University of Vermont AAHS

  AMEA

June 1999, Vol. X, Number 2

 Table of Contents

 
Summary of Crush Tests: April 1999
Safety Considerations in Equine-facilitated Mental Health Facility
Use Your Head
Letter to AMEA News
Questions and Answers
Book Reviews
United States Equine Inventory Up
Regional Variations in Equestrian Mortality in Canada
News Items
 


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MARK DAVIES INJURED RIDERS FUND
April 1999
SUMMARY CRUSH TESTS
(See AMEA NEWS February 1998 Equestrian Helmet Testing)

This work evaluated the crush protection of equestrian helmets. Four helmet models were tested: two jockey style helmets to Product Approved Specification (PAS) 015 - the British equestrian safety standard - (Champion Pro Plus and Charles Owen Competitor) one jockey helmet to American Society Testing & Materials (ASTM) F1163 - equestrian safety standard used in the United States - (International) and one lightweight helmet to ASTM F1163 (Troxel Equestrian).

A helmet may be designed to protect against crush in two distinctly different ways. The most obvious is to provide a helmet that is extremely stiff in order to resist the magnitude of the force transmitted during a typical crushing accidents. Alternatively, the helmet may absorb the energy transmitted during an accidents in such a way that the force on the skull does not exceed that which is known to cause skull damage. Transport Research Laboratory, (TRL, Old Wokingham Road, Crowthorne, Berkshire, RG45 6AU) conducted a literature search to determine the tolerance to skull crushing injuries. It was found, that when subject to a lateral crushing load, via padded plates, the onset of fracture of the temporo-parietal bones occurred at 10,000 N. (Newton, a unit of force.) It was considered that below this level most people would not suffer skull crushing injuries.

The PAS 015 1998 prescribes a crush test whereby the helmet is loaded between parallel plates, incrementally, up to a maximum force of 630N during which the deformation should not exceed 30mm. The helmet does not contain a headform and is free to collapse. The TRL advocates that the PAS 015 test procedure is not appropriate for evaluating the crush performance of helmets for three reasons: (1) the load of 630N is extremely low compared with the tolerance for skull crushing injuries (10,000N); (2) The performance of a helmet when fitted to a human head is quite different from the performance of an unsupported helmet. A well designed helmet may perform to conjunction with the characteristics of the skull and, therefore, the applied load should be resolved in terms of forces exerted on the head; (3) the applied load is quasi-static and therefore the energy absorption capacity of the helmet is not evaluated.

Nevertheless, TRL conducted crush tests on all four helmet models in accordance with PAS 1105 1998. All helmets achieved the requirement. The maximum deformation was 9mm for the Troxel (ASTM) 20mm for the Champion (PAS), 22mm for the International Riding (ASTM) and 23mm for the Charles Owen (PAS).

The PAS lateral deformation test was repeated, but with a headform fitted and the external load was increased to 10,000N. The loads exerted on the headform were between 8,000N and 9,000N for all helmet models. This result showed that only 10% -20% of the crushing load was resisted by the helmet and the vast majority (80%-90%) was exerted on the headform.

The TRL devised a more appropriate dynamic impact crush test whereby a dynamic lateral crushing load was applied using an impactor. An input energy of 200J (joule, a unit of energy) was used. which was based on the energy absorbing capacity of the helmets measured during preliminary tests. An impactor of mass 10.9 kg was used and the drop height was 1.87m; this gave 200J. During these tests, the maximum crushing loads exerted on the headform were 8,730N for the Troxel (ASTM), 11,840N for the International Riding (ASTM), 12,090N for the Charles Owen (PAS), and 13,670N for the Champion (PAS).

Based on this work, the two ASTM helmets, and the Troxel in particular, provided the best protection from crushing injuries. However, what is not known, is whether an impact energy of 200J is representative of a equestrian crushing accident.

SUMMARY PENETRATION TESTS

 

The TRL evaluated the penetration protection of equestrian helmets by conducting tests in accordance with PAS 015 1994 which specified that a 3 kg impactor with a 60° conical point be dropped onto the helmet from a height of 1 meter. These tests are designed to assess the resistance of a helmet to penetration by a sharp object which for horse riders may be a twig or branch of a tree. However, the inclusion of such a test in a standard should relate to frequently of occurrence in accidents. In this respect the U. S. and U. K. disagree because the PAS 015 requires a penetration test, whereas the ASTM 1163 does not. Instead the edge test is specified and this is quite different in principle.

It should be noted that the penetration requirement of the more recent PAS 1998 is that the same impactor should be dropped from a lower height of 0.75 meter which is a less stringent requirement.

The same four helmets where tested. Two tests were conducted on each helmet model, one to the front (crown) and one to the rear (crown). It should be noted that the Troxel helmet was fitted with ventilation holes and normally the technician would aim for such areas. However, the purpose of these tests was to evaluate the relative performance of the helmet shell and liner and, therefore, the ventilation holes were not impacted.

It was found that all helmets satisfied the penetration requirement of PAS 015 1994. It is, therefore, certain that all of the helmets would also satisfy the penetration requirement of the more recent, but less stringent PAS 015 1998. The three jockey helmets were fitted with a relatively thick outer shell that may have been expected to provide good penetration protection. However, the Troxel helmet, with a lightweight thin shell was, surprisingly, also found to provide a similar level of protection from penetration when tested away from the ventilation holes.

 

SUMMARY OF SMALL HELMET TESTS

The aim of this work was to compare requirements prescribed by ASTM F1163 and PAS 015 for size small helmets,.

