*4.1.6. Therapy with horse*

Among animal-assisted approaches, horses are the most commonly used animals in therapeutic approaches toward patients [6]. When examining thousands of years of history, no matter how much the environmental conditions change, there has always been an intense relationship between societies and horses [57]. In the literature review on the therapeutic use of horses, the concept of AAT is under two headings: therapeutic riding and hippo-therapy. These concepts are named differently as both methods are different but basically with the same goal [58].

Although there is a belief that horses were tamed and ridden and used in the treatment of the human beings in B.C., there is no definite evidence on this subject [59]. Looking at history and the use of horses as therapeutic agents, horse riding was considered as a physically during exercise in the sixteenth and seventeenth centuries. This aspect was also observed during the 29 rehabilitation of war veterans after the World War II [58]. The use of horses for disabled people has been intensified since the middle of the twentieth century. The best example regarding this was the treatment process, which resulted in Lis Hartel, professional horse-rider, participating in the Olympics and winning a medal while losing lower extremity functions due to polio. After this excellent success, equestrian federations have been established in many developed countries, mainly in England, and AATs are being covered under universal health insurance [60].

Hippo-therapy, one of the commonly used methods of therapeutic intervention, is derived from the ancient Greek word "Hyppos." With this method, horses can be used to develop or rehabilitate the individual's physical, sensory, cognitive, and social functions through the use of horseback movements. Since 2010, American Hippo-therapy Association has created a conceptual framework that includes sensory integration, including dynamic systems theory and motor learning. This conceptual framework takes into account the natural rhythm or movement of the horse that can affect the participants' neurological, motor, vestibular, sensory, and functional considerations to achieve the intended goals or outcomes [61].

visual, auditory), cognitive skills (orientation, attention, executive functions), weight bearing, communication skills (expression and acculturation language, cooperation), psychosocial skills (well-being, motivation), perception processing skills (body perception, depth perception, spatial relationships), and respiratory function (diaphragm force, positioning) [6, 64].

Animal-Assisted Therapy in Occupational Therapy http://dx.doi.org/10.5772/intechopen.76468 101

According to OTs' views and perceptions of evidence-based practice, AAT is one of the methods used in rehabilitation. Some researchers have investigated the impact of AAT on elderly participants who were diagnosed with psychiatric, physical, and developmental disabilities in long-term care settings [65]. Van Fleet and his colleagues describe an animal-supported occupational therapy as a learning process in which a professional therapist carries out a therapy session, using a dog, to facilitate the development of the skills needed by the child to have an independent function in self-help, playgrounds. A therapy dog may become part of the learning process when learning everyday tasks related to the animal [66]. OTs may add a wrist weight to gain strength from the weak arm or use a customized brush with a special handle to help the child hold the brush. Thus, the child becomes more motivated and excited to participate in the treatment. Thus, this method helps OTs, and the child can to reach the child's treatment goals more quickly and easily [67]. In another study, AAT was also applied on patients with post-traumatic stress disorder generally seen in personnel during military service; AAT was found to provide positive benefits. It was also observed that new gained in

Dogs are a popular choice for many occupational therapists. OTs showed that treatment with dogs, which are often preferred for treatment, has improved social skills, motivation, having an interest in the environment, and self-awareness of children with autism spectrum who had behavioral problems [6]. A study performed on OTs found that senior citizens in a walking program at an assisted living facility walked further when with a dog than when they walked alone, indicating the potential value of pets in physical conditioning [69]. Due to the earlier studies mentioned, the OTs believed AAT impacted individuals through internal responses to the animal and thorough responses to the external environment. On the other hand, horses proved to be effective in treatment programs, especially for physically disabled people. Among the reasons for preferring the horse in these types of patients include; it can be said that walking on the horse can feel like as the walking accent, walking distance can be adjusted by the therapist or rider if necessary, and positive feeling can increase the motivation

In almost all studies on AAT, animal interaction increased motivation of individuals:

mals and the responsibility for care given to them increases the daily devotion

• Interaction with animals raises morale of long-term care residents.

• Sense, motor, perception, cognitive, and social skills improve.

• Participation in functioning and daily living activities are facilitated.

• Those who refuse therapy may come to therapy sessions more often and easily when they

• People feel better socially people feel better about themselves the idea of ownership of ani-

combat veterans learned new skills using trained dogs [68].

of the person [6, 70].

know that animals are present.

