All Things Sensory by Harkla

#317 - Equine-Assisted Therapy in OT and PT

• Rachel Harrington, COTA/L, AC & Jessica Hill, COTA/L

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Watch this video - https://youtu.be/PkylhDc0sOY?si=k7gjWbpOixhbWLYr

Renee Anderson has been a physical therapist since 2017. She worked in an orthopedic outpatient setting until early 2021, and then started to work at HETRA (Heartland Equine Therapeutic Riding Academy) as a therapist utilizing horse movement in her treatment. She loves to see the progress her participants make after riding horses and developing trusting relationships from having the same participants every week.

Dr. Kaiti Otte is a licensed occupational therapist and PATH International Certified Therapeutic Riding Instructor. She serves as the Lead Therapist and Education coordinator at HETRA (Heartland Equine Therapeutic Riding Center) in Gretna, NE where she has been practicing occupational therapy, partnering with the healing help of horses for over 7 years. HETRA’s mission is to improve the quality of life both physically and emotionally of adults and children of all ability levels through equine-assisted services. When she is not in the arena, you can find Kaiti presenting at conferences, coordinating online webinars or hosting guests on her podcast helping everyone to understand that what HETRA does is so much more than Just a Pony Ride.

Webinar designed specifically for those in OT/PT/SLP to learn more depths about Hippotherapy and how it is effective: https://vimeo.com/ondemand/introtohippotherapy

Listen to the HETRA podcast: https://podcasters.spotify.com/pod/show/notjustaponyride

https://hetra.org/

https://pathintl.org/

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Katie:

The horses are such a motivator. Take away the movement, take away anything. Just standing there on the ground with a horse, it is so motivating to the kids. They just love them, you know, and then all of a sudden you're working on like, we'll say hi or what is this horse's name? I don't know. Ask them. What's your name? You know, and then you're starting to work on this communication that they had no idea they were even working on. But the horse isn't going to judge you or be like, what did you say? Or, you know, they're, they're not going to do that to you. And so it's, it's like a judgment free zone that's equal parts motivating. Then you have the treating therapist there to help make that therapeutic too, right?

Rachel:

I'm Rachel.

Jessica:

And I'm Jessica and this is All Things Sensory by Harkla.

Rachel:

We are both certified occupational therapy assistants and together with Harkla, we are on a mission to empower parents, therapists, and educators to help raise confident and strong children of all abilities.

Jessica:

On this podcast, we chat about all things sensory. Diving into special needs, occupational therapy, parenting, self care, overall health and wellness, and so much more.

Rachel:

We're here to provide raw, honest, and fun strategies, ideas, and information for parents, therapists, and educators, as well as other professionals to implement into daily life.

Jessica:

Thank you so much for joining us.

Rachel:

Hey there. Welcome back to All Things Sensory by Harkla. We are so happy to have you back again today. We have another exciting interview today.

Jessica:

Is this one exciting and unique?

Rachel:

Exciting and unique. It's fabulous. It is a topic that we have wanted to share about on the podcast for years.

Jessica:

Yes. Today we are talking to Renee and Katie who work for a company called HETRA, which is Heartland Equine Therapeutic Riding Center in Nebraska. Katie is a licensed occupational therapist and Renee is a physical therapist and they work with HETRA providing equine therapy assisted services. And they are going to give us all the details on what they do, how they do it, why they do it, and more. Like this conversation is incredible.

Rachel:

Especially if you are a parent, if you're a parent listening, and you've thought about going down this avenue of equine assisted therapy, or if you're a therapist, and you're like, I'm a little burnt out in the clinic. I want to do something different. Definitely listen to this episode and you will just be so inspired.

Jessica:

All right. Let's meet Katie and Renee.

Rachel:

Hello. Hello. Welcome to the podcast. Katie and Renee.

Katie:

Hello. Thanks for having us.

Rachel:

We are so happy to have you here today to talk about equine assisted therapy. But before we jump into all of the good information that you guys are going to share with us, we do have five secret questions.

Renee:

I'm excited. Bring it on.

Jessica:

First question, what is your go to happy hour beverage?

Renee:

I really like, um, gin and tonic. I would probably do that.

Katie:

I'm learning, too, about Renee. Um, Pendleton whiskey in anything.

Renee:

Oof. Usually. Yup.

Jessica:

Okay, I would, I always liked, uh, Pendleton and Pineapple was always a good mix.

Katie:

Oh, I've never had that.

Rachel:

Yeah. Okay. Look, see, this is why we do the secret questions. We learn all of the deepest, darkest secrets. Next one. What one item would you bring to a deserted island?

Renee:

My logical brain says sunscreen.

Rachel:

What does your not logical brain say?

Renee:

Like an item, not a person?

Jessica:

Yeah, an item.

Katie:

Mine would probably be, mmm, like some kind of a fire starter.

Jessica:

Mmm. Logical.

Rachel:

So nothing fun!

Renee:

No wait, I, probably something really nice to sleep on.

Rachel:

Okay.

Renee:

Not on the ground. I can't do it.

Jessica:

Like a whole mattress?

Rachel:

At this point, you can bring one thing, so you might as well just bring anything.

Katie:

Yeah, right? It would actually be like my dog, because I would need like emotional support probably for that adventure, but sure. Qualifies as a person too, so.

Rachel:

I love that. I'm surprised no one said a horse. Like, come on, you guys.

Katie:

Well, it's an island. How far do you have to travel depends on how big it is. It can't swim that far, so.

Jessica:

That's true. Very true. What book are you reading right now?

Renee:

I do listen to a lot of podcasts, but I am reading a book just about general horse stuff.

