Equine Assisted Therapy (EAT) and Hippotherapy (HPOT) can be used in the treatment of Executive Function problems. Therapists who utilize these therapeutic methods know that a therapy horse can facilitate learning, and, with children, it has long been known to help activate language. HPOT uses the movement of the horse to facilitate language, while EAT uses riding activities to promote goals; both are directed by the treatment principles and goals that apply to the particular profession of the therapist. (Macauley, 2004) Because the horse can provide stimulation to the whole body, including the nervous system and brain, the client can be helped to integrate and process language in a whole new way. HPOT and EAT can often encourage progress that cannot be achieved through other strategies or methods.
Executive Function skills are those competencies that an executive must have to be successful in the workplace. Coincidentally, these are some of the very same abilities which allow children to be successful learners, the “how to learn” knowledge which permeates daily life and classroom academics. Because a classroom is linguistically based and language driven, the ability to use language is intimately connected to Executive Functioning. All day long children are listening, talking, reading, and writing. Without Executive Function skills, children will not be able to absorb and use the information they need to carry out language learning tasks.
Children with Tourette’s Syndrome, Asperger’s Syndrome, Nonverbal Learning Disabilities, and Language Learning Disorders have been found to have various degrees of Executive Function deficiencies. Students with poor Executive Function skills do not naturally bring to the learning environment a sense of self-awareness, reflection, and task analysis that will encourage success in academic tasks. (Wong, 1994; Wong, and Blenkinsop, 1989) The difficulty with such a learning problem is that it disrupts all phases of learning and social interaction; further, the diagnosis is mostly derived through extensive behavioral observation. There is no particular “test” for executive Function ability, not to mention the fact that, because it can be highly influenced by memory and overall language development, the problem is often not identified until a student experiences repeated failure.
Children use language to talk with their teachers, each other, and even themselves. They learn, as language develops, how to make plans, discuss, evaluate ideas, participate in groups, reflect on their work, change their minds, and edit their written material. They remind themselves to finish their work on time, ask for help when appropriate, wait to speak until they are called on, and go back to find information from various sources (Cazden, 1973). Particularly after fourth grade when independence of learning is emphasized, language becomes even more intertwined with Executive Function skills (Singer, 1999).
The following list of competencies, although by no means exhaustive, make up those considered necessary for adequate Executive Functioning (Packer, 2004). These skills are dependent upon language, working memory, and attention.
Goal: ability to identify goal or set goal.
Plan: ability to develop steps toward goal – materials needed, completion date.
Sequence: arrange steps in proper order spatially or temporally.
Prioritize: establish ranking needs or tasks.
Organize: obtain and maintain necessary materials.
Inhibit: stop oneself from responding to distraction; delay gratification in service of more important long term goal.
Pace: establish and adjust work rate so that goal is completed on time.
Shift: move from one task to another smoothly and quickly.
Self-monitor: assessing one’s performance and progress towards goal.
Emotional control: regulating and modulating responses to situations.
Complete: reaching the set goal.
Hippotherapy and Equine Assisted Therapy can be the perfect tools in the treatment of clients with Executive function problems. A well chosen therapy horse can be the vehicle for helping reach goals for planning, organizing, sequencing and verbalizing these areas that cannot be taught through other methods. Further, these treatment strategies are typically enjoyable, where-as academic tasks can be tedious. To engage the “fun” part of using a horse as a treatment tool offers stimulation that cannot be encouraged through most other language therapy methods. HPOT and EAT can keep client’s interest long enough to help them understand the use of “working memory” or “planning”. Bridges can then be made to foster language, learning and academic growth, i.e., “Do you remember when you made the plan out in the arena to take the horse from ________, to _______, around ________, then came back? Make a plan for your book report. What do you need? Tell me the steps you might take.” Because working with a horse is enjoyable, the treatments are more easily attuned to the client’s sense of self, helping them understand that they do have the capacity to learn.
In my practice, Speech and Learning Services, HPOT and EAT are treatment tools that are offered to clients who might benefit from such approaches. “Three dimensions of interventions are critical to effectiveness. Interventions should be 1) responsive, 2) systematic, and 3) intensive.” (Butler, 2002) To be responsive, the student’s reaction to intervention will determine how future intervention is provided. To be systematic, the student and therapist must constantly review structured and connected goals. The intensity is determined by the amount of time spent on the goal. HPOT and EAT can meet these therapeutic requirements in a fun and challenging way. The programs, Animal T.A.L.K. (Teach And Learn Knowledge) encourages learning and language development with the use of a selected horse/pony based on either goals I have set during assessment or pre-established IEP objectives from public school testing. What follows is a session with a client we will call Annabelle, a fifth grader in a private school, with a documented language learning disability primarily in the area of Executive Function. Of particular importance in defining an expressive language treatment program for Annabelle in Executive Functioning was that she was mostly deficient in establishing goals, in knowing where to begin assignments, in working memory, and in being able to verbalize clear explanations of her tasks/goals.
