What is Hippotherapy?

       Occupational Therapy and the use of Hippotherapy as a Therapeutic Tool
                                              Nicole Walker MS OTR/L

“Occupational therapy is the use of purposeful activity or interventions to promote health and achieve
functional outcomes.” (Case-Smith et al., 1996) “Achieving functional outcomes means to develop, improve,
or restore the highest possible level of independence of any individual who is limited by a physical injury or
illness, a dysfunctional condition, a cognitive impairment, a psychosocial dysfunction, a mental illness, a
developmental or learning disability, or an adverse environmental condition.” (Case-Smith et al., 1996)
Occupational therapy services are provided to children to address deficits in fine motor, gross motor, visual-
perceptual, visual motor, sensory motor, play and self-help skills. Occupational therapy services can be
provided in a number of settings and utilize a number of therapeutic tools to assist in reaching functional
goals.

“Hippotherapy is a term that refers to the use of the movement of the horse as a tool by physical therapists,
occupational therapists and speech-language pathologists to address impairments, functional limitations
and disabilities in patients with neuromusculoskeletal dysfunction. This tool is used as part of an integrated
treatment program to achieve functional outcomes.” (American Hippotherapy Association, 2002)
Hippotherapy has been found to “offer(s) the potential for improvement in the following areas:” “arousal and
attention, balance strategies”, “bilateral integration, body awareness, circulation, dynamic postural stability,
endurance, expressive or receptive speech and language, midline orientation, mobility of pelvis, spin and
hip joints, modification of muscle tonus”, “muscle strength, musculoskeletal alignment”, ”neuromotor
function, posture”, “respiratory function”, “sensorimotor integration, symmetry and alignment, and timing
and coordination of motor strategies.”(American Hippotherapy Association, 2000) The therapist is able to
utilize the movement of the horse to assist during therapy just as a home therapist may utilize the use of a
specific toy or therapy ball. This movement in unique and cannot be imitated by any other available therapy
equipment.

Hippotherapy is a multi dimensional therapy in that it allows therapists to address numerous skills at one
time. While the child is riding the horse, the child receives constant sensory input from the horse including
vestibular, proprioceptive, tactile, auditory, olfactory and visual. The vestibular system, the system that
controls balance and equilibrium, is stimulated because the child is on a dynamic surface. The therapist also
enhances this input by having the child change positions on the horse. These positions cause 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. Typically
functioning proprioceptive systems allow a person to close their eyes and still know where their arm ends,
for example. When a child rides a horse the lower extremities receive proprioceptive input from touch the
horse. When you add in movement, which causes “bouncing” 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 in order to not fall off.
The touch, sights, sounds and smells of the horse and the barn contribute to stimulating the 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 the ball, and not consciously processing the sensory input.
Because of this, carryover frequently occurs and integration is more common.

Hippotherapy takes place inside a covered arena or outside in a riding ring. 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 constantly potential distractions such as a bird, plan or car going by,
the sound of the rain on the tin 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 can’t wait to tell their family members or
friends about how they “rode” a horse. The barn is also equipped with balls, swings, a therapy mat and toys
so more traditional therapy can be provided if necessary.

When hippotherapy is provided by an occupational therapist, the therapist addresses fine motor, gross
motor, visual-perceptual, visual motor, sensory motor, play and self-help skills. While riding, the child
participates in various games and activities. These can range from strengthening exercise such as
pretending to be an airplane or a horse on a horse, to fine motor activities such as drawing with markers or
stringing beads. Each child is individually evaluated and their needs assessed. The child’s goals reflect their
particular needs. No two therapy sessions are the same even though they all occur on the horse.  
What Is Speech Therapy?
Speech-language therapy is the treatment for most children with speech and/or language disorders. A speech disorder
refers to a problem with the actual production of sounds, whereas a language disorder refers to a difficulty
understanding or putting words together to communicate ideas.  By assessing the speech, language,
cognitive-communication, and swallowing skills of children and adults, speech-language pathologists can determine what
types of communication problems exist and the best way to treat these challenges.  Speech-language pathologists
typically treat problems in the areas of articulation; dysfluency; oral-motor, speech, and voice; and receptive and
expressive language disorders.

What is Physical Therapy?
The Model Definition of Physical Therapy adopted by the American Physical Therapy Association, states that physical
therapy includes:
Examining individuals with impairment, functional limitation, and disability or other health related conditions in order to
determine a diagnosis, prognosis, and intervention.
Alleviating impairment and functional limitation by designing, implementing, and modifying therapeutic interventions.
Preventing injury, impairment, functional limitation, and disability, including the promotion and maintenance of fitness,
health, and quality of life in people of all ages.
Engaging in consultation, education, and research.
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