Hippotherapy—Just Horsin' Around?

Guest post by Alyson who blogs at wordsofhisheart. (Make sure you check out her blog. She has a wealth of great speech resources there.)

The first time I heard about hippotherapy, I didn't take it very seriously. I envisioned children who should have been in physical therapy instead donning cowboy hats and going for a leisurely trail ride.

But when Noah turned 5 and still wasn't speaking, I remembered posts I had seen on our local Down syndrome network from parents singing the praises of hippotherapy. After doing online research and watching some amazing YouTube videos of children participating in speech, occupational, and physical therapy while riding, it became clear that these therapies were successfully coordinated into the hippotherapy session, mimicking real life experiences.

Seeing the integration peaked my interest because Noah was having a difficult time processing the information necessary for speech along with all the other skills he was acquiring. When his speech therapist confirmed a diagnosis of apraxia, I knew it was time to pursue hippotherapy.

Was it grasping at straws? Maybe. But the amazing results we’ve seen in the four weeks Noah has been participating in hippotherapy have convinced me of its value as a legitimate therapeutic modality.



The Four Week Scoop
Week 1: An adult rode on the horse with Noah. They spent a few minutes in the arena walking and then throwing balls into a basketball hoop where Noah worked on color identification. Next they rode outside on the trail where the trees were full of hanging animals—a perfect opportunity to work on vocabulary and signing. I was worried that he would be terrified; he wasn't.

Week 2: Noah rode the horse by himself. His therapist and the arena volunteers walked along either side of the horse. During this session Noah's posture had improved. Instead of the common low tone slouch, Noah was sitting straight and tall. This was an instinctual posture correction that was necessary to feel the most secure on the horse. No prompting was necessary.

Week 3: Noah couldn't get on that horse fast enough. When his time on horseback ended, Noah’s PT had him do some running, throwing, and climbing using onsite equipment.

Week 4. Noah rode that horse backward! The PT actually had him sit facing the horse's tail for part of the session. He rode in from the trail in that position, and it was evident by his posture and expression that his confidence level was very high. After the ride, he continued his running, throwing, and climbing.

The Results
The biggest change for Noah has been the area of speech. Prior to hippotherapy, he could say only a few words clearly and would attempt speech only if it was modeled for him. After only four sessions, Noah speaks about 20 words clearly and is making approximations of several more, sometimes spontaneously. Something extraordinary happens to Noah when he is up on that horse and it carries over to his daily living. The feeling of the rhythm of the horse walking seems to be helping Noah’s brain organize what it needs to make speech happen.

Hippotherapy Vs. Horseback Riding
There is a notable difference between hippotherapy and horseback riding. In hippotherapy, the horse is used as the treatment tool to achieve physical, speech, and occupational therapy goals. In horseback riding, the rider's focus is to improve on their horsemanship skills, and in the process develop companionship, responsibility, confidence, and leadership skills.

Getting Started
So, you're interested in hippotherapy for your child... now what? If your child is at least 2 years old and currently receiving early intervention services, ask his or her therapists if they offer board-certified hippotherapy or if they know of a local therapist that does. I was not even aware Noah's center offered it until I asked. You can also visit the American Hippotherapy Association to find a therapist in your area. Remember, this is not just a physical therapy option; speech and occupational therapists can also be board certified to conduct hippotherapy sessions as well.

And now for the question everyone wants answered: Will insurance pay for it? Under some policies, yes insurance will pay for it. When submitting therapy claims, the insurance company is not usually interested in what equipment is used in therapy; they just want to know who provided the service and that the therapy did take place. Unless a policy specifically excludes equine-assisted (horse) therapy, they will likely cover it. Unfortunately, Medicaid is an insurer who specifically excludes hippotherapy. The good news is that many of the hippotherapy centers offer scholarships, so don't hesitate to ask if you need one.

Happy Trails!

Your Turn
I was so excited after reading Alyson’s post that I went straight to the AHA and located a few therapists in our area. We are going to pursue hippotherapy! How about you? Has your child participated in hippotherapy? If so, were you impressed with the results? If your child hasn’t done it yet, are you interested in checking out hippotherapy?

