Equitation for Amputees
Riding for the physically handicapped is a relatively new field of endeavor. In the United States the sport has been recognized for its therapeutic value only within the last decade. For amputees riding can be a very successful and rewarding experience. However, in some instances assistive devices such as the rein bar1 are necessary for beginners learning the balanced forward Hunter-Seat type of equitation. The rein bar (Fig. 1 ) was developed at the Children's Rehabilitation Center. It was originally designed for use by unilateral below-elbow amputees, but has also been used successfully by unilateral above-elbow amputees to direct the lateral movements of the horse.
Tacking and Mounting
Although the rein bar is applicable only to the mounted rider, a look at the pre-mounted stage of riding is in order.
Since this report was prompted by experiences with a 10-year-old boy wearing an above-elbow prosthesis incorporating a Dorrance 88X hook, the discussion will be directed primarily at this level.
Before a child can become an educated, functional rider it is imperative that he learn to tack his mount. With his prosthesis the unilateral above-elbow amputee can tack almost as well as a "normal" child. The child rider is not able to bridle his mount because he is too short to reach the top of the horse's head. However, when he is tall enough he should be able to bridle the horse by resting the bit of the bridle on his prosthesis and pulling the headband over the horse's head with his unaffected extremity. It is necessary, however, for the instructor to fasten the reins of the rein bar onto the bridle.
The above-elbow amputee can saddle his mount successfully (Fig. 2 ) if an attendant assists in lifting the saddle onto the horse's back.
The amputee with this level of disability will experience difficulty in mounting a horse since mounting is a technique which requires two unaffected upper limbs in order for the rider to be self-sufficient. One arm is used for balance and the other is used to pull the rider's body onto the saddle. Thus, the upper-extremity amputee rider must learn to compensate for his disability by assuming a semijackknife position after his feet have left the ground. While he is pulling himself up, the child should be steadied by the attendant to protect him from falling backwards (Fig. 3 ).
In riding the balanced forward Hunter Seat, the unilateral above-elbow amputee has many alternatives to use of the rein bar, but all are less functional. Obvious alternatives are:
1. Using the prosthesis without the rein bar. The hook fingers of the prosthesis are used to hold one rein while the sound hand holds the remaining rein. This method is not recommended because the rein can slide out of the hook fingers. Moreover, the prosthesis could be jerked out of place by a sudden motion of the horse's head. Also, the beginning amputee rider is not able to hold the reins effectively in his unaffected extremity.
2. Riding without either the prosthesis or the rein bar. The unaffected extremity could grasp a knot formed by tying the two reins together. However, this method is not satisfactory because the rider can only pull back on the reins; he has no method of guiding the horse in a lateral direction.
3. Using the rein bar without the prosthesis. In this situation the above-elbow amputee has a method of guiding the horse. However, without the prosthesis the child does not have sufficient balance, and balance is the key to successful riding.
When the upper-extremity amputee rides with the rein bar and his prosthesis, he is a functional, competent and even competitive rider (Fig. 4 ). The prosthesis provides balance and he has a method of guiding the horse. The rein bar may also be used satisfactorily at gaits of increased speed. However, the rein
bar does not, of course, maintain the amputee's balance automatically as increased speed and different motions tend to throw the rider off balance. This can be easily seen when the amputee learns to canter (Fig. 5 ). The amputee with his rein bar and prosthesis must make the same type of adjustments to these situations as the "normal" rider.
Psychological Effects of the Rein Bar
The rein bar does make the amputee realize that he is different from other children. However, this drawback is offset by the fact that the amputee can ride essentially as normal children do (The amputee who was the subject of this report recently placed second in a statewide horse show and has become an accomplished jumper with the rein bar). In addition, the rein bar is often used only as a temporary device and discontinued after the rider reaches physical maturity.
Differences Between Below-Elbow and Above-Elbow Amputees
Horseback riding for above- and below-elbow amputees is quite similar. Both groups require the rein bar in order to have functional control of the horse. The only marked difference in the two situations is that the below-elbow amputee does not need a prosthetic device in order to maintain balance while riding since the remaining part of the upper extremity is adequate for this purpose. However, for the unilateral above-elbow amputee, balance can be maintained only through the use of the upper-extremity prosthesis which rests on the inside of the rider's thigh.
Horseback riding for the child with a single upper-limb amputation can be successful and rewarding when the necessary assistive devices are used. Both the rein bar and the prosthesis must be used in order for the unilateral above-elbow amputee to be a functional rider. Riding can be a safe, lifelong sport for amputees if it is initiated with the correct equipment and careful teaching.
The assistance of Mr. I. C. Collier of Ivy Creek Stables, and Mr. R. C. Adams, Director of Recreational Therapy and Adapted Physical Education at the Children's Rehabilitation Center of the University of Virginia Hospital, in making this program possible is gratefully acknowledged.
Linda Kuhlthau is Therapeutic Recreation Assistant, Children's Rehabilitation Center University of Virginia Hospital, Charlottesville, Virginia
1. Larkins, Carolyn, Horsemanship for the physically handicapped, Inter-Clin. Information Bull., 9:7:4-11, Apr. 1970.