Hippotherapy module 10 EN

SpecialisedVET training on Hippotherapy for
professionals working with children with
intellectual, emotional, physical and psychomotor
disabilities
2019-1-TR01-KA202-074547

10.1. 1 Effects on neuromusculoskeletal development
10.1.2. Effects on cognitive development
10.1.3. Effects on psychological development

• Cerebral palsy (CP) consists of a group of motor disorders attributed to a
permanent non-progressive injury that occurs in the developing foetal or infant
brain.
• CP describes a group of permanent disorders of the development of movement
and posture, causing activity limitation, that are attributed to non-progressive
disturbances.
• The motor disorders of CP are often accompanied by disturbances of sensation,
perception, cognition, psychological, communication and behaviour, by epilepsy,
and by secondary musculoskeletal problems.

• Cerebral palsy most commonly affects muscle tone, movement, and gross and fine
motor skills, which is why patients with CP are often good candidates for hippotherapy,
as their symptoms are what hippotherapy targets.
• Hippotherapy does measurably improve the patients’ gross and fine motor function.
• Regulation of muscle tone
• Pelvic mobilization/stabilization
• Reinforcement or the appearance of righting mechanisms and trunk control
• Improvement of the equilibrium reactions (especially in relation to changes of pace
and direction).
• Reduction of involuntary movements
https://www.sensationalkids.ie/childrens-services/hippotherapy/
https://braceworks.ca/2017/09/13/health-tech/young-patients-with-cerebral-palsy-other-disabilities-benefit-from-therapeutic-horseback-riding/
https://www.youtube.com/watch?v=S1R4_HrnHkc

• Children with CP tend to experience spasticity, musculoskeletal problems,
disorders of mobility and a decline in pelvic movements, leading to awkward
movements and posture when sitting.
• CP can also affect the abductor muscles of the lower limbs, as well as causing a
loss of motor function and gross motor skills.
• Symptoms can also include a lack of control of posture, imbalance and aberrant
movements.
• It has been demonstrated that the recreational use of hippotherapy can improve
coordination, gross motor skills, posture, control of the head and coordination.
• The horse provides a dynamic support base, rendering it an excellent tool to
improve the strength of the trunk and to boost control and balance, as well as
overall posture and resistance, weight distribution and motor skills.

• Among the natural walks of the horse (tempo, trot and canter), the tempo-cadence
and rhythmic strokes are the most commonly used in horse-assisted therapy (EAT).
Thanks to the unique features of these walks and the three-dimensional movements
applied to the patient in the saddle, it perfectly simulates the human gait (for
amplitude and frequency).
• The horse's rhythm, about 60 oscillations per minute, allows muscle tone to relax,
while the sinusoidal shape allows the normal walking movement to develop.
• The movement of the horse at sinusoidal speed creates a bridge for the rider:
• back and forth,
• side by side,
• up and down.
• Since it is aimed to correct balance and postural control, the muscles should be
adjusted to stay on the saddle.
• With the movement of the horse, the impulses are transferred to the central
nervous system. The brain sends this information to the whole body. These
adjustments are made with warnings that restore balance.

• In the studies conducted, the walking pattern of the horse is the same as that of the
human. Therefore, during the walking of the horse, the pelvis and trunk muscles
work with the same pattern in order to ensure the independence of the individual
in walking.
• Hippotherapy provides an upright posture suitable for the patient's automatic
postural response.
• This biphasic movement essentially requires the patient to engage their trunk and
lean back when the horse’s hindquarters are moving forward and for them to lean
forward when the hindquarters are moving back.
• Thanks to this, body control develops in children with CP.
• It is expected that those who receives hippotherapy will have significantly
improved balance and spasticity, less fatigue, and a higher overall quality of life.

• Hippotherapy promotes postural control and coordination in a unique environment
that provides instant sensory feedback to the rider’s body.
• During a hippotherapy session, the rider’s centre of gravity is displaced which facilitates
dynamic postural stabilization and recovery from imbalances caused by the horse’s
movement.
• Hippotherapy targets and improves these individual factors and when they are combined,
hippotherapy results in an overall improvement of gross motor function.

