What are Hippotherapy and equine assisted therapy?
“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)
Equine assisted therapy (EAT) refers to the use of a horse and horse related activities (equine assisted activities) as a tool by physical therapists, occupational therapists and speech-language pathologists. The key difference is that hippotherapy is the use of the movement of a horse and EAT is using the whole horse and the horse environment.
Hippotherapy/Equine assisted therapy 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.
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.
Benefits of Hippotherapy
“Hippotherapy offers the potential for improvement in the following areas: arousal and attention, balance strategies, belief in one’s functional capabilities, bilateral integration, body awareness, circulation, dynamic postural stability, endurance, expressive or receptive speech and language, midline orientation, mobility of pelvis, spine and hip joints, modification of muscle tonus, motivation, muscle strength, musculoskeletal alignment, neurogenic bladder, neuromotor function, oral-motor function, posture, problem-solving movement strategies in different environments, respiratory function, self confidence, sensorimotor integration, symmetry and alignment, and timing and coordination of motor strategies.” (American Hippotherapy Association, 2000)
All persons ages two and up who qualify for occupational, physical or speech therapy may be eligible for the program. Hippotherapy is not appropriate for everyone. Each person must be evaluated individually to determine eligibility.
Precautions and Contraindications:
The following conditions may suggest precautions or contraindications to hippotherapy/equine assisted therapy.
Atlantoaxial Instability-including neurologic symptoms Coxa Arthrosis
Cranial Deficits Heterotopic Ossification/Myositis Ossificans
Joint subluxation/dislocation Osteoporosis Pathological fractures
Spinal fusion/fixation Spinal instability/abnormalities
Hydrocephalus/Shunt Seizure Spina Bifida Chiari II Malformation
Tethered Cord Syndrome Hydromyelia
Allergies Animal Abuse Physical/Sexual/Emotional Abuse
Blood Pressure Control Dangerous to self or others
Exacerbations of medical conditions Fire Setting Heart Conditions Hemophilia
Respiratory Compromise Recent Surgeries Substance Abuse
Thought Control Disorders Weight Control Disorder
Age-under 2 years old Under 3 years old with Down Syndrome
Indwelling Catheters Medications-i.e. photosensitivity
Poor endurance Skin Breakdown