Sunday, February 26, 2017

Rehab Wish Lists: the wants, the needs and the "somedays"

Each of our horses has very individual needs, from expensive supplements to volunteer-based physical therapy sessions. Below we have compiled some information on what each of our current rehab horses would benefit from.

Please note that much of this comes out of our own pockets, and any little donation made toward these needs, whether of funds or your time, enriches the lives of these horses and helps speed their recoveries.

If you are an experienced horse-person and are interested in volunteering to do any of the rehab work yourself, please email us at:


- Under Weight
- Poor Hoof Health
- Poor Digestive Health
- Scratches (fungus on lower legs)  
- Soundness/Osteoarthritis

Wish List:
- Cool Calories
- Renew Gold
- Timothy/Alfalfa Hay Cubes
- Uckele Omega Hoof
- Probiotics (non-brand specific)
- MTG (for scratches removal)
- Devil's Claw (anti-inflammatory/joint supplement)

Physical Therapy List:
Regular Chiropractic Appointments - Keeps her aligned and mechanically correct through recovery
Hand-walking - Helps stimulate blood flow to her hooves, speeding their growth
Hill-walks - Hand walking up and down hills loosens the contracted muscles in her back
Brushing (she loves her mud!) - Stimulates blood flow, creates healthier skin/coat
Carrot Stretches - Helps to de-contract/relax multifidus muscles along her spine, as well as other muscles
Oiling/Picking at Scratches - Removal of scabs helps get air and blood flow to affected areas
Lunchtime Snacks - Rowan gets additional meals to help her gain weight (hay cubes, renew gold, etc)



- Over Weight
- Metabolic Disorder
- Ringbone/Osteoarthritis
- Allergies

Wish List: 
- Joint Supplements

Physical Therapy List: 
Hand-walking - Helps raise metabolism and burn calories
Carrot Stretches - Helps to de-contract/relax multifidus muscles along her spine, as well as other muscles



- Sore, Contracted Back
- Flare in hooves (connected to dysfunction of back, in motion)

Wish List: 
- Joint Supplements
- Omega Horse Shine

Physical Therapy List:
Regular Chiropractic Appointments - Keeps her aligned and mechanically correct through recovery
Carrot Stretches - Helps to de-contract/relax multifidus muscles along her spine, as well as other muscles
Lunging over poles - Engages abdominal muscles and lifts back
Hill-walks - Hand walking up and down hills loosens the contracted muscles in her back
Riding long-and-low - Increases comfort in lengthening spine

Friday, February 24, 2017

Properly Pampering Rowan the Rehab Horse

If she had it her way, Rowan would get this sort of treatment EVERY day! After her bath and hand walking yesterday, I set rowan up in a stall with a Back on Track blanket, Back on Track hock boots, and a huge bin of soaked hay cubes and rice bran. This mare was in heaven! Instead of spending her time staring out the window and calling to her BFF, Hazel, she plowed through her food for almost two hours before coming up for air!

If you're not familiar with the Back on Track products, they are made with ceramic-infused fabrics that reflect the horse's body heat back to them, increasing circulation. We are in no way associated with them, but I highly recommend them, and their saddle pads are great for horses with sensitive backs! One thing that I have noticed, in using the BoT products, is that my horses are, without fail, more calm and have a softer muscle tone throughout their bodies after wearing them. I've even considered curling up in one myself, some days!

Rowan is beginning to show the kind of improvement I like to see, and I highly suspect her increased appetite is due to her feeling better after having wraps put on her feet. When I rehabbed Branson initially, it was almost impossible to get him to eat well any time his feet were sore. What a funny coincidence that they're both Holsteiner-bred. Hmmm...

In addition to all of this pampering, I have now increased Rowan's supplements to include a half pound of Renew Gold, as well as Uckele's Omega Hoof, a scoop of MSM and a double does of "Cool Calories" once a day. She wasn't too sure about the Renew Gold at first, but began to eat it once it was top dressing her regular grain. Renew Gold is a product I have recently started using with my horses that contains rice bran, flax seed and coconut meal for a great dose of healthy omegas and fats. I will be upping her intake as soon as she decides this is something she's willing to eat long term.

She certainly knows how to tell me when she likes something!