Katie:

I am not much of a reader for fun. I'm trying to change that. So I read a lot of like self development books. I'm reading embrace the change by Jordan Lee Dooley. Jordan Lee, Jordan Dooley. I don't remember her middle name. Anyway, she has a podcast too. That's great and so yeah, that's what I'm reading now.

Rachel:

I love that. Okay, are you guys neat or messy?

Renee:

Neat, for sure. I love organizing.

Katie:

I color outside the lines. I don't know. It makes me stressed when stuff is messy, but like, in the same breath, I'm also like, a very chaotic moment to moment person, so like. If I ain't got time for that, I ain't got time for that. I just go on to the next thing.

Rachel:

I love that. The best of both worlds here, right? I love that.

Jessica:

And final question, what is your sensory quirk?

Renee:

I would say I'm very sensitive to loud noises. I don't like the TV very loud or loud music, things like that.

Katie:

I, uh, I am an occupational therapist, so I treat a lot of, um, patients that have sensory dysfunction and I feel like I relate so much to them when they're like, emotions are like, when they've just like had a day, and then every single thing is like, don't touch me like that, don't say that to me, don't say it like that. Don't say it like this, don't you know what I mean? And you get like overwhelmed by like the very littlest things. So I would say I'm that person and it takes sometimes definitely a lot of practice and coping skills to rein that in when I need to like be someone else's something, you know?

Rachel:

Love that. Okay. Well, now that we know your deepest, darkest secrets, truly. We have, there's two of you today, so I'd love for you both to just kind of give our listeners an intro, who you are, what you do, and then together what you do.

Katie:

Perfect.

Renee:

Got it? Sure.

Katie:

Okay, so I'm Katie Ott. I have a doctorate in occupational therapy, and I'm also a Path International Certified Therapeutic Riding Instructor. That's a mouthful. But basically I got my, I got my start in OT. I first even knew that wanted to do OT because I was with someone that's doing what I'm doing right now, which is utilizing equine movement and partnering with horses for therapy and she asked. I was a ranch kid, farm kid, grew up with horses, and she had asked me to come out and help her just manage the horses, you know, for this thing she was doing with these kids and I'm like, whatever. I'll be there for the horses. You know, I was like this high school kid that didn't know nothing about nothing and so I showed up and she was working with special needs children on horses. And I was like, this is it. This is my life. Like, this is my life and I was like 16 years old. And so anyway, fast forward through undergrad grad school. Here I am at HETRA and I have a background in pediatric, um, clinical therapy. I was in outpatient clinic as well for a while, but been with HETRA here either in a part time or full time capacity for about seven years, a little over seven years. So yeah, I'll tell you guys a little bit more about HETRA and that after Renee introduces herself.

Renee:

My name is Renee Anderson. I'm a physical therapist and I have always liked horses growing up. I've always loved human body movement. And I went to physical therapy school and in physical therapy school, they had us volunteer at a place just like this and I loved it. So I went to PT school in Missouri and so when I came back to Nebraska, I was like, I need to find somewhere like this. And my mom told me about HETRA, which is Heartland Equine Therapeutic Riding Academy. And I started volunteering in 2018 and I came on as a more permanent, well, I work part time here and I'm at home with my kiddos too. So really in 2021, I really started doing that. Um, I was in the clinic before and just kind of moved out here and I've loved it. It's a perfect match of my two loves.

Rachel:

No kidding. Okay. So tell us about Hetra now. The company.

Katie:

So HETRA has been around for 35 years, um, over 35 years now and that's in the grand scheme of what we do as far as equine assistance services and centers, that's a pretty long time. So we started in 1989 and really, I mean. The eighties was probably when this type of work really started to gain a lot of popularity and you saw a lot more centers popping up. So we're fortunate and blessed to be the only PATH Premier Accredited Center in Nebraska, which is a pretty big deal and we're the largest center really almost in the Midwest. So we serve 100, over 150 participants. We call them participants, but 150, you know, students or clients a week through a variety of different services. So we have therapy services, which is what Renee and I do, OT, PT, speech, mental health. So we have those services and then we have what we call adaptive riding or therapeutic riding and that is participants who have some type of a diagnosis. But aren't necessarily here for the therapy, right? So in therapy services, our goals are just like in the clinic, right? We're building core strength or we're building, you know, working on sensory things. Whatever it is, and those are our goals long term short term goals, just like it is in the clinic But in therapeutic riding or adaptive riding, they're working more on the horsemanship. So yes, they're still getting the sneaky benefits of the horses, right? And building that strength and all those things. But their focus is really now transitioned more towards, I want to learn how to, you know, trot my horse. I want to learn how to lope. I want to learn how to reign, you know, that kind of a thing where they're working on that horsemanship skill. Um, but obviously still very therapeutic. And then we have, I swear. Here at HETRA, we do such a good job of kind of reading the community need. We're a nonprofit, so we read the community need, and then we like develop a program for it. So we have all kinds of other different programs. We have programming for veterans and first responders, caregivers. Oh my gosh.

Renee:

Life skills.

Katie:

Life skills group. So we have an adult day program for adults with disabilities. We have a therapeutic carriage driving program. So participants that aren't able to sit astride on the horse or have that balance or maybe fear or that kind of a thing, they can go to carriage driving and still build that relationship with the horse. We have something for everybody. It's just kind of depends on what you're into and so we do activities both mounted and unmounted or on the ground where you're just kind of building the relationship with the horse on the ground, which can be extremely therapeutic as well.

Rachel:

Okay. So let's focus on the therapy kiddos. The ones who are coming in for like OT, PT session. Walk us through like what a session would look like from start to finish.

