Scholarly Agenda:

Hippotherapy
BY: MELISSA DE RYK, OTS

(http://autism.lovetoknow.com/Equine_Programs_for_Autistic_Children, 2016)

Introduction
PIO: Do children with congenital disorders (P) have
improved fine and gross motor control (O) after receiving
hippotherapy (I)?

(http://alatheiaridingcenter.com/project/true-therapeutic-rides/, 2015)

Why is Hippotherapy Important?

Hippotherapy is an emerging field of study for children diagnosed with
Autism Spectrum Disorder (Llambias, Magill-Evans, Smith, & Warren,
2016).
The use of horses can increase gross and fine motor skills because the
movement of a horse is unique and provides nervous system feedback
in a different way based on the horses gait pattern. (Benda, W.,
McGibbon, N., & Grant, K., 2003).
Horses challenge the balance of the rider which increases core
strength (Ajzenman, Standeven, Shurtleff, 2013).
Hippotherapy provides a rider with physical, cognitive, emotional, and
social stimulation that may remain unused during typical occupational
therapy intervention (Benda, W., McGibbon, N., & Grant, K. 2003).

Search Strategy
The following databases were utilized:

Search Terms Used:

Hippotherapy
Occupational Therapy and Hippotherapy

Inclusion Criteria:

CINAHL
Science Direct
AJOT- OT Search
Chocrane Database

Any dx of children in which Hippotherapy was a primary or secondary

intervention
Peer Reviewed

Exclusion Criteria:

Non Occupational Therapy based professionals

Psychology, social work, psychiatry, nursing

Full text unavailable

Any study before 2000

Volume and Nature of Evidence

94 articles were available on CINAHL
205 results were available on Science Direct
25 were available on AJOT OT Search

From these articles only 12 were reviewed and the top 3 studies
that best represent hippotherapy with the best quality studies were
used for evidence in this scholarly agenda.

Articles Found and Reviewed

Qualitative: 2
Quantitative: 2
Case Studies: 2
Systematic Reviews: 3
RCT: 1
Quasi-Experimental: 2

Best Peer Review Article #1: Equine-Assisted

Occupational Therapy: Increasing Engagement for
Children With Autism Spectrum Disorder

Study Objective:

Provide evidence that hippotherapy will increase typical developmental behavior towards
objects, therapists, and horses for children with ASD.

Methods:

Participants: Snowball sampling method. 7 participants- 3 girls, 4 boys between 4-8 y/o with ASD.

Design: The study followed 3 steps- Baseline, intervention, and follow up.

Settings and Procedures: All sessions were 45-60 minutes. Occurred on horseback with new
toys/activities during baseline and follow up. Vestibular input was regulated by therapist through
the horse based on childs level of arousal. Children spent greater than or equal to 20 minutes in
gross motor or physical activities, 20 minutes in fine motor activities, and the remainder of time
on cognitive activities.

Children chose their level of proprioceptive input based on how much they bounced on
the horse, however the therapist chose the activity the child participated in on horseback
to address their sensory needs.

Article #1 Continued
Outcomes:
The outcome measure used was the amount of time the child was engaged. This was
measured by whether or not the child responded to the therapists requests.
Engaged: Child responded to the therapist or horse or started the requested activity.
Not engaged: Ignored the request or attempt of capturing attention, resisted
guidance, looked away/avoided eye contact, played alone, had a tantrum/cried,
wandered away or left activity/interaction partner.
All children showed improvement based on an increased time spent engaged in
activities both during equine therapy and post intervention. However, the level of
engagement of each child increased significantly immediately after implementation of
hippotherapy.
Results:
Results were drawn from pre and post study activity choices in guided free play in a room that
contained a swing, trampoline, hammock, balls, and cognitive toys
(matching/crafts/cars/dolls).

The results suggest that including hippotherapy intervention increases the ability of a
child with ASD to focus post intervention due ot increased proprioceptive and vestibular
input.

Best Peer Review Article #2: Improvements in muscle

symmetry in children with cerebral palsy after
equine-assisted therapy (hippotherapy)

Study Objective:

Examine the muscle activity of cerebral palsy children during the use of hippotherapy.

Methods:

15 children between the age of 4 and 12 who were diagnosed with CP were involved in the
study. They needed to be independent in seating, standing with assistance of devices if needed,
able to cooperate, and have sufficient hip abduction to sit on a horse or barrel.

A pretest/post-test control group was used and all subjects were blindly randomized into either a
horseback riding group or barrel sitting group.

Pretest/post-test: Measured on a bench for a 10 second EMG immediately before and after riding.

