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File:Huifbed te Heel.jpg
Horse drawn litter in use for hippotherapy

Hippotherapy is a form of physical, occupational and speech therapy in which a therapist uses the characteristic movements of a horse to provide carefully graded motor and sensory input. A foundation is established to improve neurological function and sensory processing, which can be generalized to a wide range of daily activities. Unlike in therapeutic horseback riding, where specific riding skills are taught, the movement of the horse is a means to a treatment goal when utilizing hippotherapy as a treatment strategy. Another name for hippotherapy is Aloka.

note: The carriage called "huifbed" or "wagon bed" shown in the picture is built in the Netherlands and used for "huifbedrijden" or wagon-bed riding with people that are often multiple disabled. They are lying on a canvas positioned over the horses so they feel all movements of both horses.



Derived from the word "hippos', the Greek word for horse, the term "hippotherapy" literally means treatment or therapy aided by a horse. The concept of hippotherapy finds its earliest recorded mention in the ancient Greek writings of Hippocrates. However, hippotherapy as a formalized discipline was not developed until the 1960s, when it began to be used in Germany, Austria, and Switzerland as an adjunct to traditional physical therapy.[1] In Germany, hippotherapy was a treatment by two physiotherapists, a specially trained horse and horse handler. The theories of physiotherapy practice were applied, with the physiotherapist giving directives to the horse handler as to the gait, tempo, cadence, and direction for the horse to perform. The movement of the horse was carefully modulated to influence neuromuscular changes in the patient. The first standardized hippotherapy curriculum would be formulated in the late 1980s by a group of Canadian and American therapists who traveled to Germany to learn about hippotherapy and would bring the new discipline back to North America upon their return.[1] The discipline was formalized in the United States in 1992, with the formation of the American Hippotherapy Association (AHA). Since its inception, the AHA has established official standards of practice and formalized therapist educational curriculum processes for occupational, physical and speech therapists in the United States.[1]

Modern Hippotherapy

Equine-assisted therapy is the umbrella term for any specially trained licensed health professional who incorporates the equine environment into a treatment session within their scope of practice and professional designation. Equine assisted therapy is the umbrella term which lists hippotherapy and equine assisted psychotherapy. Licensed physical, occupational therapists, physical and occupational therapy assistants and speech and language pathologists incorporate the horse's movement (hippotherapy) into their total plan of care for their patients.

In the mental health industry, social workers, psychologists and mental health providers may incorporate equine assisted psychotherapy into their treatment sessions. This is different from hippotherapy where the movement of the horse influences or facilitates an adaptive response in the patient. Forms of equine assisted psychotherapy may have the patient on the horse or off the horse and the treatment is not focused on a set of specific movements for the horse to produce an adaptive response in the patient.

The role of the horse

The horse's pelvis has the same three dimensional movement of the human's pelvis at the walk. The horse's three dimensional movement is carefully graded at the walk in each treatment for the patient. This three dimensional movement provides physical and sensory input, which is variable, rhythmic and repetitive. The variability of the horse's gait enables the therapist to grade the degree of input to the patient and use this movement in combination with other treatment strategies to achieve desired therapy goals or functional outcomes. In addition, the three-dimensional movement of the horse's pelvis leads to a movement response in the patient's pelvis which is similar to the movement patterns of human walking. A foundation is established to improve neurological function and sensory processing, which can be generalized to a wide range of daily activities and address functional outcomes and therapy goals.

Hippotherapy can only be provided by a licensed physical therapist, occupational therapist or speech and language pathologist. Adults and children with disabilities can improve their posture, muscle strength, coordination, balance, sensory/motor development as well as speech and language skills when hippotherapy is incorporated into a total care plan for a patient.

Professional practice

Equine Assisted Therapy services are provided by licensed medical professionals. In order to provide Equine Assisted Therapy, the professional providing the treatment does so within the scope of practice within his or her professional licensure, and must have additional training in the Equine Assisted Therapy field. Examples of Equine Assisted Therapy include Hippotherapy and Equine Assisted Psychotherapy. These therapists provide treatment by the medical model. Treatment is provided to patients based on the professional's area of expertise and utilizes the horsesā€™ movement or equine environment to meet the patient's goals. The American Hippotherapy Association, Inc. (AHA) offers education to therapists and promotes research in Equine Assisted Therapy. The Faculty of the AHA, Inc., conduct Continuing Education Courses to teach PT's/PTA's/OT's/COTA's and SLP's nationally and internationally.

