Hippotherapy Overview

Animal therapy engages children and adults who have a variety of illnesses and disabilities. The animals traditionally include dogs, cats, talking birds, and horses. Hippotherapy, a form of Equine Assisted Therapy, is gaining ground as an effective way to increase the physical and emotional health of children with cerebral palsy (CP). It has the potential to help the child develop physical strength and endurance and increase balance. It can also improve the child’s communication skills as they interact with the horse and the therapist and build their overall sense of confidence and well-being.

Hippotherapy and Cerebral Palsy

This therapy involves interacting with a well-trained horse. Sessions may include feeding and petting the animal as well as talking to it. The core of the therapy involves riding on the horse’s back in a safe, controlled environment. It has been used since the 1960s and is increasingly being adopted today. Equine Assisted Therapy can improve cognitive ability, body strength, and endurance. It may also increase broader abilities such as the child’s social skills, confidence, and overall sense of well-being.

This kind of therapy is not usually used alone. It is generally a supplement to the traditional therapy practices recommended by the child’s treatment team. This may include physical therapy, speech therapy, and occupational therapy to meet various goals on the treatment plan. However, these same therapists may be certified to integrate horse therapy into their other teaching methods. Typical goals that the therapy session may address include:

  • Strengthening the muscles of the child with cerebral palsy
  • Improving balance and flexibility
  • Increasing fine motor control skills to help with everyday tasks

Not every horse is a good candidate for this specialized therapy. Only the most well-trained, gentle, and patient horses and ponies are chosen. These animals also undergo training for specific concerns that may occur during therapy. For example, the horses are trained not to startle at a child’s shout of excitement and to stop immediately if they feel the child slipping from position on the saddle.

How Do Children With Cerebral Palsy Benefit?

This therapy introduces physical activity in a safe, carefully monitored, visually interesting environment. During a session, the horse moves with a gentle, repetitive motion, gait, and tempo. The horse may move at 100 steps per minute. Over the course of a half-hour session, this movement will gently challenge the child’s body thousands of times. This stimulates the balance and motor control in numerous ways. The child with CP may:

  • Maintain balance, with appropriate assistance, over a period of time
  • Direct the horse by squeezing his or her knees
  • Turn the horse by manipulating the reins
  • Hold his or her head erect
  • Interact with the therapist and any assistants

These children may greatly enjoy the visually varied environment, and, of course, interacting with the animals themselves. This can help encourage children to meet the sometimes tiring and frustrating challenges offered by therapy.

Children may also meet, build friendships with, and learn from other children who are also taking advantage of the Equine Assisted Therapy program. This can unlock other activities to participate in. For instance, some places hold a yearly special rodeo for children with disabilities.

A well-implemented therapy session will scale the difficulty to appropriately challenge the child with CP’s physical and mental capabilities. This can improve the child’s:

  • Overall strength
  • Trunk and core strength
  • Gross and fine motor control
  • Balance
  • Posture
  • Muscle tone, for both hypotonia and hypertonia
  • The ability to give and receive visual cues
  • Sensory issues
  • Communication skills
  • Social skills
  • Confidence and self-esteem

How Effective Is This Therapy?

The various subsets of Equine Assisted Therapy have not been studied as extensively as other, more traditional methods. However, growing evidence and scientific studies show that it can work for many people. Zadnikar and Kastrin analyzed a number of other studies and determined that Equine Assisted Therapy was effective for 76 out of 84 children with cerebral palsy.

Thompson, Ketcham, and Hall’s study dived more deeply into the specific benefits of this therapy. Most of the children they looked at improved in posture and stability and walked faster on level surfaces. Half of the children developed a greater forward reach and walked faster on irregular surfaces. The therapy sessions also improved hypertonia. The children with lesser degrees of disability experienced the most gains.

Other benefits were noted by Champagne, Corriveau, and Dugas. They studied 13 children with CP, aged 4 to 12, and saw significant improvement on scores for fine motor precision, balance, and strength. These gains remained, even when the children were retested 10 weeks after the end of the therapy.

These studies suggest that many, although not all, of children with cerebral palsy will see a number of benefits from Equine Assisted Therapy.

When Can You Start Equine Assisted Therapy?

There is no set age for starting this kind of therapy. Additionally, there is no upper age limit where the child would stop seeing benefits. Children, ranging from toddlers to older teens, have successfully undergone Equine Assisted Therapy. It is more a question of whether it is the right fit for the child and family. You will need to consider both the child’s well-being and the price of therapy to determine this.

Your first step is to discuss your hopes and concerns with your child’s doctor and treatment team. This kind of therapy challenges the child’s body and mind in unique ways. The doctor and other members of the treatment team can determine if your child is in the right place to benefit from Equine Assisted Therapy.

