Adaptations and Teaching Techniques for Riders with Severe Disabilities, Part 5: Example Riders
Much thanks to my coworker Annie Cornette from PALS for writing the following about one of our riders with whom she has had much success.
- Age: 13
- Gender: Female
- Diagnosis: Cerebral Palsy (spastic)
- Additional details/conditions:
- increased spasticity in the lower and upper extremities
- lacks significant core strength to effectively maintain trunk control
- non-verbal, but demonstrates good receptive communication skills
- has had surgery in the past to assist with increase flexibility in lower extremities (specifically hamstrings) and in right arm.
- Equipment/Medical Devices:
- wheelchair for mobility purposes
- unable to bare weight substantially so requires full assistance when transferring.
- Tack: Bareback pad, surcingle
Rider Goals and Objectives:
- Goal 1: To Improve trunk control
- Objective 1.1: While at a walk, client will I maintain upright position for 15 consecutive minutes with minimal assistance from the SW’s (thigh hold only) during 3 lessons.
- Goal 2: To increase flexibility
- Objective 2.1: Client will I maintain lower leg position (heel under hips) for a minimum of 10 minutes during 5 lessons as observed by the instructor.
- Objective 2.2: Client will I extend arm past surcingle 1x per lesson with no physical assistance/manipulation during 5 lessons.
- Goal 3: To improve communication skills
- Objective 3.1: Client will utilize 1 hand to tap horse on neck for halt to walk transition 1x during quarter with min PA (physical prompt hand tap) from the instructor or SW’s.
- When client first started riding she demonstrated the ability to I maintain an upright position with no physical assistance from her sidewalkers, but had a propensity to lay forward on the horse during the lessons at irregular intervals. Some lessons she would maintain an upright position for 20 minutes and others she would fall forward after only 5 minutes leading the instructor to believe that physical ability wasn’t the cause of her inability to maintain an upright posture. During the initial client assessment, client’s mother indicated her preference for music, so the instructor opted to utilize music as a motivational tool to improve the client’s participation for the entire 30 minute lesson. Using an Iphone the client’s favorite song was played while she was mounted and upright (a cheap Bluetooth speaker helped amplify the sound), but if at any time she opted to lay forward on the horse the music was muted. When she elected to sit back up (which the instructor required she do to continue working to build core strength) the music would resume. After 3 months of utilizing the technique the client only rarely falls forward on the horse and is now able to participate in other activities due her willingness to maintain an upright position consistently.
- Figures & Structure
- The structure of the lesson is designed to first allow the client to warm up and help muscles to begin relaxing, then challenge her core strength and trunk control through figures and transitions, before further challenging the flexibility of her extremities, and then providing a relaxing cool down opportunity—-all while focusing on her maintenance of an upright posture. The initial warm up consists of two laps each direction around the arena during which the client is asked to consistently grasp the surcingle and maintain a forward gaze. Following the warm-up the client then completes a variety of patterns that utilize various shapes and turns to challenge her core strength and trunk control. Serpentine and circles of various sizes challenge the client to maintain an upright position without leaning to one side or another. Multiple changes in direction or increasing the sharpness of a figure can further increase the challenge. Circles that spiral in and out are common as well as serpentines that begin as 3 loops and can increase to upwards of 6 loops. Walk-halt transitions are then utilized to challenge the client’s trunk control with the change in momentum.
- Transitions also provide an opportunity for the client to work on communicating with her horse — utilizing a hand cue on the horse’s neck to ask the horse to walk on. This type of cue is not only appropriate for the client’s lack of verbal skills, but also encourages stretching in her upper extremities as she must reach forward beyond the surcingle and extend her elbow multiple times throughout the lesson.
- Games that incorporate similar skills — for instance pushing a dice off the horse’s neck, asking the horse to “walk-on” the associated number of steps rolled, and then transitioning back to halt to roll again– are great ways to further encourage the client to participate and complete additional repetitions of the exercise.
- Cool Down
- The lessons is completed with 2 laps of “cool down” each direction allowing the client the opportunity to once again relax and benefit from the heat of the horse before dismounting.
