Wednesday 11 April 2018

2018 Equino therapy for war veterans


                                      Eduardo C. Gerding

"Some say 'it's just a horse', but it's not 'just a horse'. A horse is a friend that listens when no one else will. A horse helps people believe in themselves when others don't believe in them. A horse helps builds trust through unbreakable friendships. A horse brings joy to those who are feeling down. A horse is not 'just a horse', a horse is a hero. A hero that is waiting for someone to be their hero. So the next time you hear 'It's just a horse', tell them a horse is more then that. A horse is a hero waiting for a hero." 18


Hippocrates, Greek physician (469-399 BC) recommended the use of horse riding to "regenerate health and preserve the human body of many ailments , especially the treatment of insomnia." Asclepiades of Prussia, Greek physician (134-40 BC) believed that horse riding was beneficial for patients with gout, epilepsy, paralysis, stroke, lethargy and frantic. It was also prescribed by Galen, Greek physician (129-199). It was mentioned by Jerónimo Mercuriales, Italian philologist and doctor (1530-1696). Thomas Sydenham advised riding for tuberculosis, biliary colic, and flatulence. Friedrich Hoffman, chemist and German physician (1660-1742) considered the horse´s walk as the healthiest gait. Denis Diderot, French philosopher and writer (1713-1784) said that horsemanship stimulated the movement of muscles. Horsemanship was also advised by Johann Wolfgang von Goethe (1749-1832), Joseph Clement Tissot French physician (1750-1826), Giuseppe Benvenuti (Italian physician) and Charles Marie E. Chassaignac (French physician (1805-1879).
The first equestrian activity related to a hospital was that of the Orthopedic Hospital of Oswentry in South Africa. In 1917 equestrian activities began at the Universitary Hospital of Oxford

 In 1972, Dr. Colette Picart Trintelin presented her doctoral thesis in equinotherapy at the University of Paris in Val-de-Marne. In 1985 the International Equine Therapy Federation was created in Italy, its current headquarters being in Belgium. 3,4

In Argentina, the Argentine Association of Equestrian Activities for the Disabled (A.A.A.E.P.A.D) was founded by Mrs. Maria de los Angeles Kalbermatter more than 35 years ago. She was a pioneer in Argentina together with centers in Brazil . It has 250 disabled students of all ages and pathologies and works with an Interdisciplinary Team of Health and Education Professionals of more than 20 people.

Terminology 7

The more common therapies and terminology used to describe them are:
·         Therapeutic horseback riding uses a therapeutic team, usually including a certified therapeutic riding instructor, two or more volunteers, and a horse, to help an individual ride a horse and work with it on the ground.
·         Hippotherapy involves an occupational therapist, a physiotherapist, or a speech and language therapist working with a client and a horse. Different movements of the horse present challenges to the client to promote different postural responses of the client by the horse influencing the client rather than the client controlling the horse. The word "Hippotherapy" is also used in some contexts to refer to a broader realm of equine therapies.
·         Equine-assisted learning (EAL) is described as an "experiential learning approach that promotes the development of life skills ... through equine-assisted activities."
·         Equine-assisted psychotherapy (EAP) does not necessarily involve riding, but may include grooming, feeding and ground exercises. Mental health professionals work with one or more clients and one or more horses in an experiential manner to help the clients learn about themselves and others, while processing or discussing the client's feelings, behaviours, and patterns. The goal is to help the client in social, emotional, cognitive, or behavioral ways. Other terms for equine psychotherapy include Equine-facilitated psychotherapy (EFP), equine-assisted therapy (EAT), Equine Facilitated Wellness (EFW), Equine Facilitated Counselling (EFC) and Equine Facilitated Mental Health (EFMH).
·         Interactive vaulting involves vaulting activities in a therapeutic milieu.
·         Therapeutic carriage driving involves controlling a horse while driving from a carriage seat or from a wheelchair in a carriage modified to accommodate the wheelchair.
·         Equine-Assisted Activities (EAA) incorporates all of the above activities plus horse grooming, and stable management, shows, parades, demonstrations, and the like.

What elements include equino therapy

Equine therapy includes activities such as combing, feeding, donning and driving a horse supervised by a mental health specialist and often with the assistance of a horse specialist. 2,10
The specialist in equinotherapy observes and interacts with the patient identifying their patterns of behavior, thoughts and emotions. Many of the benefits noted are due to the nature of the animals.

Horses do not judge, they do not have expectations or preconceived motives and they reflect in a very effective way the attitudes and the human behaviors.
Horses and people are social beings whose herd dynamics are surprisingly similar to our family structure. 17

The specialist in equino therapy observes and interacts with the patient identifying their patterns of behavior, thoughts and emotions. Many of the benefits noted are due to the nature of the animals.

