What Is Hippotherapy?

Horses are essential in hippotherapy, a form of neuromuscular therapy that can improve the posture and coordination of a child with disabilities.

child horseback riding iStockphoto

Horses are special animals and their healing powers have been recognized for thousands of years. Hippos is the Greek word for horse and hippotherapy means the therapeutic use of horses. But hippotherapy shouldn't be confused with therapeutic riding -- hippotherapy is a medically based treatment tool, whereas therapeutic riding involves teaching people with disabilities equestrian skills. Although Hippocrates first mentioned using horses therapeutically in his ancient Greek writings around 400 B.C., it wasn't until the 1960s that physical therapists (PTs) in Europe began using horses to help patients with neuromuscular disorders such as cerebral palsy or brain injury. Physical therapists believed that the horse's movement created neurological changes that helped improve a person's postural control, strength, and coordination.

American and Canadian physical therapists trained in Europe brought their expertise back to North America in the 1980s and formed the American Hippotherapy Association (AHA) for those specialized in the field. The original focus of hippotherapy was treating physical disabilities, but today it's also used by occupational therapists (OTs) and speech and language pathologists (SLPs). "A horse is powerful motivation, and this enthusiasm can be leveraged into teaching communication, social, fine motor, or any target skill" says Lois Brady, speech and language pathologist and author of Apps for Autism. "Children may feel more comfortable communicating with a horse than a human. Luckily, therapists can help children direct their horse friends by using all modalities of communication, including sign, vocalizations, and picture exchange."

    Signs Your Child Needs Hippotherapy

    If a child has a disability that qualifies him for therapy (occupational, physical, or speech and language), hippotherapy is an option, particularly if the child loves horses and has grown frustrated with the traditional school or clinical setting. Parents may consider hippotherapy if their child:

    • leans against surfaces, slides out of chairs, and bumps into things, indicating poor body awareness and postural control
    • seeks a lot of intense movement and avoids sitting long enough to manipulate objects such as crayons or puzzles
    • has difficulty following directions and communicating with words, pictures, or gestures.

    How Hippotherapy Works

    One can say that simply being on a horse is therapeutic. Through hippotherapy, a child can experience many different types of beneficial sensory stimulation -- muscles and joints receive deep pressure stimulation from bouncing and holding positions (like kneeling or standing on the horse), and the brain receives vestibular stimulation (to sense movement and balance) as the horse moves (in circles, up and down hills) and changes speeds. "Hippotherapy provides the sensory stimulation that helps a child organize his body for complex tasks," says Melanie Potock, a speech and language pathologist in Longmont, Colorado, and author of Happy Mealtimes with Happy Kids. "For some children, this may be as simple as being able to produce voice or vocalizing; for others it may be using multisyllabic words or even telling a short story." Also, because a horse walks with a gait that's similar to the human gait -- variable, rhythmic, and repetitive -- a child who has never walked or who has an abnormal gait can sit on a horse and experience what "normal" feels like. The therapist is always in control of the horse's movement, choosing activities that will help achieve specific outcomes. Some examples include:

    • Reducing muscle tone (e.g., spasticity) with slow, rhythmic movement
    • Improving attention and postural control with fast, erratic movements
    • Decreasing sensory defensiveness or sensitivities with full-body contact (when the child pets or hugs the horse).
    • Improving right and left coordination by steering the reins
    • Developing visual-motor skills with hiding puzzle pieces along a trail that need to be found

    How to Choose a Therapist

    Parents may ask therapists at their child's early intervention program or school whether the child is a good candidate for hippotherapy and if they have recommendations for licensed therapists. Unfortunately, there are a limited number of facilities and trained therapists available, and only licensed OTs, PTs, and SLPs utilize hippotherapy as a treatment tool. Some (but not all) early intervention programs and health insurance companies will cover the costs of hippotherapy as they would for therapy in other clinical settings. But insurance companies typically require that treatment be provided by a therapist with credentials in the same discipline that the child needs. In other words, if the insurance company agrees that a child qualifies for PT services to improve gait, it will pay only for hippotherapy provided by a PT.

    Of course, parents who pay out of pocket have the option of choosing any type of therapist. They can also opt to include therapeutic riding instructors who are trained and are certified to teach people with disabilities how to ride a horse -- to steer, trot, or jump over poles -- but health insurance companies do not typically pay for therapeutic riding lessons.

    To find a therapist with advanced certification training in hippotherapy, visit The American Hippotherapy Association, which has a directory of therapists: americanhippotherapyassociation.org/hippotherapy/find-a-therapist/

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