Therapeutic Riding in Dystonia: methodological guidelines in the treatment of the main target symptoms

Therapeutic Riding (TR) is especially indicated in dystonic disorders. Nonetheless, even more so than in neuromotor pathologies, the therapeutic result depends upon a correct methodological approach. Postural and motor competences of dystonic subjects are extremely sensitivite to sensory inputs; since horseback riding gives rise to a wide range of esteroceptive, proprioceptive and kinaestetic inputs, it can sensitively modify the functional competences of the subject. The difficult task of TR Therapist is to select, filter, and control the rich variety of somatosensory inputs which the horse transmits so as to inhibit pathological dystonic symptoms and to favour active control of posture, of dystonias and involuntary movements. Besides the sensitivity for sensory inputs, the dystonic subject is also markedly sensitive to environmental factors and to intrinsic factors such his state of health and his psycho-emotional condition. The motor picture is characterized by variability in muscle tone and postural and motor patterns, by inconsistent functional competences, by alterations in the coordination and temporization of voluntary movement. Frequently observed are saboteur motor patterns such as avoiding or startle and the interference of involuntary movements or tremors. Verbal and non-verbal communication may be disturbed by severe dysarthria and by grimaces. The intellectual level however, is often good even when motor impairment is severe. Associated symptoms include perceptive disorders, dysphagia, sialorrhea, and neurovegetative alterations (alterations in breathing, pressure, thermal regulation etc.). From the psychic point of view, dystonic subjects are often emotionally unstable. They move easily from one emotional state to another and find it hard to control their feelings. Variability is the only consistent factor in their pathological picture and this makes them vulnerable and potentially anxious but also tenacious and stubborn; they do not love change and seek, at least in their environment and reference figures, consistency and repetition in order to have the sensation of controlling everything that surrounds them.