(As an aside, you might be able to just see the wraps on her front feet in this photo. They're covered in arena sand, unfortunately, but they're basically a sort of hard-set cast. Lisa used them around the wall of her hoof, and built up the heel on her low side a bit to add some relief to her soft tissue as well.)

Rowan's First Bath (and a little help in the soundness department!)

Yesterday it was a bizarre and balmy 70ºF here in SE Michigan. I couldn't have asked for a better day to bathe the lovely, leggy Rowan, especially as she has been meticulously combing the field for the nastiest, stickiest, thickest mud to roll in since having her blanket pulled in this weather.

She stood like a pro for her bath, only protesting when I worked on de-crusting her sensitive flank areas. It took three applications of shampoo and four rinses to get her hair to stop oozing mud when sprayed with the hose! Like I said, she's very thorough.

While she dried, she enjoyed a lunch of hay cubes and rice bran, and after a while we went for a hand walk around the property, including over the trail bridge a few times. She certainly doesn't trust her own balance or footing at this point, but I don't blame her!

Since arriving, Rowan's feet have been a constant worry. She shows signs of significant high-low heel syndrome, implying some major underlying asymmetries (which are also blatantly apparent in her posture) and because her feet were so flat she also sustained some pretty heavy bruising on the frozen ground a when she first arrived, leading to what we expect is abscessing in her front left hoof.

You can see the differences in angle in
Rowan's feet, here.
In addition to the bruising, she has been generally sore on her flat feet. When a horse's foot is "flat" it implies that there is little-to-no clearance between their sometimes more sensitive sole and the ground. In the case of Rowan, when she was trimmed, the farrier noted that she is essentially walking on her soles. This comes from years of being shod, which would have held her up off of her soles, but the problem with this is that years of shoeing have caused her to have contracted heels, which means that her heels have developed a pinched appearance, affecting the anatomy both externally and internally.

Having contracted heels significantly restricts the circulation to and from a horse's hooves, so it can slow healing or even make the horse prone to hoof abscesses, and it often makes the horse's feet especially small, leading to greater weight distributed over a smaller area - a recipe for discomfort.

Luckily, earlier this week I was able to have our farrier (or barefoot podiatrist, technically) come out and work on Rowan. She was able to put wraps on her feet that cushion her, without being as restricting as a shoe. In fact, the next time she comes out to work on Rowan's feet she may even try putting a pliable synthetic shoe on her, beneath the wraps, in an effort to further Rowan's comfort.

If there is one thing I've learned with the rehab horses I've worked with in the past, it's that horses whose feet are sore lose weight - fast. Rowan has luckily been holding steady in her current state of
"skinny" but it wasn't until today that I really began to see a softening of the muscles in her body, showing me that she has begun to relax in her own skin, now that she is more comfortable.

It's going to be a very long road, for this mare, but I can tell you she's truly worth it. She is educated, unflappable and very, very sweet. We'll just have to exercise patience as she continues to recover in her own time!

Marla's Wellness Exam

 Marla's Visit from the Vet

            When Marla arrived at MeadowLark on Dec 1 she weighed about #400 over her ideal weight and presented moderate lameness in her right front hoof/leg. The potential to develop laminitis concerned me the most. Again, the path forward was clear; lose the weight! I hoped that as she shed pounds, the weight bearing lameness would resolve. While working an unsound horse is never ideal, the often sad reality is that "resting" in a pasture is not always the answer for a horse that is going into rehab work. Human Physical Therapists witness this conundrum frequently. Regardless, a lack of useful purpose, i.e. work, and activity got Marla into this mess in the first place.  Happily, as Marla has lost weight, her lameness has improved.
 Aside from her uneven stride, Marla had other concerning items on her medical history. She has a history of allergies and a hair analysis showed that she had shed toxic levels of heavy metals from her body. Her stature also points to some type of metabolic syndrome. Dr. Esterline, from Kern Road Veterinary Clinic met Marla this week and was able to answer all of my questions about her. The hair analysis was not concerning to him, if she had shown heavy metals in a blood analysis, that would be different. Hair tells us what has been in out environment at one time. Mar has been thriving, so I was not as concerned about the heavy metals, especially as her environment had changed when she moved.
            The most concerning issue presented at Marla's wellness exam was her persistent unsoundness. Dr. Esterline performed a flexion test. A flexion test keeps the horse's leg flexed for a minute and then is asked to trot off in a straight line. Any arthritis will be visible during a flexion test. Although I opted not to do x-rays at this time, Dr. Esterline diagnosed Marla as having Ringbone. This concurred with her symptoms and with what her previous veterinarian had said. Ringbone is a degenerative osteoarthritis of the coffin bone. Marla would need x-rays to determine the extent and exact location of her Ringbone. At this point Mar is only at the beginning to this issue, and sound management will slow the progress. Correct and frequent hoof care, joint supplements, and training her to work off her haunches will be essential, but most importantly, KEEP LOSING WEIGHT.