Surface EMG data was collected while astride the horse or barrel and electrodes measured the
bilateral posture of the cervical, thoracic, and lumbar spine. Electrode readings of the abductors
of the thighs were also notated.

The riders sat on a fleece pad while mounted and the horse was led for 4 minutes both clockwise
and counterclockwise

Article #2 Continued

Outcomes:

The control group astride a barrel had an 11.9 mean asymmetry change in muscle
symmetry while the children astride the horse showed a mean change in
asymmetry of 55.5.

Results:

This change in asymmetry suggests that the muscle tone of children with CP was
drastically decreased in the intervention group that utilized hippotherapy.

According to this data, the rhythmic nature of horses while riding closely imitates
the normal gait pattern of walking which results in higher EKG readings along the
cervical, thoracic, and lumbar region.

An unintended improvement that was not measured, but observed was that riders
showed an increase in balance reactions post hippotherapy intervention.

Best Peer Review Article #3: Effect of Hippotherapy on

Motor Control, Adaptive Behaviors, and Participation in
Children with Autism Spectrum Disorder

Study Objective:

Investigate if hippotherapy increases in motor control and function for children with Autism
Spectrum Disorder.

Methods:

Pre and post-tests were completed along with a 12 week hippotherapy intervention for 7
children diagnosed with ASD between the age of 5 and 12. The children were recruited from
local school districts and inclusion was a diagnosis of ASD, independent ambulation, and the
ability to follow one step commands.

Each session was 45 minutes long 1 time for 12 weeks and followed a progression pattern in
different functional positions on the horse; forward sitting (astride), prone, supine, backward
astride, side sit, kneeling, quadruped, and standing.

Sessions were video recorded and force plates documented sway and motor control. The
Vineland Adaptive Behavior Scale- II was used for cognitive/behavioral change ratings

Children were assessed for postural control pre intervention and re assessed after
implementation. Parents were also interviewed for self-report assessments.

Article #3 Continued

Outcomes:

After the intervention a change in postural stability was noted from the force plate readings
that monitor motor control. A 12% Decreases in sway was observed post intervention.

Results:

The center of mass (COM) and center of pressure (COP) of the childrens static stance
remained approximately the same average amount of movement, however in standing, the
pressure area was more confined and circular in nature rather than unpredictable and
linear.

Post intervention Vineland Adaptive Behavior Scales-II scores showed increase in

communication and socialization.

Participants improved from low functioning to high functioning in receptive communication.

There was no improvements in high demand leisure activities such as education and group
participation.

Video observation provided evidence that posture control increased while astride the horse.

Future Research

Hippotherapy is a unique intervention that can increase

motor control and decrease spasticity for clients with
cerebral palsy (Whalen, C., & Case-Smith, J., 2012).

Additional research regarding hippotherapy treatment with

other diagnoses will be beneficial.

There are many studies that investigate the

use of horses for pediatric clients and few
that incorporate the psychological impact
of hippotherapy.

Further research is needed to investigate

hippotherapys impact on mental health
for clients.

(http://trozarks.blogspot.com/, 2016)

References
Ajzenman, H., Standeven, J., & Shurtleff, T. (2013). Effect of hippotherapy on motor control, adaptive behaviors, and participation in children with autism spectrum disorder:
A pilot study. American Journal of Occupational Therapy, 67, 653-663. doi: http://dx.doi.org/10.5014/ajot.2013.008383
Beck, D. (2015). Trauma focused equine assisted psychotherapy: A phenomenological study of therapists' beliefs about components of effective treatment for children who
have experienced abuse and neglect. Dissertation Abstracts International Section A: Humanities and Social Sciences, 76(3-A)(E).
Benda, W., McGibbon, N., & Grant, K. (2003). Improvements in muscle symmetry in children with cerebral palsy after equine-assisted therapy (hippotherapy). Journal of
Alternative and Complementary Medicine, 96) 817-825.
Equine Programs for Autistic Children [Online Image]. (2016). Retrieved November 7, 2016 from http://autism.lovetoknow.com/Equine_Programs_for_Autistic_Children
Therapeutic Riding of the Ozarks since 1995 [Online Image]. (2016). Retrieved November 9, 2016 from http://trozarks.blogspot.com/
True Therapeutic Riding [Online Image]. (2015). Retrieved November 9, 2016 from http://alatheiaridingcenter.com/project/true-therapeutic-rides/
Whalen, C., & Case-Smith, J. (2012). Therapeutic effects of horseback riding therapy on gross motor function in children with cerebral palsy: A systematic review. Physical &
Occupational Therapy in Pediatrics, 32(3), 229-242. doi: 10.3109/01942638.2011.619251