- Age: 20’s
- Gender: Female
- Diagnosis: Cerebral Palsy
- Additional details/conditions:
- Nonverbal, but seems to understand most communication
- High tone in legs and arms
- Low tone in hands and fingers
- Tends to fixate on lights
- Walks, but unbalanced, prefers to hold on to someone or something
- Tactile defensive, often wipes hands against each other when doesn’t like the feel
- Caregiver recommends asking her to look at what she is doing and using tape markers on the lift and reins
- Equipment/Medical Devices: none
- Tack: English saddle, rainbow reins
Rider Goals and Objectives for the Quarter:
- Goal 1: Improve Riding Skills
- Objective 1.1: Rider will demonstrate halt/walk transitions by touching the horse and looking forward, 100% of the time, min VP, assistance as needed. (Reaching forward initiates a balance shift aid to tell the horse to walk on).
- Objective 1.2: Rider will demonstrate steering by looking the direction she wants her horse to go 100% of the time, assistance as needed.
- Goal 2: Improve Independence
- Objective 2.1: Rider will pick up the reins on her own when she drops them, min VP – first at the halt, then at the walk – with VP to look at what she’s doing, and tape on the reins to cue where to hold.
- Goal 3: Improve Core Strength
- Objective 3.1: Rider will demosntrate walk/trot transitions by touching her horse’s neck and looking forward 2x each direction, min VP, assistance as needed.
- Walk to lift independently, one finger on back, no matter how long it takes. Put tape on the lift for a visual marker for her to look at and know where to walk to. Originally did crest mount due to tight legs, but after riding for a year, and her caregiver telling us she is able to get her leg over into the bathtub, we progressed to a croup mount, with max assistance.
- Rider’s motivation is walking as she loves the horse’s movement and will complete most requests at the halt in order to get to walk on. I have used this to get the rider to perform progressively harder warmup exercises. We started with touching the mane, then the tail on each side. I always give her the opportunity to try on her own first, wait 5-10 seconds, tap her hand and remind her, wait again, then do hand over hand. I also ask her to look at what she is doing, cueing her to first look at the mane/tail, then reach for it. Progressively over the year I started asking her to reach further up the mane, and further back toward the tail.
- Skills – “Walk on” and steering
- When I first started working with the rider she reached forward with her good hand to ask the horse to walk on. Originally she did not reach very far, but I started asking her to actually touch the horse and asked her to try again if she was unable to, and now she is able to do so. This works on her flexibility and comfort with leaning forward, which originally she did not like to do.
- We also started asking her to switch which hand she asked the horse to walk on with, in order to encourage equal exercise of both arms and use of her “weak” arm.
- We incorporated the use of visual markers on the horse’s withers to touch for walk on, on the reins for where to hold, and near the horse’s poll for where to look while riding straight, in particular during trotting, during which I asked the sidewalkers to cue her to “look at the ribbon”.
- We also work on holding the reins the whole lesson, and if she drops them, picking them back up on her own. Whenever she is walking she must hold the reins “to keep the horse walking and tell the horse where to go”. If she drops the reins, we halt and ask her to pick the reins back up on her own, giving her time to try through several attempts, and if she is unable to get them we hold them close to her hand for her to reach. She caught on quickly but often reached for the grab strap instead of the reins. Since she does not use the grab strap, we took it off, and now she reaches for the reins almost every time.
- For steering we have just begun using hand over hand in hopes that the muscle memory and connection will develop over time.
- We also incorporate trotting to work on her core strength and to wake her up when she comes to her lesson tired. Originally we did a thigh hold with hand over hand to hold the grab strap. However her low tone hands and tactile defensiveness caused her to often get her hands loose and lean backwards. So we switched to a thigh and ankle hold and had her hold the reins, so the sidewalkers could keep her feet by the girth therefore helping her sit up straight and not lean back, and she holds on to the reins herself and does not let go.
- Cool Down
- often consists of riding without stirrups to stretch out her tight legs for a lap or two
- Dismount – croup, max assist
Do you have any suggestions to add?
Note: This is not professional advice, this is a blog. I am not liable for what you do with or how you use this information. The activities explained in this blog may not be fit for every rider, riding instructor, or riding center depending on their current condition and resources. Use your best personal judgement!