Supplements—DHA & EPA

What is it?
Docosahexaenoic acid (DHA) is an omega-3 essential fatty acid derived from fish oil. Eicosapentaenoic acid (EPA) is another omega-3 fatty acid and it is often found in products that contain DHA.

Why would I want to give it to my child?
DHA is required in high levels by the brain and retina as an essential nutrient to provide for optimal neuronal functioning (learning ability, mental development) and visual acuity.

Studies have been done on children with autism and with other developmental differences, and the results showed that after 3 months of taking DHA & EPA, there was a 6 month improvement in reading and spelling levels, as well as significant behavioral improvements.

When I asked our developmental pediatrician about omega-3 oil, he said that there is proof that it has positive impact on brain development in infants and children. I had already been using it for a while but this was reassuring to hear.

Where can I get it?
Moms can start introducing omega-3 during pregnancy by taking fish oil supplements. Then later your baby can continue to receive DHA & EPA through your breast milk. Some formulas are enhanced with DHA, (but as far as I know, only Baby’s Only by Nature’s One derives the DHA from eggs. More on this topic under side effects.) Omega-3s can also be found in enhanced milk as well as in enhanced eggs (I wonder what those chickies eat).

The easiest way to get it, and one of the safest, is through Nordic Naturals Children's DHA which has the highest omega-3 level of any cod liver oil. Nordic Naturals products have consistently high standards and test under the maximum allowances for toxins and heavy metals.

There is also a plant derived omega-3 fatty acid, a-linolenic acid (ALA), but the metabolic conversion of ALA to DHA/EPA (combined) by metabolism is very limited in humans and certain forms of ALA have risks associated with taking them.

What are the side effects and risks?
One of the positive side affects of taking omega-3 oil is that it helps to keep your baby from becoming constipated. Like some other oils, it helps to keep things moving along.

The Nordic Naturals website lists possible repeating (or spitting up) as a side effect. It says if this happens it could be because, “your body may not be manufacturing enough lipase, the digestive enzyme our bodies make to digest fats and oils. If you haven't ingested fish oils for a long time, it might take a week or so for your body to adjust and make more of this enzyme.”

Aside from that, I have found no other negative feedback associated with the Nordic Naturals omega-3 fatty acids, DHA & EPA.

Mercury and other toxins are a risk associated with some brands of omega-3 oils so do brand research before you purchase an omega-3 supplement.

Several sites mention dangers in the processing of ALA oils, Mortierella alpina oil and Crypthecodinium cohnii oil (sometimes listed as M. alpina oil and C. cohnii oil). These oils are extracted from fermented fungus and algae with a neurotoxic chemical solvent. The C. cohnii oil (algae) & M. alpina oil (fungus) used in many infant formulas are treated with hexane solvent, acid, and bleach. Some infants have experienced serious adverse reactions to these additives. Hmm, I wonder why.

Based on my research I did when choosing a formula and supplements, I found that Baby’s Only formula and Nordic Naturals omega-3 oil were the safest ways to get DHA & EPA into my babies. All of my children are still taking one or both of these products.

Your Turn
Is your child taking some form of DHA supplement? If so, what are you using and what results are you seeing if any?

Sources
DHA/EPA Omega-3 Institute
Omega-3 Fish Oil Blog
Nordic Naturals
The Cornucopia Institute

Mama Bear, Mama Bear, What Do You See?

Just as newborn babies of differing nationalities or races have visible distinguishing features, so do babies with Down syndrome. While babies with Down syndrome do share some unique features, they mostly look like their biological parents and other family members. All babies are different and not every baby will have all or even most of the physical characteristics described below.

Babies with Down syndrome have very delicate facial features (which have no negative effect on your baby’s senses or intelligence.) You will find that your baby’s features are very proportionate.

