the efectiveness of hippotherapy on children with language learning disabilities

7/22/2019 The Efectiveness of Hippotherapy on Children With Language Learning Disabilities

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205Communication Disorders Quarterly 25:4 pp. 205217

The Effectiveness of Hippotherapy forChildren With Language-Learning

Disabilities

Beth L. MacauleyThe University of Alabama

Karla M. GutierrezWashington State University

This study examined the effectiveness of hippotherapy versus

traditional therapy for children with language-learning disabil-

ities. Three boys, ages 9, 10, and 12 years, and their parents in-dependently completed a satisfaction questionnaire at the end of

traditional therapy (T1) and again at the end of hippotherapy

(T2). A comparison of the responses from T1 and T2 indicated

that both the parents and the children reported improvement in

speech and language abilities after both therapies. Overall, re-sponses were noticeably higher following hippotherapy, with ad-

ditional benefits of improved motivation and attention also

reported.

Hippocrates was the first to describe the benefits of the horse

for rehabilitation purposes, calling horseback riding a univer-sal exercise (Riede, 1987). In the time following Hippocrates,

medical professionals in Germany, Italy, Austria, and Eng-

land, as well as eventually the United States, used horses in the

rehabilitation of people with disabilities. Today, in the UnitedStates, peoples use of horses can be classified into two main

categories: equine-assisted activities and equine-assisted ther-apy. Equine-assisted activities (EAA) are activities centered on

the horse in which the purpose is to learn horse-related skills(e.g., riding) and improve a persons quality of life. EAA is a

subtype of animal-assisted activities, which can be provided

by anyone who receives specialized training and certification

(Delta Society, 2002). Equine-assisted therapy (EAT), a sub-type of animal-assisted therapy, is the integration of the horse

into goal-directed treatment and is provided by licensed ther-

apists (Delta Society, 2002).

Hippotherapy is a specialization of EAT. Hippotherapy

means treatment with the help of a horse and is derived from

the Greek word hippos, meaning horse (Heine & Benjamin,

2000). The American Hippotherapy Association defines hip-potherapy as a physical, occupational, or speech therapy

treatment strategy utilizing equine movement (2002). During

hippotherapy, the client sits on the horses back and physically

accommodates to the three-dimensional movements of the

horses walk. The client does not influence the horse; rather,the horses movement influences the rider. Functional riding

skills are not taught, and any improvement in the clients

quality of life is a secondary benefit (Klimas, 2001). Activitiesare incorporated within the scope of practice of the therapist

to complement the horses movement and help the client

move toward meeting his or her treatment goals. Speech

language pathologists (SLPs) can receive education and train-ing in EAT through the American Hippotherapy Association

and certification through the American Hippotherapy Certi-

fication Board.

Both physical and psychosocial benefits have been doc-

umented or reported from the use of EAT and hippotherapy.The direct physical benefits include improved muscle sym-

metry (Benda, McGibbon, Grant, & Davis, 2003), postural

alignment (Bertoti, 1988), facilitation of normal movement(Glasow, 1985; McGibbon, Andrade, Widener, & Cintas,

1998), improved balance and gait (Haehl, Guiliani, & Lewis,

1999), and improved respiratory and motor control of speech

(Macauley & Lombardino, 2004). Psychosocial benefits ofEAT and hippotherapy include improvement in self-concept

(Beckman, 1992; Cawley, Cawley, & Retter, 1986), locus of


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206 Communication Disorders Quarterly vol. 25, no. 4 / Summer 2004

control (Carlson, 1983; Tucker, 1994), affect (Kluewer, 1987),

and behavior (Emory, 1992). The studies by Beckman, Carl-son, Tucker, Kluewer, and Emory focused specifically on par-

ticipants with learning disabilities.

Dismuke (1981, 1985) was the first to study the use of

hippotherapy in speech and language therapy. Twenty-sixchildren with a moderately severe language disorder and

learning disabilities participated; 11 children received treat-

ment in the traditional school therapy setting and 15 received

treatment through hippotherapy. Results indicated greaterimprovement in all language measures for participants who

received hippotherapy as compared to those receiving treat-

ment in the public school setting. Dismuke stated that the

results indicated the value of initiating a multidisciplinarytreatment for the handicapped through carefully designed

hippotherapy programs and concluded that further research

must focus on generating empirical support for the effective-

ness of hippotherapy in speechlanguage pathology.