Tuesday, February 21, 2017

Hazel's Back: Staving Off Kissing Spines

Hazel came to me with significant sway back, meaning the muscles in her back have contracted in a way that creates a deep curving "hammock" look, rather than a sturdy, straight back. The owners from which I purchased her actually had already begun to rehab her back before I got her, but she had proved to be a bit more of a project than they'd originally thought.

After going to check her out, I purchased her and brought her home to rehab here at Meadowlark. I admit, I didn't know the condition of her back or the extent to which she was contracted when I purchased her, but I would probably still have brought her home even if I did. She truly is a special mare, with one of the sweetest, moochiest personalities I've ever encountered.

While I haven't confirmed kissing spines in Hazel, I highly suspect that if she doesn't already have it, she was on the road to developing it. Severely contracted back muscles, sensitivity when grooming, sensitivity when spine is palpated, bucking in trot and canter, locking of back in riding and a four-beat disuniting in the canter all point to significant back issues, and Hazel unfortunately has shown every symptom. As the rehab work for kissing spine is beneficial to any horse with a weak topline, here we are!  Many vets will diagnose "suspected kissing spines" simply from watching the horse perform. Others desire a full set of X-rays, which is out of our budget. As the rehab for kissing spine is beneficial to any horse with a weak topline, we're moving ahead with a basic kissing spines rehab program!

Some background on Kissing Spines
Kissing Spines is more common in some breeds of horses than others, but has been seen in nearly every breed-type. Basically what it means is that the tall, spindly "spinous processes" that stick up off the top of the horse's vertebrae are interfering with each other. At first it is simply inflammation, but as time goes on it can lead to osteoarthritis and even fusing of the spine. This obviously causes significant pain in the horse, especially if ridden. 

The causes of kissing spines do vary; some horses are prone to it due to natural conformation, while others are brought into it by being ridden with a hollow back. Unfortunately one of the most common causes is the long-term use of an ill-fitting saddle. 

The good news is that Hazel does not appear have anything irreparable going on in her spine. If she truly does have kissing spines, we caught it very early and she will likely recover. She has shown significant improvement since her arrival and now happily carries students and volunteers (experienced Horse Huggers!) with comfort in the walk, often stretching down and using her back very nicely. The main goals at this point are to encourage Hazel to stretch out and down, and to encourage her to lift her tummy.

In addition to her physical therapy rides, Hazel is a very lucky girl in that our good friend (and podiatrist) has volunteered to use her red-light therapy pad on Hazel's back! The photo above shows her first session, after which Hazel promptly fell asleep in her stall (and was snoring!) I will also continue to use a red-light therapy pen to increase blood flow over some significant acupressure points a few times a week for the next few weeks. This is a new therapy for me, so hopefully we'll see some added improvement!

Marla's Weight Loss: The Shape of Things to Come

Marla: The shape of things to come.

After giving Marla time to acclimate to her new life, it was time to start making some demands of her focus and intellect. I knew that Marla had previous training as her knowledge of leading, most likely of showmanship, was apparent when walking her in the arena. She stops when her handler stops, and turns with/off of her handler well. Despite this, I always train my horses on the assumption that they know nothing. That way, when they have previous knowledge, it simply advances to training process. By doing this I can ensure that I am not missing any key steps in preparing Marla for her future as a lesson horse.

      Training a horse gives them a passport to the future; it ensures a future of usefulness and of good care. While I intend to keep Marla for my lesson program, the fact remains that horses often live varied lives of their own with multiple owners throughout their lifetime. Training ensures them a value on the market, meaning that they will stay with homes that value them for their usefulness and good nature. Taking my time with Marla's training will allow her for future success. I chose to start my training with her doing basic natural horsemanship.
Progress: measurable weight

      Natural Horsemanship gives me and Marla a baseline expectation of responsiveness to each other. It lays a ground work for our future interactions. When we do set out to conquer the scary trails, natural horsemanship will be the tool we fall back on to stay safe and keep learning. Among the tools Marla and I practice is backing. She has a tendency to invade my personal space. Backing not only removes her from my space, but it also explains to her that it that I did not appreciate that closeness. In short, it asserts my dominance.

