Abstract
Equine-assisted OT, or hippotherapy, is considered a viable approach to treating children with autism spectrum disorder. The findings of a pilot study examining the effect of an 8-session intervention on sensory integration among five children resulted in overall improved sensory integration. Analysis of parent perspectives revealed improved adaptive responses among the children when applying higher level skills in occupational contexts outside of therapy.
Primary Author and Speaker: Glen S. Cotton
Equine-assisted occupational therapy, or hippotherapy, is an intervention strategy incorporating equine (pony/horse) movement that occupational therapists use to achieve functional outcomes. Therapists incorporating hippotherapy facilitate vestibular, proprioceptive, and tactile sensory input direct from the equine. Researchers examining the therapeutic benefits of hippotherapy for children with ASD have found it improves engagement, social and executive functioning, adaptive behaviors, and participation in daily activities (Ajzenman et al., 2013; Borgi et al., 2016; Llambias et al., 2016). The sensory integration (SI) benefits for this group have not been examined, despite evidence showing a strong relationship between SI dysfunction and ASD (Tomcheck & Dunn, 2007). Therefore, the aim of this pilot study was to examine the effect of hippotherapy on SI among children with ASD and to determine if an eight-session occupational therapy (OT) intervention incorporating equine movement has a positive effect on sensory integration (SI)? This multiple case study followed a mixed method explanatory sequential design, beginning with a quantitative phase measuring SI among children with autism, pre- and post-intervention, followed by a qualitative phase exploring parents' perceptions. Five children, 3-7 years old and with a diagnosis of ASD, and their parents were recruited via a waiting list at a therapeutic riding facility and a recruitment flier sent to pediatric OTs. Children were not receiving outpatient OT during the study. Children participated in eight 45-min. sessions. Parents participated in one 50-min. focus group. Quantitative data was collected using the Sensory Processing Measure – Home Form (SPM-HF) (Partham & Ecker, 2007), a caregiver questionnaire that assesses sensory processing issues, praxis, and social participation. Parents completed the SPM-HF prior to the first session and after the 8th session. The tool yields a raw score and a standard T-score. A paired-samples t-test was performed to compare the means of the T-scores from the pre- and post-intervention. Qualitative data was collected via a parent focus group after the 8th session. The focus group examined parents' perceptions of the therapeutic benefits of the intervention. Data analysis was guided by key constructs of Ayres' SIT®. Analysis of the SPM-HF data showed improvements in all but one of the eight scales of the tool. The T-score for the ‘total score scale,' which represents general dysfunction in sensory processing, was significant, with a p-value of 0.003. Analysis of the parent focus group data revealed six themes: value a mix of therapies; motivating and enjoyable; unique, with many benefits; multiple improvements; a positive experience; and barriers to continuing. Informed by the results of the SPM-HF and guided by Ayres' SIT®, further analysis of the qualitative data revealed that the intervention had the greatest impact on arousal, sensory discrimination, and sensory modulation. Despite the limitations of this pilot study, the results are important to OTs who provide services to children with ASD. Equine-assisted occupational therapy can be highly motivating and enjoyable for children with ASD and may be a viable intervention for OTs to recommend to parents of children who would benefit from a multisensory approach. This intervention resulted in overall improved SI of children with ASD along with improved adaptive responses when applying higher level skills in occupational contexts outside of therapy. Results of the study strongly support the need for additional research examining the SI benefits and functional outcomes of equine-assisted occupational therapy.
Ajzenman, H., F., Standeven, J. W., & Shurtleff, T. L. (2013). Effect of hippotherapy on motor control, adaptive behaviors, and participation in children with autism spectrum disorder: A pilot study. American Journal of Occupational Therapy, 67(6), 653-663. http://dx.doi.org/10.5014/ajot.2013.008383
Borgi, M., Loliva, D., Cerino, S., Chiarotti, F., Venerosi, A., Bramini, M., & Cirulli, F. (2016). Effectiveness of a standardized equine-assisted therapy program for children with autism spectrum disorder. Journal of Autism & Developmental Disorders, 46(1), 1-9. http://dx.doi.org/10.1007/s10803-015-2530-6
Llambias, C., Magill-Evans, J., Smith, V., & Warren, S. (2016). Equine-assisted occupational therapy: Increasing engagement for children with autism spectrum disorder. American Journal of Occupational Therapy, 70(6), 7006220040.
Tomchek, S. D., & Dunn, W. (2007). Sensory processing in children with and without autism: a comparative study using the short sensory profile. The American Journal of Occupational Therapy, 61(2), 190-200. https://doi.org/10.5014/ajot.61.2.190