Students with learning disabilities comprise 45.2% ofthe population with disabilities and 5.5% of the total popula-

tion in prekindergarten through 12th grade, and students with

speech or language impairments are the next largest group(U.S. Department of Education, 2002), comprising 17.2% of

the population with disabilities and 2.1% of the total popula-

tion. Furthermore, of the students identified as having learn-

ing disabilities, a large portion exhibit a language-learningimpairment. Miniutti (1991) estimated the prevalence of

students with language-learning disabilities (LLD) among

students with learning disabilities was as high as 75%.

Recent observations suggest that subtle language deficits

associated with learning disabilities may persist into adoles-cence and young adulthood if the child does not receive

appropriate intervention (Lerner, 2000; Mercer, 2000; Wiig &

Semel, 1975, 1984). A criterion in many definitions of learn-ing disabilities is the need for special servicesthese children

need help if they are to succeed. Therefore, it is important to

provide services that will enable children with LLD to excel in

life (Lerner, 2000; Mercer, 2000; Wiig & Semel, 1984). Manychildren with LLD receive treatment for many years. These

children may benefit from innovative therapy techniques and

environments to enable them to reach their full potential and

improve their motivation toward therapy.In addition, children with learning disabilities appear to

be at greater risk for experiencing negative emotional affectthat, in turn, negatively affects their ability to participate in

and respond to therapy (Yasutake & Bryan, 1995).Affectrefersto ones emotional state and mood, which, in turn, influences

and shapes ones behavior (Fadem, 2004). A negative affect

leads to decreased desire to participate, dysphoric mood (feel-

ings of unpleasantness),and increases in the brains chemicalsfor negative emotions. These chemical changes include secre-

tion of adrenaline, a hormone associated with increased heart

rate and the fight-or-flight response, and neuropeptides, a

group of neurotransmitters associated with such negativeemotions as fear and anger (Young, 2004). Positive affect leads

to increased desire to participate, euphoric mood (feelings of

elation), and changes in the brains chemicals for positive

mood. These chemical changes include secretion of endor-phins, natural opiate chemicals that lead to muscle relaxation

and a sense of well-being (Young, 2004).

According to Norman (2002), a persons affect changes

how the brain processes information in that, if an activity ispleasant, it is easier to do, and if an activity is unpleasant, it is

inherently more difficult (Norman, 2002). To facilitate partic-

ipation, motivation, and attention during a task that is per-

ceived as unpleasant for children with LLD, such as reading abook, a new alternative pleasant task should be initiated, such

as reading a book to a dog (Dog day afternoons, 2000).

Therefore, it is crucial to investigate the effectiveness of new

and innovative treatments that facilitate positive affect forchildren with learning disabilities. Hippotherapy is one form

of treatment that has tremendous potential for children with

LLD in that, by its nature, hippotherapy is dynamic and re-

quires the integration of all body systems. The consistent,

repetitive movement of the horse stimulates the sensorymotor system of the client, giving the nervous system a tem-

plate from which to build its physical and cognitive responses

(Macauley, 2003).The purpose of the present study was to examine the ef-

fectiveness of hippotherapy for children with LLD. We hy-

pothesized that children would make more progress toward

their speech and language goals and improve their motivationto attend therapy following a block of hippotherapy than they

would following a block of traditional clinic-based therapy.

Specific research questions addressed included the following:

1. Will children with LLD and their parents reportimprovement in speech and language abilities

following hippotherapy?

2. Will the children and their parents report im-

provement in the childrens motivation to at-tend speechlanguage therapy following

hippotherapy?

3. Will the children and their parents report im-

provement in the childrens self-concept fol-

lowing hippotherapy?

4. Is hippotherapy less effective, more effective, or

as effective as traditional clinic-based therapy?