Some concerns to think about and bring up include:

  • Your child’s physical strength and ability to stay upright and hold his or her head up with the weight of a helmet during the session
  • His or her overall health, including whether he or she has enough endurance to remain in the saddle for a productive length of time
  • Whether your child will need specialized equipment that may need to be ordered ahead of time, perhaps including a neck brace or specific kind of saddle
  • Sensory issues that may make your child reluctant to wear necessary safety gear
  • Allergies, an often overlooked problem that may halt therapy as allergy medications can make your child drowsy
  • Any phobias your child may have of large animals

You may also want to contact your health insurance to see if it covers this form of therapy. Unfortunately, many plans do not, leaving parents to pay the bills out of pocket. In that case, it is helpful to get an estimate of expenses from the Equine Assisted Therapy provider you hope to use to see if it falls within your budget.

What Can You Expect During the Therapy Sessions?

Your child’s therapist will give a baseline assessment before the therapy sessions begin. This will most likely cover your child’s physical abilities and may also include cognitive and emotional assessments. These will be repeated after a number of weeks of Equine Assisted Therapy to see if, and how much, it has helped.

The results of the assessment will be discussed with you. Your child’s therapist will give their recommendation as to whether this form of therapy is a good fit for the child’s needs. If so, they will discuss their goals for the coming therapy sessions.

The session itself will begin with a lecture or demonstration on safety. This will include putting appropriate safety gear on the child. The child will learn about the equipment used, such as reins and a bridle, and what to expect when the horse moves. The child will be introduced to his or her horse for the session. Finally, the therapist will teach the child to mount and dismount, with appropriate levels of assistance.

Once the safety training has been given, the child can begin riding. Depending on the weather, the child’s familiarity with Equine Assisted Therapy, and the stable setup, this may be done inside the barn or outside in a fenced area. The therapist will most likely walk beside the horse, modifying the animal’s movement as needed. One or more trained assistants will monitor and physically support the child as he or she rides.

Riding sessions begin very slowly. As appropriate, the therapist will challenge the child by:

  • Including turns in the course
  • Increasing the speed at which the horse moves
  • Seating the child forwards and backwards to change the physical challenge
  • Getting the child to toss a ball at a target
  • Guiding the horse around obstacles such as cones on the ground

These sessions will ideally scale in difficulty to appropriately challenge the child’s physical and mental abilities.

The length and frequency of sessions are determined by the therapist as he or she writes the treatment plan, and they can vary wildly. You can generally expect at least one half-hour session a week for perhaps 10 weeks. After that, the therapist will reassess the child to determine progress and decide if more sessions may be beneficial.

Which Therapists Can Implement This Therapy?

This is not a separate form of therapy so much as another tool that an experienced therapist may use to help the child. You may find physical therapists, occupational therapists, and even speech therapists who have gone through the extensive training and the certification process to implement Equine Assisted Therapy.

During training, therapists learn how to work with horses, how to accommodate children with special needs as they interact with the animals, and how to adapt therapy plans to this unique situation. Most certified therapists will have a minimum of three years’ experience in their personal field of study, for instance, in occupational therapy. They will also have completed at least 100 hours of training specifically for Equine Assisted Therapy. This training may include:

  • Horse anatomy and physiology
  • How horses move
  • How that movement is similar to and different from human movement
  • Best safety practices for the child
  • Best safety practices for the horse
  • Selecting the best exercises to match the child’s specific needs and therapy goals

In the United States, the certification to look out for is Hippotherapy Clinical Specialist (HPCS). In order to pass certification, many therapists use the American Hippotherapy Association’s (AHA’s) curriculum and workshops. The therapist may mention both of these organizations.

Where Can You Find Therapists Trained in Equine Assisted Therapy?

Depending on where you live in the country, finding a therapist trained in hippotherapy may be a challenge. This may not be a practical option for people in very large urban areas and rural places far from stables. However, here are some tips for your search:

  • Ask your child’s doctor if he or she can refer you to an Equine Assisted Therapy program
  • Ask your child’s physical, occupational, and speech therapists. If they aren’t trained for this, they may know someone local who is
  • Join a local cerebral palsy group and network. Other families have likely investigated this too and will be glad to share their knowledge
  • Therapeutic Horseback Riding (THR) is a different form of Equine Assisted Therapy, but there is some overlap. If a THR program is nearby, you can call and ask if they know about any other Equine Assisted Therapy programs in the area
  • Don’t underestimate the power of the internet. Web searches may turn up useful results. You can also post on the message boards of popular CP organizations

Is This Therapy Right for Your Child With Cerebral Palsy?

From anecdotes to professionally designed studies, a number of sources indicate that children who attend Equine Assisted Therapy can make substantial gains along a number of areas to gain physical, cognitive, and emotional well-being. These benefits have been experienced by children of a wide variety of ages, from toddlers to teens.

Gains tend to be kept even after therapy ends. There are no guarantees that your child with CP will experience the same results, but if their doctor and treatment team think Equine Assisted Therapy may be helpful, it is worth investigating.

Sources Used in This Article