Motor Skills

Walking through the steps of
Hippotherapy
By Nicole Walker, MS OTR/L

Children require varied developmental tools to best suit their unique needs. Through the rhythmic movement of horses, therapeutic intervention is provided for many children with a myriad of special needs.

What do many people think of when they hear the term hippotherapy? Hippos, of course. Let’s leave behind that misconception and note that hippotherapy has nothing to do with a hippopotamus. The word hippotherapy is actually derived from the Greek word hippos meaning horse. Hippotherapy is also not about learning how to ride a horse. As defined by the American Hippotherapy Association (AHA), hippotherapy is a term referring to a therapist using the movement of a horse as a therapeutic tool. Hippotherapy can be used as physical, occupational and speech therapy treatment.

How does hippotherapy work?
Hippotherapy is a multi-dimensional therapy using horse movement that allows therapists to address numerous developmental issues at the same time. A child riding the horse receives constant sensory input including vestibular, proprioceptive, tactile, auditory, olfactory and visual. The vestibular system that controls balance and equilibrium is stimulated because the child is on a dynamic surface. The therapist enhances this input by having the child change the position of his/her head. Changing positions causes movement in the semicircular canals, the part of the body that affects balance. By stimulating this area, the child’s ability to process vestibular input can improve.

Proprioception is the body’s ability to process heaviness, location and resistance of objects in relation to the body. It affects posture, movement and the ability to process changes in equilibrium. The body receives proprioceptive input when the nerve endings in the muscles are stimulated, which happens when a part of the body is touched or moved, even by gravity. For example, typically functioning proprioceptive systems allow a person to close his eyes and still know where his arm ends. When a child rides a horse, the lower extremities receive proprioceptive input from touching the horse. When you add movement, the entire body receives this input. The therapist can also enhance this input by having the child change positions on the horse, having more or less of the body touching the horse.

Both of these systems, along with the tactile system, work closely together and are all stimulated when a child is simply trying to maintain balance on the horse. The touch, sights, sounds and smells of the horse and the barn contribute to stimulating other sensory systems. During therapy, most of these systems are stimulated on a subcortical level because the child is focusing on the activity, such as throwing a ball, and not consciously processing the sensory input. Because of this, the positive effects of hippotherapy continue after the session ends.

Hippotherapy takes place inside a covered arena or outside in a riding ring where the therapeutic situation is always affected by the ever-changing environment. The child participates in therapy when it is hot or cold, rainy or sunny, calm or windy. There are constant potential distractions, such as birds, planes or cars going by, the sound of the rain on the roof or another child running by. Most children are excited and motivated to come to therapy. They love to pet and feed the horses and usually cannot wait to tell their family members or friends about how they “rode” a horse. Some barns are equipped with balls, swings, therapy mats and toys so more traditional therapy can be provided if necessary.

Hippotherapy’s history
The term hippotherapy was coined in the 1960s when physiotherapists in Germany, Switzerland and Austria began using horses as a therapeutic tool. During the 1970s, physical therapists from both the United States and Canada traveled abroad to study hippotherapy and brought learned skills back with them. By the late 1980s, American and Canadian therapists had developed a national standardized curriculum for hippotherapy. In 1994, the AHA (formed in 1992) began registering therapists and setting standards of practice for hippotherapy. A registered therapist must be state licensed, complete the introductory hippotherapy courses offered by the AHA, provide a minimum of twenty hours of hippotherapy under the supervision of a registered therapist and be a member of the AHA.

Therapists and hippotherapy
Occupational therapy (OT), physical therapy (PT) and speech therapy (ST) take place in a number of different settings including schools, daycare centers, homes, clinics, riding stables and pools. Each setting dictates particular forms of therapy. Within the various forms of therapy are ranges of tools that may be utilized. As the forms of therapy have developed, more and more therapists have begun to specialize. Therefore you may have a PT or OT with a specialty in hippotherapy. Since any decisions about a child’s therapy can be complex, it is a good idea to consult with these specialists for a further analysis regarding your child’s developmental plan.

