Impact case study database

The research demonstrating the beneficial effects of drumming on young people with ASD has benefited the individuals taking part, has enabled Schools to offer a beneficial intervention and created a new revenue stream for a drumming SME. Successful public engagement with the research means that it is now being taken up in other settings for other conditions.

Benefits to young people involved

Approximately one person in 100 is on the autism spectrum, suggesting that in Gloucestershire, where the project was based, 8,580 people may be on the autism spectrum, including about 1,200 children. There were profound changes for the 200 individuals engaged in this project. The local special school that participated in our behavioural study [3.4] is the largest in the region and one of the largest in the UK (providing for over 300 children). The school saw changes in the children involved including benefits beyond the drumming lessons [5.1].

There was a reduction in peer and behavioural problems [3.3, 3.4] and parents saw profound changes in coordination and the ability to perform real life skills (e.g. brushing teeth and eating with cutlery) [3.4]. These children performed for their parents, carers and other pupils for the first time in their school lives [5.2], a classroom teacher noted,

‘I loved it though, I cried. I was very, very proud of them. Watching them do something like that.’ (Teacher, Milestone School)

Therefore drumming also provided a vehicle that greatly improved self-esteem and confidence,

‘Pupil self-confidence demonstrated significant improvement, which had an impact on their learning and engagement in other areas’ [5.1]

One non-verbal ASD child, now attends his drumming lessons in the school hall without his one to one classroom assistant and sings to the songs he has learned:

‘One particular child, who is largely non-verbal, sang to the songs and was able to remember lyrics; he was even heard singing to himself during other lessons – an incredible achievement!’ [5.1]

Benefits to Schools

Such were the benefits to the children involved; the school has self-funded the drumming tutor to continue to provide these lessons,

‘As a result of the positive changes we saw in the children involved, the school has supported continued drumming lessons for our pupils’ [5.1]

There are twelve special schools in Gloucestershire, three are now running the drumming intervention and the other nine have committed to implement it as soon as conditions allow [5.3].

‘I am pleased to confirm our wholehearted support for your project and our wish to take part as soon as you are able to proceed and present restrictions allow’

(Chair, Gloucestershire Association of Special Schools’ Heads [5.3])

In addition to reaching all of the Gloucestershire Special Schools, drumming has also been adopted by a large local mainstream secondary school for those children with specific emotional and behavioural difficulties. This adoption has occurred as a direct result of dissemination of the research described (Hartpury University stakeholder event). This programme was self-funding using individual pupil premium and has already reached 100 children in the school [5.4]. The School observed that self-confidence improved in the children involved to the extent they used the drum sets to teach their peers the drumming they had learned. They also noted that the drumming was useful to calm children experiencing difficulties in the school day. The children were due to perform at an end of year (June 2020) music festival headlined by Coldplay. Sadly, COVID-19, meant this was not able to take place.

The public dissemination of results as described above has also led to engagement with the CBDP and the adoption of drumming interventions beyond the region, across England. This includes working with special schools and communities in London, Liverpool, Bedfordshire and Wiltshire [5.5].

Impact on SME

Inspire Drums is a small business (SME) located in Gloucestershire that was primarily engaged in private and one to one drumming lessons in mainstream schools. The owner of Inspire Drums became involved through dissemination of this work via the Hartpury Science Hub at the Cheltenham Science Festival. Inspire Drums have collaborated with Hartpury University in delivering the drumming interventions to special schools in Gloucestershire. As a result of the research findings showing the efficacy of drumming and the profound changes seen in the children engaging in drumming, Inspire Drums has grown from a company of one tutor to now employing five four? [5.6] to service the demand for drumming to assist children with ASD and other developmental difficulties. This expansion benefits this small business, creates more capacity to provide drumming to those who will benefit and expands the knowledge of drumming tutors of the needs of this population. Uptake from ASD pupils has increased in private lessons as well as the school projects described here.

‘The impact on our business is has also been profound. Working with your project has generated a new demand for drumming tuition generally and specialist drumming tuition in particular. Consequently, the business has grown from one tutor to four and we have created an entire ‘therapy’ arm of the company offering. This expansion has created a pool of tutors who are learning from us about the challenges and practicalities of delivering drumming to different populations’

(Phil Jones, Inspire Drums [5.6])

Public engagement leads to impact on other conditions

The nature of the changes seen in the brain through the research are likely to benefit other populations. As a result of successful engagement activities, researchers were approached by a care home in the city of Gloucester to provide drumming tuition and monitor dementia patient responses [5.7]. This work was due to begin in April 2020 but postponed due to COVID-19 restrictions. However, we have two care homes committed to this project once the pandemic allows this to happen. Others in the County are working with Hartpury to use drumming to assist with recovery from brain trauma and The National Star College, (a specialist further education college for people with physical disabilities, acquired brain injuries and associated learning difficulties) has also committed to join the Project and include drumming in 2021 [5.8]. The Bedfordshire Clinical Commissioning Group also plans to expand drumming provision beyond the special school environment to:

‘Include interventions with vulnerable young people in a range of settings outside typical educational provision, this may include for children who are electively home educated, children at risk of criminal and/or sexual exploitation and children displaying challenging behaviours.’

