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The MELTR: A tool for communication assessment in Therapeutic Riding/Hippotherapy - June 19, 2009

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The MELTR: A tool for communication assessment in Therapeutic Riding/Hippotherapy

By: Amy Ogburn, Ph.D., CCC-SLP and Bettie B. Borton, Au.D.

Communication is a universal and defining human attribute. The need to communicate effectively transcends age, race, socioeconomic levels, nationality, and disability. Speech and language are key components of communication, linking feelings, thoughts, records of events, and ideas with those of others. Failure to acquire age appropriate speech and language skills is one of the most devastating and isolating events that can occur in the life of a child, regardless of other limitations or abilities, and the results of such failure can have far-reaching educational, familial, and social implications.

Communication disorders, which include speech and language disorders, are a high incidence disability. According to the U.S. Department of Education (2000), approximately 20 percent of children receiving special education services are receiving those services for speech and language disorders. It is estimated that one in ten persons in the United States has a speech and language disorder of one type or another (National Information Center for Children and Youth with Disabilities, 1996). During the 1998-99 school year, a total of 1,074,548 students ages 6-12 were identified as having speech and language impairments (U.S. Department of Education, 2000).

Despite the pervasive occurrence of communicative disorders in the pediatric population, therapeutic riding instructors often view even the most basic assessment and remediation efforts as challenging. To date, the majority of formal research regarding the effectiveness of therapeutic riding/hippotherapy has primarily centered on the physical benefits inherent to these interventional strategies. From an historical perspective, physical therapy (PT) has a long-standing relationship with the industry. More recently, the development of a variety of electrophysiological tests for assessment of motor abilities has facilitated objective measurement of the physical benefits provided by equine facilitated activities. Such assessment tools often do not require cooperation from the patient to provide effective outcome measures for physical therapy, and results have provided guidelines that can be effectively used by the therapeutic riding community at large. However, the assessment of speech and language skills mandates the rider’s participation and at times, may depend on the instructor’s observational skills relative to what a child may or may not be able to accomplish via verbal or gestural communication. It is important to note that the authors are not advocating formal and thorough receptive and expressive communication assessment be performed by those individuals who are non-licensed nor certified to conduct these diagnostic measurements. This article suggests ways in which instructors can observe an individual’s communication strengths and weaknesses and determine whether a formal assessment is warranted and facilitate appropriate language stimulation. Therapeutic riding instructors, while not able to implement formal language therapy, and physical and occupational therapists engaged in hippotherapy can serve to stimulate language skills as parents, teachers, and other professionals in contact with the client are also encouraged to do.

Thus, the objective of this article is to 1) emphasize the importance of communication skills within the context of therapeutic riding activities, 2) provide an overview of the abundantly available opportunities to provide language stimulation, and 3) provide the therapeutic riding instructor with a tool to screen basic receptive and expressive communication milestones in children, the Milestones of Early Language for Therapeutic Riding (MELTR) Checklist.

The MELTR Checklist can and should be used in conjunction with Tables 1, 2, and 3, found in 3-4-5 year old chart in to assess the rider’s communication skills based on his/her age. Table 1 lists what normally developing 3-year-olds are able to do in regard to what they are able to say (i.e., expressive communication), what they are able to understand (i.e., auditory comprehension), what to expect in terms of speech abilities or how understandable the rider is (i.e., speech ability), and finally, what basic cognitive milestones should have been attained (i.e., simple age appropriate concepts that the rider should understand). Tables 2 provides information for typically developing 4-year-olds, while Table 3 indicates the performance abilities of 5-year-olds. The MELTR Checklist operates in coordination with these tables so that the instructor may informally assess whether the rider has met these basic milestones while providing the instructor with some direction for appropriate areas of basic language stimulation.

Administration of the MELTR Checklist is fairly simple and designed for use by those with little or no formal language assessment skill. The instructor may either ask the parent the questions or observe the child’s behavior and answer the questions, or both, which again are tied to the previously mentioned tables. If a parent reports the behavior has been observed, the instructor should circle “PO,” which represents that it was the parent who observed the behavior. If the instructor observes the child engaging in the targeted behavior, then the instructor should circle “TO,” which again indicates that the therapist observed the child. If the child does not engage in a behavior, the instructor should circle the “NO” response to indicate that the child has not yet demonstrated this ability. If an instructor or parent responds “NO” to two or more questions, the child should be referred for formal language assessment. However, the instructor can use the information to stimulate language in which the “NO” response occurred in a naturalistic context in conjunction with equine therapies. For example, if a child does not understand simple prepositions, the instructor can put or direct the child to place a variety of objects in front of, behind, beside, on top of, and under/underneath the horse to teach/reinforce these basic language concepts. It is recommended that if a parent seems to be unreliable in his/her response to areas in which a rider can or cannot perform, it is best to let the therapeutic riding instructor determine the responses to the MELTR Checklist as they may be less biased.

Therefore, the MELTR Checklist offers a systematic design for basic identification and classification of children who may need more formal communicative intervention, but who could benefit from a variety of language based activities designed for therapeutic riding programs. This information, in turn, provides instructors of therapeutic riding with a tool for developing and enhancing speech and language skills within the context of a naturalistic therapy environment.

References

Brooks, M. & Engmann-Hartung, D. (1976). Speech and Language of the Three Year Old. Austin, TX: Pro-ed.

Brooks, M. & Engmann-Hartung, D. (1976). Speech and Language of the Four Year Old. Austin, TX: Pro-ed.

Brooks, M. & Engmann-Hartung, D. (1976). Speech and Language of the Five Year Old. Austin, TX: Pro-ed.

Shipley, K.G. & McAfee, J.G. (2004). Assessment in Speech-Language Pathology: A Resource Manual. Clifton Park, NY: Thompson Delmar Learning.

Owens, R. (2008). Language Development: An Introduction. Boston: Allyn & Bacon.

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Many thanks to our Authors and Doctors Hearing Clinic for granting us permission to print their article on our website.

Doctors Hearing Clinic is a full service private practice, providing state-of-the-art hearing health care and non-medical treatment services to meet the patient's needs, including comprehensive hearing assessment and evaluation, state-of-the art hearing aid selection and service, auditory rehabilitation, forensic audiology, cochlear implant rehabilitation, and hearing loss prevention services for children and adults in central Alabama. Dr. Borton and her staff have more than 30 years of experience in evaluating and treating hearing impairment.

Authors:
Amy Ogburn, Ph.D., CCC-SLP. Dr, Ogburn is an Assistant Professor at Auburn University Montgomery (Alabama). Department of Communication and Dramatic Arts Speech and Hearing Clinic

Bettie B. Borton, Au.D. Dr. Borton is a licensed audiologist in Alabama, and was the first audiologist in Montgomery to hold certification by the American Board of Audiology. Currently, she is a member of the ABA Board of Governors, and will Chair the Board in 2008. Dr. Borton holds a BS degree with CED Certification in Education of the Deaf from the University of Texas, a Masters degree in audiology from the Louisiana State University Medical Center, and a Doctor of Audiology degree from the the University of Florida. She has served as a Visiting Professor and teaching associate at Auburn University, and is Supervising Clinical Audiologist at Auburn Montgomery. She was a clinical audiologist in the Department of Surgery at UAB between 1990 and 1995, and provided patient care services in The Kirklin Clinic.

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Tags: Hippotherapy SLP June 2009 Newsletter Article