Katie:

Okay. First, just so that we kind of understand the process is we do an evaluation just like any other OT, PT, speech, mental health therapist would do. So you come for your initial session and we do a complete H& P. We do Standardized tests. We do all of that to kind of help set our goals and then we transition to like the equine assessment portion of the evaluation. So that we get a better idea of how to match that rider or that, that patient to the horse. And we can talk a little bit about how we do that too. But that just gives us an idea for like the evaluation of it and then they arrive for their first session. So we have a pretty big team that's with us in the arena. I don't know if you want to talk about our team, Renee.

Renee:

Yeah, sure. So typically on the therapy side, there is a horse leader that's attached to the horse to help lead the horse around and facilitate that movement and we also have two sidewalkers and where they hold depends on the rider and the need that he or she has. Um, here we usually do one 30 minute session a week. The studies show that in 30 minutes, like how many movements are there?

Katie:

Oh my gosh. Like over 10, 000 perturbations of movement. So if you imagine, I mean. There are so many reasons why horses are so amazing and therapeutic, but if we think, if we strip it down completely to like horse movement and balance in that dynamic surface, it's, it's way more complicated than sitting on a therapy ball, but that's kind of the next best thing that we can compare that to. And if you're talking about, you know, over 10, 000 perturbations and movement before you even overlay an activity of any kind, you know, we play basketball. We do, you know, search and find puzzles, potato head, pretty much anything you do in the clinic we can do on the horse. The only caveat to that is that because we work with horses, we have to desensitize our horses to everything we use. So that makes it sometimes we have to get a little bit more creative with the objects we have, but that, you know, OTs, we love to do that anyway, so that's fine. But anyway, so the participants will arrive. We kind of, we get them on the horse. Sometimes we do pre and some kind of pre post activity. Like I think, especially for you, Renee, like with gate changes and balance change is probably where we see that pre post. You want to talk a little bit about like increased rhythm or, um, stride or anything like that that you see?

Renee:

Yeah. So sometimes. The kid or participant will come in and walk and kind of slow. They might shuffle a little bit and then we ride for 30 minutes and afterwards you can see a big difference in the participants walk just from the horse. So that's really cool to see.

Katie:

So sometimes we do some pre post things, but mostly we just get on and we always do a warmup. So connecting our mind, brain, body to the horse and kind of warming up our balance and things and then we transition into what activities we do. Ever activity we want. So kind of depending on the goals of our participant, just like you do in the clinic, and then transition down to kind of a cool down and then we dismount. And then sometimes we'll do some kind of connection activity with the horse, whether that's, we're always really, really big here on saying thank you to everybody. You know, thanking the horse for their time and energy and effort. And then also our volunteers, because we absolutely. We could not do what we do without our volunteers. I should have looked up the stats before we came on, but I mean, we're talking hundreds of volunteers a week donating their time to us so that we can serve our participants and our, and their families. So anyway, so we're really big on thanking them and kind of doing a little bit of connection there and then. Then they head out.

Jessica:

I have several questions that came to mind. Um, are the services covered by insurance just like in the clinic setting?

Katie:

So that's a hot topic. Currently, I'm very excited to say that Medicaid is starting to jump on board with us. Colorado was the first state to have Medicaid approved and now other states are starting to follow suit. However, that said, typically we are equine assisted therapy is excluded under experimental procedures is typically what happens. Um, however, we, we do not bill what we do to insurance here. Now there are some clinics that choose to do that, that do what we do. Um, it just kind of depends on what your situation is. For us, we're a non profit, so we never turn anyone away due to inability to pay and we fundraise diligently throughout the year so that we can, we can see everybody that walks through our door regardless of if they can pay or not. So we always have that going for us. However, that said, when we do our notes and our documentation, we bill with therapeutic codes. We use short term long term goals. We use all of the clinical language that you would see from a clinic So I mean the goal is really to look at our note and not not really be able to see any difference between an OT session that was done on the horse versus an OT, you know, session that was done in the clinic. But that said we have this awesome, you know partner to do our therapy with, and that is what really sets us apart. However, insurance companies aren't quite on board with all that yet, but, um, we're continuing to do research and continuing to stay diligent in that, to help, um, providers in, in the healthcare field, see that what we do is. Is highly impactful.

Rachel:

Well, you think about it in the therapy clinic, we use a swing, we use a therapy ball, we use these different sensory mediums. The horse is the sensory medium. Like, that's, that's like, the middle man, right? So it makes sense, but there's always, there's always something. Isn't it frustrating?

Katie:

It is. And it's, it all comes down to education, right? Like what we do is novel to some people. They've never heard of it. They've never seen it. They don't know what, what to expect about it, you know? And so it's like, you can easily picture a therapy ball, but I think it's hard for insurance companies and physicians and some of the people that make those big decisions for us that are higher pay grade than me to see it and imagine it and see the benefit. So we just have to continue doing that research to put, to put the quantitative to the qualitative and make it all work.

Rachel:

Exactly.

Jessica:

So cool. Another question I thought of, are you the therapist also riding a horse during your, do you call them sessions?

Katie:

Yeah. Yep.

Jessica:

Okay. During your session?

Katie:

You want to take it?

Renee:

Sure. Yeah. No, we do not ride on a horse. We will try to really look at the horse from all sides, make sure the person is staying centered. So we walk behind the horse, walk in the front to make sure the person's not leaning too far forward or back, and to cue the sidewalkers if need be, and to make sure that we're paying attention to the horse. And make sure the horse isn't aggravated by anything. So, making sure it's really safe.

Katie:

Yeah, that's the key at HETRA. What we always, always, always put our, our safe foot forward is making sure our horses are comfortable. Because at the end of the day, we can't do what we do without our horses and so, their mental health and their well being is, is, is just as important as our patient.

Renee:

Yeah.

Rachel:

Tell us a little bit about, did you have any more questions for?

Jessica:

No.

Rachel:

Okay. We had just kind of talked about this previously, but tell us how you connect and match the horses with the clients and what that process looks like.