(Joint Commissioning Manager [5.5])

As well as a wide range of public engagement events, findings were further communicated through stakeholder roundtable and research communication events at Hartpury University. The partnerships made through these events directly enabled the behavioural studies to take place [3.4, 5.1, 5.3] and for the impacts described here to take place. The ongoing work of CBDP is to build on its previous research findings highlighting the physical demands of drumming to enhance health and wellbeing through drumming. This was translated to the drumming audience and public through the individual University communication channels and by the CBDP website, social media channels and contacts [5.8]. The experimental work of the project has also resulted in high profile drummers acting as advocates for the Project [most notably Clem Burke himself, Mark Richardson (Skunk Anansie / Feeder) and Rob Rolfe (Enter Shikari)]. Consequently, this work has worldwide reach (the CBDP website has been accessed from 106 countries in 2019-20) and has altered media and public perception of the benefits of drumming. Rhythm Magazine is the premier drumming magazine in the UK and they have covered the CBDP on multiple occasions, most recently noting:

‘ Latest research from the project has made connections between learning to play the drums and changing the brain’s structure and function, something which has resulted in enhanced behaviour in a school and home environment among individuals experiencing autism.’ [5.9]

High profile drummers and advocates for the project have described the impact of this research on the perceptions of drumming in the drumming community and the public [5.10]

‘My hope is that drumming becomes an essential part of the well-being program of every school, care home, hospital and prison. After all, if it works for one of us it can work for all of us.’

*(*Mark Richardson, Drummer, Skunk Anansie [5.10] )

*‘The research that you have done, especially relating to the fitness of drummers and the positive impacts on the brain have changed perceptions of drumming.*’

(Rob Rolfe, Drummer, Enter Shikari [5.10])

Hartpury’s research presented in this case study has had a positive impact on the management and training of sport and race horses in three ways: developing best practice across industry, promoting success in equestrian sport, and through education and research-led teaching.

4.1 Developing best practice

Equine water treadmill practice: Hartpury combined with national and international partners from the UK, Germany, the Netherlands, Belgium, North America and China to establish The Hydrotherapy Working Group in 2019. The group consists of researchers, commercial equine hydrotherapy centres, equine veterinary surgeons and physiotherapists from the UK, Germany, the Netherlands, Belgium, North America and China. This group developed guidelines for water treadmill use, underpinned by Hartpury research, ‘Equine Water Treadmill Exercise – A Guide for Users’ with Nankervis as corresponding author [5.1]. These guidelines detail how water treadmills should, and should not be used, in the management and rehabilitation of sport horses. The guidelines are endorsed by British Equestrian and inform the use of water treadmills for horses on the British Equestrian World Class Programme [5.2], as well as being adopted as standard practice across equine therapy centres around the world [5.3].

In 2020, the Institute of Registered Veterinary and Animal Physiotherapists established an ‘Institute of Equine Hydrotherapists’ to set the standards for professionalism and clinical proficiency in equine hydrotherapy. The Institute advocate the use of the Hartpury guidelines as standard practice across the industry [5.3]. Practitioners recognise the value of applying our research-informed approach to their own practice, and use this the research to design protocols based on the ‘ low and slow’ methodology to generate a positive impact on horse health, performance and welfare [5.3]:

“*The research work has helped me educate staff with clear procedure guidelines, avoiding unnecessary injuries and getting the best results I can for my horses.*”

Grainne Ni Chaba-Byrne, Chair of the Institute of Equine Hydrotherapists [5.4].

Additionally the research [3.1-3.4] has been used to advise individual water treadmill users including leading racehorse trainers (e.g. Lucinda Russell), sports horse rehabilitation centres (e.g. Ivy Lodge, Northern Ireland and AK Equestrian, Netherlands), and major sport and race horse training venues (e.g. Conghua Training and Rehabilitation Centre, China). The research has also positively influenced how water treadmill manufacturers (Idots Aquatrainer, FMBs Therapy Systems, ECB Equine, Aqua Equine Treadmill Ltd.) support their clients to apply an evidence-informed approach to water treadmill use in practice:

“Our commercial customers are putting between 8 and 22 horses through their treadmills daily. The research work has helped my customers use their machines more effectively and safely. The ‘Guide for Users’ researched and published by Dr Kathryn Nankervis and Hartpury is included now in our handbook for all our customers.”

