What is Hippotherapy?

In today’s world, children with cerebral palsy often benefit from several traditional treatments and therapies designed to greatly enhance his or her abilities, and by extension, his or her quality of life. Some therapies – such as physical therapy – are commonly deployed for those with mobility and function impairment. But others, like equine therapy – also known as hippotherapy – take an unconventional path in the effort to increase a child’s physical strength and cognitive capabilities.

Based on the concept that humans with physical challenges can benefit from both learned and spontaneous reactions while riding a horse, hippotherapy was conceived in the 1960s and used primarily in Germany, Austria, and Switzerland as a companion to more established treatments. Hippotherapy was recognized in the United States in the 1980s as a therapy that not only helps patients with neuromuscular dysfunction increase physical strength and cognitive ability, but also offers the individual a chance to take advantage of an enjoyable activity that contributes to a positive therapeutic experience.

Hippotherapy is a form of physical, occupational and speech therapy that uses equine movement to develop and enhance neurological and physical functioning by channeling the movement of the horse. Hippotherapy is not to be confused with therapeutic horseback riding, in which individuals are taught specific riding skills.

Hippotherapy is built on the concept that the individual and variable gait, tempo, rhythm, repetition and cadence of a horse’s movement can influence human neuromuscular development in humans. Horseback riding triggers a series of complex physical and mental reactions; such as making physical adjustments to maintain proper alignment on the horse. Riders must also plan movements to maintain balance on the horse, and be able to interact with the animal.

Hippotherapy, through equine movement, works by further developing physical and cognitive abilities, including:

  • Strength
  • Control
  • Balance
  • Posture
  • Endurance
  • Coordination
  • Sensory integration
  • Understanding of visual cues

What are the Benefits of Hippotherapy?

Hippotherapy can help children with cerebral palsy on several fronts. Interacting with the animal can lift a child’s spirits emotionally and psychologically while also providing valuable physical exercise as the child learns how to ride the horse properly. A horse’s gait has three-dimensional movement—equine movement–similar to a human that helps a child plan physical responses to the horse’s movement. Horeseback riding requires subtle adjustments and positioning to maintain proper balance and posture.

Physical benefits include:

  • Improved gross motor skills
  • Trunk core strength
  • Control of extremities
  • Improved postural symmetry
  • Reduced abnormal muscle tone
  • Respiratory control

Cognitive benefits include:

  • Improved attention
  • Visual coordination
  • Sensory input
  • Tactile response
  • Improved timing and grading of responses
  • Improved ability to express thoughts, needs

Psychological benefits include:

  • Enjoyable interactions with the animal
  • Opportunities for social interaction
  • Improved self-esteem

When is Hippotherapy Advised?

There is no specific age, or point in a child’s therapy, that dictates when or if a child would benefit from hippotherapy. Children as young as two years old, and teens, have benefitted significantly from hippotherapy.

The decision to employ hippotherapy will be based on several factors, including whether a child’s specific physical and cognitive challenges could be improved by this therapy, and whether mitigating physical and cognitive conditions exist that would preclude a child’s interaction with a horse.

Because it is not likely to be among a child’s core therapies, hippotherapy is unlikely to be covered by many medical insurance plans.

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How is Hippotherapy Performed?

A successful hippotherapy program incorporates the multi-dimensional movement of a horse with that of a human. The therapist will likely begin any course of treatment with an assessment of the child’s physical, cognitive and psychological abilities to gage whether hippotherapy is appropriate for a child, and what accommodations should be made if a child cannot sit on the horse in a conventional manner.

Once a therapist has determined that hippotherapy is appropriate for a child, he or she will explain how sessions will unfold. Additionally, a child and his or her parents will also be given detailed instructions regarding how to physically interact with the horse, including:

  • How to safely mount and dismount a horse
  • How to utilize equipment, such as saddles
  • What to expect regarding the horse movement

After a child mounts the horse, it is the therapist’s job to strictly monitor and control the horse while the child is riding horseback. The therapist will walk alongside the horse to direct equine movement and modify movement in a way that is safe for the child. As the therapist monitors the horse, he or she is also monitoring the child to watch for changing physical reactions such as balance, control, strength and range of motion skills.

Changes in physical reactions from the child are considered positive because when a child responds naturally to shifts in gait from the horse, it not only builds physical strength, but also vital connectivity in the brain.

Because hippotherapy is practiced by physical, occupational and speech and language therapists, activities and goals in therapy may vary. Physical therapists tend to focus on improving gross motor skills, balance, and strength; occupational therapists focus on sensory processing, vestibular and proprioceptive issues, and speech therapists focus on communication.

Therapists will monitor the progress of a child, and make modifications to the child’s plan of treatment as needed.

Where is Hippotherapy Performed?

Hippotherapy generally takes place at specialized institutions, generally in a horse-farm setting. Because the children will eventually ride the horses, and they are encouraged to interact with the animals, special attention is paid to ensuring the environment is stress-free, friendly, and supportive for children and their families.

Some programs are dedicated entirely to providing hippotherapy programs all year to the exclusion of other activities, and others will have occasional or seasonal programming during certain times of the year. Regionally, it can be challenging to find nearby programs because many horse farms are located in rural communities.

Who Provides Hippotherapy?

Those who practice hippotherapy are most often physical, occupational or speech and language therapists, and have met the rigorous educational and certification requirements to practice within those disciplines. See physical therapist, occupational therapist, and speech and language pathologists. In some cases, a hippotherapy practitioner may work closely with a professional horse trainer.

The American Hippotherapy Association offers a multi-level educational program that aims to educate aspiring practitioners with a foundation of knowledge regarding how to work with both patients and horses.

Certification in hippotherapy is open to physical, occupational and speech therapists that have practiced for three years in their field, and 100 hours of hippotherapy, through the AHA. Hippotherapy Clinical Specialty Certification can be obtained after the applicant sits for the HPCS examination. More information can be obtained at the AHA’s website, which also includes a list of hippotherapy educators and certified practitioners.

The AHA’s educational and certification program addresses several concepts, including:

  • Physical attributes of the horse
  • Tacking and untacking of the horse
  • Natural gait of the horse
  • Unsoundness of horse movement
  • Links between horse and human movement
  • Emergency procedures and safety practices
  • Selecting appropriate exercises
  • Treatment plan effectiveness
  • Creating quality and beneficial movements
  • Relationship between treatment and functional outcomes

HPCS certification is valid for five years; practitioners must then undergo a re-certification process. During this process, applicants must either retake the HPCS examination, or provide written evidence of 120 hours in additional coursework. Fifty percent of the work must be hippotherapy-based, 25 percent must be related to hippotherapy, and 25 percent must be related to the applicant’s professional discipline.

Hippotherapy practitioners, depending on their professions, may utilize equine movement in different ways. Physical therapists may focus on cultivating strength ad balance in large muscles of the core, legs and arms; occupational therapists may focus on fine motor skills, cognitive functioning and sensory integration as it relates to everyday activities; and speech pathologists may focus on communication strategies that support speech and language, signing or other modes of communication.

Are There Any Risks or Special Considerations in Hippotherapy?

There are generally very few risks involved with hippotherapy, but because a child will be working with an animal, some common-sense steps should be taken by parents to ensure the safety of a child.

The American Hippotherapy Association has a list of AHA-approved hippotherapy sites that have met pre-determined qualifications for safety, education and quality of instruction. Additionally, parents should not hesitate to ask a hippotherapy practitioner if they are HPCS-certified.

Children should also have appropriate safety equipment, such as helmets and safety padding during all sessions.