• Hippotherapy also effects spasticity neurologically.
• A study evaluating the effect of hippotherapy on cerebral palsy found that hippotherapy
had a positive effect on their spasticity.
• Hippotherapy is thought to help inhibit spasticity through the position promoting hip
flexion and external rotation.
• Additionally, the flexion, extension, and torsion of the patient’s trunk was observed to
have a beneficial effect on the patient with cerebral palsy’s spasticity.
• It provides sensorimotor stimulation and positive psychosomatic influences, such
as increased self-esteem and motivation, in addition to the physical effects.
• Hippotherapy commonly helps increase muscle tone in the trunk and neck area as
discussed in regards to cerebral palsy, while also decreasing muscle tone in the
lower extremities.

• Hippotherapy is successful in strengthening trunk and core muscles which aids in
postural support, increasing balance and coordination which can then be applied
when walking, reducing muscle tone in regards to spasticity, and providing
increased body awareness to patients.
• The movement of the horse provides unique sensory input that allows all of these
outcomes to be possible across diagnoses.

• The movement in the saddle when the horse is walking slowly is similar to the
movement of the pelvis that healthy people produce when walking, thereby
strengthening the muscles of the trunk and improving balance as the trunk
responds to the movement.
• Hippotherapy affects the musculoskeletal system and neurophysiological
transmission through movement that stimulates psychomotor development and
proprioceptive and exteroceptive feedback.

• Changes were observed in gross motor outcomes, such as the functioning of the
postural alignment of the head and trunk, the adductor muscles, walking speed,
length of stride, ability to sit independently, and psychological factors.
• Furthermore, benefits in terms of stability, mobility, functionality, balance of the
trunk, head and upper limbs were observed.
• Improvements were also observed in the children’s quality of life and in various
daily life activities, such as jumping, balance in jumping, independence in sitting,
resistance and ascending and descending stairs.

• In physical therapy, multidirectional movements of the horse are utilized in gait
training, balance, postural control, strengthening, and increasing range of motion.
In many studies, improvements in gross motor skills, and functional activities have
been reported in children with disabilities.
• In occupational therapy, movements of the horse are utilized with the intention to
improve motor control, coordination, balance, attention, sensory processes, and
performance in daily activities. Sensory processes, vestibular, proprioceptive,
tactile, visual, and auditory systems are targeted simultaneously.
• Hippotherapy also targets improvements in speech, language, cognitive, and
masticatory functions.

• In horseback riding, when the horse moves, the rider activates muscles in the body
to reduce movement of the body and keep the centerline of the body.
• Statistically significant improvement in the balance in the sitting position and
dynamic balance is observed in children with cerebral palsy.
• Horseback riding improved the walking speed and distance of CP patients,
horseback riding induces pelvic movement similar to the normal gait pattern in the
human body, and facilitation of the movement also has a positive effect on walking
on the ground.
• It has been reported that the support of the upper limb decreases, the control of
the trunk increases, and the use of the hands in daily functions increases in patients
with cerebral palsy.
• The Gross Motor Function Measure (GMFM) results also showed a statistically
significant improvement.

• It provides sensorimotor stimulation and positive psychosomatic influences, such
as increased self-esteem and motivation, in addition to the physical effects.
• In studies conducted with other populations, it has been reported that cognitive
functioning in children with dyspraxia improved after participation in
hippotherapy.
• Hippotherapy also has a demonstrated improved visual perception in children with
cerebral palsy.

• Hippotherapy actually does not only involve the riding process.
• Goals are set for the child with CP to complete, such as taking the horse to a designated
area or putting a halter on the horse.
• The child will complete the task as best he can, and then discuss the thought process,
ideas and problem solving used to complete the task.
• Discussing what the child is doing at a given time allows them to develop their language
skills.
• Listening to the instructor helps improve the individuals ability to listen and follow
directions, ask questions, etc.

• It is especially helpful for children with CP who often struggle with anxiety when
they worry about the past or have catastrophic thoughts about the future.
• This activity encourages the child to be present and focus on the task at hand.
• The treatment program is adapted to the situation, taking into account the
problems observed in the child.
• Depending on the nature and severity of the anxiety, processes and techniques can be
changed.
• Cognitive therapy includes task-oriented working, activity planning, play therapy,
storytelling-listening and speech therapy.
• The treatment process includes craving, bathing and feeding the horse,
coordination, planning and active communication. These contents will reduce the
child's cognitive, psychological and muscular disorders.

