Hippotherapy.

Hippotherapy (HPOT), from the Greek Hippos for horse, is translated to therapy, or treatment, utilizing the horse. Currently, HPOT, as defined by the American Hippotherapy Association (AHA), is a physical (PT), occupational (OT) or speech/language (SLP) therapy treatment strategy incorporating the movement of the horse. This is a direct treatment session with a licensed professional who has training and experience incorporating equine movement into a treatment plan for patients who have neuromuscular impairments. HPOT integrates equine movement as a medical treatment aimed at habilitative (first time learning of functional skills) and rehabilitative (returning to a previous level of functional skill) goals.

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Focus is on Functional Goals

Hippotherapy is treatment focusing on functional goals, such as sitting, walking, dressing, or following directions off the horse. The three-dimensional movement of the horse is what is used in treatment to challenge the patient. During a treatment session, the patient is not learning how to ride or control the horse. The movement of the horse is used as a dynamic surface imparting forces to which the patient must accommodate and therefore train/retrain neuromuscular responses. Skilled therapists are responsible to evaluate the patient's response and modify the progression of the treatment accordingly.

For instance, with an individual who has very weak trunk muscles the therapist may chose to have the horse walk slowly. The movement of the horse can facilitate the trunk muscles to start working, and when the patient's muscles are more active, the therapist can increase the speed at which the horse is walking, which increasing the movement the horse provides to challenge the trunk strength. Conversely, as the continuous movement of the horse challenges the patient's trunk strength, he/she may get tired, so the therapist may show the horse's walk down, so the patient will still be able to accommodate. Even the direction the horse travels can be manipulated by the therapist to achieve desired benefits. A patient may have weakness on one side of the body, so the therapist may choose to travel in a direction that encourages the weak side muscles to work, particularly around corners.

Trunk Strength--Major Goal

Although there are three quite different professions (PT, OT, SLP) with very different goals, and each can incorporate equine movement into their practice, there is one commonality to them all: trunk strength. APT may focus on trunk strength so a patient can sit up or walk on their own. An OT may focus on trunk strength so a patient will have a stable base on which to move an arm to feed him/herself. A SLP may focus on trunk strength so a patient will have improved volume of speech. In a 30-minute treatment session the equine can take between 2,000 -3,000 steps ... try to get that many repetitions on a therapy ball in a traditional clinic setting!

Proprioceptive Input

Additionally, two very important sensory systems are affected in the HPOT environment. Each time the equine takes a step there is a concussive force transmitted to the patient giving them proprioceptive input (the sense of where the body is in relation to other body parts). By moving through space the patient receives vestibular input (the sense of movement or orientation in space). The therapist can manipulate the way a horse is moving or even the equine itself (each equine moves differently) to vary the input these systems receive. These systems play a key role in patient arousal level that affects the ability to focus on a task and follow directions.

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Historically, patients receiving HPOT as part of their treatment program have primarily been children; however, adults certainly can benefit from this treatment setting, as well. It is recommended that a child be at least two-years-old and have enough head and trunk control to accommodate the movement of the equine. There really is no upper age limit, as long as the treatment team (including the equine!) is capable of handling the impairments of the individual.

Individuals with a variety of diagnoses can benefit from HPOT. These diagnoses can include, but are not limited to:

* Cerebral Palsy 

* Autism Spectrum Disorders

* Multiple Sclerosis

* Spinal Cord Injuries 

* Down Syndrome 

* Spina Bifida

* Brain Injuries

* Cardiovascular accident/Stroke

* Attention Deficit Disorder 

Benefits can include, but are not limited to, improved:

* Strength

* Coordination

* Symmetry

* Mobility

* Behavior

* Self-esteem

* Balance

* Sensory motor function

* Postural control

* Communication

* Attention

If you are interested in receiving HPOT as part of your or your child's treatment program, go to the AHA's website (www.americanhippotherapyassociation.org) and click on the Find a Therapist link under the Hippotherapy tab and/or the AHA Liaison. You can also find programs that offer HPOT by going to The North American Riding for the Handicapped Association's website (www.narha.org). Click on Find a Center then select HPOT and your state in the purple box at the bottom of the page. If you are a Physical, Occupational, or Speech Therapist interested in learning how to incorporate HPOT into your practice, go to the AHA website and click on the Workshop Schedule under the Education tab.

Humans. Horses, and Health is a regular department of PALAESTRA which addresses material related to equine assisted activities. Marci Bender is a NARHA Advanced Level Certified Instructor and a Certified Therapeutic Recreation Specialist. Marci has a degree from Penn State University in Therapeutic Recreation and is an Instructor at Little Bit Therapeutic Riding Center in Woodinville, WA. She also serves as the NARHA Washington State Representative, an Apprentice Site Visitor, and Associate Instructor Evaluator. Marci can be reached at [e-mail] or 425-882-1554 ext. 114. Steve MeKenzie has a Master of Science in Physical Therapy from Columbia University and is a NARHA Registered Level Certified Therapeutic Riding Instructor. Steve is a Staff Therapist at Little Bit Therapeutic Riding Center in Woodinville, WA. He currently serves as the Chair of the NARHA Health and Education Committee, the AHA Washington State Representative, and is an AHA Associate Faculty Member. He can be reached at [e-mail] or 425-882-1554. Marci and Steve are the Department Co-editors.