Lessons In TR

Adaptations and Teaching Techniques for Riders with Severe Disabilities, Part 2: Physical Challenges

For all riders, posture is the first thing you address because only when you have good relaxed position on the horse are you able to use the aids separately to correctly cue the horse. For riders with severe disabilities we do the same thing, first addressing their physical challenges and the support needed to achieve the correct alignment, because only then are they adequately prepared to work on riding skills.

Covered on this page:

• Correct Alignment
• Physical Challenges, Adaptations & Activities:
  • Hypotonicity
  • Hypertonicity
  • Sensory Processing Disorders:
    • Hypersensitivity to light touch
    • Self Stimulating
    • Over Reactive
    • Under Reactive
  • Impaired Vision

Correct Alignment

First let’s look at correct alignment. Correct posture and alignment is technically not a riding skill because it’s not an aid or attempt to communicate with the horse. Nonetheless, correct posture is the best thing you can do for your rider because it allows them to receive the max therapeutic benefit from the horse and enables them to correctly apply the aids.

Correct alignment is:

• Pelvis angle (neutral, not posterior or anterior)
• Heels under hips (or in a place that correctly positions the pelvis –tight or loose muscles may affect his)
• Looking forward (not down or up)
• Viewed from the back the shoulders, hips, arms, and hands are level and stacked above each other (not collapsed)
• Viewed from the side the hands and arms are even (one is not higher than the other)
  • This is huge! I’ve noticed if a rider’s left hand is on the pommel but the right hand is on their thigh, their right shoulder will drop and fall back, their weight goes on their left seat bone, and their whole body begins to twist. (Seriously, try it right now, put your hands on your knees, now drop one to the side of your thigh – what happens?) Sidewalkers don’t often know this, so prep them before the lesson, and give reminders during the lesson via the rider, such as “Jacob, let’s keep both hands on the pommel so you can sit straight in your saddle. Maria will help you if you need it.”

Use your team to help your rider find and maintain correct posture!

• The leader needs to lead the horse straight (or the rider will be off balance and crooked with the horse)
• The leader needs to keep the horse at a speed appropriate to the rider (too fast or too slow can make it hard for the rider to keep their position)
• Use sidewalkers to manipulate your rider’s position (and show them the correct position until they can maintain it themselves)
• Sidewalkers must have the appropriate support hold (sometimes a thigh is best to keep the rider from slipping, sometimes an ankle is best to keep the rider’s ankle in the right position to correctly align the pelvis)
• Sidewalkers must have EVEN holds (view from the back their arms must be in the same place on the rider’s thighs or ankles, from the sides they must keep the rider’s ankles in the same places)
• Sidewalkers may apply downward pressure on the ankle (if the rider leans left, downward pressure on the right ankle will give them some support to get back upright! physically show the sidewalkers how much pressure is needed)
• Sidewalkers may need to use hand over hand for a bit if the rider keeps dropping a hand – to keep the rider’s hands aligned and holding the reins, grab strap, or on the pommel. This can be combined with a thigh hold easily.
• I highly recommend volunteering in hippotherapy sessions to learn more about posture and how sidewalkers can help – I learned so much from working with spectacular therapists about where to apply pressure and how much and where to keep the rider’s ankle to keep their pelvis neutral

Physical Challenges, Adaptations & Activities

The following is a list of the physical challenges I ran encountered with most of my riders, along with appropriate adaptations and ideas.

High or Low Muscle Tone

• Muscle Tone
  • Is the amount of tension present in a resting muscle and therefore how ready it is to react. It can change in different parts of the body, be asymmetrical, and can fluctuate depending on the day.
  • Is affected by: Weight bearing, Rotation, Quick movements, Excitement, Stress, Instructor’s voice, Horse’s behavior, Horse’s movement, Arena set up, Current activity, etc.

Hypotonicity (low tone)

• Definition
  • Decreased muscles tone, loose/flaccid muscles, cannot maintain posture, sometimes gets tired quickly
• Adaptations
  • Horse
    • Medium/wide horse for base of support
    • Choppy gaits
    • Highly responsive to voice commands (if weak leg aids)
  • Tack
    • Supportive & encourages neutral pelvis – dressage, western, aussie
    • Suede/synthetic seat – to reduce slipping
    • Skin protection (if feels less)
    • Dev boots or rubber bands – to hold feet in stirrups
  • Rider’s lower body
    • Rubber band the foot to the stirrup (in a safe way that the rubber band comes off or can break)
    • Use Devonshire boots (so the foot can’t accidentally slip all the way through)
    • For pictures of both rubber banding and dev boots click here
    • Secure the stirrup to the girth (use flash noseband or stirrup keeper)
    • Sidewalkers may need to assist rider’s knees to keep their hips rotated in (vs frog legs), have rider actively squeeze with his legs for upward transitions
    • If Legs flap off saddle, Velcro thighs to saddle, Paralympics allow to cross 1 square inch, which translates into using a strip of Velcro one direction (around their thigh) and another direction (down the saddle), so where the Velcro attaches in the X it is a one inch square space
  • Rider’s upper body
    • Use Eyes and Looking – to assist balance in transitions and turns
    • Give their limbs a job! Don’t just stop using them.
    • Adapt reins for weak limb
      • Ladder reins
      • Knob to hold (create with layered tape)
      • Rein handles
      • One side has regular rein and the other has ladder-style rein
      •   
    • Neck rein steer with strong hand, and stabilize weak hand by:
      • Neck strap on horse to stabilize hand
      • Band on pants to hold on to
      • Belt around body/arm to stabilize arm
  • Pelvis: slouching/chair seat:
    • attach stirrups to girth with a flash noseband, then rubber band foot to stirrup, to keep legs under them
    • use dressage saddle with big knee rolls to keep thigh back
• Strengthening Exercises
  • Move limbs against gravity (move cones, carry saddle, carry weights)
• Movements
  • Primary goal: activation of the trunk
    • Start with holding the saddle
    • Progress to hands on thighs or in air
    • Progress to holding the reins
    • Incorporate tossing and catching
  • Increase horse movement
    • Ground poles
    • Cavalettis
    • Quick movements
    • Sharp turns
    • Lots of transitions
    • Lengthen stride
    • Irregular transitions
    • Irregular rhythm
    • Downward transition (halt) facilitate anterior (forward) pelvis tilt and activates back extensor muscles
    • Upward transitions (walk, trot) facilitate posterior (backward) pelvis tilt and activates abs
    • During transitions, the less they use their hands to support themselves, the better
  • Figures (progressive)
    • Straight lines
    • To large circles
    • To small circles
    • Serpentines (half circles, equally sized)
  • Turns and Circles (progressive)
    • Start large and smooth, progress to small and sharp (increases tone)
    • Use to encourage weight shifts and balancing reactions on their own, rather than you doing it for the rider
    • Put weak side to outside, to encourage stretching and strengthening
    • Progress to weak side on inside, to encourage balance awareness and challenge them
  • Sit sideways or backwards
    • Sideways – enhances lateral weight shift, especially on the tail side
    • Backwards – gives more rotational movement, the novelty is stimulating
  • Interactions
    • Excite them – may want to include racing and competitions
    • Use excited voice
• Precautions
  • Be careful of joint dislocation because there’s less tension to keep them in place – support the limbs and be careful during mounting & dismounting
  • Temperature may affect tone, hot days may make tone more flaccid
  • Prone to fatigue, give rest periods as needed
  • Inability to maintain upright sitting posture without assistance
  • At risk for hip subluxation
• Contraindication: Unable to attain upright sitting posture may require direct treatment by a therapist.