María de los Angeles Kalbermatter-Pioneer in Argentina-

Asociación Argentina de Actividades Ecuestres para Discapacitados (A.A.A.E.P.A.D)-El poder curativo de los caballos (The horses´healing power)

Why horses ?? 4

When people first hear about equine therapy, the first question is usually - why horses? Other animals (such as dogs) are commonly used in animal assisted therapy, however horses are considered to provide more scope for behavioural change. There are a number of reasons for this, including the following:

Because of their size

As horses are large and powerful animals, they can be intimidating. For some people, this presents them with a challenge as soon as they start therapy - to overcome this fear. Combating this initial issue can be incredibly liberating and helps to boost feelings of confidence and self-esteem. Accomplishing tasks and gaining the trust of such animals only continues to reinforce these feelings of empowerment.

Because they are herd animals

Horses are herd animals, which means they naturally desire company and often want to be led. This makes them very social animals that want to create bonds - and this can be especially poignant when it comes to humans. Horses are therefore ideal for this type of therapy, as they will be inclined to develop a relationship with you when you are ready.

Because they mirror behaviour

Another reason horses are used is because they have an innate ability to mirror the thoughts and behaviours of others. Because they are prey animals, they can read body language and respond instantly. This means that if you enter the horse’s space with a negative attitude and defensive body language, chances are the horse won't want to interact with you. Alternatively, if you enter with a sense of calm, confidence and openness - you should find the horse responds more positively.
It is this trait that helps you to reflect on your behaviour and challenge the way you approach situations both inside and outside of your therapy session.

Because they have their own personality

Horses can be incredibly human in their personalities - they can be stubborn and seemingly defiant at times. They also like to have fun and often turn exercises into games. Horses can be incredibly caring too, and if you are upset they often respond in a nurturing manner. These personality traits once again make horses a natural companion during the therapeutic process, providing vast opportunity for growth. 4

What are the Benefits of Equine Therapy?
Studies have indicated that equine therapy has been successful in helping patients show marked improvements in the following areas:
·         Assertiveness
·         Emotional awareness
·         Empathy
·         Stress tolerance
·         Flexibility
·         Impulse control
·         Problem-solving skills
·         Self-actualization
·         Independence
·         Self-regard
·         Social responsibility
·         Interpersonal relationships

What Conditions/Disorders Does Equine Therapy Treat?

Equine therapy has been successfully integrated into treatment programs for adults and teens who are being treated for substance abuse, addiction, behavior disorders, mood disorders, eating disorders, learning differences, ADD/ADHD, autism, Asperger’s, grief/loss, trauma, sex addiction, compulsive gambling, bipolar, depression and related conditions. 1,6
Studying patients with Down Syndrome 16 it has been seen that equinotherapy covers neurophysiological, biomechanical and psychoevolutive parameters, taking advantage of the interaction between the horse, the trainer or therapist and the patient to stimulate the development of physical abilities, language and the personality . 12
The movements of the horse in the transverse and frontal sagittal planes stimulate the development of the cochlear vestibule system and the strengthening of the patient's muscles and joints, by means of the dissociation of the pelvic and scapular waist 9,13  improving their posture and tone, increasing neuromotor coordination and spatio-temporal orientation, as well as attention and concentration . 9,13

Cost of Equine Therapy
Sabino Recovery is a private center in Tucson, Arizona (USA) where a 2 hs session of equine therapy costs $ 225 . 8

Equine therapy for Veterans of War

There is a center in the USA. (Vancouver, Washington) created by war veterans for war veterans called Windhaven Therapeutic Riding where equino therapy is performed. According to their instructors, it is not the veteran who chooses the horse but the horse who specifically seeks the veteran. The horse is never wrong. This therapy is the perfect response for patients with PTSD
11   and achieves maximum relaxation. 5

Each session consists of 8 60-minute lessons. All veterans begin with Session 1 and may repeat the Session as many times as they deem necessary. It takes 2 years for a veteran to complete the 8 sessions if that is what he wants.

The Man O 'War Project is the first university research study in the USA. specifically designed to establish the effectiveness of Equine Therapy for war veterans affected by PTSD and to prepare treatment manuals. 
Sergeant Major Sam Rhodes of the US Army He returned in 2005 after 30 months of combat in Iraq with the diagnosis of PTSD. According to the US Department of War Veterans, 11 to 20 percent of soldiers returning from Iraq and Afghanistan have PTSD.

