Hippotherapy, also known as horse therapy refers to a physical, occupational, and speech and language treatment strategy that applies and utilizes equine movements. Its literal and direct meaning and definition is treatment with the assistance of a horse. ‘Hippos’ is a Greek word for horses. It is normally used by specially trained and skilled physical and occupational physicians and therapists for patients who have movement dysfunction.
In this form of therapy, the client is influenced and impacted by the movements of the horse. The patient is typically positioned or placed on the horse where they actively respond to the horse’s simulated movements. The movements of the horse are directed and controlled by the physician or therapist in charge who also analyzes the pattern of the patient’s response thus adjusting the movement and treatment accordingly and efficiently. Hippotherapy is typically employed as a part of an integrated treatment program.
In the current world, children born or who develop Cerebral Palsy often benefit from a variety of traditional treatment methods and therapies specially designed and developed to enhance and improve their abilities and also their quality of life by extension. Those with function and mobility impairment have various treatments such as physical therapy used on them while programs such as hippotherapy, also referred to as equine therapy, are applied in an unconventional way in an attempt to enhance the child’s cognitive capabilities and physical strength3.
The Hippotherapy program was developed in the 1960s based on the idea that people suffering from physical disabilities and challenges can benefit from both spontaneous and learned reactions and simulations while riding a horse and was mainly used in Austria, Germany, and Switzerland as a boost for more traditional treatment programs. This form of therapy would later be recognized in the United States around 1980 as a program that not only assisted patients suffering from neuromuscular dysfunction in increasing their physical strength and cognitive capabilities but also provided the clients with an opportunity to seize the advantage of an exciting and enjoyable activity which has positive contributes to therapeutic experiences1.
This form of therapy which takes the physical, occupational and speech forms applies the equine movements in the development and enhancement of neurological and bodily functions through the channeling of the horse movements. However, it should be noted that this program is different from therapeutic horseback riding which is used in training people’s in specific horse riding skills and techniques3.
Hippotherapy is developed on the concept that the person and variable gait, rhythm, tempo, cadence, and repetition of a horse’s movement can influence and manipulate an individual’s neuromuscular development in people. Horseback riding is known for triggering and stimulating a chain of complex physical and mental reactions and sensations such as the development of physical adjustments for the maintenance of proper alignments on the horse. Plans are made by the riders to ensure the balance is achieved and maintained on the horse as well as the ability to interact with the animal2.
Through the equine movements, hippotherapy works by further developing of both physical and cognitive abilities which include4:
- Comprehension of visual cues
- Integration of the sensory.
What are the advantages of hippotherapy?
Hippotherapy has a variety of advantages and benefits to its client and patients with movement dysfunctions. The program assists children who have Cerebral Palsy on various fronts. The interaction of the child with the animals is known to raise their spirits psychologically and emotionally while also offering essential physical exercises as children learn how to ride horses properly. The gait of a horse consists of the three-dimensional movement known as the equine movement which is similar to that of human beings. This action helps children in planning their physical responses regarding the moves by the horse. Subtle positioning and adjustments are required in horseback riding to maintain proper posture and balance. The benefits of this program are categorized into physical, cognitive, and psychological advantages3.
Physical advantages include:
- Enhanced skills of the gross motor
- Enhanced strength of the trunk core
- Controlling extremities
- Enhanced postural symmetry
- Reduction of abnormal muscle tone
- Controlled respiration
Cognitive advantages are:
- Improved attention
- Enhanced visual coordination
- Improving sensory input
- Developing tactile response
- enhanced grading and timing of reactions
- Improved ability to express thoughts, needs
Psychological advantages are:
- Exciting interactions with horses
- Social interaction opportunities
- Improving self-esteem
This program is termed by most miracle therapy. However, there are various disadvantages relating to hippotherapy. One of them is the danger associated with the session and program at large. Despite the fact that horses are handled by professionals, they are animals, and they may react or behave differently according to the environment. The client or children may fall from the back of the horse thus injuring themselves. This perception may be scary as one may even break their legs or ribs1. The other disadvantage is the fact that very few medical insurance covers have approved this program. This means that the costs foregone are not covered by the insurance firms forcing the clients to foot the expenses. This may be costly since the sessions are planned to take place twice a week. Some children naturally do not like animals, and their association with horses may be a challenge to the success of the program. The children may view the horses as scary animals due to their large and massive bodies and the likely lack of daily or often interaction with them. The idea of riding on horseback high above the ground on a large animal in an environment they are not used to and surrounded by people they do not know may create a negative impression on children4.
When to recommend hippotherapy
There is no specified age or point at which the program is recommended for a child for the therapy that can dictate when or if a client can benefit from it. Significant therapeutic benefits and improvements have been noted in children as young as two years of age and teens. The employment and application of a hippotherapy program is typically dictated and based on a variety of factors which include the appropriateness of this therapy in enhancing the child’s specified physical and cognitive disabilities and if the mitigation of the material and cognitive statuses exist which can preclude a client’s interaction with a horse. Due to the unlikelihood of the program being part of the child’s primary therapies, it is unlikely for the program to be covered by some medical insurance plans2.