Head: your baby may have a marginally smaller head circumference. This size difference is hardly noticeable and you may not even see it or realize it until your pediatrician measures him and marks his growth chart. The back of your baby’s neck may be chunky but this disappears with age. The back of your baby’s head may be a bit less rounded than the average newborn.

Nose: your baby may have a cute button nose with a softly contoured nasal bridge. This smoothness lends itself to a slightly more broad facial appearance.

Eyes: your baby’s eyes may turn gently upward at the outer edge. His actual eyes will be the same size as any other baby but may give the illusion of being beautifully enhanced if your baby has sparkling brushfield spots. Your baby’s eyes may also have small crinkles at the inner corner called epicanthal folds.



Mouth: your baby may have a little rosebud mouth. A smaller mouth may give the illusion that an average sized tongue is bigger than it actually is, (though the jury is still out on whether some children with Ds do have more ample tongues.)



Ears: babies with Ds are graced with petite ears that may or may not have a slight curve at the top. Sometimes baby’s ears are set a little further down on his head though this is hardly noticeable.

Hands: some babies with Ds have a single line on their palms called a transverse palmar crease. This crease occurs in more than 3 percent of the general population.Your baby’s hands may be smaller and his fingers maybe shorter than average. This does not interfere with a baby’s gross or fine motor skills.

Feet: some babies have a small space between their first and second toes which is often accompanied by a vertical crease on the sole at this spot.



Chest: your baby’s chest may appear slightly bowed out or slightly depressed. This minor difference in shape has no negative effect on your baby.

Skin and hair: you may find yourself with a fair-skinned baby who has lighter colored hair than yours. Some babies have very fine soft hair that may be thin in spots. These thinner spots should fill in as your baby grows.

Muscle tone: many babies with Ds have low muscle tone. While this has no bearing on how your baby looks, you will notice that your baby is a bit floppy with an amazing level of flexibility.

So, mama bear, mama bear, what do you see? I see an adorable baby looking at me.


Picture credits: Kacey's daughter Ella Grace, and Lisa's son Finnian

That Rowdy Tongue

The rumors are true... some of our children are well-endowed with super-dee-duper tongues that come in quite handy for long distance frosting frolicking. The tongue, being a muscle, is susceptible to hypotonia and thus may be a bit difficult for your baby to keep under control.

Don’t stress about it because there are lots of things you can do to teach your little one how to manage her tongue. In the early years you will need to do the work of training this muscle for her. The payoff is greater oral motor control which means an easier time eating and speaking, as well as keeping her mouth closed when in a resting state.

The best exercise you can do is called tongue-walking. Every time your baby’s tongue is hanging out you can walk it back in by using your finger (keep gloves or antibacterial hand sanitizer on hand) to gently tap tap tap from the end of it up the center of it until you have reached the middle portion of it. Your baby’s tongue will instinctively retract and tighten in response to your touch. Do this exercise a few times in a row several times a day and anytime you spot her tongue being lax.

Other exercises include various versions of “kissing”. Put your face up close to your baby’s face and make a rounded kiss shape with your lips. Then make the kissy sound. Your baby will try to imitate you thus pulling in her tongue and strengthening her lips and cheeks. You can also do this using the “m” sound positioning of your lips. Make the sound “ma ma ma” and then put your mouth in the closed “m” position right on your baby’s mouth and hum the “m” sound so she can feel the vibrations on her lips. This also encourages her to imitate you and helps her to feel what that closed mouth “m” sound is like.

When your baby is ready to move on from the nursing or bottle stage, you can offer a cup that has a straw. Mr Juice bear or the NUK straw cup (available online at beyondplay.com and in-store at Walmart, respectively) are great options. Teaching your baby to drink from a straw rather than a sippy cup will stimulate good lip closure and keep her tongue in. (Sippy cups allow her tongue to slide out under the spout enabling bad habits.)

As your child gets older you will be able to add gentle touch mouth cueing to get her to pull her tongue in and close her mouth. There may always be times when she is tired, excited, or concentrating hard that her tongue will try to make an escape but by working with her from a young age you will minimize this and help her to gain control over that rowdy tongue.