Warrior Outreach-https://www.facebook.com/pg/WarriorOutreach2008/photos/

Rhodes thought several times about committing suicide. In 2008 he found that working with horses achieved a sense of inner peace and purpose in life. He currently runs the Warrior Outreach entity (a 20-acre ranch) that offers free programs to war veterans and their families in Fortson, Georgia; 30 miles from the Army Base at Fort Benning. Last year, 16,800 people attended this entity. Sergeant Rhodes works full time at Fort Benning in the Ready and Resilient program at the Maneuver Center for Excellence where he helps promote strong mental health and suicide prevention guidelines for military personnel and their families. 14

Equine Therapy Entities in Argentina
Argentine Association of Equino Therapy
Brig. Gral. Juan Manuel de Rosas 279,Bella Vista, Buenos Aires
Argentine Scientific Foundation Establo Terapéutico
Dr. Alexis Carrel 7205-Haras Trujuy Moreno, 1664, Buenos Aires
Argentine Association of Equestrian activities for the disabled .
Av. Del Libertador 4489, CABA

-Andrea Pizzio-Andares Equinoterapia (A 6 Km. de Chajari, Entre Ríos)
-María de los Angeles Kalbermatter-Asociación Argentina de Actividades Ecuestres para Discapacitados A.A.A.E.P.A.D. Pionera en Argentina y Latinoamérica desde 1978.
-Windhaven Therapeutic Riding-Warhorses with Warriors-PO Box 73  La Center, WA 98629-EE.UU-

1-Asselin GPenning JHRamanujam SNeri RWard C. Therapeutic horse back riding of a spinal cord injured veteran: a case study.- Rehabil Nurs. 2012 Nov-Dec;37(6):270-6. doi: 10.1002/rnj.027.
-Asociación Argentina de Actividades Ecuestres para Discapacitados (A.A.A.E.P.A.D)- https://aaaepadpalermo.org/nuestra-historia-mas/

2-Barolin GSSamborski R.- The horse as an aid in therapy.- Wien Med Wochenschr. 1991;141(20):476-81.

3-Carreras, Faustino Dr-Historia de la Equinoterapia en el mundo-Ciberboletín Febrero de 2011-Año IX-Nº68-Asociacion Argentina de Historia de la Veterinaria
4-Counselling Directory UK-Equine Therapy
5-Cramer, Tom-Veterans conquer depression with Equine Therapy-Veterans Health Administration-May 23, 2017.
7-Equine Assisted Therapy-Wikipedia
8-Esposito,Lisa- Equine Therapy: How Horses Help Humans Heal.
9-Kate V, Wilmarth MA. Hippotherapy: A Therapeutic Treatment Strategy [Internet]. Physical Therapy CE, Jobs, and News at TodayinPT. com. [citado 2011 Jul 21.
10-Koca TTAtaseven H. What is hippotherapy? The indications and effectiveness of hippotherapy.- North Clin Istanb. 2016 Jan 15;2(3):247-252. doi: 10.14744/nci.2016.71601. eCollection 2015.

11- McKinney JMHirsch JKBritton PC. PTSD symptoms and suicide risk in veterans: Serial indirect effects via depression and anger. J Affect Disord. 2017 May;214:100-107. doi: 10.1016/j.jad.2017.03.008. Epub 2017 Mar 7.

12- Pérez Álvarez L, Rodríguez Meso J, Rodríguez Castellano N. La equinoterapia en el tratamiento de la discapacidad infantil. Revista Archivo Médico de Camagüey. 2008;12(1).

13-Schultz Ramos de Andrade, M. Control motor y equinoterapia [Internet]. En: I Congreso Brasilero de Equinoterapia. Brasil: [citado 2011 Jul 20]. p. 6.

 http://www. sld.cu/galerias/pdf/sitios/rehabilitacion-equino/control_motor_y_equinoterapiabrasil.pdf

14-Smith, Catharine-This Veteran Is Helping Others Fight PTSD — With Horses-Huffpost-https://www.huffingtonpost.com/entry/warrior-outreach-horse-riding-ptsd_us_5978b5dfe4b0a8a40e848c64

15-The Man O` War Project-
16-Uribe Posada , Ana María  , Tomás Felipe Restrepo Palacio, Dedsy  Yajaira Berbesi-¿Cómo beneficia la Equinoterapia a las personas con Síndrome de Down?- Revista CES Salud Pública ISSN 2145-9932 Volumen 3, Número 1, Enero-Junio 2012, pág. 4-10
17- Vivo, Meghan- 5 Lessons People Can Learn From Horses in Equine   Therapy-Behavioral Health- https://www.elementsbehavioralhealth.com/addiction-
18- Windhaven Therapeutic Riding-Warhorses with Warriors-