THE USE OF HIPPOTHERAPY IN LANGUAGE AND SPEECH
During hippotherapy, the horse's variable, rhythmic and repetitive movements provide effective and multi-sensory stimulation for the rider. Since the movements of the horse during walking imitate the normal movements of the human pelvis, variations in the horse's gait in the forward, backward, sideways, up, and down direction increase sensory stimulation (Meregillano, 2004). These rhythms experienced while riding a horse create significant differences in stimulating the areas of the brain responsible for memory, perception of emotions, motor control, and learning (Hession, Eastwood, Watterson, Lehane, Oxley, Murphy, 2014; Grahn ve Brett, 2007; Bengtsson, Ullen, Ehrsson, 2009). Especially when language and speech disorders are considered, when the therapeutic strategies are combined with the horse's rhythmic movement and body temperature, it is possible to develop functional communication skills by supporting the language, speech, and communication skills of the individual.
Studies in hippotherapy for speech and language therapy generally include:
-- Autism Spectrum Disorder
-- Mentally Handicapped
-- Down syndrome
-- Cerebral palsy
-- Traumatic Brain Injury
-- Motor Speech Disorders such as Dysarthria, Apraxia
-- Delayed Language and Speech Disorder
-- Special Learning Difficulty (Especially Dyslexia)
-- Mild and Moderate Cognitive Problems
-- Chewing Problems, Oral Motor Problems, Weak lip closure-poor saliva control, Insufficient breathing due to failure to achieve postural control, etc. made within the scope of.
There are also studies showing that hippotherapy is effective in providing positive changes to behavioral problems, especially in children with an autism spectrum disorder. Aizenman et al. Administered hippotherapy to 6 autistic children aged 5-12 for 12 weeks in a study conducted in 2013, and at the end of the study, decrease in stereotypic movements in children with autism spectrum disorder, all adaptive behaviors, self-care, coping, and participation in daily activities, and receptive language skills, communication and a significant increase in social interaction was observed (Ajzenman, Standeven, Shurtleff, 2013). In another study by Gabriels et al. (2018) on children with autism spectrum disorder between the ages of 6 and 16, it was examined whether the significant changes in irritability, hyperactivity, social and communication behaviors after hippotherapy continued 6 months after the intervention. As a result, they observed that the healing effect in other areas other than hyperactivity continued after at least 6 months (Gabriels, Pan, Guerin, Dechant, Mesibov, 2018).
Lambias (2013), in her study examining the effects of hippotherapy on motivation and social interaction/communication for children with Autism Spectrum Disorder, revealed that children had an increase in spontaneous communication initiation, vocalization, and adult-child speech responses and motivation. In fact, the mother of one of the participants stated that she noticed that she could read and that she was looking at the horse while drawing and also used more verbal expressions while describing each picture.
Shurtleff, Standeven, Engsberg, (2009) reported that hippotherapy affects posture control and core muscles, which are essential for speaking, in a study involving children aged 5-12 years with a diagnosis of Cerebral Palsy. During gait transitions, according to Shurtleff, the rider has to make some fine adjustments to the trunk to maintain a stable position. Because a person needs to stabilize the trunk before speaking. Trunk stabilization also improves respiratory control as it increases lung capacity. In addition, pelvic movements facilitate the lowering of the diaphragm by allowing the organs in that region to settle, and thus the inspiratory (breathing) volume increases. Therefore, poor quality of the voice due to the inability to control breathing as a result of poor posture results in a chain of inadequacy such as decreased intelligibility, shortened speech time, and reduced sentence length during speech. In a single-subject study with Traumatic Brain Injury conducted by Thrall and Moser (2015), it provided an increase in lung capacity after hippotherapy, so it provided a significant gain on attention, motor planning, coordination, and timing, as well as a healing effect on respiratory and motor speech control and near-normal speech speed. It has been determined. Lutz (2010) stated that thanks to hippotherapy, significant improvements were observed in attention span, spatial awareness, concentration, listening skills, interest in learning, and verbal skills.
Kunasegra and Subramaniam (2020) showed improvement in social skills and language repertoire in the hippotherapy study they conducted with 16 children with dyslexia, especially in the areas of auditory comprehension, phonological awareness, vocabulary, reading, and writing. In the same study, it was observed that children could convey their thoughts to the clinician more accurately with activities suitable for hippotherapy and developed self-confidence and motivation in learning based on reading (Kunasegra ve Subramaniam, 2020). Macauley and Gutierrez (2004) evaluated child and parent satisfaction based on a questionnaire in a study examining the effectiveness of hippotherapy and traditional therapy in terms of language skills in children with learning difficulties. Parents reported improvement in language and speech skills after the two therapies while both parents were speaking. However, survey responses showed that this improvement was noticeably higher following hippotherapy, as well as an increase in motivation and interest.
Hyun et al. (2016) used fMRI, one of the neuroimaging methods before and after the study, in a hippotherapy study on 12 subjects who showed normal development and were diagnosed with attention deficit and hyperactivity, and neuronal connections in the brain increased after hippotherapy application, especially in healthy individuals, thanks to the cerebellum and left occipital gyrus. increased connections, especially in the region from the cerebellum to the left occipital gyrus, fusiform gyrus, thalamus, right caudate nucleus, right superior frontal gyrus; On the contrary, in children with attention-deficit and hyperactivity, signs of increased neuronal activation from the cerebellum to the right insular cortex, right middle temporal gyrus, and right precentral gyrus were detected.
Ornales et al. (2014) in a hippotherapy study with participants who do not have lip closure, where the tongue is positioned outside the mouth and who make mouth breathing; With the integration of oral motor exercises, it was observed that the orofacial muscles strengthened and increased lip closure and mostly nasal breathing (Ornelas -Valle, Nishimori, Nemr, 2014).
Although the influence of the horse in the therapeutic field was first mentioned in the works of Hippocrates, only after 1960 the protocol was established and the question of "Hippotherapy" entered the medical literature in Germany, Austria, and Sweden in the 1960s. In the 1970s, hippotherapy began to be standardized in the United States of America (USA) and with the establishment of the American Hippotherapy Association (AHA) in 1992, hippotherapy studies in cooperation in many countries around the world gained momentum. Although it is covered by general health insurance in many European countries such as Germany, Belgium, Netherlands, Greece, and Sweden (Debuse, Chandler & Gibb, 2005; cited in, Koca & Ataseven, 2016), hippotherapy studies with international standardization in our country date back to quite recent times.
Hippotherapy is not a method applied alone, it is used in addition to traditional treatment methods. Although effective, hippotherapy cannot always meet all the treatment needs of cases. In addition, since hippotherapy is not suitable for every diagnosis and every individual, its use should be evaluated individually. In general, Hippotherapy is a form of "complementary therapy" that can provide unique results when applied in addition to traditional therapies (Leidig, 2018).
More importantly, the horse is the "mediator" of an individual's relationships with people in his social circle. Therefore, Hippotherapy creates an incentive transition for "Social integration" (Murphy, Kahn-Angelo, Gleason, 2008).
Author: Sema Karabulut - Speech and Language Therapist
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