METHOD

Participants

The participants in this study were three boys, ages 9, 10, and

12 years, with LLD who were receiving traditional speech andlanguage therapy services from the University Program in

Communication Disorders (UPCD) Speech and Hearing

Clinic in Spokane, Washington. Each participant had been in

speechlanguage therapy since the age of 5 and had an indi-vidualized education plan (IEP), which included speech

language therapy for learning disability, at his school. Results


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Communication Disorders Quarterly vol. 25, no. 4 / Summer 2004 207

from initial testing revealed that each boy had a Clinical Eval-

uation of Language FundamentalsThird Edition (Semel, Wiig& Secord, 1995) composite score of at least one and a half

standard deviations below the mean and a reading level at

least two grade levels below his current grade. Each boy had

IEP goals and speech therapy goals in auditory comprehen-sion, expressive language, reading, writing, and spelling. All

three participants were monolingual English speakers and

right handed, with normal hearing between 500 Hz and

4000 Hz. Only the 9-year-old had an additional diagnosis ofattention-deficit/hyperactivity disorder (ADHD) and was

taking Ritalin at the time of the study.

Questionnaire

A 21-item client satisfaction questionnaire was used to gather

data from all the participants (see Appendix A). The ques-

tionnaire was adapted from the UPCD client satisfaction

questionnaire. The questionnaire was designed to gather gen-eral information on clinician preparedness and therapy activ-

ities, as well as specific information on the environment,

motivation, and effectiveness of hippotherapy. Two forms ofthe questionnaire were writtenone for the parents and one

for the participants themselves to answer.

Procedures

The questionnaires were given to the participants and their

parents at the conclusion of traditional clinic-based therapy

with the instructions to complete it on the basis of their ex-

periences during the traditional sessions. If the participantwas unable to read the questionnaire independently, a parent

read it aloud and circled the number response verbalized by

the participant. The traditional therapy sessions were 1 hourlong, twice a week, during the fall academic semester.

After the winter break, the three participants received

6 weeks of hippotherapy. The hippotherapy sessions were

1 hour, twice a week. At the conclusion of the 6 weeks of hip-potherapy sessions, the questionnaires were again given to the

participants and their parents.

The hippotherapy sessions were conducted at Merlin

Farms Equestrian Center in Deer Park, Washington, in an en-closed and covered riding arena. A trained therapy horse with

the ability to produce a smooth, symmetrical walk was usedfor all sessions, and experienced equestrians served as horse

leaders (controlling the horse by holding on to a lead-rope at-tached to the horses halter) and side walkers (people who

walked beside the client for safety purposes). The SLP was

also present during the sessions.

During a hippotherapy session, the client sits on thehorse, typically on a pad and surcingle (the leather belt that

goes around the barrel of the horse to hold the pad firmly in

place) or on a saddle. The horse is then led forward at a walk

by the horse leader while the side walker walks beside thehorse. The client participates in therapy activities with the

SLP, who is typically walking in front of the client. Less fre-

quently, the SLP may stand in the middle of the arena and

speak through a megaphone or be on a horse, with a horseleader, walking adjacent to the client. During the hippother-

apy sessions for this study, the SLP either walked or stood be-

side the client. Materials can be presented to the client using

picture, word, and letter cards; small dry erase boards; and lapdesks with pencil and paper. Activities are limited only by the

creativity of the therapist. Most activities from a traditional

therapy session can be adapted to the hippotherapy envi-

ronment.The therapy activities during both traditional therapy

and the hippotherapy were individually designed to target

each childs speech and language goals. Each child had a re-

ceptive language, expressive language, reading, and writinggoal. Activities done in the traditional setting were adapted to

the hippotherapy. Examples of these activities can be found in

Appendix B.

RESULTS

A total of six questionnaires were sent to the three children

with LLD and their parents after the completion of traditionalclinic-based therapy and again after the completion of the

hippotherapy. Of the surveys sent, all 12 were completed and

returned for a 100% response rate. The responses from the

two surveys (T1 and T2) were compared. The average valuefor each question was determined for the participants and for

their parents for T1 and T2.

