Horsing Around Could Be Just What the Doctor Prescribed

Andrew Oaks and Tommy Groeger arrive within a few minutes of each other — mothers in tow. Because they live on opposite ends of town, they usually see each other only once a week — and today's the day. Not only do they appear to enjoy each other's company, they seem to have developed the kind of friendship that only comes from sharing a common bond and mutual experiences.

Andrew, 7, and Tommy, 6, both have Duchenne muscular dystrophy — but that's not all they have in common. They also meet on Saturday mornings to do their physical therapy together.

Elisa Penn has been a physical therapist since 1992, and works on the neuromuscular team at the Children's Clinic for Rehabilitative Services in Tucson, Ariz.

One of her lifelong passions is her love of horses, which explains why she's meeting Andrew and Tommy on a Saturday morning. Because what makes therapy sessions with Andrew and Tommy different from most isn't the therapist — it's her assistant.

Penn describes Couch Potato as "the lovable Appaloosa with the funny name." In 1995, he joined the staff at Therapeutic Riding of Tucson (TROT) where he was trained to help provide physical therapy to people with a variety of physical disabilities. While he works as both a lesson horse and a hippotherapist, his special area of expertise is vaulting, which is why Tommy and Andrew are here to see him today. Vaulting is an advanced form of hippotherapy in which a person performs a variety of movements, including standing, while on the horse.

Where's the Hippo?

Another name for therapeutic horseback riding is "hippotherapy." But Couch Potato and his colleagues want you to know that "hippo" is the Greek word for "horse" — and has nothing to do with their size.

As far back as the fifth century B.C., Greek soldiers placed wounded comrades back on their horses to expedite healing. In his 1772 classic text, Domestic Medicine, William Buchan described the overall health benefits of exercise, adding, "Horseback riding is an excellent form of exercise — especially for the elderly and the infirm."

Although therapeutic riding enjoyed wide popularity across Europe, it was not until the 1969 opening of the Cheff Therapeutic Riding Center in Augusta, Mich., that health professionals in the United States began to take notice.

Shortly after the Cheff center opened, the North American Riding for the Handicapped Association (NARHA) was formed. Since then, NARHA has become the primary source of instructor training and center accreditation in the United States and Canada. Today, NARHA boasts 670 affiliated centers (like TROT), with 5,000 horses currently serving more than 35,000 adults and children with disabilities.

Michael Kaufmann, NARHA's director of communications and education, explains the difference between hippotherapy and recreational horseback riding: "To the untrained eye what you're seeing is people riding horses and having fun. But it's very different when you're doing hippotherapy, which is a medical intervention, the goal of which is to expose the body to the motion of the animal. That's where the benefit comes in."

In addition to setting standards for riding centers to help maintain a safe therapeutic riding environment, NARHA also offers such educational resources as regional workshops and an annual conference.

Meanwhile, Back at the Ranch . . .

Penn has just finished putting Andrew and Tommy through their warm-up regimen, which consists of practice exercises on the stationary vault — an empty 55-gallon drum mounted sideways on a wooden frame. Meanwhile, Couch Potato has been walked into the arena and is waiting patiently.

Penn's goals also include "maintaining coordination, balance and strength. And all of those things are addressed through both the stationary positions as well as the movements we do on the horse."

Andrew Oaks, assisted by side walker Michelle Ross, kneels on Coach Potato's back.

Watching Andrew and Tommy take turns doing their exercises — looking a bit like tag team wrestlers as they exchange "high fives" between turns — a casual observer might think the activity is primarily recreational.

Not so, says Andrew's mother, Preot Oaks — who is also a member of TROT's Board of Directors.

"We used to go to clinical therapy every week or so, but now we do this instead," she reports. "This is just more interesting."

Perhaps the most remarkable aspect of the boys' session is the amount of work that seems to take place almost surreptitiously. Even the "high fives" are part of the therapy.

"I'm trying to get their arms up," Penn explains. "These kids often lose the ability to raise their hands over their heads."

Even walking back and forth, as they alternate their work on the horse, is part of Penn's plan.

"Walking is tremendously important," she says. "If I make the space too short, they don't get a comfortable enough stride going," so they don't stretch their legs.

Sarah Schwegel, 8, of Kirkwood, Mo., is also an avid rider with no less than three favorite horses: Magic, Rex and J.R.

"I think 'J.R.' stands for 'Just Right,'" adds Sarah, who's MDA's national goodwill ambassador and has spinal muscular atrophy.

"I got Sarah involved in horseback riding because her therapist said that Sarah would be able to work muscles that she would never be able to work on land," says mom Sandy Schwegel. "I thought, if this is something that she likes, then while everyone else is involved with dance and soccer and baseball — maybe Sarah can do horseback riding."

Tall in the saddle, Tommy Groeger gets a full body stretch on Couch Potato.

Safety: Your Child and the 1,000-Pound Horse

"The first time she got on the horse she was scared," Sandy Schwegel recalls. "She was 19 months old, and here I am thinking she'd be on a pony — I'm thinking little kid, little horse."

Not to worry — folks at therapeutic riding centers take the riders' safety very seriously.

Before any prospective rider is enrolled in a class, the center's staff does a thorough evaluation to determine his or her individual needs and capabilities. The physical therapist meets with an NARHA-certified riding instructor to coordinate every aspect of the rider's instruction, from initial horsemanship training to selection of the horse best suited to a given rider.

