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Hippotherapy
Evidence reviewed as of before
01-01-2021 Author(s): Ogourtsova, T. (PhD OT); Steven, E. (MSc App OT); Iliopoulos, G. (MSc App OT); & Majnemer, A. (PhD, OT, FCAHS)Share this
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Hippotherapy
Introduction
The term hippotherapy refers to the use of equine movement for therapeutic purposes to improve sensory, neuromotor and cognitive systems. Occupational therapists, physical therapists and speech language pathologists can all use hippotherapy as a therapy tool to achieve goals in these domains.
Accessed on May 18, 2022 from https://shininghopefarms.org/2018/03/what-is-hippotherapy/
Equine movement provides rhythmic, consistent and predictable neuromotor inputs. Each session could provide up to 2500 neuromotor inputs that can communicate messages to the brain (e.g. normal gait mechanics). A therapist can modify different conditions during a session, including movement, positioning, posture, tempo and speed to work on different goals (e.g. postural control, balance etc.) and increase/decrease the level of difficulty for the client.
It is believed that hippotherapy can stimulate all sensory systems simultaneously (including vestibular and proprioceptive systems). Multiple subsystems are also stimulated at the same time (sensory, muscular, skeletal and limbic) and, according to dynamic systems theory, this facilitates the ability of the brain to self-organize.
Research on the use of hippotherapy as a therapy tool has demonstrated that it is effective with a broad range of clients with neuromotor, cognitive and/or communication deficits (e.g. cerebral palsy, autism spectrum disorder, multiple sclerosis and stroke).
Hippotherapy is an equine-assisted therapy, where a therapist (occupational therapist, physiotherapyist or speech language pathologist certified to provide hippotherapy) sets goals and plans activities to improve sensory, motor, cognitive and/or communication function(s).
This approach requires the riding of a horse and utilizes the horse’s movement (which walks at a rate of about 100 steps per minute). In only a few minutes, hundreds of neuro motor inputs extend to the person riding the horse. The neuro motor inputs send messages to all of the body’s sensory systems simultaneously which provide the opportunity to improve sensory processing used for walking, talking, attention and coordination.
The activity of riding is often used to improve skills required for walking. Sitting on a horse while it is in motion helps to build postural strength, endurance, balance as well as stimulate normal pelvic alignment and movements that resemble the same positioning as during walking.
Hippotherapy can be used with a variety of clienteles and ages (typically 2 years of age or older) but is commonly used for cerebral palsy, autism, cognitive disabilities (including brain and spinal injuries), developmental delays and genetic disorders. It not only provides many physical benefits but social and emotional benefits as well.
Hippotherapy can be used for strength, muscle coordination, and sensory processing used for walking, talking and motor skills for activities of daily living and general attention to tasks. It can also be used a way to motivate children who find traditional approaches difficult. Many children are more enthusiastic and excited to participate in hippotherapy and tolerate sessions better. In addition, there is some evidence that hippotherapy provides social-emotional benefits as well.
There are two types of equine-assisted activities and therapies: hippotherapy and therapeutic horseback riding. Therapeutic horse back riding teaches the rider how to ride a horse while hippotherapy uses the movement of the horse as a therapy tool (without any active control of the horse by the rider). There are no other types of hippotherapy but each professional (occupational therapist, physiotherapist and speech language pathologist) uses different types of activities to achieve goals.
There is limited research on the use of hippotherapy in children under 5 years of age. One study found hippotherapy more effective in improving gross motor function and balance in children with cerebral palsy compared to home based aerobic exercise.
Regardless of whether you are seeking hippotherapy from an occupational therapist, speech language pathologist or physiotherapist, an initial interview and baseline evaluation in the respective domain will be conducted to set individualized goals.
The first session will be used to familiarize your child to the safety procedures and equipment. A short ride with a horse that is selected by the therapist will be completed to determine the characteristics of the horse that will be paired with your child (depending on their needs) as well as your child’s tolerance riding a horse (this could determine the session durations and frequency).
Following the initial session(s), your child will begin treatment where a variety of activities will be planned by the therapist. You may be asked to participate in the session with your child (for example, walking next to the horse) to provide emotional or physical support to your child.