Research Question 1

To determine whether the participants and their parents re-

ported improvement in speech and language abilities follow-

ing hippotherapy, the averages from questions 4, 8, 18, 20, and21 from the parent questionnaires and the averages from

questions 6, 15, 17, 19, and 21 from the participants T2

questionnaires were examined (see Table 1). Responses in the

range of 1 to 3 were considered negative (i.e., regression ofskills), responses in the range of 4 to 6 were considered no im-

provement(i.e., maintenance of previously learned skills), and

responses in the range of 7 to 10 were consideredpositive im-

provement(i.e., active learning and retention of new skills). Ifa parent circled two numbers, the average of the numbers was

used in the calculations (i.e., if a parent circled 8 and 9, thenan 8.5 was used). As can be seen in Table 1, all the average

scores fell in the 7 to 10 range, and the overall average for thefive parent questions was 9.2, indicating that the parents

strongly agreed that hippotherapy was effective in improving

their childrens speech and language abilities.

From the participants questionnaires, two of the re-sponses fell in the 5 to 7 range indicating neutral responses,

and three of the average scores fell in the 7 to 10 range indi-

cating agreement. Because the overall average was 8.0 for the

five questions, it was determined that, according to the par-ticipants, hippotherapy was effective in helping them improve

their speech and language skills.


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Research Question 2

To determine whether the participants and their parents re-ported improved motivation to attend therapy following hip-

potherapy, the averages from questions 6 and 12 from the

parent questionnaires and the averages from questions 4, 16,18, and 20 from the participants T2 questionnaires were ex-

amined. As can be seen in Table 2, all of the parents average

scores fell in the 9.5 to 10 range, and the overall average forthe two questions was 9.9, indicating that the parents strongly

agreed that the participants were very motivated to attend the

hippotherapy sessions.

From the participants questionnaires, the average scoresfor the four questions fell in the 9 to 10 range, and the overall

TABLE 1. Reported Improvement in Speech and Language Abilities Following Hippotherapy

Question Average Range

Parent Responses

4. There were noticeable improvements in my childs ability to communicate following thesemester of therapy. 9.0 810

8. My childs ability to communicate in everyday situations is better. 8.8 89.5

18. I would re-enroll my child in the therapy program. 9.5 910

20. I would refer others for services. 9.5 910

21. Overall satisfaction rating. 9.2 99.5

Overall average 9.2

Participant Responses

6. My talking and understanding in everyday life is better. 6.8 5.57.5

15. My clinician helped me improve my listening skills. 8.8 7.59.5

17. My clinician helped me improve my talking skills. 8.8 7.59.5

19. My clinician helped me improve my reading skills. 8.8 7.59.5

21. My clinician helped me improve my writing skills. 6.8 5.57.5

Overall average 8.0

TABLE 2. Reported Improvement in Motivation to Attend Therapy Following Hippotherapy


Parent Responses

6. My child was motivated to attend the therapy sessions. 10 1010

12. My child was willing to participate in therapy activities. 9.8 9.510

Overall average 9.9


4. I looked forward to coming to therapy. 9.5 910

16. I would come back to therapy for another term. 9.5 910

18. I would tell others to come here for therapy. 9.5 910

20. Overall, I liked therapy. 9.5 910

Overall average 9.5


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average was 9.5, indicating that the participants agreed that

they were very motivated to attend the hippotherapy sessions.

Research Question 3

To determine whether the participants and their parents re-ported improvement in self-concept following hippotherapy,

the averages from questions 14 and 16 from the parent ques-

tionnaires and the averages from questions 10 and 12 from

the participants T2 questionnaires were examined. As can beseen in Table 3, all the average scores fell in the 7.5 to 10 range,

and the overall average for the two questions was 8.5, indicat-

ing that the parents agreed that hippotherapy improved their

childrens self-concept.From the participants questionnaires, the responses fell

in the 7 to 10 range, and the overall average was 8.5, indicat-

ing that the participants agreed that hippotherapy facilitated

improvements in their self-concept.

Research Question 4

To determine whether hippotherapy is less effective, more ef-fective, or as effective as traditional clinic-based therapy, the

averages for each question from T1 and T2 were compared

using a paired ttest. Results from the parents responses indi-

catedp < 0.000, t= 12.73, df= 21. Results from the partici-pants responses indicatedp < 0.002, t= 3.46, df= 21.

