Whether you attribute it to American essayist Will Rogers or former British Prime Minister Winston Churchill, the old adage remains: “The outside of a horse is good for the inside of a man.” Today, the horse is also a resource in physical therapy, offering benefits ranging from improved motor coordination to increased social skills.
Derived from the Greek word hippo, meaning “horse,” hippotherapy (as defined by the American Hippotherapy Association, Inc.) promotes using equine movement as a treatment strategy in physical, occupation, and speech-language therapy. It has been shown to improve muscle tone, balance, posture, coordination, motor development and emotional wellbeing.
According to Andrew Guccione, PT, PhD, FAPTA, senior vice president with the American Physical Therapy Association, “APTA recognizes hippotherapy as a treatment tool in which the movements of the horse, and related activities, are used to address impairments and functional limitations in patients primarily with neuromuscular dysfunctions in order to achieve functional outcomes.”
Director V. Judith Thomas, MGA, with the American Occupational Therapy Association, Inc., says, “AOTA recognizes hippotherapy as appropriate depending upon the treatment goals. Therapeutic horseback riding, in which the goal is to achieve the skill of riding, would not be considered occupational therapy.” The umbrella term, therapeutic riding, has caused confusion among the medical community. When a therapist utilizes the movement of the horse to improve neuromuscular function, the correct term is “hippotherapy.”
Can hippotherapy offer you and your clients “the ride stuff”? Asking the right questions is the first step:
Who should consider hippotherapy?
Physical therapists, occupational therapists, and speech-language pathologists may all find hippotherapy beneficial to their programs.
PT: Promotes functional outcomes in skill areas related to gross motor ability such as sitting, standing and walking.
OT: Works on fine motor control, sensory integration, feeding skills, attention skills, and functional daily living skills.
S-LP: Helps the physiologic systems that support speech and language, effective for communication disorders.
Why the horse?
A horse’s walk (according to AHA) provides sensory input through movement that is variable, rhythmic, and repetitive. The movement responses in clients mirror human pelvic movement during walking, and variability in a horse’s gait enables a therapist to grade the degree of sensory input and combine the movement with other treatment strategies. Plus, clients generally respond to the experience with enthusiasm.
How long has hippotherapy been used?
Hippotherapy began in the late 1980s; the AHA was created in 1992.
What conditions might indicate using hippotherapy?
Generally speaking, children and adults with mild to severe neuromusculoskeletal dysfunction may benefit. Such medical conditions include:
- Autism Spectrum Disorder
- Cerebral Palsy
- Developmental Delay
- Genetic Syndromes
- Learning Disabilities
- Sensory Integration Disorders
- Speech-Language Disorders
- Traumatic Brain Injury/Stroke
Might other impairments also benefit?
Yes. These include:
- Abnormal muscle tone
- Impaired balance, coordination or sensorimotor function
- Impaired communication
- Postural asymmetry, poor postural control, or decreased mobility
- Limbic system dysfunction related to arousal and attentional skills
Is there research to support its benefits?
Yes, and data are encouraging. Studies on children with cerebral palsy suggest hippotherapy has a “positive effect on functional motor performance” (1) and “significant improvement in symmetry in muscle activity” (2). A 2007 study on postural stability in people with multiple sclerosis determined that hippotherapy shows promise treating balance disorders. For spinal cord injury, hippotherapy can “significantly reduce spasticity of lower extremities” (3). Most recently, (October, 2009) the Journal of Autism and Developmental Disorders published a study on its effects on children along the autism spectrum and determined an improvement in sensory functioning, as well as more social motivation and less distractibility.
The bottom line? Dr. Gucchione says, “A physical therapist is responsible for designing a plan of care based upon examination and evaluation of the patient. In cases where physical treatment utilizes a horse to assist, hippotherapy should be considered no differently than any other tool within the scope of physical therapist practice.”
Hippotherapy is a relatively new chapter in our history with the horse but, bolstered by modern research, the old adage rings truer than ever: The outside of the horse is good for those needing our care and compassion.
1. "Improvements in muscle symmetry in children with cerebral palsy after equine-assisted therapy (hippotherapy)," Benda W., McGibbon NH, Grant KL (2003) Journal of Alternative Complement Medicine , Dec. 9(6): 817-25
2. "Effect of hippotherapy on children with cerebral palsy," Casady RL, Nichols-Larsen DC (2004) Pediatric Physical Therapy , Fall; 16(3): 165-72
3. "Short-term effect of hippotherapy on spasticity in patients with spinal cord injury," Lechner HE, Feldhaus S, Gudmundsen L, Hegemann D, Michel D, Zach GA, Knecht H, Spinal Cord , Sept;41(9):502-5