Cerebral Palsy and Horse Therapy

Therapeutic Horseback Riding Techniques for Cerebral Palsy

May 27, 2007 Mary C. Vrtis

Cerebral palsy can be mild or extremely severe resulting in wheelchair dependence. Therapeutic horseback riding can be very effective in preventing further disability.

Cerebral palsy (CP) is a neurological disease that is characterized by poor muscle function and impaired muscle coordination. This disorder may be caused by brain damage at birth due to hemorrhage or lack of oxygen, early infections of the brain such as meningitis, or traumatic head injuries. The brain damage can also occur during fetal development prior to birth, at birth, or within the first few years of life.1,2

The severity of cerebral palsy varies. Some children may have minor deficits and be able to lead a relatively normal life, but walk with an unusual gait. Other children have profound deficits that cause them to be wheelchair bound from an early age. Problems with swallowing and eating, speech disorders and bowel/ bladder incontinence are common with severe CP due to impaired muscle function.1,2 Mental retardation, seizure disorders and vision problems are sometimes co-existing issues for children with CP.2

There are four types of CP, characterized by the type of muscle movement disturbance observed:

• Spastic CP characterized by tight or spastic muscles.
• Athetoid or Dyskinetic CP in which slow, uncontrolled, writhing movements of the extremities and possibly the tongue are seen.
• Ataxic CP which affects balance, depth perception and coordination (this form is rare).
• Mixed CP where symptoms of the other forms of CP are combined.2

As with any other form of disability, the goal for a child with cerebral palsy is maximum independence. Treatment for CP is directed at improving nerve and muscle coordination and preventing further dysfunction.1,2

Therapeutic horseback riding is a type of treatment that helps to improve nerve and muscle coordination as well as muscle strength, and it also helps to prevent further dysfunction that could result from contractures caused by decreased use of muscles and joints. The horse’s rhythmic movement helps to strengthen muscles that are used in walking, sitting upright, breathing and speech. Published case histories indicate that joint flexibility, balance, posture, breathing and verbal abilities have improved as a result of therapeutic riding.3,4,5,6 Children who find verbal communication difficult are motivated to speak in order to give their horse commands and to respond to the instructor and volunteers, thus helping to strengthen the muscles used for speech.3,4,5

Therapeutic riding is designed to improve cognitive as well as physical function and so it includes games to identify shapes, colors, letters, numbers and pictures. The riding experience is rich in sensory stimuli, for example, the setting includes the sights and sounds of the outdoors, the rider receives verbal and sometimes tactile direction from the riding instructor and assistants, experiences the horse’s movements, and looks for the visual cues are used in the riding arena. The child has to use her/ his five senses, think and process the auditory, visual and tactile information while riding. The child is challenged to use all of her/ his abilities (and the focus is on the child’s abilities and not her/ his disabilities), so volunteers are educated to give the child time to process and act on the information.3,4,5

In addition to the physical, cognitive and sensory improvements that the child may experience with therapeutic riding, studies have shown that the experience also helps to build self esteem.5 This is particularly important for children with disabilities such as severe cerebral palsy, as they frequently miss out on the experiences that allow able bodied children to build self esteem.

The North American Riding for the Handicapped Association (NARHA) is an excellent source for more information on therapeutic riding.7

References

1. NINDS (April, 2007). Cerebral Palsy Information Page. Retrieved May 19, 2007 from URL: http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm.
2. UCP (October, 2001). Cerebral Palsy Facts and Figures. Retrieved May 19, 2007 from URL: http://www.ucp.org/ucp_generaldoc.cfm/1/9/37/37-37/447.
3. Heine, Barbara. Noah’s Story. Retrieved May 19, 2007 from URL: www.narha.org/PDFfiles/Noahs_Story.pdf.
4. Baker, Liz. Cerebral Palsy and Therapeutic Riding. Retrieved May 19, 2007 from URL: www.narha.org/PDFfiles/tr_cp.pdf.
5. Gatty, Carolyn M. Psychosocial Impact of Therapeutic Riding: A Pilot Study. Retrieved May 19, 2007 from URL: www.narha.org/PDFfiles/Psychosocial_Impact.pdf.
6. Sterba, John A. (Spring, 2007). Therapeutic Riding and Cerebral Palsy. NARHA’s Strides 13(1): 30-38.
7. North American Riding for the Handicapped, Inc. www.narha.org.