Furthermore, the differences in each question across T1

and T2 were compared (see Table 4). A difference less than 2

points was considered negligible, a difference between 2 and 4

points was considered important, and a difference greaterthan 4 points was considered noteworthy. Please note that the

same clinicians conducted both the traditional therapy and

the hippotherapy sessions.As seen in Table 4, the differences in the parents re-

sponses from T1 and T2 ranged from 0.5 to 6.5, with an aver-

age difference of 3.3 (see Figure 1). This average is considered

important, indicating that, according to parents, hippother-

apy was more effective than traditional therapy. The differ-ences in the participants responses from T1 and T2 ranged

from 1.9 to 6.3, with an average difference of 1.9 (see Ta-

ble 5 and Figure 2). This average is considered negligible, in-

dicating that the participants believed that traditional therapyand hippotherapy were equally effective.

DISCUSSION

In the parents questionnaire, the questions with differences

greater than 4 points between the two therapies were 6, 12,

and 14. These are important findings because therapy always

runs more smoothly with a willing participant. When a clientrequires external motivation to participate in the therapy ses-

sion, valuable time and energy is taken away from the activi-

ties and teaching time to motivate the client. If a client has

been in therapy for many years, he may be bored and hostile

toward the therapy environment, resulting in a negative af-fect. The child may begin to feel different from his friends be-

cause he has to go to therapy, but his friends do not. Many

clinicians today are becoming innovative in the therapy ses-sion, but the sessions still typically occur in a small room,

with or without windows, that has a table and chairs. Results

of this study indicate that hippotherapy improves the motiva-

tion of the child to attend and participate actively in therapyactivities and that improvements in the childs speech and

language abilities are not compromised. In this study, each

child demonstrated improvements in his speech and language

abilities and progressed toward therapy goals.

In the participants questionnaires, the questions withdifferences greater than 4 points between the two therapies

were 2, 4, 10, 14, 16, and 20. These are also noticeable results

as the answers indicated that the boys looked forward to com-ing to the hippotherapy sessions, enjoyed the activities, and

even talked about their therapy with friends. It is more com-

mon for parents to bribe, beg, or cajole their elementary and

TABLE 3. Reported Improvement in Self-Concept Following Hippotherapy


Parent Responses

14. My child talked about his/her therapy with his/her friends. 8.2 7.59

16. My childs self-esteem has improved as a result of therapy. 8.8 810

Overall average 8.5


10. I talked about what I did in therapy with my friends. 7.5 78

12. I feel better about myself. 9.5 910

Overall average 8.5


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middle school children to attend therapy. The children areusually reluctant to talk about their therapy with their peers

as it indicates that the child has a problem and may be per-

ceived as different. It is exciting to note that the boys who par-

ticipated in this study appeared to regard the hippotherapy assomething to take pride in and to share with their friends.

Another finding from this study was that the parents re-ported that their children made greater improvements in

speech and language abilities, motivation, and self-concept

following hippotherapy when compared to results from tra-

ditional clinic-based therapy. Questions 4 and 8 of the par-ents questionnaire dealt with improvements in speech and

TABLE 4. Parent Responses From Post-Traditional and Post-Hippotherapy Questionnaires

Question Post traditional Post hippotherapy Difference

1. Clinician/supervisors were prompt in meeting therapy or

diagnostic appointments. 8.3 8.8 0.52. The therapy environment was healthy and appealing. 7.0 8.0 1.0

3. The clinician was courteous and concerned in his/herclinical activities. 7.2 9.8 2.6a

4. There were noticeable improvements in my childs ability tocommunicate following the semester of therapy. 6.0 9.0 3.0a

5. Communication with the clinician was open, and questionswere readily answered. 6.7 10.0 3.3a

6. My child was motivated to attend the therapy sessions. 3.5 10.0 6.5b

7. The clinician was interested in my child as an individualand considered his/her special needs. 7.2 10.0 2.8a

8. My childs ability to communicate in everyday situations isbetter. 5.3 8.8 3.5a

9. The instructions given to my child were clear andunderstandable. 6.5 9.5 3.0a

10. The clinician helped my child relate the therapy activities toeveryday life. 5.0 9.0 4.0b

11. Therapy tasks were appropriately chosen and wellorganized. 5.8 9.5 3.7 a

12. My child was willing to participate in therapy activities. 4.8 9.8 5.0b

13. The clinician was well prepared. 6.7 9.8 3.1a

14. My child talked about his/her therapy with his/her friends. 3.5 8.2 4.7 b

15. The clinician was alert and competent in executing thetherapy activities. 5.8 9.8 3.0a

16. My childs self-esteem has improved as a result of therapy. 5.5 8.8 3.3a

17. Sufficient equipment and materials were available for eachsession. 6.5 9.5 3.0a

18. I would re-enroll my child in the therapy program. 5.8 9.5 3.7 a

19. The clinician provided helpful emotional support andcounseling as needed. 6.5 9.5 3.0a

20. I would refer others for services. 6.8 9.5 2.7 a

21. Overall satisfaction rating. 6.2 9.2 3.0a

Overall averages 6.0 9.3 3.3a

aImportant. bNoteworthy.