Combined HPOT and EAT Session with Executive Function Goals
The Animal T.A.L.K. Skills Checklist/Goals Module was used to establish starting points for the sessions. Annabelle had previously been evaluated and had been found to have expressive language, memory and Executive Function problems even though she scored well academically. The module noted that she was functioning at Level 2 of the Speech and Learning Scale for following directions – Able to process three-step directions with help, and explain the steps. Also included on the module was her NARHA Equestrian Proficiency Level. Annabelle was functioning below L1 – Demonstrates control around arena at walk, change directions, and halt. Although she had had previous riding experience at camp, her actual ability to independently make a horse move forward was very weak. Therefore, the combination of the Executive Function skills of goal setting, planning a sequence, while recounting her specific steps through the HPOT and EAT treatments of moving towards Level 1 of the NARHA Proficiency Levels and explaining what she was doing during/after riding were established. To clarify further, my treatment plan would work on Annabelle being able to control the horse at the walk, change of direction, and halt while making plans for that movement in the arena, and being able to verbalize these during and after she performed them. The therapy horse chosen for Annabelle is a registered 24-year-old Connemara mare named Curry. Curry’s temperament and love of children are well suited for therapy. Annabelle’s size fit Curry’s stride/height and their temperaments matched. It was a combination destined to happen.
The first session was brief, but noteworthy. Annabelle had extreme difficulty moving Curry forward, encountering in each other the “stubbornness” of a pony and little girl with planning problems: How do you keep in mind all of the aides (working memory) while you push to make a very smart pony move forward to a pre-arranged target? That was a huge challenge. I pointed out to Annabelle that Curry “knew” how not to work, something that Annabelle herself knew. I repeated to Annabelle that to move forward with Curry, one had to watch the aides, look toward the target, and, at the same time, “visualize” Curry walking forward. After several failed attempts, Annabelle finally got the 14.2 pony to move forward, but that was only after I got on and demonstrated, something that often has to happen in a classroom with a student who has Executive Function problems – the demonstration (do it this way) helps the student then be able to visualize what they must do, and then re-explain to the therapist the steps involved. Often this means that a therapist must also exhibit several parts, and then help the student put it all together. I had Annabelle tell me the steps she had to go through before, during, and after she completed the tasks. At each passing point, she was required to tell me the next target until she had completed the entire set of directions. Then she was asked to tell me the sequence of what she had done, and how she had gotten Curry to move forward.
After two of three sessions with Curry, Annabelle had made it to the first NARHA level and was able to move Curry forward at a walk, change directions, and halt. She also could follow 3-step directions while riding and could explain the sequence when riding and from memory after the task was completed. Therefore, she was able to plan, execute, and explain the steps needed to accomplish her goals. Then it rained, and Annabelle went on a family vacation. Interruptions from therapy, particularly in the early stages, sometimes similar to breaks or vacations in school, may have negative effects on learning. The necessary transitions accompanying them often have the effect of setting the student back while he/she tries to regain what was lost. For a student with Executive Function issues, these breaks or interruptions can take a longer transitioning time. For Annabelle, the results were at first disastrous. She had forgotten classroom assignments, could not explain how to make Curry move forward, and when questioned, could not even seem to verbalize where to begin. However, once these difficulties were discussed, because she loved the pony and learning about riding, not to mention her stubborn streak, she quickly picked up where she left off. The breaks were then used to help her understand the value of sticking to a plan, making explanation for the plan, and of routinely carrying these out.
Annabelle is now moving into trotting while accomplishing the same Executive Function goals. After a time, I will move here into further planning. Eventually, she will be required to write an essay about what she has learned, an essay that will be carefully planned and sequenced, one that will require her first to verbalize, then plan in writing. The working memory portion will be Annabelle’s recalling of how she learned.
Bio-
Carol Murphy, MA, CCC-SLP, is a licensed speech/language pathologist and board certified educational therapist. She was trained at the National Center for Equine Facilitated Therapy. Her business, Speech and Learning and Psychology Services, is located in Santa Cruz County for 23 years, with a division called Animal T.A.L.K., that uses horses for Equine Facilitated Therapy. Currently she is serving on the CA State Speech-Language Pathology, Audiology and Hearing Aid Disperser’s Licensing Board and supervises graduate Speech-Language Pathologists for California State University Northridge in Santa Cruz and Monterey counties. Carol can be reached by phoning 831.234.4181, or email her at admin@carolmurphy.org.
A protocol for assessing Equine Facilitated Therapy riding ability and appropriate levels has been developed.
References
Butler, Katherine G (Ed.) (2002). Enhancing Academic Performance of Students with Language
Learning Disorders, Topics in Language Disorders, Vol 22, No.2
Cozden, C.B., (1973). Problems for Education: Language as Curriculum and Learning Environment Daedalus, 102, 135-148
Cozden, C.B. (1988). Classroom Discourse: The Language of Teaching and Learning. Portsmouth, NH: Heinemann.
Denckla, M.B., (1996). A Theory and Model of Executive Function: A Neuropsychological Perspective.
In Gr.R. Lyon and N.A. Krasnegor (Eds.) Attention, Memory, and Executive Function (pp. 263 – 278). Baltimore, MD: Paul Brookes.
Macauley, Beth, (2004). Hippotherapy and Equine Assisted Therapy: Who does what?, Hippotherapy, 13, 1: 10-11
Packer, Leslie E. (2004) Self Evaluation Form, from Tourette’s Syndrome “Plus”www.tourettesyndrome.net
Singer, Bonnie and Bashir, Anthony S. (1999). What are Executive Function and Self-Regulation and what do they have to do with Language-Learning Disorders? Language, Speech and Hearing in the Schools, 30, 265-273
Wong, B.L. (1994). Instructional Parameters Promoting Transfer of Learned Strategies in Students with Learning Disabilities. Learning Disabilities Quarterly, 17, 110-120
Wong, B.L., Wong R. and Blenkinsop, J. (1989). Cognitive and Metacognitive Aspects of Learning
Disabled Adolescents’ Composing Problems, Learning Disability Quarterly, 16, 320-322. www.narha.org North American Riding for the Handicapped Association.
www.asha.org American Speech Language Hearing Association
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