          Backing lead to yielding, and yielding led to lunging. After losing an estimated 75 lbs, Marla was ready to work on the lunge line. Due to her lessened but ongoing lameness in her RF, she is more comfortable working to the left rather than her right.  I am careful not to overwork her tracking right, but not to ignore the necessity to build strength and flexibility tracking in that direction.
Dapples, a sure sign of good health!

            Marla and I do many physical therapy exercises. We work over poles at the walk, trot, and canter as she is able to. This is specifically good for her core and her stifles, as she has to engage her core to lift her feet over the poles. Another exercise for stifles is "drifting", a precursor to the leg-yield that asks the horse to move laterally by stepping out rather than crossing over. We still have a ways to go, but her strength is building. All of this work has helped Marla shed fat and build her muscle tone. Her coat shines brightly, her dapples have even returned!

Marla's Weight Loss: The Journey

Marla's Weight Loss: The Journey 


meeting the mirror 
         Upon Marla's arrival at MeadowLark she needed to get to work on losing 400+ pounds! No small feat when her lameness prevented her from carrying a rider comfortably and lunging could damage her joints further due to the added stress of moving on a circle. We started with walks, lots and lots of walks. We walked around the barn and to the arenas. We met the mirrors and equipment in the indoor, we learned to cross tie and how to have our hooves picked. Marla hasn't quite gotten used to the trails, the isolation from other horses and unfamiliar surroundings still frighten her. This might be a good job to do with Dodger as he recovers from colic surgery: introduce Marla to the trails! 

        Along with frequent hand walks, I also encouraged Marla to free lunge and explore the indoor arena. This gave me the ability to get her trotting and cantering, but allowed her to navigate her own balance so she wouldn't fall or injure herself. She enjoys free lunging immensely. Her canter started out quite lateral but developed a clear three beats as she started to shed the pounds! I also developed an understanding of her "repertoire of behaviors", that will be essential to her future training. I was able to observe her reactions to my demands and challenges, gauge her submissiveness,  measure her spookiness, and see her excited bursts of energy, all safely from the ground. What I saw impressed me. Marla did not challenge me for dominance, although she was rather skeptical of me. I can't say I blame her though, I did have to "encourage" her around a bit to get her running by gesturing, clapping, vocal commands, or swishing a dressage whip. She and I would "join up" after she finished running around. Again, she didn't really trust me at first. I even had to lie down in the arena footing to get her to come over to me!

           Frequent hand walks and free lunging helped Marla to start to burn fat. Getting her out of the pasture multiple times a day, for short bursts of work that didn't over tax her joints was the primary game plan for conditioning. All of her scheduled activity was supplemented by her new life as member of a seven mare herd. Marla lives in a pasture 24 hours a day with her pasture mates. She enjoys rich social interaction with competition for food, status, and play.
         Due to her previous isolation, and new found socialization, Marla has a tendency to feel claustrophobic and anxious. She dislikes being in a stall and panics when being asked to go on the trails. Luckily she does not take issue to being cross tied or working alone in the arenas. She enjoys exploring the barn yard and seems to revel in the activity. She would get excited by the activity in the first months at MeadowLark, but seems to have settled in a learned to focus as her work load has increased.

Marla's Weight Loss

Marla's Weight Loss Journey: the beginning

   This might end up a huge post, no pun intended!
More frequently than not, many horses in a state of "rescue" arrive to their new homes emaciated or substantially underweight. This was far from the case for Marla! Her estimated weight on arrival was #1400+ on a frame built to carry about #1000! She registered as a 9 on Henneke Body Condition Scale. The Henneke scale provides equine professionals a way to visually and tactilely measure a horse's body condition and ranges from 1 (poor) to 9 (extremely fat). Horses that measure as a 9 can be characterized by an obvious crease down their spine, a cresty neck, and patchy fat behind withers, at their flank, inner thighs, and tail head. Marla had all of these, her crest felt rock hard, an indicator the  risk for a myriad of serious health issues that she might face. Laminitis topping the list of the potential conditions she could develop. The dorsal crease and fat patches are visible in the photo of her back that I took when I met Marla in mid November.