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211

FIGURE1.Parent

responsesfromT1(

)andT2(

).PleaserefertoTable4forthelistofquestions.

*Overallaverages.

*


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language abilities. In response to Question 4, there was a

3-point increase from traditional therapy to hippotherapy.

Parents felt that their children made greater progress follow-ing the hippotherapy program than they did following thetraditional program. The parents also reported that their chil-

drens ability to communicate in everyday situations was bet-

ter following the hippotherapy than it was following the

traditional therapy. In contrast to their parents, the partici-pants responses indicated that they believed their speech and

language abilities in everyday life improved more following

the traditional therapy than the hippotherapy.

These responses may indicate that during traditionaltherapy, the child is focused on the paper and pencil tasks or

listening and talking activities that target his speech and lan-

guage goals so the child is more aware of what he is doing

the difficulty, the repetition, and the monotony of the tasks.

The child is conscious that the tasks relate to his languagedeficits. In contrast, the activities during the hippotherapysessions targeted the childs speech and language goals, but in

a new, exciting, and different way. As a result, the childs at-

tention was on the fact that he is on a horse in an arena (al-

though not in charge of the horseduring hippotherapysession, the horse is controlled by a horse-leader) and not on

the therapy tasks themselves. Therefore, the children may not

have been aware that the activities in which they were partic-

ipating targeted their speech and language deficits and werenot as aware of the relationship between the therapy activities

and their talking in everyday life.

TABLE 5. Participant Responses From Post-Traditional and Post-Hippotherapy Questionnaires

Question Post traditional Post hippotherapy Difference

1. My clinician was on time. 9.5 9.7 0.2

2. The place where I did my therapy was fun. 3.7 9.7 6.0b

3. My clinician was nice and paid attention to me. 8.2 9.5 1.3

4. I looked forward to coming to therapy. 3.2 9.5 6.3b

5. My clinician answered all my questions. 9.3 9.5 0.2

6. My talking and understanding in everyday life is better. 8.7 6.8 1.9

7. My clinician was interested in me and appeared to careabout me. 9.0 9.7 0.7

8. The therapy activities will help me do better at school. 9.3 7.5 1.8

9. I understood the directions my clinician gave to me. 9.3 9.5 0.2

10. I talked about what I did in therapy with my friends. 3.2 7.5 4.3b

11. My clinician was well organized. 8.3 9.5 1.2

12. I feel better about myself. 9.3 9.5 0.2

13. My clinician was ready for my sessions. 9.3 9.5 0.2

14. The therapy activities were fun and interesting. 4.5 9.5 5.0b

15. My clinician helped me improve my listening skills. 7.7 8.8 1.1

16. I would come back to therapy for another term. 3.8 9.5 5.7 b

17. My clinician helped me improve my talking skills. 5.0 8.8 3.8a

18. I would tell others to come here for therapy. 9.3 9.5 0.2

19. My clinician helped me improve my reading skills. 8.3 8.8 0.5

20. Overall, I liked therapy. 3.8 9.5 5.7 b

21. My clinician helped me improve my writing skills. 6.3 6.8 0.5

Overall averages 7.1 9.0 1.9

aImportant. bNoteworthy.


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213

FIGURE 2. Participant responses from T1 ( ) and T2 ( ). Please refer to Table 5 for the list of questions.*Overall averages.

*

The results of this pilot study showed that, with a small

number of participants, hippotherapy was successful. We ac-knowledge that the parents may have responded positively to

hippotherapy because of its novelty, as well as the inherent in-

fluence of the researchers expectations during survey-based

research. Future research should examine this therapy toolwith greater numbers of subjects in other geographic loca-

tions to improve external validity. Research into the effective-

ness and efficiency of hippotherapy as a treatment tool for

clients with communication disorders other than LLD also is

needed. We would like to encourage SLPs, especially thosewith equestrian skills, to complete continuing education

courses in hippotherapy and to begin integrating hippother-

apy into their practice.