The mass of the headform is a key factor when evaluating the impact performance of a helmet. Both PAS 015 (and EN 1984 European) and ASTM F1163 specify a range of test headforms, and each size of helmet is tested with an appropriate size of headform. However, within PAS 015 the mass of each headform is proportional to the size, the smallest headform is the lightest and the largest headform is the heaviest. Whereas, within ASTM F1163, all sizes of headform have the same mass. For medium size headforms, both PAS and ASTM prescribe a similar mass, but for small and large headforms the difference in mass is considerable.

The impact energy during a test is proportional to the mass of the headform for a prescribed drop height. Thus, the impact energy of a heavier headform is greater than a lighter headform. As a consequence, when a helmet is tested with a heavier headform, it is required to absorb more energy and is more likely to crush the liner to the limit. This may suggest that a helmet that was certified with a heavy headform, such as a small ASTM helmet, would be safer because it has the capacity to absorb more energy. However, the acceleration level measured during a test also relates to the mass of the headform, whereby a lighter headform will accelerate at a higher rate for a given impact force. (At a given force, a lighter mass will accelerate at a higher rate than a heavier mass. Editor) As a consequence, a helmet that was certified with a heavy headform such as a small ASTM may yield a higher peak acceleration when tested with a lighter headform. The aim of the small test work was to investigate which of these conflicting mechanisms is predominate.

Two sizes of helmets were evaluated (size medium and size small) using two helmet models, PAS 015 jockey (Charles Owen Kids Own) and ASTM F1153 lightweight (Troxel Equestrian). Impact test were conducted at 6 m's in accordance with the procedure prescribed by ASTM F1163 except that for the size small helmet test a lighter headform to PAS 015 was used.

The ASTM helmet was found to provide very good protection in both sizes medium and small. However, although the PAS helmet was found to provide very good protection in size medium, the size small PAS helmet provided a lower level of protection, particularly at the front and rear. The small PAS helmet was found to bottom out during these test.

The small ASTM helmet was, therefore, found to provide a higher level of protection than the small PAS 015. helmet. The test prescribed by ASTM for size small helmets, whereby helmets are tested with a "heavier" headform, may be expected to result in size small ASTM helmet which are slightly stiffer than equivalent size medium ASTM helmets. However, the difference is marginal. Furthermore, the size small ASTM helmet was able to conform to the requirement of ASTM even when tested with the light PAS headform whereas the size small PAS did not meet the requirements.

Mark Davies Injured Riders' Fund
Little Woolpit
Ewhurst, Cranleigh, Surrey
United Kingdom
GU6 7NP

Comment on Penetration Tests

In ASTM F1163 each sample is impacted at four sites, which must be on or above the test line, and not less than 1/5 the circumference of the helmet from one another. The sites are chosen by the technician and may be in the front, the left side, middle of the back, and low on the right side at his/her determination. The technician measures with calipers to avoid being too close to other test sites, the edge or ventilation holes, and marks the impact sites. When the helmet goes on the headform, the assembly is rotated to be sure that the helmet will hit the anvil on one of the marks. Then the headform/instrument package/helmet is raised to the proper drop height and the wire is tripped to drop it. The computer records the peak g's and prints out a record. The ASTM standard uses the years of Snell, ANSI and DOT standard information which shows that penetrating impacts are so scarce as to be nonexistent, thus ASTM standard allows vent holes.

Drusilla Malavase
Chairman ASTM subcommittee equestrian helmets.

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Safety Considerations in Equine-facilitated Mental Health Facility

Maureen Vidrine, MS, RN, CS and Priscilla Faulkner, Psy. D.

Robert L Faulkner, MD

 

The goal of this article is to highlight some of the unique safety issues associated with mental health clients, to describe the types of clients that can be safely served by this type of program, and to enhance awareness regarding the various organizations supporting this unique form of treatment. This article reports the experience of an equine facilitated mental health center program.

Horse Time is a non-profit equine-facilitated mental health center in Covington, Georgia, that was founded to bring horses and humans together to promote psychosocial healing and growth. Central to the mission of this unique program is the concept of providing services in a context of wellness. Based on 100 acres of typical horse farm, Horse Time is able to expose clients to and involve clients in a wide variety of activities, ranging from mounted activities such as vaulting or riding, unmounted activities such as grooming, feeding, or bathing, and associated farm activities such as stall cleaning and tack care.

Horse Time offers individual, group, and family psychotherapy facilitated by licensed, credentialed psychotherapists who are also experienced equestrians, and therapeutic horsemanship sessions for special needs clients who do not require the intensity of psychotherapy. Therapeutic horsemanship sessions are facilitated by instructors who have been certified by the North American Riding for the Handicapped Association (NARHA) and have additional training and experience in working with clients to achieve psychosocial and behavioral goals.

Horse Time clients have included children with diagnoses of autism, attention deficit disorders, conduct disorders, and anxiety disorders in addition to physical challenges such as cerebral palsy. Adult participants have been challenged by conditions ranging from schizophrenia and depression to eating disorders and substance abuse. Many clients are also seen in a traditional therapeutic setting by therapists who report dramatic improvement after initiation of equine-facilitated treatment. Our therapists have seen autistic children with little interest in human interaction demonstrate empathy for their horse "therapist" (such as the 7 year-old who willingly surrendered his "magic string"- with accompanying sound effects -when told it might frighten the horse.) Children previously crippled by attention deficits are able to process and organize information and focus on the steps necessary to learn advanced equestrian skills. One adult struggling with depression related to chronic physical illness was motivated by her love of horses to care for her own medical needs. Each client is unique, but all have shared the healing power of the equine experience.

