Today we have Allie (from @PatchesOfOT on Instagram) talking about her experience at her level 2 placement in hippotherapy! This is a special interest of mine as well, so I was so excited to get her perspective and advice on all things OT and horses!
My name is Allie Watkins and I am a current 3rd year student finishing up my Doctorate Capstone in the Pediatric ED working with Forensic Nurses and burnout and trauma. Additionally, I am starting to study for the boards while in school as well. I graduate in May of 2021! whoo hoo! I am from Indianapolis, Indiana and hope to work in PRN in pediatrics/hippotherapy. My goal is to work really hard to pay off my student loan debt in the next couple years. I hope to document my school to debt free journey on my blog.
What setting are you sharing about today and can you give a brief description of it? What qualifies a person to receive therapy in this setting?
The setting I am sharing about today is Hippotherapy. Hippotherapy is utilizing the movement and gait of a horse to provide motor and sensory input. It is utilized to improve neurological, sensory processes, and overall strength. Any and all patients can use the horse to help with physical and mental disorders. Exception would be anyone who has recently undergone surgery and has precautions to riding horses or harsh movements.
What is OT’s role in this setting?
There are so many things OT’s can do or work during hippotherapy. OTs can work on sensory processes with different patients. For instance, if a patient is overstimulated, an OT can use a certain pattern for the horse to go into in order to meet sensory needs for the patient. OTs can work on core strength, UB strength, and balance by asking patients to receive rings out of BOS. OTs can use bigger rings to work on ADLs while riding horses by donning and doffing rings like the patient would a shirt. OTs can work on other ADLs such as brushing out the mane or dressing the horse in attire to increase motivation for the patient to do likewise. OTs can work on vision while riding the horse by having the patient look for objects while riding the horse. Therefore, OTs can work on accommodation, saccades, convergence, and figure ground. Lastly, OTs can talk to the patient while riding on the horse to talk about emotions and dealing with hard situations.
Did you feel prepared going into this setting based off of your classes? And how did you prepare before starting?
To be honest, we did not have any Hippotherapy classes at my school. However, I felt a little prepared due to some pediatric classes. I only had a couple days before my rotation started due to COVID. Therefore, I was honest with my fieldwork site mentors and told them I knew little about Hippotherapy, but very excited to dive in. My fieldwork site mentors were happy that I was honest and very supportive.
What resources were the most helpful during your time there?
The best resources were my site mentors and just observing the first couple weeks. There are not many resources about Hippotherapy. Therefore, I leaned in on everyone (OTs, PTs, and barn horse handlers.).
How did you stay organized and manage your time?
I brought my calendar and wrote a To-do List everyday to help me stay organized. To manage my time was very hard. Therefore, I usually stayed after hours to complete notes or evaluations. I also had night classes due to COVID, therefore, I would write some notes at home on word and copy and paste to the computer once I got to my site to help manage my time. Managing my time was quite the most difficult part due to external factors brought by COVID. Every weekend, I looked at activities or research to help with the patients that I saw for that week.
What was your schedule like?
I got to work at 7:45 and saw our first patient at 8 am.
I saw 4 patients in the morning,
1 hour of documentation
1 hour of lunch/documentation
4 patients in the afternoon.
Last minute documentation.
What assessments did you use most?
I used BOT-2, Sensory Profile, and a general anxiety assessment (lots of anxiety due to COVID).
What conditions/diagnoses did you see most often?
The most conditions/diagnosis that I saw was Autism, Down-Syndrome, and neurological disorders.
What did a typical session look like?
Depending if we rode on the horse first or second session, the session looked like this:
25 to 30 minutes of OT in the clinic. We worked on the patient’s OT goals during this time.
3 to 5 minutes placing belt and helmet on child.
20 to 25 minutes on the horse.
Take the belt/helmet off and back to the parent.
How did you stay client-centered and occupation-based?
The OTs and PTs let the patient lead the session and the OTs and PTs will sprinkle in the goals once the patient picks out what they want to do. I would always use This and Then method for occupation-based goals. First shirt then swing. Or I would use the facility service dog to make donning and doffing clothing fun. The service dog would retrieve clothing items and bring back to the patient or pull off a patient’s sock. Which the kiddos LOVED that.
Did you have to do a project or in-service? Could you share what topic you chose?
I did! I worked with my site mentor on visual interventions to do on the horse. Therefore, I made a vision surcingle. The vision surcingle is requested by the therapist. The kiddos can work on saccades, accommodation, writing names, and fixation.
What was your favorite part of this fieldwork experience?
My favorite part of this fieldwork experience was seeing the kiddos face when they are on the horse. The kiddos are SO happy. I also love working with animals. It is my personal patch. I gain so much from working with animals and patients and seeing the benefits of animal-assisted therapy. It is truly magical.
What was your least favorite part of this fieldwork experience?
My least favorite part of the fieldwork experience was the time management. It was super hard to balance writing notes, evaluations, planning with night class after fieldwork due to COVID. I was mentally and physically drained some days.
What is something you learned that you will take with you for the rest of your career?
I learned SO MUCH. The biggest takeaways from the fieldwork site was Hippotherapy in general and I hope to continue to work in the Hippotherapy space. Additionally, talking to kiddos and using an empathic voice. Often therapists are drilling kiddos with commands and not realizing it. Kids react so much better when we talk about our frustrations and limitations and then move onto a new area. All Emotions are good emotions.
What advice do you have for a student about to start in this setting?
Take it all in. Enjoy every minute. Hippotherapy is so magical and something that is not taught in schools. The benefits of Hippotherapy are amazing and to see kids go from not walking or talking to improving drastically is something that is truly the best thing to witness in your career. Change takes a lot of time, but you are making an impact.