OTH 5 5 5 : OC C UP ATION-BAS ED HEALTH P ROMOTION

Hippotherapy
in the Management of
PelvicFloor Dysfunction
Cassidy Crider, Ruby Guevara-Nava,
Mollee Gray &Annie Turtura
 PelvicFloor Dysfunction
The pelvic floor is made up of several muscles that support the
re ct um like a sling. Coord inat e d cont ract ing and re laxing of t he
p e lvic floor m uscle s cont rol b lad d e r, b owe l and se xual funct ions
(Corrê a e t al., 20 19 ; Frot a e t al., 20 18).

Pe lvic floor d ysfunct ion (PFD) occurs whe n t he re is e it he r t oo

m uch t e nsion on t he p e lvic floor m uscle s or not e nough (De Silva
& Rose nb e rg, 20 17).

PFD sym p t om s includ e :

• Urinary issue s like p ainful urinat ion or t he urge t o urinat e
• Lowe r b ack p ain
• Pain in t he p e lvic re gion, ge nit als, or re ct um
• Const ip at ion or b owe l st rains
• Muscle sp asm s in t he p e lvis
• Pre ssure in t he p e lvic re gion or re ct um
• Discom fort d uring se xual int e rcourse
 Prevalence &
effect on qualityoflife
At least one in three women will experience a pelvic floor
d isord e r in he r life t im e , and one in four wom e n old e r t han 20
ye ars of age will e xp e rie nce p e lvic floor sym p t om s like urine or
st ool le akage (Wu e t al., 20 14).

Re ce nt st ud ie s (Re is e t al., 20 21; Zhu e t al., 20 19 ) have id e nt ifie d

t hat t he p re se nce of PFD and t he im p act of it s sym p t om s lowe rs
he alt h-re lat e d q ualit y of life in wom e n in t he following ways:

• lim it s act ivit y

• incre ase s social isolat ion
• je op ard izes p e rsonal re lat ionship s
• re d uce s p art icip at ion in le isure act ivit ie s
• ne gat ive ly im p act s t ask p e rform ance
 Disparities
• Increasing age and hormonal changes are associated with increasing prevalence of
PFD (Kenne et al., 2022).
• Health literacy is disproportionately lower in women of lower socioeconomic status,
non -English speaking, older age, and ethnic minorities (Hartigan & Smith, 2018).
• With less access to education overall, Hispanic women are more vulnerable to
poverty and poverty -related health conditions that impact their ability to receive
appropriate care for PDF (Gurayah et al., 2024).
ContributingFactors
• Rural women experience poorer pelvic health
outcomes and have less access to health care than
urban women (Lee et al., 2020).

• Many women do not seek treatment either because

of embarrassment or because they do not
understand the etiology and possible treatment
options (Anger et al., 2012).

• Women earn less than men and are more likely to

face challenges affording and accessing care
primarily due to their reproductive and postpartum
healthcare needs (Glynn et al., 2016)
 Treatment for PFD
Surgical treatments include:
• Vaginal, laparoscopic, or robotic surgery for pelvic
organ prolapse;
• Mid -urethral sling or urethral bulking procedures for
urinary incontinence;
• A pacemaker-like device is surgically implanted in the
fleshy part of the buttocks to stimulate the sacral
nerves that affect bladder function ( Gokhan, 2023).

Nonsurgical treatments include:

• Pelvic floor muscle training;
• Manual therapy;
• Biofeedback therapy;
• Electrical stimulation;
• Vaginal pessary;
• Environmental modifications;
• Education on lifestyle changes, hygiene practices,
nutrition, relaxation and pain management, and
medication management. (Bahr, 2023).
OccupationalTherapy’sRole
Pelvic floor rehabilitation is an emerging yet essential area of
OT (Ald e n e t al., 20 20 ). OTs can significant ly im p rove a clie nt ’s
he a lt h a nd we ll-b e ing and incre ase p a rt icip a t ion in t he ir role s,
act ivit ie s, and occup at ions b y e st a b lishing a nd re st oring
p e lvic floor funct ion in t he following ways:

• Ed uca t ion ap p roache s focus on m ind fulness, b e havioral

st rat e gie s t o achie ve re laxat ion, and life st yle change s,
includ ing wat e r int ake , nut rit ion, and p hysical act ivit y;
• Act ivit ie s focus on e xe rcise s t hat st re t ch and st re ngt he n
t he p e lvic floor m uscle s;
• Physica l a ge nt m od a lit ies use e le ct rical ne rve st im ulat ion
t o se nd m ild e le ct rical p ulse s t o ne rve s in t he lowe r b ack
t o he lp m anage urinary funct ion, and visual/aud it ory
st im uli p rovid e b iofe e d b ack t o he lp clie nt ’s m ake t he ir
e xe rcise s m ore e ffe ct ive (St rom sd orfer, n.d .).
 Stakeholder Interview
Who are They? Identified Needs Unique Characteristics

• Professional Association of • A lack of funding, access to • Targets cognitive, physical and

Therapeutic Horsemanship transportation, and awareness psychosocial needs.
(PATH) Certified. of what hippotherapy and • Is fit for all ages and types of
• Responsible for preparing equine -assisted therapy can pelvic floor conditions.
teaching materials for the provide to clients. • Fills the gap in an area that is
lessons, educating clients and • Limited access to educational, currently under -served and that
volunteers on safety protocols, behavioral, and physical has limited services.
and ensuring safety throughout resources in the community to • Services can be transported to
the sessions. support the average woman’s various locations.
needs.
ProgramPlan Mission
Using equine-assisted interventions to empower all women
to take control of their physical and mental health.

