The feasibility of occupational therapy using Zones of Regulation™ Concepts in an equine environment.

Introduction: The current paper aimed to assess the feasibility of a modified intervention protocol named "Occupational Therapy using Zones of Regulation Concepts in an Equine Environment" (OT-ZOR Equine). Methods: A single arm A-B feasibility study was conducted, involving 14 autistic youth ages 6-13 years who first received 10-weeks of occupational therapy without horses (OT-ZOR Clinic) followed by 10-weeks of OT-ZOR Equine. Results: All participants completed the study and attended 95% of OT-ZOR Equine sessions. Occupational therapists maintained 91% fidelity to the OT-ZOR Equine intervention protocol and there were no serious adverse events. All participants' caregivers and study occupational therapists rated being satisfied or very satisfied with the OT-ZOR Equine intervention. Youth demonstrated improved self-regulation following participation in the OT-ZOR Clinic and OT-ZOR Equine interventions. However, participants' social functioning only improved after OT-ZOR Equine. Discussion: This study demonstrated that OT-ZOR Equine is feasible to implement, acceptable to recipients and providers, and may offer additive benefits in social functioning compared to occupational therapy intervention without horses. The current study provides a foundation for future efficacy research aimed at quantifying additive benefits of integrating horses into occupational therapy for autistic youth.

Occupational Therapy Using Zones of Regulation™ Concepts: A Feasibility Study.

There is a lack of peer-reviewed research on occupational therapy using Zones of Regulation™ concepts for autistic youth. The purpose of this article is to describe the feasibility of a newly-developed occupational therapy intervention using Zones of Regulation™ concepts (OT-ZOR) for autistic youth. Specifically, we aimed to evaluate: (a) participant recruitment, retention, and attendance; (b) intervention fidelity, safety, and assessment completion; (c) intervention acceptability; and (d) preliminary participant outcomes. A single-arm feasibility study was completed with outcome measures before and after 10 weeks of OT-ZOR. Fourteen autistic youth ages 6 to 13 completed the study. Youth attended 94% of OT-ZOR sessions. Providers achieved 97% fidelity to the intervention. Occupational therapists and caregivers expressed overall satisfaction with the OT-ZOR intervention. Youth demonstrated significant decreases in irritability, hyperactivity, emotional reactivity, and dysphoria. OT-ZOR is feasible to implement, acceptable to providers and caregivers, and may improve self-regulation in autistic youth.

Occupational Therapy Using Zones of Regulation Concepts: A Feasibility StudyThe research team developed an intervention that combines occupational therapy best practices for autistic youth with concepts from a widely used curriculum for teaching self-regulation skills, the Zones of Regulation™. This article describes the feasibility of implementing this new intervention, named occupational therapy using Zones of Regulation (OT-ZOR). The current feasibility study provided 10 weeks of OT-ZOR to autistic youth ages 6 to 13 and collected data about feasibility of implementing the intervention, acceptability of the intervention to caregivers and providers, and preliminary participant outcomes. OT-ZOR was feasible to implement, as indicated by high rates of retention, attendance, and fidelity to the intervention. OT-ZOR was acceptable to the occupational therapists who provided it, and the caregivers of autistic youth who participated. Youth demonstrated improvements in self-regulation. Overall, we concluded OT-ZOR was feasible to implement, acceptable to providers and caregivers, and may improve self-regulation in autistic youth.

The potential usefulness of standardized assessments to measure participant outcomes of adaptive/therapeutic horseback riding: a survey study.

Adaptive or therapeutic riding (A/TR) is a recreational activity which provides mounted and ground-based horsemanship opportunities adapted to the abilities of the participants. A/TR provides physical and psychological benefits to participants with diverse disabilities, including physical, developmental, cognitive, and age-related disabilities, promoting higher quality of life. A/TR professionals may be limited in their capacity to implement outcome assessments and report the benefits of their community-based A/TR services to a broad audience. The purpose of this study was to identify whether and how A/TR professionals currently measure participant outcomes; benefits and barriers to implementing standardized assessments in A/TR; and characteristics which would make assessments useful in the community-based A/TR environment. To address this purpose, we conducted a survey among A/TR professionals. We found that while A/TR professionals measure outcomes among their participants, they typically do not use standardized assessments. Survey respondents believed benefits of implementing standardized assessments included bolstering the A/TR profession, acquiring funding, and communicating about A/TR services to a broad audience. Respondents also identified several barriers to implementing standardized assessments including time, systemic, and expertise constraints. Respondents reported that useful standardized assessments would be relevant to all age groups and populations who receive A/TR services. Finally, respondents shared that for standardized assessments to be useful, they would need to be low-cost, require less than 10-20 min, and available in either paper or computer format. This study revealed that standardized assessments may be a strong support to the A/TR profession; however, assessments must meet the unique needs of A/TR professionals.

Self-Regulation Mediates Therapeutic Horseback Riding Social Functioning Outcomes in Youth With Autism Spectrum Disorder.