• Hippotherapy is often used as a treatment for anxiety.
• Horses sense danger and respond with heightened awareness of their surroundings,
oftentimes trying to flee if the situation seems too dangerous to them.
• Individuals suffering from anxiety disorders may be able to feel these changes through
observation, then allowing them to discuss anxious activities with the therapist.
• Focusing on the apprehension of the animal rather than oneself can greatly reduce the
individual’s anxious response and allow them to challenge automatic thoughts.
Throughout this process the patient would practice remaining calm and taking
responsibility of his or her own thoughts.

• Storytelling encourages stories about what the animal is thinking and conveying
emotions.
• This is a great tool to stimulate the development of language skill and creativity.

• It has been reported that hippotherapy enhances the ability to recover from
disease, reduces depression and sense of loneliness, and maintains social support
in the elderly, suggesting its physical and psychological effects.
• Hippotherapy refers to deliberately planned, educational, and socially integrated
interventions that use animals with a group of children, adolescents, adults, or the
elderly with cognitive, affective, and motor skills disabilities and behavioural
problems.
• Hippotherapy is effective in enhancing self-esteem in children.
https://www.youtube.com/watch?v=NWqwZan7PMU

• Horses have a lot of qualities such as warmth, smell, smooth movements, big and
intense eyes that may stimulate the important aspect of the attachment process for
human development.
• Horses relationship established with the horse is also an extraordinary element to
recover the consciousness of patients’ psychomotor skills, reactions and emotions.
• Hippotherapy is often used as a team building exercise or in family or group
therapy.
• This causes an increase in interpersonal communication.
• Because it is goal-oriented, it also positively affects the development of communication
skills by enabling the group to work together to achieve a common goal.

• Individuals with Down Syndrome (DS) often have muscle hypotonia, which creates
a decreased sensorimotor control due to a decrease in segmental excitability of
motor neurons and a reduced stretch reflex. This causes a slow or ineffective
muscle contraction.
• Postural changes in DS may occur due to the difficulty of perception of postural
responses, which impairs the feeling of the movement correctly.
• Thus, muscle activation through activities in children with DS using postural
correction techniques helps to reduce the physical impairment.

• The delays in achieving motor development pieces may imply that patients with DS
usually have balance and postural deficits, longer movement and reaction times,
and altered motor synergies.
• Furthermore, the delayed motor development of babies and children with DS
usually presents with ligament laxity and generalized muscle hypotonia.
• Gait and balance impairments also result from submaximal exercise capacity and
altered gait kinetics and kinematics, due to joint laxity, obesity, muscle hypotonia
as well as autonomic dysfunction.
• It is worthy to note that such low levels of physical fitness limit the ability of DS
adults to perform daily life activities, thus affecting their quality of life.

• Hippotherapy is an effective tool when considering therapeutic interventions for
children, age 2 and older, with DS.
• Hippotherapy provides sensory stimulation to muscles and joints, impacts balance
and movement sense, and provides variable tactile experiences through the
horse's body heat.
• In addition to the horse's body heat, this effect is observed when the client rubs or
embraces the horse.
https://www.youtube.com/watch?v=QvpYjjN70W8
https://www.youtube.com/watch?v=hGkHJefC86Y

• The horse’s normal temperature of 38°C may aid in the rider’s muscle distension
and body relaxation.
• By being seated on a horse, a hippotherapy patient receives around 1800 to 2250
tonic adjustments per 30 minutes, and about 90 to 110 multidimensional impulses
per minute, stimulating the proprioceptive system and the receptors of the
vestibular system. In this way, dynamic and static balance reactions are developed.
• Each movement of the horse allows the rider to adjust her/his muscle tone
according to the body diagram, which is neurological and is established with
simultaneous proprioceptive and exteroceptive information.

• When the position of the individual over the beat and the movement of the horse
are combined, postural corrections and the pelvic and shoulder belts must be
separated. Thus, postural stability, trunk corrections and tonic adjustments are
provided.
• It is known in the literature that rhythmic release of the horse's spine stimulates the
patient's postural reflexes and provides motor recovery through balance training.
• Thus, hypotherapy usually represents a therapeutic approach to improve postural
alignment in DS children with postural changes.
• Among the goals of hypotherapy are to improve balance, increase muscle strength
and improve fine motor coordination.

