Inside Track: Boosting therapy with horsepower
GVSU prof puts patients with disabilities in the saddle.
Beth Macauley is one of only four speech-language pathologists in the country certified in hippotherapy, an emerging technique that puts patients on horseback to improve speech, motor and cognitive functions.
She’s brought the technique to Grand Rapids and to Grand Valley State University, where she is an associate professor, and plans to open the community’s first hippotherapy center (“hippos” is Greek for horse) by the end of the summer.
Though details are still being finalized, Macauley said the Grand Rapids Equine Assisted Therapy Center, or the GREAT Center, will be housed at an existing equine center in the area. It will start by offering physical, occupational and speech therapy services one evening a week.
The program has one donated horse.
“Our five-year plan would be to have our own facility here in Grand Rapids eventually. Specifically, a premier center for therapy, teaching and research across the three disciplines,” Macauley said.
Macauley said while Equest in Rockford is a wonderful therapeutic riding center, the GREAT Center’s physical, occupational and speech therapy services are different from therapeutic riding.
“Therapeutic riding is the more recreational aspect of teaching people with disabilities to ride horses, and as secondary to that they (develop) better physical skills, social and emotional skills and a better quality of life,” she said.
Hippotherapy focuses on how a horse’s natural movement can impact a patient’s nervous system and improve his or her cognitive and motor skills.
“Physical, occupational and speech therapies all go back to same nervous system,” Macauley said. “Even though you may see it more readily in the physical gross motor realm, it is still improving the fine motor and cognitive aspects, and speech is a motor process.”
Macauley said three-dimensional movements — up and down, side-to-side, and front to back — of a horse’s pelvis are very similar to that of a human pelvis.
“When a person with a disability is on a horse, the horse’s nervous system becomes a framework for that person,” she said.
In addition to benefits gained from sitting on the back of the horse as it moves, hippotherapy incorporates different tasks during the ride, such as participating in a verbal exchange, which also improve function.
“Instead of going into a room and using books and cards for speech therapy, you’re now doing those same activities on a horse, and the horse's movement facilitates improved neurological function.”
Macauley said anyone referred to speech therapy can benefit from hippotherapy, but she said the greatest improvements are typically seen with patients with specific neurological issues.
She gave the example of a child with autism spectrum disorder.
“That child’s nervous system only knows one way to work — this is how their brain works, how their neurology works, all the abilities or problems that the child has,” she said. “The horse has an intact nervous system. When the horse walks, it provides repetitive, systematic inputs to the person.”
Macauley said the theory is that as the child rides the horse, the horse’s nervous system affects the child’s nervous system.
“So the nervous system of the child is reacting,” she said. “It provides a new framework for the nervous system for the person on the horse, so that person doesn’t have to think so much about basic function, and it frees up their brain.”
Macauley said after hippotherapy sessions, children with autism spectrum disorder often try to initiate communication, something they would not have done otherwise.
“Over a series of sessions, a lot of our kids with autism spectrum disorder are becoming verbal, saying first words and initiating communication using an augmentative communication device,” she said.
Macauley said she grew up riding and showing horses and wanted to find a career that incorporated her love of horses with her passion for helping people.
She was studying speech pathology at the University of Florida in Gainesville, when she found out about a woman in New Mexico who was doing hippotherapy as part of her clinical practice.
“Ruth [Dismuke-Blakely] let me come spend a week with her and watch how she did all her sessions and how she ran her business,” Macauley said. “I came back and did my master’s thesis on hippotherapy.”
She said clinicians were at the beginning of understanding how hippotherapy worked and applying it to physical, occupational and speech therapies.
Hippotherapy was first adopted in physical therapy because results were easy to observe immediately following a riding session.
“They get off the horse and they walk,” Macauley said. “You can immediately see the benefits in motor coordination, gait and balance. It expanded rapidly in the physical therapy realm.
“Occupational therapy came along next because of the fine motor and cognitive aspects,” she said.
“Speech therapy was the third one to come along, because you don’t see the benefits immediately after a session unless you talk to a person or are specifically looking for it.”
She said the practice is becoming more widely known now in all three disciplines but is still least utilized in speech therapy.
Macauley said she was focused on clinical practice when she finished her master’s degree and hadn’t intended on becoming a professor, but realized she could do more for the field as a whole if she took that route.
After earning her Ph.D., she taught at a handful of universities across the country.
“I came to GVSU to help start the speech pathology program,” Macauley said.
She said the program launched in 2010 with two faculty and 20 undergraduate students. In 2013, the graduate program was added.
Today, Macauley said the undergraduate program has 75 students enrolled, the graduate program has more than 60, and there are 11 full-time faculty members.
Hippotherapy has not been a main focus of GVSU’s speech pathology program, but because Macauley is one of the only speech pathologists with certification through the American Hippotherapy Association, she said students interested in the technique have begun applying to GVSU to work with her, and she expects that interest will increase.
She also said with the speech pathology program up and running now, this fall she will be able to resume her research projects.
She plans new research this year that will look at the impact of different horses on speech articulation and respiration.
“We are hoping to get people with different motor impairments and unclear speech, and we’ll be putting them on different horses to see which walk of which horse facilitates the most improvement,” she said.
She said like people, different horses have different ways of walking.
“We can have everything from 14-hand ponies to 16-hand thoroughbreds. There are differences,” she said. “What’s critical for us is, ‘how does that horse walk?’ — the three-dimensional movement to the horse’s walk.”
Eventually, she hopes to get a grant for $50,000 to purchase a portable brain-scanning device that can be worn by the rider and collects data on how the brain reacts to the hippotherapy sessions.
Macauley said the study will help clinicians understand more about matching horses and patients for the greatest outcomes.