Thursday, May 25, 2017

Tales from the Barn

A couple years ago, I had the good fortune of meeting the owners at a nearby occupational therapy clinic: Fingerprints in Naperville, Illinois. Since then, we have referred clients to each other and collaborated on treatment plans for a couple little ones. In April 2015, my practice: Naperville Therapediatrics, was invited to participate in therapeutic riding sessions with Fingerprints at a barn in Plainfield, Illinois. After two months, I learned much about the many benefits of horseback riding and its positive impact on physical, speech, language, and social communication development. This post reviews some of the themes that Ready, Set, Ride organized and the prompts/ cues that we incorporated as physical and speech therapists to address one, young client's unique needs. 

I'm not sure who enjoyed the themes that Ready, Set, Ride used in their sessions, myself, or the young riders. Among my personal favorites were the baseball, pirate, grocery shopping, and birthday themes. During baseball week, riders took turns swinging whiffle bats and trotting bases during much of the session. The coordinator was kind enough to give me a week's notice about this theme, so I donned my favorite Red Sox t-shirt and printed some simple CVC visuals, laminated them, and attached them to an accordion corded key chain so I could prompt my client with his target sound pattern and remain hands free. Pirate week included some thrilling sword fights, treasure hunts, and ring tossing as we followed along and practiced some motor planning patterns such as "P/Pow" and sound imitation for "Ar." Most of us do not enjoy food shopping, present company included, but it is way more fun to reach, twist, and grab a food list while riding a horse. With list in hand to coordinate holding the reins and a paper, riders searched different stations for objects matching items on his or her grocery list. Not only were there plenty of opportunities to exercise core muscles, but we were also able to work on varying communicative intents to label foods and comment about likes and dislikes using vocalizations. Finally, the birthday theme gave us an opportunity to improve imitating oral motor movements while we removed ice cream and sprinkles from the corners of our mouths by using just our tongue and lip musculature. I acted as a mirror for my client as he tried imitating the mouth movements while keeping his eye contact. It was great being in a position where my client could easily maintain his gaze and focus on my mouth without me having to continually find ways to get his attention.

It was rather impressive watching my young rider improve his strength, balance and coordination in just a few weeks. The physical therapy assistant who walked along the other side of our rider provided weekly feedback to caregivers about noticeable improvement in our saddle-free riding client, especially with regards to range of motion and core strength. Meanwhile, on my side of the horse, our rider was learning how to coordinate moving and vocalizing, which was one of the most challenging goals for this youngster. Typically, goals of this nature require all sorts of encouragement and games with bells and whistles to prompt client participation, but on horseback, you do not need to go that extra mile. The horse takes care of all of that for you! I only worked with this client at the barn and his mother would tell me weekly that her son did little during their clinic based treatment sessions, but I saw a completely different child in my setting. From start to finish each week, it took very little to encourage him to try different positions, such as facing backwards, and imitate sound sequences. In fact, the only time he responded with "no" was when we asked him if he wanted to go faster and "Trot", but he allowed it nonetheless and we eventually stopped asking and told him it was time to make the horse "Trot."

Along with having challenges coordinating movements and vocalizations, my client struggled with initiating requests using vocalizations. However, as the weeks progressed, he became a bit more spontaneous with initiating actions. At first, we prompted him to say "Walk on", "Trot on", and "Whoa", but after a couple sessions, he proudly and loudly initiated these commands in order to get his horse moving. Even at a young age, he knew that if he didn't speak up, then his horse would not move much! Right up to the last session, he did struggle with saying "Whoa" without prompting, so we worked him down from a brief "3, 2, 1" countdown to give him some time to take in his surroundings and get the word out. Besides initiating actions, I observed our rider initiating greeting the animals that roamed the barn as I had modeled for him during the first half of the spring program. The language opportunities were seemingly endless in this natural setting.

If you are ever given an opportunity to step out of your clinical space and work with a client in any natural setting, then I highly recommend you venture to the great outdoors! Barns, swimming pools, restaurants, and zoos have all the materials and stimulation that you will need, so leave those therapy bags at home and go have some fun.

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