What is Hippotherapy?

What is hippotherapy? It has nothing to do with a hippopotamus. Think Greece. “Hippos” is the Greek word for “horse”.

A clear description of hippotherapy is one provided in an abstract by Brandon Rhett Rigby, M.S.B.M.S. (2009) who states:

Hippotherapy is a treatment strategy that uses horse movement as a physical therapy tool for clients with a broad range of diagnoses, including cerebral palsy and multiple sclerosis. Studies show that the gait motion of the horse provides sensory stimulus and movement patterns to the rider that mimic natural movements of healthy humans…[1]

Providing the horse is relaxed under the rider, the movement of the horse can relax the entire body of the rider, freeing up tight and underused areas, which are commonplace for those confined to wheelchairs or for those who have difficulty walking.

At Valley Therapeutic, where I have been studying the impact I have on clients when playing the violin, part of the session is spent out in the woods on their private trail, weather permitting. Objects are strategically placed in the woods to assist with stretching, touching and vocalization, and all the while, passively interacting with and reacting to the horse’s movements. Balance and core strength is also improved as hands reach up for objects rather than hanging on. I follow or lead them out, like a Pied Piper, creating musical stories around the found objects.

All aspects of the session improve neurological function and sensory processing. Inside the arena, games are played, songs are sung or conducted with cues from the violin, all the while working on breathing, vocal projection, strengthening and stretching.

All lesson plans have intention and outcome. For instance, if a client is collapsed on one side due to cerebral palsy or scoliosis, the direction traveled in the arena will be in the direction that challenges the muscles on the weaker side. Another example: changing positions on the horse can also influence speech production, particularly a sitting backwards position. Sitting backwards encourages the tongue to recess, decreasing spit production and the likelihood of tongue engagement, and therefore a greater likelihood of speech/language initiation. The addition of the violin expands and extends the actions arising from these treatment methods.

The over-arching goal is to reach as independent a state as possible. Speech is the ultimate desirable. The sound and frequencies of the violin triggers speech and lights up the language areas of the brain. When speech or vocalization are triggered, the client is a step closer to independence. 

Riding as Therapy

Ancient Greece: as early as 600 B.C. and later the Romans recognized the therapeutic value of horseback riding. In Europe, France in particular, had documented the therapeutic use of horse riding as early as 1875. After World War II, it gained popularity, prescribed to address mental, physical and emotional issues (Meregillano, 2004). By the 60’s, riding centers were popping up to help full spectrum diagnosies, such as MS, stroke, Downs, spinal cord injury, ADHD, autism and CP.

It is time to clarify the difference between therapeutic riding and hippotherapy. For riding therapy, instructor teach the disabled rider to control the horse using basic riding skills. There is no deliberate clinical application for this type of therapeutic riding. Hippotherapy is a different beast. Clinical physiotherapy is applied to the mechanical advantages of the horse, which is often referred to as a 1200 lb. therapist partner, give or take a few pounds. Physical therapists and occupational therapists use the equine movements to improve balance, posture, gross and fine motor skills.

Borton and Bettie (2011) write, “Physical therapists who have had training in hippotherapy may incorporate the multi-dimensional movement of the horse to achieve gait training, balance, postural/core control, strengthening and range of motion goals. Improvement in gross motor skills and functional activities for developing children with disabilities has been reported. Impairments are addressed through the variability of the horse’s movement by modifying the rhythm, tempo and cadence of the horses movement.

Occupational therapists providing hippotherapy utilize the movement of the horse to improve motor control, coordination, balance, attention, sensory processing and performance in daily tasks. The reciprocal multi-dimensional movement of the horse helps with the development of fine motor skills, visual motor skills, bilateral control and cognition as well. Sensory processing via hippotherapy simultaneously addresses the vestibular, proprioceptive, tactile, visual and auditory systems. The occupational therapist incorporates the movement of the horse, hippotherapy, to modulate the sensory system in preparation for a therapy or treatment goal that leads to a functional activity.

Hippotherapy has also seen use in speech and language pathology. Hippotherapy uses a horse to accomplish traditional speech, language, cognitive, and swallowing goals. Using hippotherapy, appropriate sensory processing strategies have been integrated into the treatment to facilitate successful communication.” [2]

However, there can be cross-over into the therapeutic riding sector, especially if riding instructors teach simultaneously  in the same space. What is being recognized more and more, is that all therapies are related and can be inter-disciplinary. This is even showing up in the university setting, where speech, occupational and physical therapy faculties are beginning to recognize the value of checking in with each other, that there is overlap and beneficial trading of information.

Studies suggest that hippotherapy improves coordination during riding between the rider’s upper and lower trunk as well as between the rider’s lower trunk and the horse’s back. Additionally, supporters of horseback riding interventions state that the warmth, shape, and rhythmical, three-dimensional movements of the horse improve flexibility, posture, balance, and mobility of the rider. 

“From a dynamic systems perspective, the…..variations of seating on the horse, offer the rider multiple opportunities for adjustment. Varying the position in which the child is placed on the horse (for example, prone, sitting, side-sitting, and side-lying), the terrain, or the number and direction of turns presents different physical challenges.”(Thelen & Spencer, 1998). Requiring more participation on the part of the rider also challenges attention span.

Presently the North American Riding for the Handicapped Association (NARHA) and the Hippotherapy Association (AHA, American 2003) set program standards and provide training and licensure for hippotherapy. The former provides certification.

1.Brandon Rhett Rigby, M.S.B.M.E. Mentor: Brian A. Garner, Ph.D., “Comparing the Pelvis Kinematics of Able-Bodied Children During Normal Gait and When Riding a Therapeutic Horse” Retrieved December 3, 2015 from https://baylor-ir.tdl.org/baylor-ir/bitstream/handle/2104/5420/Rhett_Rigby_masters.pdf
2.Borton, Bettie B., Au.D. and Ogburn, Amy C., Ph.D., CCC-SLP, “Therapeutic Riding and Hippotherapy: What Is It and How Does It Work?” Retrieved February 17, 2011 by Wikipedia citation: Hippotherapy