ABOUT THE AUTHORS

Beth L. Macauley, PhD, CCC-SLP, HPCS, is an assistant professor

in communicative disorders at the University of Alabama. Her re-

search interests are neurogenic communication disorders and equine-

assisted therapy with special emphasis in hippotherapy. Karla M.

Gutierrez, MS, is working in Winnipeg, Manitoba, Canada.

AUTHORS NOTES

The authors would like to thank Joyce Morgan, Mellissa Morgan,

Shawn Macauley, and Merlin Farms Equestrian Center, Deer Park,

Washington, for their assistance with this project. This research was

supported by a grant from the Edward R. Meyer Fund, Washington

State University, Pullman, WA.

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APPENDIX A

Parent QuestionnairePlease circle the number to the right of the question that best fits your response.

Strongly Disagree Neutral Strongly Agree

1. Clinician/supervisors were prompt in meeting therapy or diagnostic

appointments. 1 2 3 4 5 6 7 8 9 10

2. The therapy environment was healthy and appealing. 1 2 3 4 5 6 7 8 9 10

3. The clinician was courteous and concerned in his/her clinical activities. 1 2 3 4 5 6 7 8 9 10

4. There were noticeable improvements in my childs ability to com-

municate following the semester of therapy. 1 2 3 4 5 6 7 8 9 10

5. Communication with the clinician was open, and questions were

readily answered. 1 2 3 4 5 6 7 8 9 10

6. My child was motivated to attend the therapy sessions. 1 2 3 4 5 6 7 8 9 10

7. The clinician was interested in my child as an individual and considered

his/her special needs. 1 2 3 4 5 6 7 8 9 10

8. My childs ability to communicate in everyday situations is better. 1 2 3 4 5 6 7 8 9 10

9. The instructions given to my child were clear and understandable. 1 2 3 4 5 6 7 8 9 10

10. The clinician helped my child relate the therapy activities to every-

day life. 1 2 3 4 5 6 7 8 9 10

11. Therapy tasks were appropriately chosen and well organized. 1 2 3 4 5 6 7 8 9 10

12. My child was willing to participate in therapy activities. 1 2 3 4 5 6 7 8 9 10

13. The clinician was well prepared. 1 2 3 4 5 6 7 8 9 10

14. My child talked about his/her therapy with his/her friends. 1 2 3 4 5 6 7 8 9 10

15. The clinician was alert and competent in executing the therapy activities. 1 2 3 4 5 6 7 8 9 10

16. My childs self-esteem has improved as a result of therapy. 1 2 3 4 5 6 7 8 9 10

17. Sufficient equipment and materials were available for each session. 1 2 3 4 5 6 7 8 9 10

18. I would re-enroll my child in the therapy program. 1 2 3 4 5 6 7 8 9 10

19. The clinician provided helpful emotional support and counseling

as needed. 1 2 3 4 5 6 7 8 9 10

20. I would refer others for services. 1 2 3 4 5 6 7 8 9 10

21. Overall satisfaction rating. 1 2 3 4 5 6 7 8 9 10

Participant Questionnaire

Please circle the number to the right of the question that best fits your response.


1. My clinicians were on time. 1 2 3 4 5 6 7 8 9 10

2. The place where I did my therapy was fun. 1 2 3 4 5 6 7 8 9 10

3. My clinician was nice and paid attention to me. 1 2 3 4 5 6 7 8 9 10

4. I looked forward to coming to therapy. 1 2 3 4 5 6 7 8 9 10

5. My clinician answered all my questions. 1 2 3 4 5 6 7 8 9 10

6. My talking and understanding in everyday life is better. 1 2 3 4 5 6 7 8 9 10

(appendix continues)


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APPENDIX B: SAMPLE ACTIVITIES FROM TRADITIONAL THERAPY AND HIPPOTHERAPY

Example 1

Goal: Improve auditory comprehension.

Task: Listen to a story; repeat main points of story; an-

swer questions about details.