Choosing the appropriate horse for the therapy session helps the individual to meet the rehabilitation needs with the individual and the horse feeling more comfortable. The features of an ideal therapy horse are an average age of 10–12 years, an average height of 150–160 cm to help control horses and riders and side holders to about 45° tilt (the stepping stones will get harder as the angle of the bog is lowered), and being calm and gentile [6, 60]. The sessions with hippo therapy, which consist of meeting, warming, working, relaxation, and farewell, are planned by interdisciplinary professionals. Hippo-therapist, occupational therapist, physiotherapist, special education specialist, private horse instructors, and volunteers who have been educated about hippo therapy may be included in the rehabilitation sessions in menaj [61].

As a treatment strategy, hippo therapy may primarily be dependent on the theory of sensory integration because the movement of the horse provides a sensory experience for the rider. The role of therapists is to determine the amount of sensory stimulation and the input [61]. For example, walking slowly cannot be enough incentive to allow the rider to join a relative. On the other hand, brisk walking or jogging can increase the attention span. In addition, riding bareback can help the rider get the maximum possible proprioceptive input. As an alternative approach, stirrups (used with a saddle or backpack) can help proprioceptive input by gravity on the hard surface. Sans, Fortney, and Willenbring [71] argue about this approach of sensory integration as a rider. In addition, this internal drive can be further improved through the connection between the rider and the horse.

At a hippo-therapy session, the horse changes motion by an average of 2000 steps, which means that the rider is also taking 2000 strokes—about 2000 muscle contractions. It has been proved that the increased number of repetitions support motor learning. Therefore, the increase in the number of repetitions due to hippo therapy is the most important parameter supporting the development of static-dynamic balance, weight transfer, motor planning, and motor skill in the direction of the individual's motor learning principles [62]. During hippotherapy intervention, following the provision of a suitable position for the rider, the three planes are prepared in accordance with the principles of movement, rhythm, motor learning, and motivation. It has a positive effect on coordination, reaction time, sensory processing, respiratory control, motor planning, and postural control [6, 62]. This multifunctional approach helps to increase the positive effect of the therapy and success of the therapy.

#### *4.1.7. Animal-assisted therapy and occupational therapy*

Occupational therapy is a client-centered approach to these individuals in rehabilitation practices. The assessment and intervention of occupational therapy are aimed to improve the participation in their daily living activities more meaning and oriented [63]. Occupational therapists use a lot of approaches in their practice to improve quality of life and well-being in their patients. A range of target areas that can be addressed with the help of therapy animals are listed in the book for AAT interventions for OT: motor skills (gross and fine motor), neuro-musculoskeletal skills (range of motion, strength, balance), sensory functioning (tactile, visual, auditory), cognitive skills (orientation, attention, executive functions), weight bearing, communication skills (expression and acculturation language, cooperation), psychosocial skills (well-being, motivation), perception processing skills (body perception, depth perception, spatial relationships), and respiratory function (diaphragm force, positioning) [6, 64].

motor learning. This conceptual framework takes into account the natural rhythm or movement of the horse that can affect the participants' neurological, motor, vestibular, sensory, and

Choosing the appropriate horse for the therapy session helps the individual to meet the rehabilitation needs with the individual and the horse feeling more comfortable. The features of an ideal therapy horse are an average age of 10–12 years, an average height of 150–160 cm to help control horses and riders and side holders to about 45° tilt (the stepping stones will get harder as the angle of the bog is lowered), and being calm and gentile [6, 60]. The sessions with hippo therapy, which consist of meeting, warming, working, relaxation, and farewell, are planned by interdisciplinary professionals. Hippo-therapist, occupational therapist, physiotherapist, special education specialist, private horse instructors, and volunteers who have been educated

As a treatment strategy, hippo therapy may primarily be dependent on the theory of sensory integration because the movement of the horse provides a sensory experience for the rider. The role of therapists is to determine the amount of sensory stimulation and the input [61]. For example, walking slowly cannot be enough incentive to allow the rider to join a relative. On the other hand, brisk walking or jogging can increase the attention span. In addition, riding bareback can help the rider get the maximum possible proprioceptive input. As an alternative approach, stirrups (used with a saddle or backpack) can help proprioceptive input by gravity on the hard surface. Sans, Fortney, and Willenbring [71] argue about this approach of sensory integration as a rider. In addition, this internal drive can be further