The North American Riding for the Handicapped Association was founded in l969 to promote and support therapeutic riding for all special needs in the United States and Canada. In an effort to ensure quality services, NARHA provides instructor training and certification and program accreditation opportunities for all of its members. In l996, NARHA approved creation of the Equine-Facilitated Mental Health Association (EFMHA) as a special interest section. The NARHA Operating Center Standards and Accreditation Manual for Therapeutic Riding Centers includes administration, program, and facility standards that are followed by 500+ member centers across North America. Now revised annually, this manual also includes a listing of medical and behavioral precautions and contraindications to therapeutic riding and suggested forms with which to gather information from program applicants and their health care team.

To ensure safe service delivery, Horse Time adheres to safety guidelines offered by both NARHA and the American Vaulting Association (AVA). Additionally, the program has developed policies and procedures beyond those available from NARHA or AVA. The remainder of this article will illustrate the application of precautions and contraindications and safety standards to our program’s operations.

Because they must be considered in pre-participation screening, precautions and contraindications are especially critical. The NARHA Education Committee’s goal in developing these guidelines is to assist programs to make accurate decisions regarding which clients it can safely serve. Rather than a static list of diagnoses, the committee acknowledges that precautions and contraindications relate to functional capacity, and that the degree of coping and adaptation can fluctuate from person to person and minute to minute.

In the general introduction to the specific precautions and contraindications, the committee offers these common-sense reminders.

Therapeutic riding inherently involves movement-whether the client is riding, vaulting, or driving. If the movement activity will cause a decrease in the client’s function, and increase in pain or generally aggravate the medical condition, therapeutic riding may not be the activity of choice.

The essence of therapeutic riding is the human-animal connection. If this interaction is detrimental to the client or the horse, equine activities may be contraindicated.

Therapeutic riding requires the use of certain equipment in a prescribed environment and is, by definition, interaction with a horse. If the therapeutic riding program cannot accommodate the client’s equipment needs, or the environment will aggravate his condition, riding may not be the activity of choice.

Mounted activities always present the potential for a fall. In most instances, the fall would be from four to six feet above the ground. Such a fall may cause a greater functional impairment than the client originally had. The possibility of a fall should be given careful consideration, and may lead to the informed decision that therapeutic riding is not the activity of choice.

Working around horses involves risk. Even the well-trained therapy horse is sometimes unpredictable, subject to its instinctive fight or flight responses. Horses are large, move quickly, and can be dangerous to the client who is unable to respond appropriately. (North American Riding for the Handicapped Association, l997.)

Because Horse Time is situated on a farm that is not wheelchair accessible and is focused on meeting psychosocial and behavioral needs, we require that participants be ambulatory. All applicants provide medical history including chronic conditions, surgeries, accidents, allergies, medications (including herbs and over-the-counter preparations), pregnancy, and special situations such as photosensitivity or sensory deficits. Each medical history is reviewed by a registered nurse who screens for obvious precautions and contraindications, gathers more data as indicated, obtains input from other members of the individual’s health care team as needed, and notifies the Horse Time service provider as appropriate.

The NARHA Precautions and Contraindications addresses 30+ medical conditions, including seizure disorders and orthopedic conditions. The list of psychosocial and behavioral precautions and contraindications developed by EFMHA (1997) is considerably shorter:

Contraindications: Client is currently

Actively dangerous to self or others (suicidal, homicidal, aggressive)
Actively delirious, demented, dissociative, psychotic, severely confused
Actively substance abusing
Medically unstable (related to psychiatric condition)

Precautions: Client has

History of animal abuse
History of fire setting
Suspected current or past history of physical, sexual, and/or emotional abuse
Gross obesity
Medication side effects
Stress-induced reactive airway disease
Migraines

Since Horse Time offers several levels of service, the amount and type of mental health data gathered is variable. In all situations, however, enough information is obtained to screen for the above precautions and contraindications. Similar to the handling of the medical information, the mental health data is reviewed by a master’s level mental health professional who screens for obvious precautions and contraindications, gathers more data as indicated, obtains input from other members of the individual’s health care team as needed, and notifies the Horse Time service provider as appropriate.

Because most of the programs’ clients have experienced one or more of the above precautions, a dynamic assessment of each client’s mental and behavioral status is essential. To achieve this, Horse Time therapists are supported as needed by assistants who are held to standards exceeding those required by NARHA for therapeutic riding volunteers. These "clinical assistants", as we call them, have all met minimum criteria for experience and education in health and human services and most are also experienced with horses. They are required to commit consistently to attend sessions and attend pre-and post-session treatment team meetings. Additionally, they are aware of the possibility for transference and counter-transference between themselves and the clients and are encouraged to participate in clinical supervision.

The NARHA program accreditation standards address facility safety in some detail, particularly emphasizing accessibility and safety. Horse Time found that the needs of our client population and our horses called for additional attention in this area. For example, an adolescent client was suspected to be smoking in the bathroom and required closer monitoring and a more stringent behavioral plan. With almost exclusively able-bodied riders, our horses get a substantial work-out emotionally and physically and so require daily pasture turnout and individualized training programs.

