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APPENDIX Hippotherapy and Land Based Treatment Activities and Progression.

Session Hippotherapy Activities Land Based Activities 1 Evaluation 2  Forward and Rear astride  Stop/Start postural challenges  Sit to partial squat transitions  Side sitting  Quadruped x 600 ft  Quadruped with alternating arm raises  Upper Extremity Activities: weight-bearing and pulling against resistance

3  Forward and Rear astride  Stair negotiation without  Stop/Start postural challenges upper extremity support,  Sit to partial squat transitions placing both feet on each  Side sitting step, with contact guard  Quadruped x 400 ft assistance  Tall Kneel x 400 ft  Upper Extremity Activities: reaching and pulling against resistance

4  Forward and Rear astride  Balance beam with hand  Stop/Start postural challenges held assistance  Sit to partial squat transitions  Hopscotch  Sustained partial squat on moving horse x 10 s  Single leg stance x 1 s on  Side sitting right leg ; x 4 s on left leg  Quadruped x 400 ft  Tall Kneel x 400 ft  Upper Extremity Activities: reaching and pulling against resistance 2

5  Forward and Rear astride  Ascend stairs without  Stop/Start postural challenges upper extremity support  Sit to partial squat transitions alternating feet, with arms  Sustained partial squat on stationary horse 3 x held in high guard 20 s  Descend stairs without  Sustained partial squat on advancing horse 5 x upper extremity support 10 s alternating feet 40% of  Side sitting the time  Upper Extremity Activities: reaching and  Throwing and catching pulling against resistance small ball

6  Forward and Rear astride  Ascend stairs without  Stop/Start postural challenges upper extremity support  Sit to partial squat transitions alternating feet, with arms  Sustained partial squat on advancing horse 5 x held in high guard 10 s  Descend stairs without  Side sitting upper extremity support  Upper Extremity Activities: reaching and alternating feet 40% of pulling against resistance the time

7  Forward and Rear astride  Single leg stance x 2 s on  Stop/Start postural challenges right leg  Sit to partial squat transitions  X 4 s on left leg  Sustained partial squat on advancing horse 6 x  Wall squats 2 x 15 s hold 20 s  Ascend and descend stairs  Upper Extremity Activities: reaching and without upper extremity pulling against resistance support alternating feet 100% of the time with left arm in high guard

8  Forward and Rear astride  Ascend and descend stairs  Trunk rotation activities without upper extremity  Stop/Start postural challenges support alternating feet,  Sit to partial squat transitions focus on decreased speed  Quadruped x 400 ft and increased control  Quadruped with alternating arm raises  Wall squats 10 x 10 s hold  Upper Extremity Activities: reaching and pulling against resistance 3

9  Forward and Rear astride  Throwing ball to basket 5  Trunk rotation activities ft away with 50%  Sit to partial squat transitions accuracy  Side sitting  Quadruped with alternating arm raises  Tall kneel x 400 ft  Upper Extremity Activities: reaching and pulling against resistance

10  Forward and Rear astride  Trunk rotation activities  Side sitting while completing throwing activities  Sustained partial squat on advancing horse 3 x 30 s  Quadruped with alternating arm raises on advancing horse  Tall kneel x 400 ft  Upper Extremity Activities: reaching and pulling against resistance

11  Forward and Rear astride  Running over uneven  Side sitting with changes in speed and direction surface  Sustained partial squat on advancing horse 4 x  Squat to stand activities 30 s  Quadruped with alternating arm raises on advancing horse  Tall kneel x 400 ft  Hand-eye coordination activities

12  Forward and Rear astride  Trunk Rotation Activities  Side sitting while completing throwing activities  Side sitting without UE support  Sustained partial squat on advancing horse 1 x 10 s, 1 x 15 s, 1 x 20 s, 1 x 25 s  Quadruped x 400 ft  Quadruped on stationary horse while completing alternating arm and leg raises  Grip strength activities 4

13  Forward and Rear astride  Ascend and descend stairs  Side sitting while completing throwing activities without upper extremity  Side sitting without UE support support alternating feet,  Sustained partial squat on advancing horse 1 x focus on decreased speed 30, 1 x 40, 1 x 50 s and increased control  Quadruped x 400 ft  Quadruped on stationary horse while completing alternating arm and leg raises

14  Forward and Rear astride  Running over uneven  Sustained partial squat on advancing horse 3 x surface 60 s  Squat to stand activities  Quadruped on stationary horse while  Ascend and descend stairs completing alternating arm and leg raises carrying object in both  Hand-eye coordination activities on advancing hands alternating feet horse with contact guard  Upper Extremity motor timing activities on assistance advancing horse

15  Forward and Rear astride  Ascend and descend stairs  Abrupt stop/start balance challenges carrying object in both  Sustained partial squat on advancing horse 1 hands alternating feet minute 30 s with contact guard  Side sitting while completing throwing activities assistance  Quadruped x 400 ft  Tall Kneel x 400 ft

16  Forward and Rear astride  Abrupt stop/start balance challenges  Sustained partial squat on advancing horse 3 x 30 s  Quadruped x 400 ft  Tall Kneel x 800 ft  Upper Extremity movement grading activities 5

17  Forward and Rear astride  Ascend and descend stairs  Abrupt stop/start balance challenges carrying object in both  Sustained partial squat on advancing horse 4 x hands alternating feet 30 s with contact guard  Side sitting assistance  Quadruped x 400 ft  Tall Kneel x 800 ft  Upper Extremity movement grading activities

18 Re-evaluation