Spina Bifida (Neurological modality)
- Jaithra Kakarla
- Apr 28, 2020
- 6 min read
Updated: Aug 2, 2020
Spina Bifida is a neurological condition whose main characteristic is a lack of the spine to fully close prior to birth. As the fetus develops in the first month of pregnancy, the brain and spinal cord form from a small piece of tissue called the neural tube. For one in approximately every one thousand babies, this neural tube does not close properly after the spinal cord has developed, resulting in a portion of the spinal cord being exposed at birth.
Many of the problems associated with the two more severe forms of Spina Bifida can be improved with equine-assisted activities. Due to the fact that all forms of Spina Bifida affect the spinal cord and nerves of the individual, the most common problems associated with the disease relate to motor coordination as a result of lack of feeling, weakness, or paralysis in the lower limbs. Sometimes, difficulties with bilateral integration can also occur depending on the specific individual’s disability. Often, individuals with Spina Bifida have increased muscle tone and some spasticity in their legs. Usually, they are able to walk with the use of equipment such as leg braces, body braces, crutches, and walkers, but have abnormal gaits and have difficulty standing without movement. They can also have difficulty withholding themselves in a sitting position if the nerve damage affected their ability to feel and control their hips and waist. Due to the lack of feeling in some parts of the body, some individuals with Spina Bifida may have problems with sensory integration to some extent. In some cases, mental along with the physical function is affected and the individual may have some degree of mental retardation, but this is often not the case.
Individuals with Spina Bifida could participate in and benefit from two main Equine Assisted Activities: Hippotherapy and Therapeutic Riding. Because Spina Bifida primarily causes physical problems, hippotherapy would probably be the best option, as it is a true therapy that would provide more medical benefits than a therapeutic riding lesson alone could provide. However, hippotherapy could be used in conjunction with therapeutic riding. Hippotherapy and Therapeutic riding would provide very different benefits, however, they both have the potential to improve an individual’s physical motor skills along with their mental and social skills if those areas were affected. Hippotherapy would most likely be the best option for an individual with Spina Bifida, as the condition’s primary manifestations affect the physical abilities of the individual, requiring more assistance from a physical therapist to improve motor function.
Hippotherapy
Hippotherapy would most likely be the main equine-assisted activity for riders with Spina Bifida. It would provide the required physical therapy to improve muscle tone and motor function, more so than therapeutic riding alone. The activities and exercises in hippotherapy target neuromuscular function, movement disorders, and sensory integration disorders, which are all areas that can be affected in a person with Spina Bifida. Overall, as with other equine-assisted activities, the horse would provide perfect three-dimensional motion and warmth, allowing the rider to relax their muscles and let the horse move their legs and hips. This movement would be key, as many individuals with Spina Bifida focus on learning how to walk so they are not confined to a wheelchair. Though many will not be able to walk without crutches or braces, the movement of the horse can teach them both mentally and physically what the patterns of walking look and feel like so that someday they may be able to implement the motions off the horse.
Since the purposes of hippotherapy revolve around goals related to physical and sensory abilities, the rider would be focused on improving in some of the following areas. Most importantly, the stretches and balancing exercises in hippotherapy could help improve muscle tone and movement, allowing the rider to work on further developing their balance, posture, and mobility. Some examples of these exercises could include the rider standing in the stirrups, with assistance if needed, trying to maintain balance, or the rider laying on their back on the horse, using their leg muscles to hold themselves upon the horse’s neck. Ultimately, all of the skills and improvements gained from hippotherapy sessions could lead to a final goal of improved gross motor skills such as walking, sitting, and standing which are the simple daily tasks that most Spina Bifida patients struggle with throughout their lives.
Therapeutic Riding (Component of EAA*)
Therapeutic Riding could benefit riders with Spina Bifida, but would most likely be in addition to hippotherapy. Therapeutic riding could provide the added benefit of social interaction and learning riding skills on top of the more intense physical therapy gained from hippotherapy. Therapeutic riding could provide a setting in which the rider could refine the stretches and activities learned in hippotherapy and apply them on a more simplistic level while riding in a therapeutic lesson. Whether in Hippotherapy or Therapeutic Riding, the same fundamental benefits of simply being on the horse would exist. The three-dimensional motion and patterns of the horse’s gait would encourage walking, and in this setting would be more relaxed than in an intense physical therapy-type lesson.
Though hippotherapy would provide most of the necessary therapy components to a rider with Spina Bifida, therapeutic riding does have several aspects that are not present in hippotherapy that could greatly benefit the riders. They would be required to use their bodies a little bit differently in a riding lesson-that is, rather than the horse simply being a prop that moves underneath them while the laydown or stretch, they would have to integrate their movements with those of the horse. The riders would need to use their legs to signal the horse to walk on, and they would need to maintain balance and posture throughout the lesson, requiring them to use their leg, hip, and trunk muscles. In certain activities, such as trotting and two-pointing, they would be required to use their leg muscles, even more, to keep balanced and remain steady on the horse. This may be very challenging for some individuals, depending on their level of weakness or paralysis in the legs.
On top of these benefits, therapeutic riding would provide a setting in which individuals could interact with other riders and their volunteers in a fun and relaxed setting. Hippotherapy, as it is a true therapy, would most likely be very challenging and tiring, and therapeutic riding could provide a setting in which riders could enjoy the company of other people and horses in a less intense session.
Conclusion
Spina Bifida is a common neurological disorder that can cause a lack of feeling, weakness, and paralysis of the lower extremities. The problems associated with Spina Bifida and its co-occurrences primarily affect motor function and the tactile, proprioceptive, and vestibular senses. For this reason, equine-assisted activities such as Hippotherapy and Therapeutic riding can have a very positive impact on riders with Spina Bifida. One or both of these activities can be implemented in the individual’s routine to improve their motor function, specifically in terms of their abilities to use the muscles in their feet, legs, hips, and trunk. Gross motor skills such as standing and walking are the main challenges that individuals with Spina Bifida face and the natural movements of the horse, along with therapy exercises and activities can be very effective in improving these skills in order for individuals to achieve more independence and in turn, a better quality of life.
RISKS
Though a rider with Spina Bifida can benefit greatly from equine-assisted activities, there are several risks that should be considered before beginning with either hippotherapy or therapeutic riding. Many of the common contraindications of riding horses are present in individuals with Spina Bifida. However, some can be present but mild enough so as not to limit the rider. Either way, it is important to consider all of the possible risks before an individual begins either a hippotherapy or therapeutic riding session.
I implore any individual considering any form of EAA* or EAT** to consult with their physician or any related doctor before beginning this form of therapy. It is highly important that you are well aware of the risks of participating in this form of therapy, which sometimes may be entirely related to the health issue too. If you have any queries or suggestions please leave a comment below or reach out to me through the Contact Form on the Home page.
*Equine-Assisted Activities
**Equine-Assisted Therapy
Visit the "Current medical use of horses" post to gain more clarity about the interventions for specific modalities: https://www.equineinsight.info/post/current-medical-use-of-horses
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