Traditional Therapy: The client walks around room as

the clinician tells a story. At the end of the story, the clinician

asks the client to retell the story. The client retells the story

while continuing to walk around the room and has to tell the

next part of the story as he or she passes by a corner. The

client then continues to walk in circles, serpentines, or around

chairs and answers the clinicians questions about the story.

Hippotherapy: The client walks around the indoor arena

on horseback, with a horse leader leading the horse and a side

walker on the ground beside the client for safety purposes,

while the clinician tells a story. The client retells the story

while continuing to walk around the arena and has to tell the

next part of the story as he or she passes by a cone on the

ground. The client continues to walk in circles, serpentines,

around cones, and over poles while he or she answers the clin-

icians questions about the story.

Example 2

Goal: Improve phonological awareness.

Task: Determine the first, middle, or end sound of dif-

ferent words.

Traditional Therapy: The client sits at a table and listens

to the words said by the clinician. The client then writes the

correct letter or group of letters (e.g., th) that fits the instruc-

tions (first, middle, or end sound) on a piece of paper or

chalkboard. An alternative strategy would be to post the let-

ters around the room and have the client walk to the correct

sound following each presentation or group of words.


on horseback, with a horse leader leading the horse, and lis-

tens to the words said by the clinician. Before each word, the

clinician says, first, middle, or end sound. After hearing the

word, the client writes the letters that make up the chosen

sound on a small white board in his or her lap. An alternative

strategy would be to post the different sounds around the

perimeter of the arena and have the client ride to the correct

sound following each presentation or group of words.

(Appendix A continued)


7. My clinician was interested in me and appeared to care about me. 1 2 3 4 5 6 7 8 9 10

8. The therapy activities will help me do better at school. 1 2 3 4 5 6 7 8 9 10

9. I understood the directions my clinician gave me. 1 2 3 4 5 6 7 8 9 10

10. I talked about what I did in therapy with my friends. 1 2 3 4 5 6 7 8 9 10

11. My clinician was well organized. 1 2 3 4 5 6 7 8 9 10

12. I feel better about myself. 1 2 3 4 5 6 7 8 9 10

13. My clinician was ready for my sessions. 1 2 3 4 5 6 7 8 9 10

14. The therapy activities were fun and interesting. 1 2 3 4 5 6 7 8 9 10

15. My clinician helped me improve my listening skills. 1 2 3 4 5 6 7 8 9 10

16. I would come back to therapy for another term. 1 2 3 4 5 6 7 8 9 10

17. My clinician helped me improve my talking skills. 1 2 3 4 5 6 7 8 9 10

18. I would tell others to come here for therapy. 1 2 3 4 5 6 7 8 9 10

19. My clinician helped me improve my reading skills. 1 2 3 4 5 6 7 8 9 10

20. Overall, I liked therapy. 1 2 3 4 5 6 7 8 9 10

21. My clinician helped me improve my writing skills. 1 2 3 4 5 6 7 8 9 10


(appendix continues)


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Example 3

Goal: Increase sentence complexity.

Task: When given two or more words, the client will usethem correctly in the same sentence.

Traditional Therapy: The client sits at a table and listens

to the words said by the clinician. The client then writes or

says a sentence using the given words. For example, the clini-

cian says, or, tomorrow, and client responds, Tom is com-

ing over today or tomorrow.


on horseback, with a horse leader leading the horse, while lis-

tening to words given by the clinician. The client then writes

a sentence on a white board he or she is holding or says a sen-

tence to the clinician using the given words and the given

sentence type.

Example 4

Goal: Improve spelling ability.

Task: Spell given words following discussion on specificspelling rules.

Traditional Therapy: The client spells the word given by

the clinician while jumping from one lily pad (piece of

green paper on the floor) to another, one letter per lily pad.

Hippotherapy: The client spells the word given by the

clinician while his horse walks over ground poles (long poles

used to make jumps that are set on the ground rather than in

a jump). The client must say one letter per step over a ground

pole. If the client makes an error, the horse stops and cannot

keep walking until the error is fixed. To increase or decrease

difficulty, the horse can walk faster or slower and the poles

could be placed closer together or farther apart.


(Appendix B continued)

the efectiveness of hippotherapy on children with language learning disabilities

Documents