Vaulting demands specific footing, as outlined by the AVA. Horse Time was also assisted in the development of program standards by AVA. All clients participating in vaulting perform stretching exercises and practice on the barrel prior to mounting. Our vaulting horses and equipment meet AVA rules, which are more detailed than the vaulting guidelines provided by NARHA. In accordance with NARHA standards, however, every vaulter (and rider) wears an ASTM-SEI approved helmet.

In summary, several organizations are available to guide safe equine-facilitated mental health service delivery. Each program, however, must integrate these standards and guidelines in ways that work best for them. For Horse Time, the accreditation standards and precautions and contraindications provided by NARHA and the guidelines of the AVA have proved extremely valuable when supplemented with internally-generated policies and procedures. In the 20 months we have been in business, we have provided approximately 1200 hours of direct client service without one serious injury. Maintaining this track record will mean constant commitment to every program’s most important feature: SAFETY.

Maureen Vidrine, MS, RN, CS is nationally certified both as a psychiatric clinical nurse specialist and as a therapeutic horsemanship instructor. She has over 15 years experience in the field of therapeutic horsemanship and is currently Director of Horse Time equine-facilitated mental health center in Covington, Georgia, and serves as Co-chair of the Equine-Facilitated Mental Health Association’s Standards Committee.

Priscilla B. Faulkner, Psy. D. , President of Horse Time, is a psychologist who also coaches the Falconwood Vaulters of Covington, Georgia. Dr. Faulkner has taught vaulting to special populations for over five years and currently serves 50+ clients per week at Horse Time.

For more information, contact: Robert L. Faulkner, MD, family practitioner, a member of the AMEA, 4186 Mill Street, Covington, GA, 30209, FAX 770/786-5348.

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USE YOUR HEAD

Results from the USPA's testing of helmets are out, and they show that all he1mets are definitely not created equal.

In spring 1997, the Executive Committee of the United States Polo Association sanctioned the Polo Safety Committee to collect polo helmets from retailers' shelves and test them according to our established safety index. Because some junior players still use the conventional hunt cap, we also tested the most widely sold hunt cap as well as a popular Bell motorcycle helmet. The Executive Committee has started a precedent to periodically send helmets for independent testing by the Safety Committee. It has also been resolved that if a manufacturer introduces a new helmet that agent should send his helmet to the Wayne State Testing Laboratory before the helmet is introduced into the retail market. The cost of such testing would be born by the manufacturer. Later the Safety Committee would collect the same helmet from a retail store and run its own independent safety test that would be performed by the Wayne State Bioengineering Laboratory.

The last such thorough testing of polo helmets was done in 1987. During the 1980s, while working with Wayne State Bioengineering Laboratory, the severity index standards for polo helmets were developed. The current National Organizational Committee for Safety Athletic Equipment standards for polo helmets are the most stringent for any sports helmet.

The Safety Committee felt it was important to answer some practical questions about helmets. For example, if the helmet has a shelf life of more than five years, should it be discarded and not worn by a player? What effect does drilling holes and attaching a facemask have on the structural integrity of a helmet? What force does it take, for example, if a horse were to roll across the helmet and crush it? In the 1980s and early 1990s, the Safety Committee did three player injury survey studies. Those studies have been published in POLO magazine over the past few years. There were some striking results. Despite the fact that fractures, bruises and contusions constitute 54 percent of the injuries, mostly to the arm, face, head and neck, concussions at 11 percent remains a daunting figure. Thirty-three percent of injuries occurred to the face, compelling us to look at the face mask and goggle issue. In 1993, seven of the nine helmets used in interscholastic polo did not even meet our safety standards. It is out of such studies that the Safety Committee recommends to all players that they wear an approved helmet and facemask.

Helmets won't protect against all head injuries. We recommend placing an effective facemask on all helmets. Helmets with or without facemasks will not protect against neck injury. There are been arguments that a facemask could cause a neck injury, but that has not been our finding. We do not know of any neck injury related to wearing a helmet with or without a facemask. Testing of helmets shows that they will crush and deform if a force of 500 to 800 pounds is applied to the side of the helmet--that is if a horse were to roll across one's head. The same force deforms the stainless steel facemask attached to the helmet, but the welds to the facemask do not break and the facemask does not detach from the helmet.

Over the past 10 years some helmets have disappeared while others have become more popular, mostly for cosmetic reasons. We have seen an uptick of helmets from South America that, for the most part, have no testing standards applied to them at all. Some helmets have disappeared because a low demand for polo helmets makes it impractical to continue manufacturing them. Nevertheless, over the past year, we found 14 helmets in current use.

The important number to remember when looking at the helmet selection data is 1,100. If the number is below 1,100, it is a safe helmet and the risk of severe brain injury decreases dramatically. However, if the number is above 1,100, then the risk of severe brain injury dramatically increases. The helmets are tested from four sides--the front, the side, the rear and the top, and therefore receive four different scores. The helmets may score differently from different positions and the ideal scenario would be to have all four scores under 1,100. More often than not, that is not the case, but if the helmet scores well in at least three categories, the fourth should probably not be far out of line.