Hippotherapy is especially useful in a wide range of health disorders:

  • Different types of paralysis
  • Down Syndrome
  • Multiple Sclerosis
  • Epilepsy
  • Alzheimer
  • Autism
  • Cerebral atrophy
  • Cystic Fybrosis

It is also recommended in orthopedic disorders and injuries in general; rheumatologic problems such as arthritis and osteoarthritis, and psychiatric and psychological categories as phobias, stress and sensory disturbances.

What can hippotherapy help with?

  • Gross motor skills
  • Speech and language abilities
  • Articulation
  • Oral motor skills
  • Respiration and postural/core control
  • Fine motor skills
  • Sensory processing
  • Behavioral and cognitive abilities

Uses in Physical, Occupational, Speech & Language Therapies

Physical therapists who have had special training in hippotherapy will incorporate the three-dimensional movement of the horse to achieve gait training goals, balance goals, postural/core control goals, and strengthing and stretching. Improvement in gross motor skills and functional activities for developing children with disabilities are gained as the natural environment and variability of the horse's gait present as new and unique to a child. Coordination and balance as well as equilibrium skills are addressed through the variability of the horse's movement as well as the rhythm, tempo and cadence of the horses movement.

In Occupational therapy a specially trained occupational therapist will incorporate hippotherapy, the movement of the horse, to improve motor control, coordination, balance, attention, sensory processing and performance in daily tasks. The reciprocal three 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, olfactory, and auditory systems. The occupational therapist will incorporate 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.

Although many people associate hippotherapy with physical therapy, hippotherapy as a speech and language therapy strategy is growing more common. Hippotherapy uses a horse to accomplish traditional speech, language, cognitive, and swallowing goals. Carefully modulated, well-cadenced equine movement offers an effective means of addressing speech and language deficits through facilitation of the physiological systems that support speech and language function. Using hippotherapy, appropriate sensory processing strategies have been integrated into the treatment to facilitate successful communication.


Some medical conditions for which hippotherapy may be commonly indicated are listed below. However, hippotherapy is not for every patient; specially trained Physical or Occupational Therapists or Speech and Language Pathologists evaluate each potential patient on an individual basis as per their professional designation and within their scope of practice. There are specific contraindications and precautions for some conditions and diagnosis.

  • Autism spectrum disorders
  • Cerebral palsy
  • Cerebral vascular accident (stroke)
  • Developmental delay
  • Down syndrome
  • Functional spinal curvature (scoliosis)
  • Learning or language disabilities
  • Multiple sclerosis
  • Sensory processing disorders
  • Traumatic brain injury

HPCS certification

Hippotherapy Clinical Specialty (HPCS) Certification is a designation indicating board certification of therapists who have advanced knowledge and experience in hippotherapy. Physical therapists, occupational therapists, and speech and language pathologists who have been practicing their profession for at least three years (6,000 hours) and have 100 hours of hippotherapy practice within the three years prior are permitted to take the Hippotherapy Clinical Specialty Certification Examination. Those who pass become board certified in hippotherapy and are entitled to use the HPCS designation after their name. HPCS certification is for five years. After five years the therapist can either retake the exam, or show written evidence of 120 hours of continuing education distributed over the five years, with a relative balance of 50% (60 hours) in education related to equine subject matter: psychology, training, riding skills, etc., 25% (30 hours) in education related to direct service in your professional discipline and 25% (30 hours) in any other subject related to hippotherapy or show written evidence of scholarly activity appropriate to the field of hippotherapy. Acceptable scholarly activity includes graduate education in hippotherapy, publication of articles on hippotherapy in juried publications, scientific research related to hippotherapy, the teaching or development of hippotherapy, or acting as AHA-approved course faculty.


External links


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