What do Speech-Language Pathologists do?
According to the American Speech-Language Hearing Association (ASHA), speech-language pathologists (SLPs) work to prevent, assess, diagnose, and treat 5 main areas in children and adults. These areas are:
- Speech difficulties
- Language difficulties
- Social communication difficulties
- Cognitive-communication difficulties
- Swallowing difficulties (dysphagia)
What is hippotherapy?
According to the American Hippotherapy Association (AHA Inc.), the term hippotherapy refers to “how occupational therapy, physical therapy, and speech-language pathology professionals use evidence-based practice and clinical reasoning in the purposeful manipulation of equine movement to engage sensory, neuromotor, and cognitive systems to achieve functional outcomes. In conjunction with the affordances of the equine environment and other treatment strategies, hippotherapy is part of a patient’s integrated plan of care.”
Why might speech-language pathology professionals incorporate hippotherapy into a client’s treatment plan?
SLPs can incorporate hippotherapy in a client’s treatment plan while addressing any of the 5 main areas that SLPs treat. An SLP may choose to incorporate hippotherapy into a client’s treatment plan for a variety of reasons. Research indicates that incorporating animals into a client’s treatment can increase motivation, participation and engagement in therapy. In addition, the AHA Inc. Reference List has identified 96 peer reviewed journal publications along with 8 published systematic reviews that show support for the value of the use of equine movement in facilitating the neuro motor systems that support functional skills.
ASHA recognizes hippotherapy as “one of many treatment techniques that can be used by SLPs, provided that the SLP has the necessary education, training, and expertise, and abides by the ASHA Code of Ethics“. Before beginning to use hippotherapy in treatment, therapists should receive continuing education from the American Hippotherapy Association. After completing training, they should pursue certification from the American Hippotherapy Certification Board. In addition, therapists incorporating hippotherapy in treatment should be aware of and follow the Best Practice Statements from the AHA Inc.
ASHA states that “hippotherapy may be used by SLPs as an approach to meet designated communication or swallowing treatment goals as part of a larger plan of care”. Here is how and why an SLP might use hippotherapy in the treatment of each of the 5 main areas that SLPs address:
- Speech Difficulties:
Speech difficulties occur when a person is unable to produce speech sounds correctly or fluently, or when a person has problems with their voice or resonance. The production of a single syllable requires the participation of 8-10 body parts and the coordinated action of 70+ muscles! When used as part of a larger total plan of care, equine movement can be used to facilitate the neuro motor systems that support speech sound production. SLPs may use various developmental positions on the horse in addition to skilled purposeful manipulation of equine movement to target breath support, praxis, vocal volume, speech sound production, rate and fluency. Clients are also motivated to practice and improve productions both during and between sessions so their equine friend can “hear” how well they say things!
- Language Difficulties:
Language difficulties occur when a person has trouble understanding others (receptive language), or sharing thoughts, ideas, and feelings (expressive language). SLPs can use hippotherapy in treatment to facilitate the neural activity that is responsible for arousal and attention. This impacts joint attention, engagement, learning, word finding, and the speed of linguistic processing. While using equines in treatment, the SLP can use naturally occurring and planned communication opportunities to target receptive and expressive language abilities. The SLP can further increase language opportunities by overlaying toys, games and therapy tasks just as they would in any other clinical setting. When used as part of a larger total plan of care, the use of equines, equine movement and the equine environment can be an engaging, motivating and effective way to address a wide variety of language goals. As an added perk, practicing language in this highly meaningful way and the excitement of incorporating equines in treatment often results in clients speaking about therapy after they leave, which encourages continued practice long after the session has ended.
- Social Communication Difficulties:
Social communication difficulties occur when a person has trouble with the social use of verbal and nonverbal communication. Pragmatic language difficulties fall under this category. SLPs can use hippotherapy, as part of a larger total plan of care, to help clients improve social communication difficulties. Incorporating equines, the equine environment and equine movement into treatment, under the guidance of an SLP, provides natural opportunities for social communication practice. A treatment team of 2-4 people is generally used during a speech session incorporating hippotherapy. As a result, there are natural opportunities for the SLP to facilitate pragmatic language practice. Interactions occur with the horse handler, side walker and other support personnel. Communication with the horse itself through both verbal and nonverbal signals can promote better understanding of “communication rules” which can be transferred into practical applications for a client’s daily communication needs.
- Cognitive-Communication Difficulties:
Cognitive-communication difficulties occur when clients have trouble organizing thoughts, paying attention, remembering, planning, and/or problem-solving. Equine movement can be used to facilitate the neural circuitry that supports functional arousal, attention to task, information processing and speed of processing. SLPs can use equines, the equine environment and equine movement as part of a larger total plan of care to provide an endless number of cognitive-communication and executive function tasks. Recalling information, attending, planning, and organization are easily addressed and challenged in this setting with good clinical evidence of skills transferring into activities of daily living.
- Swallowing Difficulties:
Swallowing disorders (dysphagia) are feeding/swallowing difficulties, which may occur when motor or sensory deficits impede on a person’s ability to eat/drink as expected. SLPs can use equine movement to improve swallowing and feeding by addressing the motor and sensory systems that effect a client’s ability to chew and swallow foods of various textures. SLPs can also use hippotherapy to address oral motor control and awareness, resulting in improved saliva management and decreased drooling, that carries over after the session. In addition, for children with feeding difficulties, animals can be used as a motivator to encourage them to prepare, explore and try new foods. When combined with other standard tools and strategies, hippotherapy can be an integral part of the larger plan of care.
Speech Language Pathology in Motion has offices in Hauppauge and Islandia NY. We incorporate hippotherapy into treatment, when appropriate, as part of a larger total plan of care. For more information visit www.speechinmotion.com
*This article was updated on 5/2/18. Thank you to Ruth Dismuke-Blakely, MS/CCC-SLP, HPCS, Melanie Dominko-Richards, MS, CCC-SLP, HPCS, and Kathleen Henne M.S. CCC-SLP for contributing to this post.*
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© 2017 – 2018, Tina M. Rocco, M.A. CCC-SLP, HPCS. All rights reserved.