Of the 14 helmets tested, the Bond Street, the Polo Gear 2000 and the Spectra had the best results. A cumulative score rating would show very few mid-range helmets and some very obviously poorly constructed helmets. The hunt cap does not test well and probably should not he used as a polo helmet, and the Bell Hard Shell motorcycle helmet tested only slightly better than the hunt cap. All helmets received two tests. Only two helmets clearly stood out as having a good recovery, and they were the Bond Street 1998 and the Polo Gear 2000. The remainder when tested the second time had a dramatic increase above 1,100, 'This data should he interpreted to mean that these helmets should be discarded if one had a severe head injury and especially if there was an obvious crack in the helmet after a traumatic incident. All helmets were tested with a commercial chin strap. Breaking of the chin strap was not a factor, and, therefore, we believe the chin strap on polo helmets is relatively safe. Some chin straps employ a plastic buckle and these have been known to break. There is also a chin strap with a steel buckle. Aside from the occasional rusting of the buckle, there was no reason to believe that there was any safety issue with a conventional under-the-chin strap or buckle type strap.

It is the hope of the Safety Committee that old and new players alike will make an educated decision when purchasing their first polo helmet or replacing their old helmet. The number to remember is 1,100. If it's under 1,100, the helmet is safe; if it is over 1,100, the risk of severe head injury is higher in case of a collision. There arc some safe, cosmetically appealing helmets in the retail stores. Purchasing helmets that have not undergone standard testing procedures should he avoided. We recommend that facial protection be used as well. Thus far, we think the present stainless steel mask is far superior to wearing no facemask at all. Although goggles are becoming more popular, we thus far do not have a goggle that will withstand the impact of a polo ball traveling at 84 mph.

Tim Nice, MD
USPA Safety Committee, Chairman
Hillcrest Hospital, 6770 Mayfield Road Suite #426
Mayfield, OH 44124 Phone 440/461-3127, FAX 440/449-0641

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Letter to AMEA News

Dear Editor,

I have just returned from Lexington after observing the medical group at Rolex. Words can’t express how impressive their system is. Ptti Howard from Central Baptist Hospital coordinated all of the medical personnel which included physicians, nurses and paramedics. Paul Holler coordinated four wheeler response with paramedics. These folks really have it together.

Patti had two people at each jump for cross-country. Paul had four wheelers and transport vehicles within minutes of each jump. Lexington Fire Department had ambulances on standby and University of Kentucky had a helicopter on site. All parties worked very well together and it was very defined as to who was supposed to do what, when, where and how. They also were very nice and fun to be around.

In my discussions with riders, officials and spectators, it was very common knowledge that these medical people were good and quick to respond. There was no worry as far as any of these people were concerned that if something happened it would be well taken care of. The only fairly serious casualty was when Buck Davidson fell and within seconds Patti herself and her crew was evaluating him. It don’t get much better than that folks! They even had him ready to compete in show jumping with a separated shoulder and stable rib fracture.

Russell W. Lowe, Jr.
EMT-P
301 Lejuene Way
Birmingham, AL 35243

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QUESTIONS AND ANSWERS

Question: I am recently pregnant and want to know if I can ride my horse?

Answer:

If your doctor has determined you are in good health without contraindications to exercise, you may continue riding if you are an experienced rider. You should not start horseback riding as a new activity. You should wear head protection at all times when mounted. The types of injuries that are most frequent in horseback riding are head injury and fractures. Contraindications to riding are bleeding and uterine cramps. If you have problems and your doctor recommends that you stop riding, replace horseback riding with walking, swimming or cycling.

Donna Walker, MS, PT

Question:

I have an equestrian patient who found that she had spina bifida on an investigation after a motor car accident. She wants to know if she should ride.

Jane Sorli, MD

Answer:

Frequently, indeed more commonly, spina bifida is an incidental finding on x-ray. If she rode before the accident without problems (she had the 'condition' then, of course) why not now? If she has pain or discomfort, it is on the basis of the injury itself and NOT the presence on the congenital condition. Spina bifida should not preclude anyone from doing anything.

William Brooks, MD

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BOOK REVIEW

GAMES ON HORSEBACK

GAMES ON HORSEBACK by Betty Bennett-Talbot and Steve Bennett is a beautifully illustrated 138 page book covering basic group and elimination games, basic and relay races, timed games, jumping, roping, distance and polo games, finishing the last four of the fifty-three chapters with mounted drills. The introduction gives what to wear and Safety Tips on Games on Horseback.

Each chapter gives the equipment needed, purpose, instructions, cautions and tips for the activity. Each activity has hand drawn illustrations which frequently include graphics for the movement in the activity. Games on horseback will improve the skill and control of riders, reinforce tactful use of natural aids, offer a diversion for both the rider and the horse -- and best of all are fun! You will benefit from as well as enjoy GAMES ON HORSEBACK. This book is available at your book store, tack shop, farm store, or directly from Storey Books, Schoolhouse Road, Pownal, VT 05261 web site www.storey.com. The cost is $19.95 plus shipping and handling.

Doris Bixby Hammett, MD

 

Heads Up! Practical Sports Psychology for Riders, Their Families & Their Trainers

While the American Psychological Association (APA) mutters something about practicing within one's "boundaries of competence in accordance with APA Ethical Principles", the truth is, a psychologist's decision to call herself a sport psychologist remains a personal one. Consequently, I couldn't think of a better reason to be skeptical of the book Heads Up! Practical Sports Psychology for Riders, Their Families & Their Trainers. I had to know. Did the author Janet Sasson Edgette, PSY. D. – hunter/jumper competitor, Practical Horseman columnist, practicing psychologist – cash in her rat and Skinner box for a horse and rider?

After reading the book, I still don't know if Dr. Edgette has the knowledge and experience that the APA would like to see. But, I do know that her thoughts on fear are rooted in equestrian sports. "Fear is not a random emotional experience. It has purpose: it signals that something is amiss. It has value: it tells you when you are outside your zone of comfort or safety. No wonder we can't wish it away. … Once a rider is feeling afraid on horseback, the situation has changed. It doesn't matter whether the objective reality is that the rider is or was capable of doing that very same movement or jump or gait one day ago. If her feelings about it are different today, so will her riding be different."