• Individuals with DS are predisposed to respiratory complications resulting from
obstruction of the upper airway, lower airway disease, pulmonary hypoplasia,
congenital heart disease, sleep apnoea, immunodeficiency, obesity and hypotonia.
Weakness of the trunk muscles and extremities can further increase these
diseases.
• Hippotherapy in children and adolescents with DS, increases the strength of the
trunk, upper extremities, which affects respiratory muscle strength.
• Failure to maintain the quality of posture and movement offered by people with DS
reflects on the trunk, changes the harmony of breathing mechanics, changes chest
and abdominal pressures.
• The assisted motor evolution balances the chest and abdomen, establishing a
balance between these two cavities and adjusting lung capacity and volume.

• The repetitive movements are a support for cerebral organization, particularly
bilateral coordination and neural connectivity between cerebral hemispheres,
which is essential for speech and language.
• This is also the case in hippotherapy.
• It has been suggested that improvements in both speech and language could be
observed after hippotherapy as a result of the horse’s movement.

• While the reason for taking into account the effectiveness of hypotherapy on
language abilities may be in traditional therapy, the child is usually in a static
position (sitting), while the movement of the horse affects the whole body.
• It is known that when children receive simultaneous stimulation in more than one
system, this enables the modification and rearrangement of the nervous system.
• The need to constantly pay attention while riding, the concentration, the maximum
possible self-organization, the need to remember and plan the sequence of action
while riding and maintaining the horse activates mental processes. Auditory-motor
and visual-motor coordination of those involved develops.

• Hippotherapy may also affect psychological, cognitive, behavioral and
communicative functions for children.
• Children are taught to relate appropriately to the horse, while also improving their
decision and awareness of their body as it relates to their environment.
• These activities develop memory, improved communication skills, and instill self-
confidence in a child with DS.
• The bond that develops between a child and a horse during hippotherapy
treatment is something that a child will both cherish and be motivated by.
• This therapeutic activity can also encourage self-confidence and the child's
success.

• In addition to improvements of motor and postural control, social and emotional
interactions may have positive effects on the quality of life and the self-esteem.
• In the researches, it was found that verbal and nonverbal communication of the
child improved, eye contact increased and as a result, communication abilities
improved.
• It has been reported that applying hippotherapy there is more improvement in
speech and language skills, motivation and self-esteem compared to traditional
treatments.

• Self-realization functions of hippotherapy include meeting the inner potential of the
person and the need to be respected on the other side.
• The development of communication with people is a gain brought by tactile
communication with the horse. This provides an increase in the quality of life of the
child with DS and accordingly an improvement of its psychology.

• Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized
by impairments in social skills and communication, and repetitive and stereotyped
behaviour. Although not all, 80-90% of affected children have this feature.
• These fine motor disorders can affect children's ability to initiate, effectively
perform and switch between targeted movements, and to engage in
developmentally appropriate activities, with the potential to affect communication,
social interactions, and performance of daily activities.

• Studies have reported that children with ASD have less postural stability compared
to typical developing children, and development is delayed.
• Sensorimotor disorders are also present. Decreased stability in the proximal
muscles leads to a decrease in fine motor skills and loss of control.
• All this can lead to a decreased quality of life, decreased communication skills and
psychological disorders.
https://www.youtube.com/watch?v=drPzexd-V_Y
https://www.youtube.com/watch?v=TjqYgiCXKlg

• Staying on the horse improves the postural stability.
• Because the horse’s movement continually challenges stability, they may have
developed automatic postural mechanisms to better engage in therapeutic and
functional activities, suggesting that hippotherapy affects very basic skills
fundamental to the development of more complex motor skills.
• Increased body stability allows the person to perform upper limb functions more
independently and develop fine motor skills.
• Increased upper extremity skills increase the person's participation in
performance and daily life activities. Communication ensures coping and
increased professional involvement in daily activities.
• Since hippotherapy provides all these mentioned effects, it has been reported that
it is a useful treatment method to help the development of children with ASD.

• Because every step of the horse is a challenge for stability, hippotherapy offers a
unique opportunity to challenge and improve postural control.
• In a working walk, the horse makes about 100 steps per minute. Thus, in a 45-
minute hippotherapy session, the horse makes about 4500 steps.
• As a result, children must respond repeatedly to variability in horse movement to
maintain stability.
• They must maintain this and long postural stability is developed.

• Hippotherapy affects very basic skills, fundamental to the development of more
complex motor skills.
• These complex distal upper extremity and hand skills are important for
performance and participation in daily activities.