(Serena Hickson, Managing Director FMBs Therapy systems [5.5]).

Supporting clinicians (veterinary surgeons and animal physiotherapists) in the management of sport and race horses: The research on outcomes measures has been used to assist veterinary surgeons’ clinical decision-making informally individually, and formally via British Equine Veterinary Association CPD [5.3]. The equine water treadmill guidelines were also circulated to all UK equine veterinary surgeons via the British Equine Veterinary Association website to inform referral, and are supported by leading clinicians who use these with clients to enhance performance and within rehabilitation [5.3]. The video abstract for paper 3.3, explaining why high water should not be used for horses with back pain, or for dressage horses, is the most frequently viewed Equine Veterinary Journal video abstract: https://vimeo.com/267791535 (over 2,500 views).

Evidence-based Assessment Guidelines for Equine Physiotherapy : In 2020, a working group consisting of experts from ACPAT and Hartpury researchers (Tabor and Allen) compiled physiotherapy clinical guidelines based on current best practice evidence and Hartpury research for use in the assessment of neuromuscular health and performance in horses and dogs. The UK national professional group for animal physiotherapists, ACPAT, recommend that the clinical guidelines are adopted in practice by all those involved in musculoskeletal care of sporting, leisure and companion animals including physiotherapists, veterinary surgeons and therapists [5.6]. The guidelines and underpinning studies have been disseminated via publications and meetings to international physiotherapy practitioner groups including the Danish and the Canadian Physiotherapy groups and the Australian Physiotherapy Association Animal group [5.7].

4.2 Supporting Olympic Success in Equestrian Sport

The ‘low and slow’ water treadmill exercise protocol used within the Equine Therapy Centre at Hartpury University underpins professional practice in the Centre. In this REF period, hundreds of sport and race horses have been cared for using this protocol resulting in successful return to competition post injury and improved competitive success. In 2014, having achieved a World Record score of 94.3%, Charlotte Dujardin attributed her horse Valegro’s fitness to twice weekly water treadmill sessions within the Equine Therapy Centre at Hartpury University [5.2]. The ‘ low and slow’ protocol we advocate has been applied to the training programmes of British, Irish, and Italian team horses, across dressage and eventing within Hartpury’s Equine Therapy Centre, including that of Valegro, winner of Olympic Gold in Individual dressage in Rio 2016. The value of this contribution is recognised by British Equestrian [5.3]:

“The protocols developed as a result of work done by Hartpury University have been of great value in the training of horses on our Podium and Podium Potential Pathways, particularly in the preparation for major international competition, including those aiming for the Tokyo Olympics”.

(Dr Robert Oulton, British Equestrian Squad Veterinarian [5.8]).

The much-publicised use of Hartpury’s water treadmill enhancing performance within the GBR Dressage gold medal horses [5.6], stimulated widespread uptake of water treadmill exercise for training of elite dressage horses and wider equestrian disciplines:

“The equine water treadmill industry has grown 10-fold over the last 5-6 years. I truly believe this is down to new research coming out proving that water treadmills are not only a tool to be used for rehabilitation work post injury but also are very effective to support training with horses and ponies from many disciplines improving performance”

(Serena Hickson of FMBs Therapy Systems [5.5)].

4.3 Education and research-led training

Hartpury University is one of only two universities that runs an MSc programme for Chartered Physiotherapists who want to qualify as an animal physiotherapist, accredited by the Chartered Society of Physiotherapists. Successful completion enables registration as a professional practitioner with ACPAT and the Register of Animal Musculoskeletal Practitioners. The research presented across this case study is embedded into delivery, supporting the development of sound clinical reasoning and best practice approaches in equine therapy and rehabilitation, which students take with them into professional practice [5.9]. It is also integrated into animal and equine programmes across Level 3 to 7 (28 programmes; ~ 1000 students), enabling these students to enter the equestrian industry with a foundation of best practice in the management and training of sport and race horses. Our research also underpins equine hydrotherapy training courses around the world [5.10]:

“Based on the studies that Dr Nankervis conducted, we created an underwater treadmill course (the Aquatrainer Academy) for professional horse people in the Netherlands. The goals of this course are to increase the quality of the exercise on the treadmill, decrease the risks and increase the welfare of the horse”.

(Morgan Lashley, Aquatrainer Academy, Netherlands [5.10]).