I found those two passages near the end of the first section of the book, Part One: For the Rider, in a chapter aptly called "Performance Anxiety is One Thing, but What if I'm Really Scared?" Although Dr. Edgette never has a lot to say about fear, she always jumps a fast, clean round. She touches on the topic again in the next chapter, "Rider-Trainer Relationships", in response to a student who feels her trainer never takes her fears seriously. "As far as I'm concerned, a rider's fear is real – it's a nonnegotiable issue. What it feels like to her is what it is. Period."

Don't worry, Dr. Edgette doesn't leave clients dangling over water hazards; she goes on to tell trainers how to, and how not to, deal with fear, what to say and what not to say. She highlights ways riders and trainers can work together to deal with fear and helps them decide when and how (or even if) a rider should turn his hindquarters to a fear and gallop on to spite it.

Most of the chapters in Part One, however, address anxiety-managing, performance-enhancing strategies. In the second chapter, "Breaking Myths about Relaxation: New Twists on an Old Story", the author helps you discover what type of rider you are and then she points out the strategies you should use. The next five chapters teach you how to use these strategies, which include mental rehearsal, mind-body response training, and self-hypnosis, as well as constructing and protecting a riding resource room. Now that my mind has been massaged by hypnotic suggestion, could you please pass me the purple and black crayons? I need to finish the monster behind the oxer in my room.

There are two sections in the last half of the book – Part Two: For Trainers and Instructors and Part Three: For Everyone. The three chapters in Part Two address the psychological aspects of teaching, the business aspects of being a teacher, and stress in the work place. Dr. Edgette lists common obstacles to learning that teachers and riders face, shows you how to set and maintain boundaries in professional relationships, and explains the best ways to work with parents. Her sense of humor shows through in response to questions often heard in her private practice, such as what to do with parents who are too competitive. "You buy a dozen hobbyhorses and you hold a Parents' Horse Show. The parents all compete in a variety of classes with their kids serving as their trainers. Your barn manager is judge. Hysteria and caricature are strongly encouraged."

The last section of the book was written for everyone and has two chapters: "To the Parents and Trainers of Young Riders" and "The Many Faces of Competition Stress". In the first chapter, the author helps parents reevaluate how they define success and failure and answers frequently asked questions, such as: How can I teach better sportsmanship? How can I tell if my involvement in my child's sporting life is excessive? In the final chapter, Dr. Edgette subtly reminds you that it doesn't matter if you're chasing points in the baby green division or juggling a barn and family – stress is stress and the good doctor is here to help.

Personally, I think Heads Up! is well-written, accurate, and informative, and its casual, conversational style make it enjoyable to read. Although the author used enough cliches and hunter/jumper references to kill even the slyest fox, equestrians who teach, take lessons, compete, or keep their horses at large boarding stables would benefit the most from this book.

Heads Up! Practical Sports Psychology for Riders, Their Families & Their Trainers is a small, hardbound book – 217 pages and nary a photograph. You can buy it at a local tack shop or book store for $25.

Johanna Harris
Equestrian Athletics, Inc.
118 Lower Sand Branch Rd., Black Mountain, NC

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United States Equine Inventory Up

Inventory of equine in the United States as of January 1, 1999, totaled 5.32 million head, up 1.3 percent from the 5.25 million head on January 1, 1998. Equine includes horses, ponies, mules, burros, and donkeys. Texas ranked first in equine inventory with 600,000 head followed by California, and Tennessee with 240,000 and 190,000 head, respectively. Florida, Oklahoma, and Pennsylvania tied for fourth with an inventory of 170,000 head. Ohio ranked seventh with 160,000 head, followed by Kentucky, Minnesota, New York, and Washington with 155,000 head. An additional fifteen States had equine inventories of 100,000 head or more.

The January 1, 1998, total equine inventory was 5.25 million head. Equine located on farms totaled 3.20 million head. Equine located on non-farm places were 2.05 million head or 39.1 percent of the total.

- Equine sold totaled 558,000 head in 1998, an increase of 3.3 percent

- from the 540,000 head sold in 1997. Texas had the most equine sold in 1998 at 60,000 head followed by Kentucky with 28,000 head, Michigan with 21,000 head, and Florida, Oklahoma, and Tennessee each with 18,000 head.

- Value of sales from equine sold in 1998 was $1.75 billion, up 6.9 percent from $1.64 billion in 1997. The top ten States were Kentucky, Florida, Texas, California, Virginia, New Jersey, Tennessee, New York, Pennsylvania, and Maryland.

United States Department of Agriculture (USDA) All NASS reports are available free of charge on the worldwide Internet. For access to this report, connect to the Internet and go http://usda.mannlib.cornell.edu/reports/nassr/livestock/equine/eqinan99.txt or you can call the NASS TOLL-FREE ORDER DESK: 800-999-6779 (U.S. and Canada)

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 Regional Variations in Equestrian Mortality in Canada

Introduction: An Agriculture Canada Survey in 1991 found that most of the half-million horses in Canada lived in the provinces (in order of horse population) Alberta, Ontario, Saskatchewan, Manitoba and British Columbia. Only 30,000 horses lived outside these three provinces. Since 1991 the horse population has doubled. In 1997 there were approximately 1 million horses across Canada. It is estimated that 500,000 people ride horses in Canada. Each year some of these riders will be fatally injured.