Hypertonicity (high tone)

• Definition
  • Increased Muscle tone, spastic and/or rigid muscles, difficulty releasing position
• Adaptations
  • Horse
    • Narrow/medium based
    • Gaits rhythmic, long, fluid
    • Easily mountable height
  • Tack
    • Don’t put reins on bit due to involuntary movements or tight pulls – use sidepull, hackamore, reins on halter
    • Saddles that allow close contact, comfort, and input from horse
      • Bareback pad with surcingle
      • Close contact English saddle
    • Seat saver if needed
    • Dev boots or rubber bands – to hold feet in stirrups
  • Rider
    • Upper body adaptations the same as above
    • Lower body adaptations the same as in the posture section above
  • Warmup
    • May need to give more time to warm up and relax muscles. If so, mount first to give muscles time to relax, unless prone to fatigue.
    • When mounting and dismounting be aware of decreased range in motion and flexibility
    • Don’t force limbs into position – allow the horse’s motion to reduce tone, then reposition and check stirrups/tack
    • Focus first on aligning pelvis to neutral and correct head/neck alignment to promote balance
    • Make sure sidewalkers don’t put excess pressure on stiff limbs (tends to cause tenseness)
    • Sidewalkers may provide help at rider’s heels to lengthen calf – be careful not to grasp the shoe while the heel lifts out
  • Movements
    • Focus on stretching and relaxing
    • Start with straight lines with low impulsion
    • Progress to circles with more impulsion
    • Put weak side on outside (track away from weak side) to elongate outside of body; make the rider aware that they are collapsing on that side
    • Rounder turns decrease tone (vs. sharp turns)
    • Ride backwards – has more rotation so can decrease tone (unless scared, then will increase)
    • Dismount – If goes prone easily, do leg exercises such as 5 leg or knee swings before crossing that leg over, because flexes at hip
  • Interactions
    • Avoid excitement – may not want to including racing or competing
    • Use soothing voice
• Precautions
  • Tightness after riding – ask how rider feels after session – If muscled tighter, decrease the amount of stimulation, and offer time to rest after
  • Weather
    • Cold winter increases tone = do exercises, stretching
    • Hot weather decreases tone = not best for someone with already low tone
  • Inability to position on equine
  • Adductor tightness that does not decrease with equine movement
  • Extensor thrust with or without specialized training
  • Handling skills of staff
• Contraindication:
  • Strong extensor thrust
  • Inability to separate legs to accommodate equine with or without adapted tack

Sensory Processing Disorders

• note these are usually listed as a cognitive disability, but impact the physical aspect of riding so I listed them here

Hypersensitivity to light touch

• When overreacts, say “I know that didn’t feel good”
• Use firm tough
• Let them know when you’re going to touch
• Adapt equipment (reins, etc.)
• Provide a variety of tactile experiences
  • Touch horse
  • Groom
  • Game props

Self Stimulating (hand flapping, jumping, etc.)

• Increase horse movement
  • Change ground surface
  • Half halts
  • Schooling figures
• Or Decrease input, if too much is excitatory

Over Reactive

• Quiet soothing voice
• Slow down lesson
• Take away stimuli
• Soothing music
• Limit speaking
• Weight bear on hands/feet
• Rhythm in horse’s movement
• Deep breathing
• Count footfalls
• Turn down lights and sounds

Under Reactive

• High and low 5s
• Quick transitions
• Trot
• Figures
• 2 point
• Posting
• Squeeze sensory balls
• Toys
• Upbeat music
• Games

Impaired Vision

• Be aware of footing
• Prove hand held assistance as appropriate
• Allow extra time to navigate
• Bright visual aids (tape on reins, bold colors in arena instead of letters,etc.)

Do you have anything to add? If so, please comment!

Coming up next: Adaptations and Teaching Techniques for Riders with Severe Disabilities, Part 3: Cognitive Challenges

See the last page for a full list of sources

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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!