Present Use of Hippotherapy

AHA 2000 Hippotherapy is a term that refers to the use of the movement of the horse as a strategy by Physical Therapists, Occupational Therapists, and Speech-Language Pathologists to address impairments, functional limitations, and disabilities in patients with neuromusculoskeletal dysfunction. This strategy is used as part of an integrated treatment program to achieve functional outcomes.


Physical therapists, occupational therapists and speech-language pathologists have used the movement of the horse in therapy in the United States since the 1970′s. Internationally, physical therapists have been using hippotherapy for over 30 years. Recent review has shown that hippotherapy is currently used in 24 countries. In order to provide a forum of education, communication and research among health professionals using the movement of the horse in treatment, the American Hippotherapy Association (AHA) was formed in 1992. It became an official section of the North American Riding for the Handicapped Association (NARHA) in 1993. The AHA membership is composed primarily of physical therapists, occupational therapists, and speech-language pathologists interested in the use of the horse in treatment.


The American Hippotherapy Association created a conceptual framework for the use of equine movement as a treatment strategy. The conceptual framework is based on dynamic systems theory, integrated with principles of motor learning, sensory integration, and psycholinguistics. The framework was developed to (a) provide therapistswith a theoretical basis for the use of equine movement in an integrated treatment program, (b) promote effective clinical problem-solving, and (c) aid the generation of hypotheses for scientific research.


Therapists who use equine movement as a treatment strategy are encouraged to pursue specialized training in this area. AHA has developed two approved 3-day courses: Introduction to Hippotherapy – Principles and Applications and Intermediate Hippotherapy – Clinical Problem Solving. Clinicians in the United States have offered a number of continuing education programs directly related to hippotherapy since 1984. The American Hippotherapy Association published Hippotherapy Standards for use in the NARHA accreditation process for operating centers where licensed health professionals use equine movement as part of a patient’s treatment plan. Through the Standards committee, AHA sponsors therapist registration which acknowledges that a therapist has met specific education and practice requirements in hippotherapy. The American Hippotherapy Certification Board (AHCB), in collaboration with an independent testing organization, established a certification process to recognize a higher level of hippotherapy knowledge and experience. The first candidates for the Hippotherapy Clinical Specialist (HPCS) designation sat for the exam in 1999.


Hippotherapy is used as one part of a patient’s integrated treatment plan. The treatment program is based on the therapist’s evaluation and the functional goals of the patient. The therapist may choose the horse’s movement as a strategy to be used in the treatment plan if hippotherapy is the most effective and efficient means for the patient to achieve positive functional outcomes. This decision is reflective of the therapist’s own profession and theoretical model of treatment. The therapist may use the horse in a variety of ways depending on the needs of the patient. Equine movement is continually modified during a treatment session and over a period of time in response to patient changes. The therapist provides hippotherapy most often in a one-on-one treatment, but sometimes in small groups. Standard documentation reflects progress of treatment, and follows the guidelines of the therapists’ profession. Current Procedural Terminology (CPT) codes used for billing are chosen based on how this strategy is used to address specific goals of treatment.


The use of hippotherapy is consistent with standard practice for Physical Therapy, Occupational Therapy and Speech-Language Pathology as the activity is experiential, functional and in a natural environment. The movement of the horse, as the tool, can be compared to other therapy tools such as balls, scooters or swings. The variability of the horse’s movement, the rhythm, dimensionality, regularity, and the ability of the therapist to modify these movement qualities, is where the horse, as a tool, supersedes the others.


Horses used for patient treatment must meet specific selection criteria regarding movement quality, temperament and training. Even when an ideal horse is used, the treatment quality and results are based on the specialized hippotherapy training of the therapist, their clinical experience and expertise, and how well they integrate the use of the horse into a comprehensive treatment program.


There is widespread acceptance of hippotherapy within the medical/professional and educational communities. The American Physical Therapy Association (APTA), American Occupational Therapy Association (AOTA) and the American Speech and Hearing Association (ASHA) recognize hippotherapy. There are a number of universities that request placement of their health professional students in affiliations that include hippotherapy. A number of school districts pay for school based therapy that includes hippotherapy in a treatment plan because it produces educationally relevant functional outcomes. Major third party payers throughout the country reimburse for treatment that includes the movement of the horse as a treatment strategy. Continuing Education Units (CEU’s) are routinely granted for AHA approved and other courses taught by clinicians with recognized expertise in hippotherapy. Articles on the use of the horse in treatment are published in peer reviewed journals such as Physical Therapy, Physical and Occupational Therapy in Pediatrics, and Developmental Medicine and Child Neurology in addition to numerous articles in clinical publications. Presentations on hippotherapy are given at many Regional, National and International professional conferences.


Hippotherapy, the use of equine movement as a treatment strategy, has evolved over 30 years. Through education and clinical experience, therapists will continue to refine the use of hippotherapy in treatment. Using the movement of the horse as the strategy of choice has resulted in improved functional outcomes for a wide variety of patients. These positive results ensure that hippotherapy will continue to be used in treatment for many years to come.


Prepared by the American Hippotherapy Association Practice Committee
April 2000 – May be reproduced in its entirety.

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