Therapists have tapped into the unique benefits of horses for rehabilitation and therapeutic purposes. Rehabilitative equine programs offer patients with varied medical conditions the ability to take advantage of the unique movements of the horse. These planned and purposeful interactions between the patient and the horse create a truly unique type of intervention that fosters a wide range of beneficial outcomes.
Equine rehabilitative programs typically feature both therapeutic riding and hippotherapy. Therapeutic riding is an umbrella term to catch the variety of equine activities in which people with disabilities partake. Hippotherapy involves a therapist using a horse’s movement as a treatment strategy in order to improve function. The word is derived from the Greek word “hippos,” which means horse. Specially trained therapists, including physical and occupational therapists and speech-language pathologists use this intervention in order to treat an eclectic array of movement dysfunctions.
Broadly speaking and for simplification’s purpose, with therapeutic riding the intent is for the patient to try to influence and control the horse by teaching riding skills. With hippotherapy, the intent is to have the movement of the horse influence the patient as a treatment for neuromuscular function and sensory processing.
Equine therapy has recently received an explosion of publicity and interest. Highlighted in everything from TV, to newspapers, to medical journals for its therapeutic value, there seems to be something to the buzz. Although organized therapeutic riding is a relatively recent development, the value of therapeutic riding goes back centuries when the horse was used by multiple civilizations as a mode of transport.
The advent of therapeutic riding as we know it today is generally credited to European roots and the achievements of Liz Hartel of Denmark who overcame the limitations of polio to win the silver metal for Grand Prix in the 1952 Helsinki Olympics. Soon thereafter, medically oriented equine centers sprang up in Canada and America. The North American Riding for the Handicapped Association (NARHA) estimates that more than 38,000 individuals received benefit from these activities last year and numbers continue to grow.
Therapeutic riding and hippotherapy is used for patients with a broad spectrum of disabilities and medical conditions. Some of these include muscular dystrophy, cerebral palsy (CP), multiple sclerosis (MS), Down syndrome, autism, mental retardation, spina bifida, spinal cord injuries, traumatic brain injuries, amputations, developmental delay, learning disabilities, hearing impairment, visual impairment, weight control disorders, ADD/ADHD, cerebral vascular accident (stroke), at-risk youths and limbic system dysfunction. 1
While there are many traditional rehabilitation/treatment approaches for the above patient populations, the horse provides a treatment that is a solely distinctive intervention. The movements of the horse provide a dynamic base of support, which inherently make it an ideal surface to challenge core/trunk strength and control, balance/proprioception, postural strength and endurance, sensory input and motor planning.
While using the horse as a treatment medium, the patient must accommodate to the horses subtle movements by making adjustments through their trunk in order to maintain a stable position. The walking movement of the horse provides a spectrum of sensory input through movement that is variable, rhythmic and repetitive. This sensory input affects most every system responsible for sensation and control of movement – including the auditory, tactile, pain, proprioceptive, kinesthetic and vestibular systems. Directing this sensory input is where the therapist comes into play.
The therapist grades the degree of this sensory input to the patient by controlling different aspects of the horse’s movement, position and management. Using various techniques and adaptive equipment, the therapist can then use this unique movement to achieve the desired results – whether it is improving muscle tone, balance, coordination, posture, sensation or general mobility. These improvements can be generalized to functional outcomes with daily activities which require sitting, standing and walking.
There is a growing body of evidence that supports hippotherapy and equine activities for the treatment of various medical conditions. Multiple studies have been conducted using hippotherapy on patients with multiple sclerosis (MS), cerebral palsy (CP), spinal cord injury and traumatic brain injury. Results are encouraging and appear to show beneficial trends for the improvement of postural stability, balance, regulation of muscle tone, functional motor performance and symmetry of muscle activity.
Positive results were also shown with spasticity reduction, improved coordination, energy expenditure, vital lung capacity and range of motion. Trends were also shown for improved attention span and psychological status (including increased self-esteem and confidence and decreased anxiety and agitation).2-4 Many patients were found to respond enthusiastically to the unique relationship they formed with the horse, which elevates the motivation for improvement and the makes treatment process all the more enjoyable.
If properly used by the appropriately trained therapist, the horse is yet another tool that can be added to the list of interventions that are at your disposal. It indeed has the potential to become a truly interactive treatment.
1 Americanhippotherapyassociation.org. (2011). Basic principles and effects of hippotherapy.
2 Lechner, et al. (2007). The effect of hippotherapy on spasticity and on mental well-being of persons with spinal cord injury. Journal of Neurologic Physical Therapy, 88(10), 1241-1248.
3 McGibon, et al. (2009). Immediate and long-term effects of hippotherapy on symmetry. Medical Rehabilitation, 90, 966-974.
4 McGee, M., & Reese, N. (2011). Immediate effects of a hippotherapy session on gait parameters in children with spastic cerebral palsy. Pediatric Physical Therapy, 25(30).
Ben Wiggin is the practice manager at Huggins Hospital Back Bay Rehabilitation in Tamworth, NH. He has interest in sports medicine, manual interventions and orthopedics.