Katie:

Yeah. So there's a lot of different things that go into selecting horses for riders. One of the big things that we look at is movement. So horses movement. They have dominant patterns of movement, just like humans do, right? So we can have a more AP gait or a more lateral gait, horses can too. Um, the cool thing about horses is that their pelvis is actually shaped extremely similarly to the way a human's is, except for it's on a different plane of movement because they walk on four legs instead of two. And so what we see there is that because that movement is so similar, you get the, the forward, you get the rotation, and then you get the, what do they call that Renee? When you like foot strike, like we call hoof strike, but you know, foot strike, just like you do in people. So you are activating the exact same muscle groups that, so if I put a rider on a horse that let's say has never taken independent steps before, they are going to be activating the exact same muscle groups on the horse as if they were walking independently, so super cool.

Rachel:

Now, now that you say that I'm like visualizing, I'm like, oh my gosh. That's so true.

Katie:

Yeah.

Renee:

Yeah. It's pretty neat. I took a riding lesson once and I was wearing my like step counter and it counted like I had like thousands. I was like, whoa, okay, this is awesome because yeah, it's like, it's like walking. It's so cool.

Katie:

Yeah. So that's why we see such big improvements in gait and independent balance and core strength and all of that is because like, hello, they're doing like. I don't know how many steps. There's research on that too, like some 3000 steps in 30 minutes, like that's incredible, you know? So, um, so first of all, it's really important that we get good quality movement from our horse and that we match that appropriately. Right. So I probably wouldn't put somebody who has a severe scoliosis on a horse that moves very laterally, right? Because that's gonna perhaps create more instability than we want there, right? However, maybe a little bit of lateral movement is good. All horses have all planes of movement because we want to strengthen the muscles on, you know, the side that we need to strengthen to help with the scoliosis, right? So we're looking at movement quality. We're also looking at Sensory environment. So if I have a participant that is very sensitive to movement and very sensitive to sensory stimulation, I'm going to put them on a horse that moves very flat and moves very, let's see, it doesn't have a ton of like pronounced movement in one way or the other. Maybe a horse that's shorter. We can also look at stature, right? So whether a horse is big or small. Really helpful for our friends who might have gravitational insecurity or something like that, because that can be a big deal, right? Okay. Um, they're big animals. So looking at size of your horse matters. Width of your horse. So if you have a horse, that's like a big drafty type and has a big old belly, that's not going to work well for our participants who have really, really tight hips or something like that. Right. However, if you want to increase that mobility, maybe something you can look at. Right. So another thing we look at is temperament. So we have horses of all different temperaments. You, you typically, and you think like, Oh, that horse is a therapy horse that they're just like, like a dead head, you know. They're just like, you know, but that's not the case at all. We have horses of all different types of personalities and those personalities, believe it or not mesh well, or don't mesh well with our participant personalities. And so we can also look at our horses from that perspective as well.

Renee:

Another tool we have here that I don't think we've talked about yet. We have, it's called an Equisizer, we call them EQ. So it looks like a horse, but he's on wheels. So.

Katie:

He rocks and rolls and moves and so we can control that equine component of things a little bit more to help either help kids transition or adults transition to the horse eventually, or there might be some participants that we stay there because of, um, you know, certain precautions or contraindications that don't mesh well with mounted activity. So. We have a lot of different options.

Rachel:

There's so much more that I even thought went into it. I was thinking temperament, you know, that's it. You know, we got to make sure their temperament matches, their attitudes, you know, line up, but I never thought about all of the little, like biomechanical details as well. But it's like light bulbs. I'm like, Oh my word. Like there's so much more that goes into it that meets the eye. Obviously that's like OT, PT, you know, in a nutshell, but wow.

Jessica:

That's amazing.

Katie:

Thank you. We love it.

Jessica:

I know what I really want to do now. You guys are kind of inspiring me to like, look around our area and see if we have anything like this because I kind of don't think we have anything like this.

Rachel:

I know there was 1, but I think they sold the ranch. I know. That's what I was telling them before we jumped on. So.

Katie:

And the important thing to consider too, is that there are different Okay. What's difficult about what we do is that there isn't really any overarching body that, number one, protects us as professionals. But number two, do you know that you're going to get the exact same service, if that makes sense. So what we do at HETRA, we are very, we're incredibly, quality is our, is our thing. We, we're, we're, we look at all the details very specifically. And then there's some centers there a little bit are a little bit more, you know, holistic and don't, you know, look at all of those things as specifically and focus more on other areas. And so a good place to look at, to see if you have centers in your area, just to kind of talk about that a little bit is, we are a member of, PATH, which is the Professional Association of Therapeutic Horsemanship and that's a good place to look at. They do accreditation for their centers, so we know that they're safe. We know that their instructors and therapists are very high quality, so that's a good place to look at is their website, and I can send you guys a link to that, to see if there are any of those centers in your area, because that will help you kind of identify the quality.

Rachel:

Yeah, I'm just thinking of people who are listening. In my mind, you know, maybe they have never ventured into this type of therapy, maybe they're curious about it, like me, and they're like, okay, how do we get started? So, like, what's the first step? Besides, you know, after finding a place that is, you know, qualified, and we know that it's going to be safe and effective, you know. What's kind of the, what's the next step?

Renee:

I would say contact them. Um, I would think the place should be willing to give you a tour. We give monthly tours for volunteers and participant families and you can get a feel for if that's good. If you're interested like go volunteer if you're a therapist that's If you really want to like do the work I would say start with volunteering is probably the best way to go.