And it doesn't stop there. During Andrew and Tommy's session, Penn is assisted by both the riding instructor and a volunteer, called a side walker, who's also received NARHA training.

Once the parents' fears are overcome, the riders' hesitation soon melts away, resulting in another of the seemingly endless array of "hidden benefits" of therapeutic riding — a marked increase in self-esteem.

"When we first came here, Andrew was terrified of the horse," Preot Oaks recalls. "Now he has a sense of freedom and self-confidence that he never had before."

Schwegel agrees: "When Sarah has her bad days and says 'I can't,' we talk about things that she can — and one of those things is horseback riding."

After each of Sarah's sessions, she feeds carrots to her horse from a bowl on her lap.

"Just that alone, for Sarah to have to hold onto the bowl while a huge horse is eating carrots — she's working her arm muscles," Schwegel explains. "But for Sarah to be up close and able to feed a large animal like that — it's an awesome experience."

But Does it Really Work? Parents Say Yes

"When Sarah first started riding, her head would immediately fall forward," Schwegel recalls. "She just didn't have the neck control to keep her head up. After six riding sessions she was able to keep her head up. So I saw her inability to do it, and then after working those muscle groups I saw her become able to achieve something."

Monica VanSickle of Southport, Pa., has spent a bit more time studying therapeutic riding than most. Her son James started riding at age 4. James, who has Duchenne muscular dystrophy, is now 10 and has become a member of his local 4-H club.

"James started with two side walkers and a lead," she recalls. "But he's now progressed to the point where he doesn't need [side walkers]. There's one in the ring with him, but only for safety."

In addition to being the parent of a child with Duchenne, Monica VanSickle is also a certified occupational therapy assistant.

Couch Potato — "the lovable Appaloosa with the funny name."

"When he was diagnosed, I decided that I just had to teach him how to be self-confident, and get him to make independent decisions," she says. "And I wanted something that he could call his own — something his big brother or sister didn't ever do. Now James has quite a few horse trophies on our trophy shelf."

To be sure, therapeutic riding — or any other form of exercise or physical therapy — can't reverse the damage to muscles caused by neuromuscular diseases like DMD. But progress is measured in many other ways.

"For me, progress with kids with DMD is maintenance of functional ability," Penn says. "So if I have a kiddo from the beginning of the year, and at the end of the year the parents tell me that they haven't lost any skill at home — that, to me, is progress."

Because therapeutic horseback riding is considered physical therapy, your health insurance company may be willing to cover part of the cost.

"Practitioners in some states do get the sessions reimbursed," says NARHA's Michael Kaufmann. "The only sessions that can potentially be covered by insurance are those that are conducted by licensed medical professionals.

"A different way of looking at it is, the therapist working with the horse is using the horse's movement as a tool — in the same way they would be using a beach ball or a swimming pool, or a whole lot of other options of exposing the patient to therapy. It just happens to be a horse."

Schwegel doesn't have insurance coverage for Sarah's sessions, which can cost "$220 to $260 per 12-week session," she says. "I don't know what the math is, and I don't care. It's worth it."

For the VanSickles, the math is even simpler. "In this program, everything is donated and all the workers are volunteers," she says simply. "No cost to families."

The Right Stuff in Horses and Horse People

"Horse people are horse people," VanSickle explains. "They're really a rare breed. Their hearts are into it."

Kaufmann agrees. "Eighty percent of the therapists, the instructors and the administrators who run NARHA programs are volunteers," he asserts. "They do this — besides their 'real jobs' — after work and on weekends."

In Tucson, Penn estimates that "over 100 volunteers donate their time to TROT. Without them we couldn't exist. There would be absolutely no way."

Denise Adamy of Wasilla, Alaska, is looking to start her own therapeutic riding program — and not because her therapy at a center in nearby Peter's Creek costs $45 per session. Adamy, who has Charcot-Marie-Tooth disease, simply wants to "start a business off the ground to help people."

Therapeutic riding, she says, "works muscles that you can't normally work," she asserts. "When you're on the horse and you feel like you're hanging on for dear life, you're using [those muscles] and you don't even know you're using them until you get off."

Couch Potato reviews research notes with Bill Benda.

It takes a special kind of horse to handle the unique constraints of therapeutic riding, Kerrill Knaus-Hardy explains.

Knaus-Hardy, who has spinal muscular atrophy, is the president of the Adaptive Riding Institute of Scotts Mills, Ore. In addition to providing wilderness recreational adventures on horseback for people with disabilities, Knaus-Hardy's institute also offers breeding and training programs.

"We can spend upwards of 10 years training and preparing that horse for the advanced level of carrying a disabled rider," she says.

Knaus-Hardy describes the ideal horse as courageous and "bomb-proof," meaning it won't become skittish or react to sudden loud noises. The horse also needs to be "people-friendly" and willing to respond to human commands.

It's a difficult combination to find, Knaus-Hardy says, "because a horse that is very brave and independent will also be more stubborn. And a horse that is more people-oriented is going to tend to be more timid. So it's kind of a contradiction in qualities that we're looking for. We want the horse that's brave enough to do it on its own, but kind and sweet enough to look to you for directions at the same time."

Continued . . .