Method: Information was obtained from the Chief Medical Examiner's Offices in each of the five provinces listed above. Alberta data was available from 1975 - 1995, Ontario 1986 - 1996, British Columbia 1989- 1996, Manitoba 1991 - 1997, and Saskatchewan from 1995 - 1998.

Results: Based on 500,000 riders in Canada the death rate is 1.4 per 10,000 riders.

Variations in the death rate and cause of death were noted. Alberta had the highest death rate at 2.5 persons per year, British Columbia 2.4, Saskatchewan 1, Manitoba

0.6 and Ontario had the fewest deaths at 0.3 riders killed per year studied.

The causes of death were also varied. Total deaths for the five provinces were 83, of which head injuries accounted for 49 deaths (60%). Head injuries generally occurred when the rider was mounted and fell.

The remaining 40% of deaths were varied indeed. Of the 34 deaths from other causes associated with horses, 2 riders drowned, 1 rider attacked by a cougar , 1 bear attack , and one horse and rider struck by lightening. Eight people were crushed, 1 was trailer loading a draft horse colt, 1 person was logging with a draft horse, 1 was feeding, 1 was a horse drawn sled which overturned, 2 drivers and one passenger were killed in motor vehicle accidents in which the horse flew threw the windscreen, crushing the driver and 2 were rodeo accidents. Several children were killed; a 3 year old was sitting on her fathers horse while he was holding it but it spooked and fell over, crushing the child. A 4 year old was riding double with father and one child entered a corral and was kicked to death.

Discussion: The most common cause of death was head injury. This finding is consistent with several other studies.(2,3,4,5,6) Only one rider is known to have been wearing an approved helmet, a Polo helmet, at the time of injury.

Regional variation occurred in the fact that Ontario had the fewest deaths and they all resulted from head injuries secondary to a fall. In Manitoba no deaths occurred to riders but 2 motorists were crushed by horses coming through windshields and 2

handlers were crushed by draft horses on the ground. Saskatchewan had only 4 deaths; one was a rider who fell, one a lightening strike and two people died of kicking while in a corral. The two Western provinces of Alberta and British Columbia had similarly high death rates and most were riders falling off the horse.

The purpose of the horse seems to vary from province to province. While Ontario, Manitoba and Saskatchewan have more horses than BC, many of them are not ridden but used for estrogen production from the mare's urine. In Ontario most riders are English-style riders who jump or perform dressage in arenas. Alberta has almost three times the number of horses compared to British Columbia but the mortality rate is similar. Alberta has large ranches for breeding horses. Pleasure riding in both provinces is common and this has been shown to be the activity in which equestrians are most likely to be injured. (4,5) Increased risk taking may contribute to the increased risk of death in Alberta and British Columbia's untamed regions. Ingemarson et al recommended outdoor riding for experienced riders only and the above information would substantiate their conclusions. Unfortunately, experience alone does not protect from riding injuries.

Conclusion: Head injury is the most common cause of death. The American Standard for Testing Materials / Safety Equipment Institute approved helmets must be mandatory or at the least recommended in every aspect of equestrian activity, particularly trekking in the wilderness. The horse is a lovely and lethal partner in sport. This must always be kept in mind and only protective equipment plus knowledge can save lives.

Janet Sorli, MD
15321 16 Avenue
Surrey, BC V4A 1R6

References:

1. Agriculture Canada 1991 Survey of Horses in Canada

2. Aronson, H. Tough, SC Horse Fatalities in the Province of Alberta, 1975 - 1990 Am J of Forensic Med and Path 14(1):28-30,1993

3.Ingemarson, H, Grevsten, S, Thoren, L Lethal Horse-riding Injuries J of Trauma 29(1):25-30,1989

4. Pounder, D " The grave yawns for the horseman" Equestrian deaths in South Australia 1973 -1983. Med J of Australia 1984; 141:632-635

5. Sorli, J Equestrian Mortality; A Comparison of 1975-1990 and 1991-1995 in Alberta, Canada A Med Equestrian Assoc Newsletter 1998;IX,2,p5

6. Sorli, J Equestrian Injuries, A Five Year Review of Hospital Admissions in British Columbia, Canada Presented at the AMEA Annual Meeting 1998, Nov 6-7 Duke University, NC.

7. Sorli, J Equestrian Injuries: A Survey in British Columbia, Canada A Med Equestrian Assoc Newsletter IX,2,9-11

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News Items

President's Report

In 1997 the AMEA released the Rider Safety Video, a fifty minute program which demonstrates a variety of techniques for reducing the dangers of working around horses. The video was underwritten by the estate of the Neil Ayer. Following release of the video, work .was begun on a packaged lecture program for speakers to use with the film The first Neil Ayer Rider Safety Lecture was held for 30 people in March 1999 at the Trojan Horse Trial.

The lecture package is designed to make it easy for a speaker to give the presentation, with slides at the end of each of the lecture sections. These lead logically into a question and answer session on that portion of the lecture.

The goal of the lecture project is to increase safety awareness. The Trojan Horse Trial group was very receptive. Other AMEA members who are interested in using the materials for their own barn, at a horse show or other equestrian audiences are encouraged to contact the AMEA for additional information.

