Hippotherapy: A Clinical Description

In Hippotherapy (HPOT) the movement of the horse is a treatment strategy facilitated by a Physical Therapist, Occupational Therapist, or Speech-Language Pathologist to improve muscle tone, balance, posture, coordination, motor development, communication and overall emotional well being.  The movement of the horse is used to facilitate desired responses for repetitive reactions for improving functional outcomes. 1, 2 This multi dimensional, repetitive, rhythmic movement through space provides a cause and affects opportunity for the patient to respond to.   Goals are created by patients, families and therapists and the movement of the horse is modified to facilitate the needed response for each individual patient. 264

In addition, the movement of the horse facilitates trunk lateral flexion and pelvic rotation similar to the movement of normal human walking. 1, 3, 4 This dynamic creates a motor memory learning environment.  Shurtleff and Standeven 5 report that the experience of riding a horse can be thought of as a massed but variable practice of 3000 to 5000 repetitions of a postural challenge per 45 minute of treatment.

hippotherapy2Reports of the positive effects of HPOT have been supported for many years. 1,2  and  studies are improving in the quantitative nature with increased control groups, blind testing and overall interest in the success of this industry.   Silkwood-Sherer and Warmbier completed a study reporting statistical improvement in balance with individuals with multiple sclerosis receiving HPOT.  Testing measures included the BERG and the Tinetti Performance Oriented Mobility Assessment. 7     Numerous articles have presented evidence of improvement in trunk, posture, head control and function in children with cerebral palsy, 8,9,10  Casady et all 9 reported significant improvement in ten children with cerebral palsy using the PEDI and GMFM.   Shurtleff and Standeven 5 completed a study to determine dynamic trunk/head stability and functional reach after hippotherapy.

Physical Therapist, Occupational Therapists and Speech Pathologist undergo specialized training.  Each potential patient is evaluated to determine the individual appropriateness of including equine assisted therapy as a treatment strategy.

The therapy professional works closely with the horse handler  to manipulate various aspects of the horse’s movement, position, management style, equipment and types of activities to generate effective remediation protocols and to promote functional outcomes.

Population – children and adults with mild to severe neuromusculoskeletal dysfunction

Medical Conditions Impairments
Autism Spectrum Disorder Abnormal Muscle Tone
Cerebral Palsy Impaired balance responses
Developmental Delay Impaired Coordination
Genetic Syndromes Impaired Communication
Learning Disabilities Impaired Sensorimotor function
Sensory Integration Disorders Postural asymmetry
Speech-Language Disorders Poor postural control
Traumatic Brain Injury/Stroke Decreased mobility
Limbic System Dysfunction related to arousal and attention skills


1. American Hippotherapy Association. Hippotherapy Treatment Principles-Level I, II: Clinical Problem Solving. 2006.

2. Heine B, Benjamin J. Introduction to Hippotherapy. Advance for Phys Therapists. 2000;11(13):11-3.

3. Garner B, Rigby R. Analysis of Human Pelvis Motions When Riding on a Horse and When Walking.  North American Riding for the Handicapped Association (NARHA) National Conference; Fort Worth, Texas2009.

4. Rigby RB. Comparing the Pelvis Kinematics of Able-Bodied Children During Normal Gait and When Riding a Therapeutic Horse Waco: Baylor University; 2009.

5. Shurtleff TL, Standeven JW, Engsberg JR. Changes in dynamic trunk/head stability and functional reach after hippotherapy. Arch Phys Med Rehabil. 2009 Jul;90(7):1185-95.