Katie:

That's my number one suggestion is go volunteer and see if it is for you. You know, if you like here at HETRA, we have people who work here that are instructors or therapists that have absolutely zero horse experience, right? So you don't have to have horse experience to do what we do. You just have to have a place that's willing to train you and willing to, you know, spend the time to do that with you. A couple other good resources. First, go volunteer. Second, try to find some resources that you can do a little continuing education in this area, and that will also help you understand a little bit about if this setting would be right for you. AHA is the American Hippotherapy Association. I can send you guys that link too, and they are kind of our national body, and they do trainings. So you can do level one, level two, um, you can also be like board certified in hippotherapy. So. That that is a really good resource too and you can, anybody can join those classes. They do webinars and lunch and learns, and that's all great. Um, another resource just kind of, I mean, I guess a shameless plug, but not really, is HETRA does a ton of education. So I'm the lead therapist and also the education coordinator here at HETRA and we do a ton of webinars. We do a ton of, you know, come out and see us come tour with us. Come, you know, learn about what we do. Our goal is just to help everybody understand that what we do is not just a pony ride, right? I know that's the name of our podcast too. But it's, it's important to us that people understand what we do and how important it is and that it's, it's not just, just walking around on a horse for 30 minutes. And so we have taken that to heart and tried to help people through education and that type of thing too. So I sent you guys the links to some of those things. So those would be my, my three big spots to look for sure.

Jessica:

Yeah. And we will link the podcast in our notes so that everyone listening can go check that out. I did have another question. Do the horses get special training?

Katie:

Mm hmm. So we have three. full time staff here whose job is strictly to train and manage our horses. It is incredibly important that our horses are prepared for their jobs and that they really like it, and that they get the training that they need. So one of our Equine operations managers used to say, like, you know, if someone asked you to go run a marathon tomorrow without any training, how would you do right? So our therapy horses are the same. They have to have a lot of training and a lot of preparation for what they're going to do. This work is considered performance work. It's considered a discipline of equine, the equine world. So there's like Western riding and dressage, you know, all these fancy horse terms and hippotherapy is a discipline and so the horses that come to us, their job is important. Their job is, is, can be stressful, right? They, they carry riders that aren't completely a hundred percent balanced, like you or I, or anybody else that would ride them that is conditioned to riding horses. Right. And that, you know, horses can feel a fly. If you've ever seen a fly land on a horse, they immediately their skin shakes because they know it's there. So it's important that our horses are conditioned to, to the types of riders that they're going to have and also the equipment that we use, right? Not, you know, not every horse that walks into our arena for the first time has ever seen a wheelchair or a walker or, you know, things like that. So, um, it's important that they get the training they need and I would say anywhere, once we get a new horse, depending on their background, anywhere from three months to over a year. You know, 18 months. A horse could be in training before they ever even have a patient or a participant on their back in sessions.

Rachel:

Okay.

Katie:

Yeah.

Rachel:

My next thought. So let's say we have a participant riding a horse who maybe stims and maybe their movements, maybe their vocal stimming is unexpected. What's like the process? How do we keep the horses calm? I mean like walk me through this.

Renee:

Katie just did an episode on her podcast. That's so great.

Katie:

This is something, it's a good question. Really good question because it's something that we deal with a lot, especially as for us, we do industry surveys and our largest population that we serve right now are those on the autism spectrum. And so we know that that can be a part of that diagnosis. And so we're trying to prepare everybody as best we can for what that might look like. So all of our horses are trained to spontaneous noise, um, from a variety of different, um, avenues, I guess, in training. Um, but that is something that we consider when we're looking at precautions and contraindications for what we do. Sometimes, at the end of the day, we have to make the difficult decision that, um, maybe this tyoe of treatment is not the best type of treatment, right? So it's just like anything else we do in the clinic. You might decide that e-stim is really good for this participant or patient or not good for this patient. Right? So we look at it the same way is how can we best benefit our patient. But our horses are trained for that and then we also have the equisizer and so typically what we will do is if we know that's going to be something that we might need to address. Is we'll do a few sessions on the Equisizer, see what kind of vocalizations we get, and then work through some strategies. So, can we work on some coping skills? Can we, can we decide where that vocalization is coming from, from a sensory perspective? You know, is it auditory? Is it, you know, what is it? So that we can satisfy that need in another way and then that helps us kind of troubleshoot through that so that we can then safely transition to the equine. Like I said, we always, our horses and our participants are the most important, you know, pieces of this puzzle, right? So how can we advocate for our horse? Because I can't ask my horse to they'll and they will, and they'll, they'll, they can handle it and they could do it and they'll, you know, they'll do it because they love, they truly love their participants. Like truly, it is the craziest thing and they will do it for us and they will wear, they will kind of carry that, you know, cross and stress, but then we have to ask them to immediately go into another session or, you know, immediately go, go to somebody else and help somebody else. And so they, horses can get that kind of like, yeah, compassion, fatigue, you know, kind of like, you know, us as therapists do, we go to one to the next to the next, that can be hard. So we do the best we can on the front end and that's why we do a really thorough evaluation is. So that we don't invite a new patient to come and then immediately pop them on the horse and then find out we have some things that might be more difficult. So doing that thorough evaluation, I think is key.

Jessica:

Yeah.

Rachel:

I love that.

Jessica:

For the horses, is there, how do you know when a horse is? done and they need to transition out of the therapy world and move on to the next phase of their horse life.