Keep in mind that not all hippotherapy is the same. Although all hippotherapy and equine assisted therapy is done on and around a horse, a child’s goals and treatment plan will be very different depending on what discipline provides the service. It is imperative to determine first if a child would benefit from OT, PT or ST and then decide if that discipline, in the form of hippotherapy, is right for the child.

Although some people consider hippotherapy and equine assisted therapy to be synonymous, they are not. Equine assisted therapy refers to skilled therapy that involves a horse. If therapy is occurring without horse movement, it is actually equine assisted therapy. During a session, a therapist would commonly use both forms depending on the needs of the patient at that time.
Children with all types of diagnoses participate in hippotherapy programs. If a physician and evaluating therapist deem it medically necessary for a child to receive occupational, physical or speech therapy it is a collaborative decision as to what treatment forms should be used. Hippotherapy is not suitable for all children with special needs. Each child must be individually evaluated to determine if hippotherapy is appropriate. There are aspects to hippotherapy that may cause more harm than good to the child or put the horse, therapist or volunteers at risk of injury. Hippotherapy is not recommended for children under the age of two. It is vital that the treating therapist, referring physician, the child and the parent or guardian all be in consensus with the treatment plan and be comfortable with the decision to participate in a hippotherapy program.

Case study
Although clinical research is lacking, therapists and families continue to participate in hippotherapy programs because they see the positive effect it has on the children. Joe is a 7-year-old boy with a diagnosis of autism and mild cerebral palsy. He has been receiving occupational therapy in the form of hippotherapy for approximately two and a half years. When he first began receiving therapy, Joe could not maintain midline alignment on the horse, he could not mount or dismount independently, he could not complete a three-step task with verbal cues and he would not attend to any fine motor or visual motor activities. Joe is now maintaining midline alignment independently indicating a significant improvement in proprioceptive processing. He mounts and dismounts independently, and he completes up to a seven-step task with only minimal cueing. He can complete puzzles with minimal assistance and will draw a line independently and a circle with minimal tactile support.
Joe’s mother frequently states that during Individual Education Program (IEP) meetings with his teachers and school therapists, she is constantly telling them that many of the things they are saying he cannot do he does consistently during his hippotherapy sessions. During a recent re-evaluation, it was decided to complete Joe’s evaluation on the horse rather than in the clinic because he was having a difficult time attending to the required tasks. After receiving sensory input from riding, Joe was able to attend and complete the evaluation.

Hippotherapy is a tool in a child’s developmental kit
Success stories like Joe’s continue to be reported by parents and therapists who participate in hippotherapy and equine assisted therapy programs. However, hippotherapy is limited in its applicability, as is every type of therapy with its individual benefits and disadvantages. It addresses only certain aspects of a child’s deficits and problem areas in one particular setting. Children are different and their needs differ significantly. It is important to determine the most significant problems that need to be addressed and, together with your therapeutic advisors, choose the form of therapy and setting that best suits your child’s needs.

Nicole Walker MS OTR/L owns Walker Therapy Services, LLC, a hippotherapy program and can be reached at (678)467-7264, www.walkertherapy.net.

Occupational Therapy Dictionary

• Proprioception (PRO-pree-o-SEP-shun): the body’s ability to process heaviness, location and resistance of objects in relation to the body.
• Tactile: the sense of touch
• Auditory: the sense of hearing
• Olfactory: the sense of smell
• Subcortical: The portion of the brain immediately below the cerebral cortex associated with the higher brain functions—voluntary movement, coordination of sensory information, learning and memory and the expression of individuality.

Equine Definitions

• Equine assisted activities are simply any activities involving a horse.
• Equine assisted therapy refers to skilled therapy that involves a horse.
• Therapeutic riding involves riding skills and horsemanship taught to people with disabilities by a horse expert.
• Hippotherapy is when a therapist uses movement of a horse as a therapeutic tool.

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