Trotting toward better health

KAREN LOPEZ, a 60-year-old Spokane resident, can tell when she hasn’t spent time with Jake. Her balance isn’t as good and she can’t walk as well. And she just isn’t as happy.

Lopez has multiple sclerosis. Jake is the horse — an 18-year-old paint — that she rides as part of her physical therapy.

“You do different stretches, raising your arms and walking with your arms in the air, and twisting,” Lopez says of her “hippotherapy” sessions. “It’s a very fun experience.”

Derived from the Greek “hippos” for horse, hippotherapy is what happens when physical, occupational and speech therapists take patients out of the treatment room and into the ring.

The goal is to improve balance, posture, motor skills, concentration and speech in patients with conditions such as cerebral palsy, sensory integrative dysfunction and developmental delays.

Lopez receives her hippotherapy from Paula Dillon Mays, one of two such therapists in the area. Mays owns five physical therapy clinics around Spokane, in addition to running the hippotherapy program out of her own indoor arena.

Seeing her horse-riding patients make such great strides is almost as gratifying for Mays as it is for her clients and their families.

“It affects your heart. You feel like you’re doing something special for people,” Mays says.

“But, in fact, you’re doing regular physical therapy. … It’s the best tool I’ve ever come across for physical therapy.”

A lot of firsts

Dr. Stephen Glass, a Woodinville, Wash., child neurologist, has prescribed hippotherapy as a supplement to traditional physical and occupational therapy for more than 20 years.

Besides improving balance and motor skills, he said, hippotherapy can help kids learn where their bodies are in space, something most people take for granted.

Most people can close their eyes and still touch their knee or nose. But that’s not true of people with an impaired sense of body awareness. It’s a condition often found with cerebral palsy, spinal-cord injuries or autism, and it can make it difficult for the person to integrate his senses and understand how his body relates to external forces and surfaces.

In hippotherapy, which typically involves riding without a saddle, sensations the patient gets from the horse’s movement can improve body awareness, Glass said. With each step, the child is made aware of where parts of his body are in relation to the horse.

But how can a horse teach a child to walk?

As the horse walks or trots, the motion moves two-year-old Carter Fitzpatrick’s pelvis the same way it would if Carter were walking, said his occupational therapist, Barbara Sifferman, and therapeutic-riding instructor, Pam Grudin.

“It teaches the pelvis what we’re wanting it to do,” Sifferman said. The movement also stimulates other bones, ligaments and joints by gently moving the Seattle boy back and forth and side to side.

“We see a lot of first steps and first words here,” Grudin said.

Because sitting on the horse can improve a patient’s posture, breathing can improve, making it easier to speak, she said. The excitement of riding can also help prompt speech.

“Sooner or later that child is going to say ‘walk on’ to get that horse to move,” Grudin said.

Grudin and Sifferman team up with volunteers to offer hippotherapy two days a week. Clients, who range in age from 2 to 5, come once a week.

Physical therapist Robyn Moug, who used to work for Mays, recently started offering hippotherapy in Deer Park. Therapy on the horse is unlike anything she could perform in her office, Moug says.

“It’s the three-dimensional movement of the horse,” she says. “The horse moves in three planes, just as the human pelvis does. Not only are you moving through three planes, you’re rotating and moving through space. There’s no way I can duplicate that on the therapy ball.”

Little research, so far

Even avid supporters of hippotherapy acknowledge there isn’t much research behind it.

Nancy McGibbon works with children who have cerebral palsy at Therapeutic Riding of Tucson, Ariz., and has helped do a few of the handful of U.S. studies.

One involved 15 children with cerebral palsy. Some got a short session of hippotherapy. Others were put astride a stationary barrel, a technique used in clinics.

Afterward, researchers measured improvements in muscle symmetry. With cerebral palsy, McGibbon explained, a muscle on one side of the body may work harder than its twin on the other side. The harder-working muscle gets stronger and strains certain joints.

Children in hippotherapy showed significant improvement in muscle symmetry, researchers found, while children on the barrel did not. The study ran last year in the Journal of Alternative Complementary Medicine.

In Spokane, Moug is in the early stages of a research project involving autistic children and hippotherapy.

McGibbon, who plans to do further hippotherapy research with the University of Arizona School of Pediatrics, said the lack of research is one of the biggest obstacles hippotherapy faces.

Both Glass and McGibbon say they’ve seen patients who’d stopped progressing in traditional treatment suddenly make improvements in hippotherapy, but proving the horse helped is tough.

Health insurers leery

Debra Peet-Walker, a Woodinville physical therapist, is a certified therapeutic riding instructor through the North American Riding for the Handicapped Association. She says the balance a horse teaches is invaluable.

“Trunk control is the prerequisite for everything else,” she said.

Peet-Walker provides hippotherapy at Little Bit Therapeutic Riding Center in Woodinville.

One of her clients, Sam McNiff, 8, has to use a walker to get around and has trouble sitting up on his own. His mom, Erica McNiff, started bringing him to Little Bit four years ago.

At first, Sam needed Peet-Walker and volunteers supporting him all around his body to keep him mounted. Now, McNiff said, all he needs is an occasional hand of support on his back.

Parents like McNiff pay $90 to $115 per session for hippotherapy at Little Bit. Though McNiff gets some help from the state Department of Social and Health Services for Sam’s various treatments, her health insurer does not cover hippotherapy.

Glass said he thinks insurance companies don’t reimburse for hippotherapy because they view it as recreational and not therapeutic.

“They think it must be too much fun, it can’t be work,” he said.

Before Premera Blue Cross of Washington State will cover hippotherapy, there will have to be more proof it works, spokesman Chris Jarvis said.

“The literature doesn’t show enough evidence of it being medically necessary or effective,” Jarvis said.

Regence BlueShield doesn’t reimburse for hippotherapy either. Nor does Group Health Cooperative.

Mays accepts insurance, billing the hippotherapy treatments just as she would for any other physical therapy session. Moug does not accept insurance, but she has been holding fund-raisers to help support patients who are unable to pay the $89-per-session fee.

Becky Stipe’s 3-year-old son, Hayden, has been receiving hippotherapy from Moug for the past two summers. Hayden has cerebral palsy and is not able to walk unassisted, but his mom has noticed improvements after he spends time on Odie the horse.

“We’ve seen some really nice benefits, increasing trunk strength and balance,” Stipe says.

Plus, she says, “He just has so much fun, he doesn’t realize that it’s therapy.”