Josh Sharman and Fiona Suthers, from the Clinical Skills Team at Middlesex University and Emma Hunter, a physiotherapist and RDA coach, discuss the benefits and risks of horse riding for young people with disabilities
The Riding for the Disabled Association (RDA) is a life changing and life affirming charity that enables people with disabilities to experience the positive effects of horse riding.
The RDA are committed to researching and measuring the effects of horse riding with their research demonstrating how horse riding has physical benefits, boosts confidence and improves communication skills as well as help with the development of relationships (RDA, 2020).
The therapeutic use of horses known as hippotherapy, has been used as a medical treatment since the second century (Granados & Agis, 2011) with Florence Nightingale in 1969 reporting in her diaries how pets provide health benefits (Nightingale, 1969).
Hippotherapy is widely reported to provide benefits to those with physical disabilities, however enabling those with physical disabilities to ride does pose challenges and risks that need to be comprehensively understood and addressed.
A recent study investigating equine-assisted therapies found that they are a viable intervention option for people who have impairments in balance, gross and fine motor function, gait, spasticity and co-ordination (Stergious, 2017).
They also provide emotional, cognitive and social wellbeing factors that have been shown to benefit riders, not to mention the experience of engaging in outdoor activities, something that people with disabilities often seldom experience.
Positive effects of equine therapy
As the movement of a horse is that of similar gait to a human the action of riding has been found to encourage an erect posture due to the practising of balance (Cherng, 2004).
The positive effects that equine therapy has on people who suffer with disabilities is clear. However, there are potentially complex issues that volunteers face from a moving and handling perspective, especially when dealing with those who present with a physical disability and require assistance with mounting and dismounting.
Group coaches are responsible for the delivery of safe sessions, riding and carriage driving procedures. Each coach completes modules which are nationally recognised to ensure competency (Riding for the Disabled Association, 2012).
Coaches within RDA groups are primarily responsible to maintaining safety and understand the accountability required with this role.
With the average height of a horse at 1.4 to 1.8 meters, enabling those with disabilities to mount and dismount a horse poses serious challenges and potential injuries for volunteers, riders and horses.
The RDA have strict guidance on this process and clearly outline that each participant should have an individual risk assessment and that the group should have equipment available to assist them with mounting and dismounting.
RDA groups not only have to face the issues of patient handling, but these groups often have to move large, heavy pieces of equipment such as ramps and blocks, used for mounting and dismounting, making it essential to understand moving and handling of inanimate loads.
As a nurse academic and moving and handling trainer, I [Josh Sharman] often find myself troubleshooting patient handling issues and offering advice as to where risk can be reduced. However, I was acutely aware of the risk when teaching an RDA group.
It’s important to remember that each of the RDA groups are run by volunteers. While some may have a background within healthcare, often volunteers come into these groups with no previous patient handling experience.
Volunteers under the Health and Safety at Work Act (1974) have the same duties as employees and for that reason can be held accountable for their actions and should be cooperating to ensure their own safety and that of others as well as be willing to receive any training necessary to carry out their work safely.
For this reason, all volunteers have to have an understanding of the Health and Safety at Work Act (1974) and have an understanding of how law and legislation applies to them as volunteers.
Certain companies do supply specialist hoist equipment to these groups reducing the risk to volunteers, participants and horses. Different from conventional hoists, the device has no sling to support the rider, providing support under the arms and across the chest. Hoisting directly from the wheelchair, it comes over the participant and ‘clamps’ across their thorax and hooks provide support under the legs.
Once prepared, the device then hoists the patient to a maximum height of 13 ft, where it can then be placed over the horse and lowered into the set position. This process has to be performed with exact precision and with an animate object underneath (horse), it can pose serious risks that should be taken into consideration. The horses used within this process are often de-sensitised over a period of time and assessed to be safe.
The equipment and techniques used to enable hippotherapy, while it has its risk as with all moving and handling activities, provides life changing therapy that truly impacts on those that need it the most.
Instilling the importance of safety and awareness when teaching these groups is paramount, allowing them to reflect on their own practice, continuously risk assess, taking into consideration their own safety, wellbeing of the horse as well as the riders.
*Article originally published in the National Back Exchange magazine
Cherng, R., Liao, H., Leung, H. & Hwand, A. (2004) The effectiveness of therapeutic horseback riding in children with spastic cerebral palsy. Adapted physical activity quarterly 21(2)
Garnados, A. & Agis, I. (2011) ‘Why children with special needs feel better with hippotherapy session: a conceptual review’ Journal of Alternative and Complementary Medicine. 17(3).
Health and Safety at Work Act (1974). Available at: http://www.legislation.gov.uk/ukpga/1974/37 (accessed: 6/2/20)
Nightingale, F. (1969) Notes on Nursing: What it is, and what it is not. New York: Dover Publications.
Riding for the Disabled Association [RDA] (2012) ‘Mounting and Dismounting’. Available at: https://www.myrda.org.uk/assets/Mounting-and-Dismounting.pdf (accessed: 6/2/20)
Riding for the Disbaled Association (2020) ‘Impact’. Available at: https://www.rda.org.uk/impact/ (accessed 3/2/20)
Stergiou, A., Tzoufi, M., Ntzanu, E., Varvarousis, D., Beris, A. & Ploumis, A. (2017) Therapeutic effects of horseback riding interventions. A systematic Review and Meta-analysis. American Journal of Physical Medicine & Rehabilitation, 96(10), pp. 717-725