Emerging evidence suggests therapeutic horseback riding improves self-regulation behaviors, social functioning, and language in youth with autism spectrum disorder (ASD). It has been theorized that interacting with horses is calming for youth with ASD, which may influence social and language outcomes. The current study is an exploratory secondary mediation analysis of a previously published randomized controlled trial of therapeutic horseback riding for youth with ASD. We hypothesized that self-regulation would mediate therapeutic horseback riding's effect on social and language outcomes in youth with ASD. Results indicate that self-regulation mediates therapeutic horseback riding's effect on social, but not language outcomes. This paper provides support for the hypothesis that interacting with horses may have a calming effect that serves as a platform for improving social outcomes in youth with autism.

Preliminary Efficacy of Occupational Therapy in an Equine Environment for Youth with Autism Spectrum Disorder.

The purpose of this study was to identify appropriate outcome measures and assess preliminary efficacy of occupational therapy in an equine environment (OTee HORSPLAY) for youth with autism spectrum disorder (ASD). Twenty-four youth with ASD aged 6-13 were randomized to 10 weeks of OTee HORSPLAY or to a waitlist control condition, occupational therapy in a garden. Youth demonstrated significantly improved goal attainment and social motivation, and decreased irritability after OTee HORSPLAY. When compared to the subset of participants who completed the waitlist control condition, the OTee HORSPLAY group still demonstrated significant improvements in goal attainment. This study provides preliminary evidence that horses can be integrated into occupational therapy for youth with ASD to improve social and behavioral goals.

Hippotherapy Practice and Safety Patterns in the United States: A Descriptive Survey Study.

Objective: The use of equine movement as a therapy tool in a plan of care, or hippotherapy, has grown considerably over the past three decades. However, there is little evidence of safety rates and related practice patterns to guide key stakeholders such as clients, therapists, the health care team, and third-party payers. The purpose of this article is to describe the safety and practice patterns of contemporary use of hippotherapy. Design: A survey was distributed to occupational therapy (OT), physical therapy (PT), and speech-language pathology clinicians who incorporate hippotherapy into their practice. The survey included questions about clinicians' practice patterns, safety procedures, and rates of safety incidents. Results: Results indicate that hippotherapy is most often used by PT and OT clinicians for pediatric clients. Use of hippotherapy varies by geographic location, and frequency and duration vary widely. Clinicians most often contract their services to a program that provides a facility and horses. Recommended safety practices are widely adopted, and rates of safety incidents requiring basic first aid (0.05% of sessions) or off-site care (0.01% of sessions) are low. Emergency dismounts are frequently practiced and often effective in preventing an incident. Conclusions: Although there are inherent risks to incorporating horses into a therapeutic plan of care, these risks appear to be well managed by recommended safety practices. Results of this study can (1) help clinicians to make informed decisions regarding practice and safety procedures, (2) provide evidence of safety practices and incident rates to clients, members of the health care team, and third-party payers, and (3) maximize safety for clients who participate in hippotherapy.

Parental Perspectives of Occupational Therapy in an Equine Environment for Children with Autism Spectrum Disorder.

This paper reports on the qualitative phase of a mixed methods study of occupational therapy in an equine environment for children with autism spectrum disorder (ASD). The study's quantitative phase found that this intervention improved the occupational performance, social motivation, social communication, and self-regulation of some children with ASD. The study's qualitative phase, reported herein, subsequently aimed to describe parental perspectives on children's experiences of the intervention and its influences on everyday life. Using a qualitative descriptive research approach, five parents participated in two rounds of semi-structured interviews. Interview data were analyzed using theoretical thematic analysis. Although parents expressed some concerns about the intervention, overall they found the intervention to be appropriate and acceptable. Next research steps include creation of a manual for the intervention and assessment of feasibility across a broader range of practice sites, occupational therapists, children with ASD, and their parents.

Pilot Study: Occupational Therapy in an Equine Environment for Youth With Autism.

Despite growing prevalence, research investigating occupational therapy incorporating horses for youth with autism is limited. This study aimed to (a) pilot a screening, evaluation, and intervention protocol of occupational therapy in an equine environment and (b) assess preliminary effects on occupational performance goals, behavior, and social functioning of youth with autism. A multiple baseline single-case experimental design was used. Six youth with autism participated in a no-treatment baseline phase and 10 weeks of intervention. Therapists implemented the intervention with 95% fidelity. Per parent report, participants improved in occupational performance goals, social motivation, and communication; four demonstrated decreased irritability and hyperactivity. This research operationalizes a screening, evaluation, and intervention protocol for occupational therapy in an equine environment, and demonstrates it may improve occupational, behavioral, and social outcomes for youth with autism. Next steps include manualizing the intervention, refining feasibility measures, and implementing a randomized controlled efficacy study.

Autism and Equine-Assisted Interventions: A Systematic Mapping Review.

This systematic mapping review mapped current knowledge of equine-assisted interventions for people with autism to help guide future practice and research. Thirty-three studies including children and adolescents with autism, 3 of which confirmed diagnoses, were reviewed. Five types of equine-assisted activities were identified across 25 studies, with reported improvements in behavior, social interaction, and communication. Four types of equine-assisted therapies were identified across 8 studies, with reported improvements in motor control and self-care. Different approaches to therapeutic riding and hippotherapy, the most studied interventions, were evident. While this literature reflected early scientific development, it offered broad proof of concept that equine-assisted interventions can benefit children and adolescents with autism. Promising outcomes support continued investigation focused on standardization, appropriateness, and efficacy.