Hippotherapy (“hippos” in Greek means “horse”) is a form of animal-assisted therapy that can be used as physical therapy, occupational therapy, and speech or language therapy. Equine movement has similar rhythms to human movement; it is thought that the patient, while riding the horse, will use her body to adapt to the horse’s movements, thereby creating or healing neuronal pathways. Hippotherapy sessions are guided by the patient’s therapist, who instructs the patient to perform certain tasks while riding or otherwise interacting with the horse, which create desired therapeutic outcomes.

Instances of hippotherapy appear in medical literature as far back as Hippocrates, but it was in the 1960s that European physical therapists began to standardize hippotherapy protocols. In the 1980s, a group of American and Canadian therapists traveled to Germany to learn current techniques. In the 1990s, the American Hippotherapy Association (AHA) was established and created treatment standards and international protocols. It developed an examination for a “certified hippotherapy clinical specialist” (HPSC) designation, which can be earned by physical, occupational and speech/language therapists.

Hippotherapy is distinct from therapeutic horseback riding, in which disabled individuals earn social and cognitive benefits of through learning riding skills. Unlike therapeutic horseback riding, hippotherapy sessions are often covered by health insurance.​

Possible Uses

Hippotherapy has been shown to be effective in treating a variety of cognitive, psychiatric, and muscular disorders. Studies have shown hippotherapy to be effective in treating Down Syndrome, autism spectrum disorder (ASD), cerebral palsy, muscular dystrophy, traumatic brain injury (TBI), developmental delays, depression, anxiety and PTSD.

Given its wide range of benefits, it may be especially effective in treating children with co-occurring disorders. It can also be a great treatment alternative to children who are resistant or unresponsive to traditional therapeutic settings, such as school and clinical offices.

How It Works

Horseplay Therapy in Saint Augustine, Florida explains the mechanics of hippotherapy as follows: “The movement of the horse influences the client, and the client actively responds to the movement. The therapist directs the movement of the horse, analyzes the patient’s response, and adjusts the treatment accordingly. The movement of the horse creates a combination of sensory, motor, and neurological input. This effective strategy is integrated into the treatment plan to help patients reach their goals.”

When used for physical therapy, the equine movements help patients’ bodies learn “normal” gait, balance, posture and range of motion. Patients often exhibit improved motor skills after a few sessions. As occupational therapy, the therapist uses the interactions with the horse to facilitate sustained attention, sensory processing, tactile, visual and auditory stimulation. In speech and language therapy, therapists often find that children are more motivated to communicate with the horse than with parents and teachers, and patients often speak their first words or express their feelings to the horse when doing so to friends and family is too fraught. 

This article in Parents Magazine offers examples of outcomes of hippotherapy:

  • Reducing muscle tone (e.g., spasticity) with slow, rhythmic movement
  • Improving attention and postural control with fast, erratic movements
  • Decreasing sensory defensiveness or sensitivities with full-body contact (when the child pets or hugs the horse)
  • Improving right and left coordination by steering the reins
  • Developing visual-motor skills with hiding puzzle pieces along a trail that need to be found
  • A hippotherapy session requires a team to ensure the safety and effectiveness of treatment. Most sessions involve the therapist as well as a handler or horse trainer and riding instructor. The team walks on both sides of the horse while the child rides, providing support and supervision throughout the session. “Receiving the movement transmitted by the horse’s pelvis – which results in weight shifts, balance reactions, and core/pelvis motions – helps the kiddos develop the skills – like motor planning, bilateral coordination, muscle strength, balance, visual perceptual, sensory regulation, weight-bearing, timing, and more – so essential for daily life,” says Children’s Theraplay, a hippotherapy center in Carmel, Indiana. “In short: The dynamic movement of the horse combined with the dynamic environment leads to functional change.”

    Things to Consider

     Any child who struggles verbally expressing herself, manipulating objects, or who has trouble standing and maintaining posture may be a good candidate for hippotherapy. However, it’s important to have a realistic understanding of your child’s fears about horses and/or the outdoors in order to determine their suitability for hippotherapy. For children who enjoy horses, the fact that they’re going to go riding can motivate them and distract them from feeling that they’re “different” from their friends who don’t attend therapy sessions.

    This parent, whose child received treatment for cerebral palsy at Horseplay Therapy, describes the effect of hippotherapy on their young daughter:

    “Prior to starting hippotherapy, Kaelynn could walk and run but was uncoordinated, and had no fine motor skills. Over time we noticed that running became more natural for her, her hands became stronger, and she actually wanted to color, string beads, and cut with scissors. These things were super hard for her prior to starting hippotherapy. She is also better at following directions and concentrating to complete her tasks. The best part is that Kaelynn doesn’t even realize she is in therapy when she is on the horse. She’s just excited that she get to go horseback riding every Wednesday!”

    Hippotherapy is only one component in a comprehensive treatment plan, and parents should inquire with other members of their child’s treatment team about their ability to integrate the hippotherapy work with other forms of physical, speech, or occupational therapy.

    Hippotherapy is available in most cities, and parents can locate local options on the AHA website or through Professional Association of Therapeutic Horsemanship International (PATH). Hippotherapy is often covered by insurance, but many centers are non-profits and also provide payment assistance or scholarships to children in need.