     Not only did Marla's weight put her health at risk, but her comfort had already been compromised. Upon my first appraisal of her, I found that she had trouble lifting her hooves, presumably from the difficult of loading and balancing on her other three legs. She showed moderate lameness in her front right hoof/pasturn, as well as mild compensating lameness in her left hind. It was hard for me to tell if her lameness was internal or more mechanical from the large patches of fat affecting her mobility. Probably both. Her previous owner had her vet take a quick look at the RF, he found no heat or digital pulse (good signs!) but described it as swelling at the top of the coffin joint due to stress from her obesity. Without x-rays the degree of arthritis starting in that joint would be difficult to diagnose. The doctor pronounced her comfortable enough to be transported. It was time to go pick Marla up!

          Now one good question you might ask yourself, and that I certainly pondered, is: How did Marla get so fat in the first place? Typically the formula for obesity is clear; too much food. However this was not the case for Mar. Her body condition was apparent, and her diet was sparse. She picked through her 6 flakes of hay a day and ate the chaffe, turning up her nose at the roughage. She had her supplements (the topic of a future post!) delivered on a cup of alfalfa pellets. That is it. I believe that much of her growing weight could be attributed to inactivity. Marla lived by herself for a number of years following the death of her companion. Perhaps a thyroid imbalance is to blame; she isn't necessarily a good candidate for Insulin resistance, IR, as excessive sugars or an improper diet did not contribute to her weight. At the time that I brought Marla to MeadowLark, I opted not to have her see the vet immediately (but scheduled an appointment for a few months down the road). The path forward was clear, LOSE THE WEIGHT!

Friday, February 17, 2017

Introducing: Marla

Meet Marla

Name: Marla (Rosewater's Alert Darlene)
Sex: Mare

Height: 15+ hh
Breed: Lippit Morgan
Arrived at MeadowLark: 12/1/16
Favorite Treats: Carrots, but she doesn't need many!
Traits: Respectful and sweet

Special Needs: Marla has a specially mixed detox formula that she eats to help her body shed heavy metals that have accumulated to toxic levels. Her previous owner could not locate the source of these metals in Marla's environment. 

Physiotherapy: Marla needs to lose weight fast. She was morbidly obese at her arrival to MeadowLark, easily a 10 on the body condition scale. She was at great risk of developing laminitis due to her condition. The more active she is, the better she will feel. 

Marla gained so much weight mainly due to inactivity. She was fed a very conservative diet with her previous owner, and still continued to become more and more rotund. Her weight added stress to her joints and caused inflammation at the top of her coffin joint. Lameness is present at the right front hoof. This diagnosis was made by a vet without the aid of x-rays prior to my ownership. The real condition of her coffin joints is not yet known to me, but hopefully I will know more after my vet does a general wellness exam. When Marla came to MeadowLark my primary goal was to help her lose weight safely and quickly and see how the lameness, and her overall health resolved.


Thursday, February 9, 2017

Hug-A-Horse: How to Donate Your Time

Beginning in March, we will be hosting Volunteer Orientations every other month for anyone interested in donating their time to help us rehab our horses. These jobs are already available to active members in the Meadowlark community who are horse-savvy and familiar with barn rules. If you are interested in being added to our mailing list or in donating your time to our program as a volunteer, please comment below or email us at

Jobs for volunteers include:

  • Grooming/brushing horses
  • Walking horses in hand
  • Hand grazing
  • Medicating
  • Stretching
  • Rehab walks up and down hills (weather permitting)
  • Bridge/balance board work for horses
  • Lunging (with/without tack or wraps)
  • Light riding (in walk - must be current, intermediate+ student to be eligible)
We often have our primary rehab horses, but many of these jobs would benefit our school horses as well. If you are in love with a particular school horse, or hoping to help out with something in particular please be sure to let us know! The more the merrier! 

Wednesday, February 8, 2017

Introducing: Rowan

Name: Rowan
Sex: Mare
Age: ~18
Height: 17.2 hands
Breed: 1/2 Holsteiner, 1/2 Thoroughbred
Breeding: Was told her father was L-line Holsteiner
Arrived at Meadowlark: 01/22/2017
Favorite Treats: Rowan is still learning to trust people, so treats can be hit-or-miss. She LOVES alfalfa cubes, though!
Unique Traits: Shy and sweet

Special Needs: Rowan is on a joint supplement, due to her age and conformation, as well as a hoof supplement to strengthen her feet, "cool calories" and rice bran mash for weight gain. 