Performance of hippotherapy
A successful and influential hippotherapy program includes the multi-dimensional locomotion of a horse with that person. The physician or therapist administering the program is likely to start any course of treatment by assessing the child’s physical, psychological and cognitive abilities to evaluate whether the hippotherapy program is necessary for the child, and the accommodations appropriate in case the child is unable to sit on the horse in a current posture.
Once the appropriateness of the hippotherapy for the child is determined by the therapist, explanations and directives on how the sessions will be conducted are issued. Consequently, detailed instructions are given to the child and their parents or guardians regarding how physically interact and mingle with the horse which include:
- Safe mounting and dismounting a horse
- Utilization of equipment, such as saddles
- Expectations in regard to horse movements
Once the child fits the horse, the therapist must ensure strict monitoring and control of the horse while the session is in progress and the child is riding the horseback. They are required to walk by the horse side to direct the equine movement and modify and adjust the actions to suit the child’s safety4. While the therapist monitors and controls the horse, they also follow the children to observe any changes in physical reactions such as control, balance, and strength among a variety of movement skills. Differences in the physical responses are taken to be positive since when a child naturally responds to changes in gait by the horse, it develops and enhances both physical strength as well as the essential connectivity in the brain4.
The activities and objectives of the therapy program may vary because it is practiced by physical, occupational, and speech therapists. Physical therapists mainly focus on enhancing gross motor skills, strength, and balance as occupational therapists concentrate mostly on sensory processing, proprioceptive and vestibular issues. Speech therapists, on the other hand, are concerned with communication. Therapists usually monitor the progress of their client making modifications and adjustments on the child’s plan of treatment as required3.
Where is hippotherapy offered?
The therapy program usually takes place at specialized facilities and institutions, typically in a horse farm setting. Children are encouraged to interact and mingle with the horses since they will eventually ride them. Particular and close attention is paid to ensuring a stress-free, supportive and friendly environment for both the children and their families1.
While some programs are dedicated entirely to the provision of hippotherapy programs throughout the year with the exclusion of other activities, others usually have seasonal or occasional programming and modifications at specific intervals in a year. It can be challenging to access nearby programs regionally since most of the horse farms are situated in rural communities2.
Who offers hippotherapy?
Physicians who practice hippotherapy are mostly physical, occupational, and language or speech therapists who have attained rigorous educational and certification qualifications to rehearse and perform within such disciplines. This may include occupational therapists, physical therapists, and language and speech pathologists. In some scenarios, hippotherapy practitioners are likely to work closely with professional horse trainers. Multi-level educational programs are offered by the American Hippotherapy Association with the aim of educating and training aspiring hippotherapy practitioners with a knowledge foundation regarding how to work with both the clients and the horses2.
Certifying hippotherapy practitioners usually is open to speech, physical and occupational therapists that have been in the field for three years and have taken 100 hours of hippotherapy through AHA. Once applicants sit for an HPCS examination, they can obtain the Hippotherapy Clinical Specialty4.
The educational and certification program by AHA covers a variety of concepts which include;
- Physical characteristics of the animal
- Horse tacking and untacking
- The natural movement of the animal
- Horse movement unsoundness
- Links between human and horse gait
- Safety practices and emergency procedures
- Selection of necessary exercises
- Effectiveness of the treatment plan
- Creation of quality and beneficial changes
- Relationship between treatment and functional outcomes
The HPCS certificate is a validity period of five years after which they are required to undergo a re-certification procedure. During re-certification processes, the applicants must either provide written affirmation evidence of 120 hours of additional coursework or retake the HPCS examinations and assessment tests. Fifty percent of the work is usually based on hippotherapy while 25 percent should be related to hippotherapy and the other 25 percent related to the professional discipline of the applicant3.
In their professions, hippotherapy practitioners may utilize equine movement in a variety of ways. Physical therapists can focus on the cultivation of strength and balance in big muscles of the core, arms, and legs. Occupational practitioners can concentrate on excellent motor skills, sensory integration, and cognitive functioning since they are related to daily activities while language pathologists can be concerned with communication strategies that support and facilitate language and speech, signing among other modes of communication2.
What are the risks or special concerns in hippotherapy?
There are typically few risks involved with hippotherapy, but since children usually work with animals, some common sense and apparent steps need to be taken and put in place by the parents or guardians in ensuring the safety of their child1.
There are some AHA-approved and recommended hippotherapy sites that have met the pre-determined requirements and qualifications for education, safety, and proper instructions quality. Consequently, parents and guardians should not be hesitant to enquiring from the hippotherapy practitioner if they are HPCS-certified and approved. The children ought also to have the necessary safety equipment such as safety padding and helmets while attending all sessions1.
From the precedent, it is evident that hippotherapy is a significant therapeutic program. This is because it can assist children and other clients suffering from movement dysfunction in responding and developing movement capabilities. It is also recommendable since it is not drug or medicine related thus chemical free.
1. Russell J, Cohn R. Hippotherapy. Edinburgh, Scotland: Lennex Corp.; 2012.
2. Huston C. James Goes To Hippotherapy. Charleston, SC: CreateSpace Independent Publishing Platform; 2014.
3. Ayoubi L, Gerling C. Hippotherapy. Porirua, N.Z.: Wellington, New Zealand Riding for the Disabled; 2012.
4. Koca T. What is hippotherapy? The indications and effectiveness of hippotherapy. Northern Clinics of Istanbul. 2016. doi:10.14744/nci.2016.71601.