Safety equipment is used to support your child while riding the horse (belt, helmet etc.) but there may be additional support worker(s) present during sessions to assist the therapist and your child.
Hippotherapy can be utilized as a treatment tool or strategy by occupational therapy, physical therapy and speech language pathology professionals, while working within their scope of practice. Hippotherapy is not a separate service; rather it should be seen as a complementary method within these professions.
Professionals who provide hippotherapy must obtain a license from a hippotherapy association. In North America, the American Hippotherapy Association is commonly the licensing body.
Session duration (usually 30-60 minutes long) as well as frequency (typically weekly or bi-weekly) will be determined collaboratively with the child, family and therapist.
Hippotherapy may not be suitable for every child. It is important to inform the therapist of all medications, allergies, medical conditions/diagnosis (e.g. seizures, skin breakdown, orthopedic issues/surgeries) and behaviours (aggression, anxiety etc.) to ensure the safety of the child, animal and therapist(s).
There is some risk of physical injury (e.g. falls) when participating in hippotherapy. Each therapist is trained to provide the safest circumstances for your child, which may include having additional support worker(s) and equipment to prevent injuries.
More research is required to determine if hippotherapy is an effective tool for younger children with CP when working on occupational therapy, speech language pathology and physiotherapy related goals.
One recent study showed that hippotherapy was more effective in improving gross motor function and balance compared to aerobic exercise in children with spastic, dyskinetic or ataxic CP and GMFCS levels I to IV.
Hippotherapy may not be suitable for every child. It is best to contact a licensed hippotherapy professional to assess whether it is appropriate for your child.
Information on this website is provided for informational purposes only and is not a substitute for professional medical advice.
One high quality RCT (Kwon et al., 2015) investigated the effects of a hippotherapy program on balance among children with CP (spastic/dyskinetic/ataxic types; GMFCS level I-IV). In this high quality RCT, children were randomized to receive hippotherapy or home-based aerobic exercise. Balance was assessed using the Pediatric Balance Scale at post-treatment (8 weeks). A significant between-group difference was found, favoring hippotherapy vs. home-based aerobic exercise.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that a hippotherapy program is more effective than a comparison intervention (home-based aerobic exercise) in improving balance in children with spastic/dyskinetic/ataxic CP (GMFCS level I-IV).
One high quality RCT (Kwon et al., 2015) investigated the effects of a hippotherapy program on gross motor function among children with CP (spastic/dyskinetic/ataxic types; GMFCS level I-IV). In this high quality RCT, children were randomized to receive hippotherapy or home based aerobic exercise; both groups received conventional physiotherapy. Gross motor function was assessed using the Gross Motor Function Measures-88 at post-treatment (8 weeks). A significant between-group difference was found, favoring hippotherapy vs. home-based aerobic exercise.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that a hippotherapy program is more effective than a comparison intervention (home-based aerobic exercise) in improving gross motor function in children with spastic/dyskinetic/ataxic CP (GMFCS level I-IV).
References
Kwon, J. Y., Chang, H. J., Yi, S. H., Lee, J. Y., Shin, H. Y., & Kim, Y. H. (2015). Effect of hippotherapy on gross motor function in children with cerebral palsy: a randomized controlled trial. Journal of alternative and complementary medicine (New York, N.Y.), 21(1), 15–21. https://doi.org/10.1089/acm.2014.0021
A group of lifelong disorders affecting a person’s movement, coordination, and muscle tone and which are the result of damage to the brain before, during, or shortly after birth.
Examines the process of change and development rather than developmental outcomes. It sees any development as the outcome of interactions of systems that changes over time. For example, motor development can be seen as a process of repeated cycles of stabilizing and destabilizing behavior patterns.
Gross Motor Functional Classification System. It is a tool used to categorize the gross motor skills of children with cerebral palsy into 5 different levels across 5 age bands. It evaluates the child’s abilities in sitting, walking and wheeled mobility as well as the type of assistive devices needed for mobility. The levels are assigned based on the severity of the limitations, ranging from mild (level I) to severe (level V).
It is the sensory system that provides the perception of the position of different parts of the body. Proprioception allows you to understand where your body is positioned in space. This helps the brain coordinate movement and maintain balance.