Physiotherapy: Currently enjoying a leisurely life of long walks, light lunging and love. She also gets regular chiropractic care, carrot stretches and stifle strengtheners, and will begin work over poles this week.

Considerably less confident than Hazel, Rowan is going to take some pretty serious rehabbing before she can join the lesson program full force. Her shy disposition has unfortunately leant well to a codependency on her new super-bold, red-headed sister. While Rowan and Hazel do call to each other when separated, they have been (thus far) respectful while apart. When together, however, Rowan has taken to hiding behind Hazel and poking her head out occasionally to sneak a treat from outstretched fingers. She is warmer and warmer, however, and I am confident that she'll be strutting around like a schoolie in no time. 

Rowan came to me with considerable muscle wasting and weight loss, as well as a severe fungal infection on her legs and ankles, rain rot across her back and a condition referred to as "pneumovagina" (don't google this unless you are seriously curious) so must be monitored for infections. Her back is not fit enough to carry a saddle at this point, and her sacroiliac joint is enflamed and juts rather angrily out of her hind end, not to mention she has high-low heel syndrome, so naturally we've got a long way! 

Monday, February 6, 2017

Saddle Fitting Adventures: Hazel

As many of you know, I take saddle fit very seriously. It kind of comes with the territory when you're a professional, independent saddle fitter!

When I first attempted to fit Hazel, her back muscles were so contracted that I couldn't even begin to figure out what she should be fitted in. She was severely sway-backed, and doing belly lifts only brought her back up about a half inch, amidst her tail flicking and hoof stamping as she communicated her discomfort.

After an initial visit from our chiropractor as well as a week of carrot stretches, she was then able to lift her back almost two inches, and I was able to see that despite her sunken topline she is actually a very flat-backed horse, requiring a very different styled saddle than I originally had assumed.

Now, nearly three weeks later, she is able to lift her back to what appears to be its full height with little discomfort and it sits more than three inches above where she generally chooses to hold herself when unengaged. This dropped appearance should begin to resolve as the muscles of her back and neckbegin to stretch out from their contracted state. She is also beginning to stretch her neck down during belly lifts and make "oh la la" eyes instead of showing signs of discomfort. You can even feel the lift in her back happening when she begins to extend her neck in riding, though not nearly to its full extent. In time she should return to having a nice loose topline and a well-muscled abdomen, so that she can comfortably carry a rider again!

It is so crucial that we remain watchful for signs of discomfort in our horses. The damage to this mare's back appears to have been from long-term contraction - likely even from before the previous owner had her, as she only had her a short while. I cannot stress enough the importance of slow, correct training (including strength and elasticity training) as well as a correctly fitted saddle!

 - Emily

Thursday, February 2, 2017

Introducing: Hazel

Name: Hazel
Sex: Mare
Age: 16
Height: 16.1 hands
Breed: 3/4 Hanoverian, 1/4 Belgian
Breeding: by Don Alfredo, out of mare by All The Gold
Arrived at Meadowlark: 01/20/2017
Favorite Treats: Anything! This mare isn't picky, and she loves to have the sides of her neck scratched.
Unique Traits: This mare has the biggest forehead I've ever seen on a horse! LOL!

Special Needs: Hazel is on a joint supplement, due to her age and conformation

Physiotherapy: Currently on a "long and low only" regimen to encourage her to lift and release her contracted back muscles. Daily carrot stretches and regular chiropractic care. 

Hazel is perhaps the most "in your pocket" mare I've ever had come into my program. She is always happy to come across the field when she sees you coming, and she loves to snuggle. Her huge, floppy ears and natural lack of a forelock make her very endearing, as well!

The woman I purchased Hazel from was in the process of teaching her to drop her neck to help stretch her back. Her back muscles are severely contracted and atrophied (think pre-kissing spines) and being ridden can cause her pretty severe discomfort if she is allowed to go around with her nose in the air. She is currently ridden on a "PT only" basis, primarily in walk, while encouraging her to stretch her neck and lift her sunken back muscles.