Safety is always a slow process but comments regarding how well prepared the Rolex CCI**** event medical coverage was is encouraging. And hopefully will "raise all expectations" on that subject. Julie Ballard MD, AMEA Director and Chairman of the USCTA Safety Committee, is doing extensive work on the protocol for eventing through her committee. Many factors and issues must be brought together in a reasonable package.

I would encourage everyone to come to the annual meeting in Vancouver, a beautiful city. Janet Sorli, M.D., has spent significant time in planning it and has a excellent program. I find it one of the highlights of the year for me and I enjoying seeing physicians from around the world and from the lectures and the associated discussions among those attending.

The more I am out and about the more I see the need for safety and the many roles horses can play in our lives.

Bill Lee, MD
President, American Medical Equestrian Association

 

The Executive Secretary's Report

As noted in an article in the February issue of the AMEA News, there are growing efforts to institute municipal and state mandatory helmet laws for minors and even in some cases for adults. The AMEA Board of Directors has been reviewing these policies, because the organization has always strongly supported use of protective headgear.

Statistics demonstrate clearly that the use of ASTM/SEI helmets reduce the severity of head injuries and the number of fatalities. Still a majority of riders -- and particularly those who ride Western -- do not wear helmets. Supporters of mandatory helmet rules posit that if junior riders are required to wear helmets, it will not only reduce accidents among young riders, but they will become accustomed to headgear and continue to wear helmets after reaching 18.

Conversely, there are those who believe that government coercion will produce a backlash which will either cause potential equestrians to try other sports or generate strong opposition to helmet use. These people propose continued educational efforts rather than government regulation.

A number of other sports and recreational activities have experienced this same debate. Many organized sports (e.g. youth baseball and hockey) have required helmets and as participants graduated to senior and professional activities, they have continued to wear helmets.

Recreational activities such as skateboarding, bicycling and rock climbing encourage helmet use, but there are only a few state or local governments which require them.

Finally, motorcycling has gone through a period where most states required helmets on public streets, but a strong user backlash has led to the repeal of many of those state statutes, and helmet use has declined in many areas.

Before adopting an official position on mandatory helmet laws, the AMEA would like to know the views of the membership. Do you support mandatory helmet laws for minors riding on public property? How about adults? How should these rules be enforced? If you have thoughts or comments please send them to the AMEA office 4715 Switzer Road, Frankfort, KY 40601, or email your views to AmerMedEqAssn@bigfoot.com.

Michael Nolan
Executive Secretary, American Medical Equestrian Association

 

 ANNUAL MEETING ACTIVITIES VANCOUVER

The Annual meeting for 1999 will be held at the Delta Vancouver Airport Hotel and Marina in Vancouver, Canada. Take advantage of this opportunity to visit one of the world's most beautiful cities. The Hotel is the closest hotel to the Vancouver International Airport but only 20 minutes away from downtown. It is located on 9 acres of land on the banks of the Fraser River. Special rates have been negotiated and children 18 and under stay free in the same room.

Vancouver itself offers its supernatural surroundings including the ocean and the mountains. Every type of outdoor activity may be organized. Go whale watching or rent a horse and ride in the untamed beauty of Golden Ears National Park. (Bring your own helmet. ) Heli-ski at Whistler. Trips to picturesque Victoria for real English High Tea or a tour of the Bouchart Gardens may be arranged, take the ferry or a helicopter to Vancouver Island. Take advantage of the great exchange on the American Dollar to book an extended stay after the conference.

Be prepared for a very informative conference. Sports medicine specialists, orthopedists, scientists and others will teach you how to identify, treat and prevent sports injuries as applied to the horse rider. Many speakers have first hand knowledge of riding or are currently riders and/or trainers. Learn about everything from dehydration, development of the pediatric rider to death at an event. An international list of faculty will make this an exceptionally educational conference and Vancouver will make it an outstanding vacation.

Janet Sorli, MD
Chairman, AMEA annual meeting

 

ANNUAL MEETING AND EQUESTRIAN MEDICINE SYMPOSIUM

ANNUAL MEETING AMERICAN MEDICAL EQUESTRIAN ASSOCIATION

Janet Sorli, MD, Chairman

November 5 & 6, 1999, Vancouver, British Columbia, Canada

PRELIMINARY PROGRAM

Dehydration and Temperature Considerations
-Dr. C. J. Mackie (sports medicine), (Crystaal Corporation)

Growth and development of the Pediatric Athlete
-Johanna Harris MA (Glaxo-Wellcome Inc.)

Action of the Movement of the Horse on the Human
-Pippa Hodges hippotherapy

Biomechanics of Head and Neck Injuries
- Jocelyn Pedder Ph.D.

Four Cases of Atraumatic Instability of the Cervical Spine in Riders
- Dr. George Koepke

Maxillofacial Injuries
- Dr. Murray Fain (oral surgeon) (Purdue Frederick)

Panel: Successful Methods of Safety Promotion

Osteoporosis
- Dr. David Kendler (endocrinologist) (Merck Frosst Inc.)

Injuries to the Hip and Pelvis, Considerations for Riders
- Dr. Robertson Lloyd-Smith (sports medicine)

Knee Injuries in the Female Athlete
- Dr. Rui Avelar (sports medicine) (G II Orthotics Inc)

Muscle Imbalance in the Lower Limb
- Dr. Steven Stark (podiatrist)

Elbows, a Special Problem
- Dr. W. D. Regan (sports medicine)

Shoulders, Common Injuries
- Dr. R. G. McCormack (orthopedist)

Injuries to the Hand in Riding
- Dr. Peter Gropper (plastic surgeon)

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