Good Intentions - Planning for the Future - Part 1

There are several parts of planning for your child’s future that I will be covering over the next couple months, ranging from writing your will to buying life insurance. I am going to start with the Letter of Intent because it is free and you can get it done with no professional help.

A letter of intent is a document written for future caregivers that describes your child and the life vision you have for him or her. (Older and adult children can and should help with the life vision but I am writing for the 0-24 month crowd, so you’ll be doing all the planning for now.)

What does this mean? Well, imagine that tomorrow someone else had to step into your shoes and take care of your baby. What routines should they know about, food allergies, preferences, dislikes? What is your bedtime routine? Does your baby love the bath? Is your child on medication? It is important to document these things.

And what about the future you envision? Should your teenager have an allowance? What type of discipline do you want to employ? Do you want to restrict your child from watching rated R movies? Do you want your child raised in a particular faith? Do you want your child to have a particular diet?

After researching several sources on the letter of intent, I have put together a template letter that you can use as the base for your child’s letter of intent. Download the .pdf file and use it as a guide, or email me for a text version of the file that will enable you to type into the document.

Keep in mind when you are writing the letter that you will be updating it every six months or so to keep it current. You’ll need to keep a completed copy of the letter with your important papers, as well as a working copy on your desk or computer.

It is hard to think about what life would be like for our children without us. However, if we don’t go through this exercise, we risk our children not benefitting from all the loving care we have planned for them in our hearts.

Your Turn
Is there something I forgot to put in the letter? Have you already written your letter of intent?

Got Tone?

Babies with Down syndrome have low muscle tone, or hypotonia. When I first heard this, I thought it had something to do with the muscles themselves and that once strengthened everything would be fine. I harbored secret fantasies of mommy/baby strength training with a cute twenty-something trainer. In my imagination, she and I both ended up with hard bodies.

I soon found out that the strength of a muscle is not related to its tone, although low tone can contribute to lower muscle strength. Muscle tone has to do with the amount of resistance to movement in a muscle. This means that the muscle is less stiff than usual and more easily stretched, making it more difficult for the muscle to maintain stability. It also has to do with the speed of the muscles’ responses. It is considered to be a central nervous system disorder and can be thought of as sketchy communication between the brain and the muscles.

You probably don’t need me to describe the clinical characteristics of low muscle tone. You see it everyday. I do too. But just in case you not sure what types of situations are caused by it, I’ll share a few examples. My daughter has difficulty with muscle control (evident when she tries to eat a puff but misses her mouth), slowness of muscle responses to her brain’s commands (the delay between when I jiggle her abs and when she rolls over), and slower reflexes (it takes just that little bit longer for her to cry when she gets a boo-boo.)

However, she can eat a puff, roll over, and cry when she hurts. Low muscle tone doesn’t mean your baby will not develop along the same path as a typical baby. She will... as long as you provide intervention... you know it, the training sessions I was so eagerly fantasizing about.

Work Those Abs, Baby




The strategy for minimizing the effects of low tone has a two-pronged approach. Provide lots of stimulation to improve your child’s muscle function and control, and exercise her muscles regularly to instill a deep, conscious awareness of how her muscles work. Think of it as waking up sleeping muscles and then helping to pave the communication highway between the brain and the muscles.

What should be reflexive (automatic) isn’t and must be learned, and the earlier the better. That is why early intervention is so valuable to counteracting low tone. Starting early ensures that a conscious awareness of how to use her muscles will be deeply ingrained, thus providing the most benefits possible. Early and consistent muscle stimulation and training will help your child reduce the effects of low tone.

Wait, There’s More
Hypotonia does not affect intellect. That’s good news. So say it to yourself loud and clear... the effects of my baby’s low tone have no bearing on his cognitive abilities. Your baby is smarter than you know.



Picture Credit
TUC's Kimani

If you have pictures of your baby under the age of two that you would like to share for use on this blog, tell me. I will visit you and let you know what I need for upcoming posts.