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HOPKINTON, R.I. (AP) — With his forehead creased in concentration and his hands tightly gripping the reins, Jon West stretches and works his muscles to steer his horse down a winding wooded trail.

His shoulder grows stiff as he sits in a wagon, an instructor beside him, and drives his horse Monty. West doesn’t mind. The 26-year-old former Marine is having fun, practicing muscle control and rebuilding confidence — goals he’s had to continuously strive for since a 1996 hiking accident left him near death.

“First, they said I wasn’t going to live and then they said, ’Well, if he does live, he’ll be like a vegetable,’” West said about the two months he spent in a coma. “I had to relearn how to speak and breathe. I’m still relearning how to walk.”

And the walking has come easier since he learned how to ride.

West is one of 130 students taking weekly lessons at In Harmony Therapeutic Riding Inc., a nonprofit riding center that uses the movement of a horse to help improve motor skills, balance and confidence of people with physical, mental and emotional disabilities.

The riders have disabilities such as cerebral palsy, spina bifida and mental retardation. Some suffer from depression. Many participate in therapeutic riding, which uses a variety of techniques to improve strength, muscle control, hand-eye coordination and social skills.

West suffered a traumatic brain injury when he fell more than 115 feet while hiking down the Silver Cascades in New Hampshire. He hit his head on a rock and landed face first in a pool of water, where he was submerged for about 10 minutes.

After nine months in the hospital, he was afraid to try to walk.

He remembered his experience as a new rider vividly.

“I held on with both hands like ’Oh shoot, oh shoot! I’m gonna fall!’” he recalled. “I held on for dear life.

“This gives you confidence and it gives you balance,” he said. “This made me walk.”

When West began riding, he participated in hippotherapy, a form of physical therapy that uses the natural gait of a horse to stimulate the rider’s balance and postural responses. Hippotherapy requires the assistance of a physical therapist; therapeutic riding does not.

“When Jonathan first came here, he was in a wheelchair. Within six months, he came in with his cane,” said Maria Blackstone, the center’s executive director. “We have people that haven’t spoken until they come here. A lot of children have taken their first steps as a result of strengthening their body from rising” on the horse.

More than 100 volunteers help with lessons and care for the stable’s 20 or so horses — all of which are specially trained to handle riders who are often stiff, or may have outbursts while on horseback.

Instructors say therapeutic riding works partly because of an innate connection people have with horses.

“It’s the horse, it’s the magic of the horse,” said Barbara Poulin, a driving instructor. “If the person is receptive to that horse, the motivation is there.”

The bond is evident in the smile of Annie Grills, an 11-year-old girl who has a seizure disorder and developmental delays resulting from meningitis she contracted when she was just 8 days old.

Annie, who is blind, balances herself on her horse Windsor and leans forward to stroke his mane. With the help of an instructor and volunteers, Annie rides around the indoor ring, focused on sitting up straight.

“Hug!” she shouts in the middle of it all, and leans forward to wrap her arms around the horse’s neck.

Annie is slowly learning to use a walker. Balancing upright and standing in the stirrups have helped her immensely, said Amy Maslyn, who works with Annie at her home and volunteers at the center.

“It made it easier for her to retrain the muscles. It’s helped her socialization, definitely,” Maslyn said. “She picks out the people she likes … and all she can do is talk. Her speech has improved because she is learning new words.”

Hippotherapy was developed in Europe in the 1950s and 1960s and made its way to the United States in the ’70s and ’80s, said Michael Kaufmann, spokesman for North American Riding for the Handicapped Association, a Denver-based accreditation organization.

The therapy works, he said, because as a horse walks, its gait causes the rider to react with movements at the trunk and hip that are very similar to the natural strides of humans.

“We don’t have expectations that this is going to cure someone tomorrow,” Kaufmann said. “It’s a benefit actually that over time has really helped a lot of people, and everyone improves at their own pace.”

About 30,000 people participate in the more than 600 accredited therapeutic riding programs in North America, Kaufmann said. Some centers, like In Harmony, offer hippotherapy and therapeutic riding; others offer just one program. In Harmony is the only accredited center in Rhode Island, and it is one of 45 centers in New England.

A physical therapist at Hasbro Children’s Hospital in Providence said hippotherapy is a legitimate form of treatment with tremendous physical and emotional benefits.

“We’ve seen improvements in head control, trunk balance and sitting balance,” said Ellen Sturtevant, pediatric certified specialist in physical therapy. “Some of the more involved children don’t actually even sit on the horse, they lay on the horse. It’s the way that the horse moves.”

Sturtevant said hippotherapy has emotional benefits because it is fun and it removes the stigma sometimes associated with therapy.

“Spirits are lifted, the parents see the child enjoying another activity that’s fun,” she said. “They see their children participating in another activity that they may not have thought they could.”

Blackstone said most insurance companies do not cover hippotherapy.

“The tricky thing is, even though they may come in and they’re working with a licensed physical therapist, the insurance companies are so reluctant to recognize it as therapy just because there’s a horse involved and it might be fun,” she said.

Representatives of Rhode Island Medicaid and the Health Insurance Association of America said coverage is approved on a case-by-case basis.In Harmony Therapeutic Riding The North American Riding for the Handicapped Association

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