
Those types of ways that werepresent ourselves as
occupational therapy providerswhen we are using hippotherapy
as one of our tools, how do weshare the information of our
skillset?
With sensory integration and ourskillset with using
(25:39):
hippotherapy, without sayingthat hippotherapy is sensory
integration.
Because when we compare andcontrast them, we can see that
hippotherapy is not sensoryintegration, but it can help
with different sensoryprocessing challenges with
sensory discrimination, thatsensory modulation piece.
So thinking about, how do wearticulate those components and
(26:03):
how do we make it in a reallyparent-friendly way because I
think a lot of times once we getinto kind of clinical speak,
it's very easy to lose parents.
Being able to break it down soparents can understand what
we're focused on and, and whatwe're doing when we have their
child on a horse and we aremanipulating that movement to
(26:25):
have a sensory impact, it'simportant that we can translate
it to them.
Or, if we have fieldworkstudents with us, we can
translate it for them in that weare changing the horse's
movement to impact the sensorysystems.
We might be changing theclient's position on the horse
or the type of equipment thatwe're using to get that just
(26:46):
right challenge and that it is amulti-sensory input we have
visual proprioceptive,vestibular, tactile input.
And we're really looking forthat just right challenge as we
change the movement, change thehorse, change the equipment,
change the environment, all ofthose different components that
we're looking at when we'redeciding how to set up our
(27:09):
session to address thoseunderlying deficits that are
gonna work towards thatlong-term functional outcome.
Certainly in another episode, wecan talk a little bit about what
do some of those long-termfunctional outcomes look like,
and maybe that backwardsplanning of, when we're setting
our OT goals and then looking atthe tools and strategies that we
(27:32):
might have available to us,whether it is hippotherapy as
one of our tools or otheranimals that we might be working
with or being in the aquaticenvironment.
How do we take those functionalgoals and backwards plan in our
sessions based on theinformation and evidence that we
have?
So I hope this was helpful foryou.
(27:53):
If you have any questions, Iwould love to hear them.
If this was useful to you,please go ahead and like, or
share our podcast so that wayothers can find us.
Thanks for listening.
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