At a hippo-therapy session, the horse changes motion by an average of 2000 steps, which means that the rider is also taking 2000 strokes—about 2000 muscle contractions. It has been proved that the increased number of repetitions support motor learning. Therefore, the increase in the number of repetitions due to hippo therapy is the most important parameter supporting the development of static-dynamic balance, weight transfer, motor planning, and motor skill in the direction of the individual's motor learning principles [62]. During hippotherapy intervention, following the provision of a suitable position for the rider, the three planes are prepared in accordance with the principles of movement, rhythm, motor learning, and motivation. It has a positive effect on coordination, reaction time, sensory processing, respiratory control, motor planning, and postural control [6, 62]. This multifunctional approach helps to increase the positive effect of the therapy and success of the therapy.

Occupational therapy is a client-centered approach to these individuals in rehabilitation practices. The assessment and intervention of occupational therapy are aimed to improve the participation in their daily living activities more meaning and oriented [63]. Occupational therapists use a lot of approaches in their practice to improve quality of life and well-being in their patients. A range of target areas that can be addressed with the help of therapy animals are listed in the book for AAT interventions for OT: motor skills (gross and fine motor), neuro-musculoskeletal skills (range of motion, strength, balance), sensory functioning (tactile,

functional considerations to achieve the intended goals or outcomes [61].

100 Occupational Therapy - Therapeutic and Creative Use of Activity

about hippo therapy may be included in the rehabilitation sessions in menaj [61].

improved through the connection between the rider and the horse.

*4.1.7. Animal-assisted therapy and occupational therapy*

According to OTs' views and perceptions of evidence-based practice, AAT is one of the methods used in rehabilitation. Some researchers have investigated the impact of AAT on elderly participants who were diagnosed with psychiatric, physical, and developmental disabilities in long-term care settings [65]. Van Fleet and his colleagues describe an animal-supported occupational therapy as a learning process in which a professional therapist carries out a therapy session, using a dog, to facilitate the development of the skills needed by the child to have an independent function in self-help, playgrounds. A therapy dog may become part of the learning process when learning everyday tasks related to the animal [66]. OTs may add a wrist weight to gain strength from the weak arm or use a customized brush with a special handle to help the child hold the brush. Thus, the child becomes more motivated and excited to participate in the treatment. Thus, this method helps OTs, and the child can to reach the child's treatment goals more quickly and easily [67]. In another study, AAT was also applied on patients with post-traumatic stress disorder generally seen in personnel during military service; AAT was found to provide positive benefits. It was also observed that new gained in combat veterans learned new skills using trained dogs [68].

Dogs are a popular choice for many occupational therapists. OTs showed that treatment with dogs, which are often preferred for treatment, has improved social skills, motivation, having an interest in the environment, and self-awareness of children with autism spectrum who had behavioral problems [6]. A study performed on OTs found that senior citizens in a walking program at an assisted living facility walked further when with a dog than when they walked alone, indicating the potential value of pets in physical conditioning [69]. Due to the earlier studies mentioned, the OTs believed AAT impacted individuals through internal responses to the animal and thorough responses to the external environment. On the other hand, horses proved to be effective in treatment programs, especially for physically disabled people. Among the reasons for preferring the horse in these types of patients include; it can be said that walking on the horse can feel like as the walking accent, walking distance can be adjusted by the therapist or rider if necessary, and positive feeling can increase the motivation of the person [6, 70].

In almost all studies on AAT, animal interaction increased motivation of individuals:


OT should focus on the use and participation of meaningful activities to improve the quality of life of an individual in AAT intervention. For these purposes, it is aimed to develop correct posture and walking pattern, mobility of the pelvis and hip region, head and trunk control, muscle tone and strength, sense regulation, social communication, self-confidence and empathy, motor and cognitive skills. It is thought that the ability of individuals to improve their skills, function, and quality of life can be improved by pet ownership, care of animals, and regular interaction during therapy.

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The frequency of use of the AAT and AAA in the field of rehabilitation for the last 10 years has been rapidly increasing. Animal-supported approaches from different countries and disciplines showed positive effects on sensory, emotional, and cognitive functions, especially the physical structure and functions of individuals at different ages and diagnoses. OTs emphasize the effectiveness of this method in studies conducted in the field of occupational therapy. At the same time, we believe more qualitative and quantitative research and more detailed studies are still needed and OT's and OT intervention programs focusing on therapeutic use of animals in rehabilitation must continue.