Katie:

Yeah, we, so we have three people on our team that that's all they do is they pay attention to our horses and their behaviors, right? So it's the part that makes it tricky is that it's our job as therapists to notice very subtle, nuanced behavior in these horses. And if you have never had horse experience, sometimes it takes a lot of training to kind of train your eye to those things. But, you know, things like pinned ears, harsh eyes, flicking their tail, things that we can notice from a horse behavior standpoint, just like we notice in our, you know, our patients, right? We can kind of see these rumbling behaviors happen before we have a meltdown or before we have something like that. Same thing in horses. So we, we just need to be able to see those signs and know what is normal for those horses and what is not and then our equine staff tracks those very diligently. So anytime we notice a different behavior, they track it and then they're seeing, Oh, you know, Joe has had, you know, a good couple of weeks here where he's hasn't been super happy. Let's pull him from programming. Let's evaluate what's going on because safety is number one, right? We don't want to have any kind of emergency or accident happen, but sometimes horses do act like horses and that's part of the liability here in this. setting is that we have to weigh the pros and cons. But we do the absolute maximum best we can to prevent those things from happening and noticing those, like you said, like little subtle, subtle things for burnout and noticing that in our horses.

Jessica:

Yeah. So then what happens if a horse is showing those signs and they get kind of pulled from the program? Like what happens next?

Katie:

Yeah. So we have a conditioning program that operates in the mornings and it's important that those horses, one, get ridden really regularly and they keep their skills up and things. It's good for their mental health too, right? Um, so sometimes they just need a break. Sometimes we pull them, you know, and they, they can get it some time just to kind of be in their pasture and be a horse. And, and that's good kind of mental health reset, which is the same thing we do. Right. We go on like.

Rachel:

Oh, these are all things I do

Katie:

Mexico for a week when we need a break. Right. So sometimes, sometimes our horses need a break too, and that's enough. To really, to really do it, do something well for them. But there are occasions when sometimes the horse is just ready to move on to a different job and there's nothing wrong with that. Just like us, we might get into a job that we're like, eh, this isn't a great match for me and that's okay. We just, we find another match for them, whether we take them in on lease or whatever the situation might be. We just help them find a home that they're more comfortable in and just kind of move on from there.

Jessica:

I think what I love so much about everything you've been talking about is that it's like, yes, this company is designed to help the people who are coming in for services, but simultaneously you guys care so much about the horse's well being as well. That it's just such an incredible thing you're doing. Whereas I think, I'm sure there are other companies out there that the focus is just on the patients. Not so much on the horses and I'm sure that the benefits are not nearly as much as what you guys are doing.

Katie:

I appreciate that. Thank you. That really means a lot to me. We, we work hard at HETRA to, to, to do just that, you know, and I think it speaks volumes to our participants too. Because They come in, we have participants that more and more, even, you know, since COVID, we're just seeing a lot of mental health need right now and so for us, it's, it's so easy to draw the parallel between self care for you, self care for the horse. And, you know, what does this horse behavior tell you and how does it, you know, how does it match with you? Cause there's so many things that are the same. Right. And so, um, focusing on that can be something that's both equally therapeutic for the person and also the horse, right?

Rachel:

Okay, I have a question, or like a case study if you can give me. We talked a little bit about like the gait before and after the sessions. Do you have any, like, positive experiences for maybe a kiddo who comes in and they're really dysregulated? Maybe they are really afraid, posturally insecure, gravitationally insecure? You know, before and after a session or like a session.

Jessica:

A success story.

Rachel:

Yeah.

Renee:

I have definitely one over time. I've been treating somebody first that, you know, he started in a wheelchair pretty much. So that's how he got around and now he's like independently using forearm crutches and we're working now on independent walking and that's been so rewarding to see and So good

Katie:

uh, my This sounds so cheesy and you guys are gonna probably gonna all roll your eyes, but like honestly, every single day I have participants that come to me disregulated, not themselves, not functional, can't follow directions, struggling, not sleeping, all of that. I have participants that come to me and then, after 30 minutes, they leave their affect. I wish I could explain it to you. The affect is like completely different. We're focusing, we're attending to tasks. We're, I mean, we're just so much more regulated. I have families that tell me like the two days after HETRA, we sleep so good. I wish we could do Huchra like every other day because we sleep so much better, you know, or this sounds crazy too. But the cool thing about horses is that we're impacting every single, every single system in our body at the same time. So it's funny because like, I'll have participants that struggle that are maybe wheelchair bound or things like that, that struggle with regularity and constipation, like, it's great. We always have a bowel movement on HETRA day.

Jessica:

I was thinking about that when you were talking about the steps.

Katie:

Yeah.

Jessica:

Oh, it's just like if you go for a walk, so I wonder if it affects there.

Katie:

Yeah. A hundred percent. It does. So to answer your question, I mean, the long and short of it is that, um, I think we see so much of that all the time that it's almost kind of just something that we're like, yeah, it's just what the horses do, you know? But Yeah. Yeah. Yeah. Yeah. It, we have this beautiful partner and you know, not only, not every therapist gets to say that and yeah, yeah, we're the therapists and I don't know if you ever feel this way, Renee. But sometimes the people are like, Oh, you know, like you, what you did with my, my participant, my patient or my kid was so, was so incredible. And I'm like, I was there, you know, but it was our facilitator. Um, but yeah, I mean, like gravitational insecurity is one that we battle with because horses are tall. I mean, even a short horse is taller than most any surface a child has been on and I have worked. We've worked baby steps where we always mount from a mounting block platform. So if you go up a few steps up to the platform. And I've had participants that we worked for several weeks just to climb the platform, you know, to get on and then we sit and then we immediately get off, you know, because it's really scary. And now, you know, we're riding 30 minutes. So it's. It's incredible and I think then people are like, okay, so they can ride a horse, but like, what does that do for their daily life? Right. And like, I could stand on that soapbox forever, but I think about that in particular is does so much for a kid or anybody, an adult, anybody's confidence in themselves. Right. Like if they can conquer this hard thing that you can do anything, you know, and I mean, we look at it from a sensory perspective. If You know, we can get that input and we can do, we can, we can do these things within 30 minutes and then that input is lasting 24, 48, you know, hours or longer. What functional impact is that having on them in school or at home or with their friends on the playground? Right. Because their bodies feel more regulated. And I know Renee sees it all the time from like, just strength and conditioning and balance, and that transitions to everything we do. So.