Core Values
Community
Compas s ion Empowerment
Collaboration
• Empathetic • Helping • Creating a
and women gain network of
nonjudgmental control over resources
care their health
ProgramPlan
Goals
Go a l 1
By the end of the 8 -we e k p ro g ram, 8 0 % o f p artic ip ants will
d e mo ns trate s afe ho rs e hand ling te c hnique s and e me rg e nc y
re s p o ns e s kills at the s tart o f e ac h e quine -as s is te d the rap y s e s s io n,
as me as ure d b y a s afe ty c he c klis t s c o re o f 10 0 % with minimal c uing .
Go a l 2
By the e nd o f the 8 -we e k p ro g ram, 8 0 % o f p artic ip ants will re p o rt a
4 0 % imp ro ve me nt in the ir o ve rall me ntal he alth and we ll-b e ing , as
me as ure d b y the De p re s s io n, Anxie ty, and Stre s s Sc ale (DASS-2 1).
Go a l 3
By the e nd o f the 8 -we e k p ro g ram, 8 0 % o f p artic ip ants will ac hie ve at
le as t a 3 0 % imp ro ve me nt in the ir ab ility to p e rfo rm d aily living
ac tivitie s ind e p e nd e ntly, as as s e s s e d b y the Pe lvic Flo o r Imp ac t
Que s tio nnaire —s ho rt fo rm 7 (PFIQ-7).
 ProgramPlan
Model
Person-Envrio nme nt-Oc c up atio n-Pe rfo rmanc e
This mo d e l a to p -d o wn a p p ro a c h e mp ha s izing tha t o c c upa tio na l p e rfo rma nc e is s up p o rte d
b y the inte ra c tio ns b e twe e n the p e rs o n, the ir e nviro nme nt, a nd the ir o c c up a tio ns
(Ba s s e t a l., 2 0 15 , a s c ite d in Co le & Tufa no , 2 0 2 0 ).

Frame ofReference Frame ofReference

Co g nitive -Be havio ral Bio me c hanic al
Fo c us e s o n ho w a p e rs o n's b e ha vio r, e mo tio ns , Fo c us e s o n c lie nt's kine ma tic s , s ta b ility,
tho ug hts a nd / o r e nviro nme nt c a n c re a te b a rrie rs e nd ura nc e , a nd s tre ng th while a d d re s s ing p ro p e r
to the ir o c c up a tio na l p e rfo rma nc e a nd will g uid e e rg o no mic s a nd mo d ifying a c tivitie s to d e c re a s e
s up p o rt g ro up inte rve ntio ns b y e nc o ura g ing p a in a nd p re ve nt furthe r d a ma g e o r wo rs e ning
wo me n to s up p o rt e a c h o the r’s b e ha vio rs , p e lvic flo o r d ys func tio n.
e mo tio ns a nd tho ug hts .
 ProgramPlan
TypesofIntervention
Ac tivity - Us e s hip p o the ra p y to s tre ng the n p e lvic flo o r mus c le s .
Gro up Inte rve ntio n - Sup p o rt g ro up to d is c us s b a rrie rs a nd c re a te g o a ls .
Ed uc a tio n a nd Tra ining - Info rm c lie nts a b o ut the ir p e lvic flo o r a nd its d ys func tio n.
Ad vo c a c y - Dis c us s PFD with s ta ke ho ld e rs with ho p e o f no rma lizing to p ic .

Frequencyand Duration
Eig ht-we e k c o urs e
M/ W/ Sa t: 6 0 -minute s e s s io ns
Mo nd a y: Ed uc a tio n We d ne s d a y: Sup p o rt Gro up Sa turd a y: Hip p o the ra p y
Client health
education
Purp ose
• What are our goals?
• What do we want clients to gain
Audience
• Who will be participating in the sessions?
• What are their needs and expectations?
• Is it accessible to all clients?
Content
• Is it relevant to the clients?
• Will they learn something new?
Client health
education cont.
Form at
• Simple, clean, straightforward, and
written at the appropriate level for the
target audience;
• Incorporate visual elements to appeal
to different learning styles;
• Incorporate activities to help the
listeners learn and retain information
(Cutilli, 2020).
 Activity Chum Chum & Pancake
Secrets can hold immense power over people.
Wh e n yo u t e ll a p o n y a s e c re t , e s p e c ia lly a n
e m b a rra s s in g o r s h a m e fu l o n e , it s p o we r
d im in is h e s .

Yo u ’re in lu c k b e c a u s e t h e re a re s o m e p o n ie s
wa it in g o u t s id e t o h e a r yo u r s e c re t !

Ta ke n o t e o f yo u r c u rre n t e m o t io n a l s t a t e &
re a s s e s s a ft e r t h e a c t ivit y.

Bt w, t h e b e s t ke p t s e c re t is a
s e c re t s h a re d wit h a p o n y.
 References
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Thankyou!