Renee:

Just walking up a curb like this parent the other day was like my kid walked up a curb for the first time, you know, like, like structurally like hold yourself up.

Katie:

One of my favorite, um, things I ever had a participant mom tell me was, um, he has forever, we have never been able to get in the bathtub. Like that has been like a motor plan that has been like, we can't figure it out. So I always have to pick him up and put him in the bathtub. But the other day I said, we'll say the horse's name was Joe. The other day I said, we'll do it just like when you get on Joe. So they stood there and we put two hands down on the saddle, lift your legs, swing him over and get in. And she was like, and then he just got in the bathtub and I was like, why did I not think of that sooner? And I'm like, there's some that's functional, functional stuff right there. We love that.

Rachel:

Well, and I know you guys aren't speech therapists, but you work with speech therapists. So do you see progress in speech as well, being with the animals?

Katie:

Oh, yes. So much.

Rachel:

It's almost like there's no pressure. It's like that pressure's been taken off so they just, it's more spontaneous. That's kind of the vibe that I, I'm feeling.

Katie:

100%. The horses are such a motivator. Take away the movement, take away anything. Just standing there on the ground with a horse is so motivating to the kids. They just love them, you know. And then all of a sudden you're working on like, we'll say, hi, or what is this horse's name? I don't know. Ask them, what's your name? You know, and then you're starting to work on this communication that they had no idea they were even working on, but the horse isn't going to judge you or be like, what did you say? Or, you know, they're, they're not going to do that to you. And so it's, it's like a judgment free zone. That's equal parts motivating and then you have the treating therapist there to help make that therapeutic too. Right.

Rachel:

I just like, cry and like, squeal all, all at once.

Jessica:

Squeal.

Katie:

The other cool thing about speech too that I don't want to go unnoticed is that it's not just the motivation, but also, um, there's a lot of research that shows that it helps with, breath support, speech production, diaphragmatic support when you're sitting astride on the dynamic surface like that and so there was a really cool video I just watched. I should try to find it of a, of a little guy that had like no breath support and could hardly, they were doing like a, ah, like yell as long as you can deal, you know? And like, he did it before he got on and he was like, ah, you know, and then he got off and he held that note for like forever, you know? And it, so it's, it's like more than the motivation. It's. It's just, it's so many things. It's crazy.

Jessica:

It's incredible.

Rachel:

I almost think of like the vibrating plate that we use in therapy. It's almost like giving me the same type of input that the vibrating plate does, only it's more natural.

Jessica:

Mm hmm. And rhythmic.

Rachel:

More rhythmic. Right, because the vibrating plate's not rhythmic in any way.

Katie:

And that can be a big proponent of things for our participants who have neurological conditions or brain based conditions. That rhythmicity is huge and so that's something we look at a lot at HETRA is horses can have a a rhythmic gait too, you know. They can kind of stumble or the way they place their feet or they can have old injuries or whatever too that inhibit that and so we look really closely at the quality of that movement too because that rhythmicity makes a huge difference for a lot of our kids.

Rachel:

Totally. Oh my goodness, so many things.

Jessica:

What's the youngest age you work with for kids?

Renee:

I think for mounted on a live horse is two years old and we can use EQ before that. Yeah.

Katie:

So the reason we do, or the reason two is our youngest that we see on a mounted horse is just because of pelvic development and their ability to really absorb that movement and all can be more difficult before that just because of the way the pelvis is developed. But yeah, two is the industry standard and then currently, I mean, we've our oldest participant we've ever seen is like 92. I think our current I think our current is like 78 or something, but that's mounted. Yeah.

Renee:

Oh, wow. Nice.

Katie:

So everybody, come one, come all. Come on out. And we have a, like, some people would call it like a Hoyer lift, like a mechanical lift and so we're able to see a lot more participants of a lot different ability levels because of using that lift. So we can.

Rachel:

You can lift your patients onto horses?

Katie:

Straight from their wheelchair onto their horse. Yeah. Leave the wheelchair in the dust, we're going riding.

Rachel:

Wow.

Katie:

Yeah.

Rachel:

Wow. Okay.

Katie:

The other tool, I mean, I don't want to say tool, because they're not tools, they're partners, they're amazing, is we have miniature horses too. So you can have big, small, little, whatever your fear level sometimes, or your, you know, your comfortability, or your, your size and stature, or, yeah, we, yeah, we can accommodate a lot of folks.

Jessica:

Amazing. Oh my gosh.

Rachel:

I could honestly pick your brain so much. I want to listen to your podcast as well because I haven't listened to it yet. But we'll make sure that we link that. But just a few more questions. Like what's the biggest challenge with what you, with like your work and what you do every day?

Renee:

I would say, and we kind of talked about this, just the safety of it and, um, making sure like we're paying attention to the horse and the rider at all times and reading both the horse and the rider to make sure it's all safe and just being creative too. It's a fun challenge because we are limited with what's approved. So it's like, Oh, I want to work on this. Like what? Do we already have that can achieve that goal?

Katie:

Yeah, I would agree with Renee and say, the challenge is every therapist who comes to HETRA to learn how to do what we do is an incredible therapist and there's no doubt about that. But adding that extra layer of the horse communication, horse behavior, and then you got to learn like horses wear tack, right? They wear all these different saddles and all these different equipment that is, is in the equine world that you might not be familiar with. And so it's like. It's like going to grad school all over again for something else. There's a lot of things that play into it. So it's tricky.

Renee:

Yeah. I, I did not grow up with horses. I just grew up like in Omaha and so I've, everything I've learned about horses has been from HETRA. Like I'd never put a saddle on a horse before coming here. Yeah.

Rachel:

So there's hope for me.

Renee:

Yeah. So I.

Rachel:

There's hope.

Renee:

You just welcome me, show me things, taught me things, really patient with me, thankfully.

Rachel:

It's just like in any other field, you know, or any other part of OT, like having a mentor, you know, same with PT, having a mentor, someone to teach you all the things that you need to know. I mean, you learn 80 percent of everything on the job, I feel like in the therapy world.

Katie:

For sure.

Rachel:

That's so fascinating.

Jessica:

We're going to link everything in the show notes, website, podcast, all of that, but, so that parents, therapists, everyone can learn from you.

Katie:

But I was going to tell you guys too that I will send you, every year we do a patient spotlight, a participant spotlight story. So I will send you one if you want to share it with your audience. Um, so you can kind of like see it in action. Sometimes it's hard when people are describing it to you're like, you're going to do what with what now? So if you can see it, sometimes it's better. So I'll send you that too.

Jessica:

Yeah. Thank you. Can each of you give us one piece of advice that you want to give to parents, therapists, anyone listening?

Renee:

I'll kind of piggyback off of what I just said was I didn't have any, I just always liked horses. I didn't have any experience. But if there is a therapist out there that is working, maybe an outpatient, like they want to do something more, like follow your passion, go for it. Like it's worth it. So.

Katie:

I would say to patient families or caregivers, the therapy road can be, it can be really difficult, right. And finding a good therapist, that's a fit for you and finding a good clinic or whatever, you know, you're doing. Don't be afraid to think outside the box and don't stop until you find something that's beneficial. There's so, so many of our participants, I would say, over 50 percent are here at the barn because nothing else worked and I'm not saying that as Um, you know, to, to make us sound good. I'm saying that because it's a struggle and until they found something that was truly beneficial for them and something that worked, it was really hard and so even if it's music therapy. If it's art therapy, whatever it is, you know, if they like to play soccer, find a way to make it therapeutic. Don't stop until you find something that, that they enjoy, that they can benefit from, and that, yeah, brings you joy.

Rachel:

I love that. You both are so wonderful. This has been so fun. I honestly could talk to you for like hours and hours. I'm hopping on a plane tomorrow. I'm gonna come and visit and get the tour, bring my kids, do all the things.

Katie:

Come on out to Gretna, Nebraska. You won't regret it.

Jessica:

Just don't drive through Nebraska. My family is from Omaha, Nebraska, and so when we were scheduled to talk to you guys, I was like, man, that's the worst drive ever.

Renee:

From Idaho, yeah? That's for sure.

Jessica:

Awful.

Katie:

Corn into cornfields. It's, yeah, it's not for you, probably.

Rachel:

I love it. Oh, well, thank you so much, ladies. We can't say thank you enough. We appreciate your time.

Katie:

Yes. Thank you for having us. We're excited to share a little of what we do with everybody. So don't hesitate. If anyone's listening, don't hesitate to reach out to us. We're always here to answer questions. So thank you.

Rachel:

Thanks ladies.

Jessica:

Thank you. This conversation makes me want to get on Google, search up equine therapy services in the Treasure Valley. And if there's not one, I need to start doing some research because this sounds amazing. But also maybe I should get some experience with horses first. Even though Renee said you don't need to, I feel like I want to.

Rachel:

Yeah, I, like I said, I just feel equally like I want to squeal and.

Jessica:

I don't know how you say that.

Rachel:

I just feel giddy, you know? Like, it was so inspiring to me, talking with them and learning about this. Because it's just something that I've really not experienced and I'm just feeling very

Jessica:

inspired.

Rachel:

Inspired.

Jessica:

Yes, very inspired. I think what they do is so incredible and I think that we need to do more of it and get this in all areas because clearly it is so impactful.

Rachel:

Yep. Make sure that you check out the show notes and click on all the links. Definitely check out the podcast that is linked there and take just a hot minute. If you're still with us here today, take a hot minute and leave a review on iTunes or Spotify. We really appreciate when you take that time to leave a review and we have guests on because it can be a little, you know, intimidating to come on someone else's podcast, like Renee said. You know, this was her first podcast. I don't know if she said that while we were recording.

Jessica:

Oh yeah, I don't know if she did, but she, it was her first podcast.

Rachel:

So take a minute, let them know, let us know your thoughts. We appreciate that and we will just plan on chatting with you next Wednesday.

Jessica:

Okay. Bye.

Rachel:

Thank you so much for listening to all things sensory by Harkla.

Jessica:

If you want more information on anything mentioned in the show, head over to Harkla.co/podcast to get the show notes.

Rachel:

If you have any follow up questions, the best place to ask those is in the comments on the show notes or message us on our Instagram account, which is at Harkla_family, or at all things sensory podcast. If you just search Harkla, you'll find us there.

Jessica:

Like we mentioned before, our podcast listeners get 10 percent off their first order at Harkla. Whether it's for one of our digital courses or one of our sensory swings, the discount code is sensory will get you 10 percent off. That's S E N S O R Y.

Rachel:

Head to harkla.co/sensory to use that discount code right now.

Jessica:

We are so excited to work together to help create confident kids. all over the world. While we make every effort to share correct information, we're still learning.

Rachel:

We will double check all of our facts, but realize that medicine is a constantly changing science and art.

Jessica:

One doctor or therapist may have a different way of doing things from another.

Rachel:

We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties, and what we have found to be beneficial that will be a s evidence based as possible.

Jessica:

By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your child.

Rachel:

Consult your child's pediatrician or therapist for any medical issues that he or she may be having.

Jessica:

This entire disclaimer also applies to any guests or contributors to the podcast.

Rachel:

Thanks so much for listening.