• Postural control and stability are associated with language, social participation,
play skills and academic abilities.
• There are studies showing that hippotherapy provides improvement in at least one
of the areas mentioned.
• Parents were interviewed and reported positive changes in their children after
hippotherapy, such as having “an easier time at school,” interacting “with peers
much more,” and paying “attention to consequences of behaviour”.
• It has been reported that developing physical activity improves social maturity and
hippotherapy reduces hyperactivity in children with ASD.
• Hippotherapy has been reported to increase motivation in children with ASD. The
increase in motivation enables the child to increase its learning ability, to improve
the communication with its peers and to feel better psychologically.

• Views on the potential impact of impaired motor control on professional
responsibility are varied; however, postural control is associated with language,
social participation, playing skills and academic abilities.
• As a result, motor difficulties can limit interactions with the physical and social
world, reduce opportunities for developmentally appropriate skills, and possibly
contribute to social isolation, anxiety, and emotional difficulties for children with
ASD and their families.
• The problems experienced by children with ASD in daily life are actually related to
their problems with sensory processing. Motor control and sensory processing
theories show that the ability of children with ASD to regulate the degree, intensity,
and type of responses to sensory information is reduced, resulting in limited ability
to acquire and adapt during daily activities.

• Motor control and sensory processing theories suggest that children with ASD have
a decreased ability to regulate degree, intensity, and type of responses to sensory
information. This results in limited abilities to habituate and adapt during daily
activities.
• Hippotherapy is a unique treatment strategy for children with disabilities because
it considers the context of the therapy session while offering support necessary to
challenge the cognitive–sensorimotor systems.
• It has been shown that hippotherapy practice leads to improvements in adaptation
and increased willingness to participate in daily activities.

• Hippotherapy is thought to cause positive changes in nervousness, hyperactivity,
social and communication behaviours in children with ASD.
• Motor challenges can limit interactions with the physical and social world, reducing
opportunities to acquire developmentally appropriate skills. It causes children with
ASD and their families to experience social isolation, anxiety and emotional
difficulties.
• This may cause children with ASD and their families to be negatively affected and
their quality of life to be reduced.

• Parents of many autistic children who participate in the hippotherapy program
observe significant improvements in their children's physical, social and sensory
functions.
• Hippotherapy positively affects the behaviour of autistic children.
• Hippotherapy sessions applied twice a week for 12 weeks have been observed to
decrease postural oscillation, increase all adaptive behaviours (communication,
imitation), improve self-care, light activities and social interaction in children with ASD.
• Hippotherapy has been shown to have positive effects on this paediatric population and it
has been reported that it may be one of the complementary treatment strategies in
autistic children.

• Studies offered evidence that people with ASD who participate in hippotherapy
may experience improvements in social interaction, positive emotions, stress,
communication, and motor skills.
• There are studies reporting that there is a decrease in the negative behaviour of
the child, especially during riding (e.g. emotional displays, stereotyped
movements), and after the intervention (e.g. irritability, hyperactivity, and
aggression).
• In addition, hippotherapy reported improvements in one or more areas of
interpersonal interaction, including adaptive social behaviour, mood and tone of
parent-child interactions, social cognition, social communication, and general
social functioning.

• At the same time, the influence of certain hormones was recently revealed in the
behaviour of children with ASD. It has been reported in studies that it is associated
with an imbalance in the progesterone hormone and an increase in the cortisol
hormone.
• These hormonal changes indirectly cause a decrease in the amount of oxytocin.
• Hippotherapy has been reported to reduce cortisol levels, provide progesterone
hormone balance, and increase the amount of oxytocin. It has been reported that
this leads to an improvement in social and psychological attitudes in the population
with ASD.

• Hippotherapy reportedly improves one or more areas of interpersonal interaction,
including adaptive social behaviour, mood and tone of parent-child interactions,
social cognition, social communication, and general social functioning.

• Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder
characterized by developmental disorder symptoms of inattention, hyperactivity,
and impulsivity.
• These features may lead to academic failure, decreased motor performance, and
social relationships in children with ADHD.

• The mechanism of action of hippotherapy in children with ADHD is uncertain.
There are several possible explanations for improving ADHD core symptoms.
• First, physical activity may positively affect inattention and impulsivity. Recent meta-
analysis of the efficacy of exercise interventions indicates that exercise intervention
has specific beneficial effects on inhibitory, cognitive, and memory function.
• A second hypothesis is that the repetitive symmetric and rhythmic motion of horse
riding stimulates a range of vestibulo-cerebellar system processes.
• A third hypothesis is that hippotherapy contributes to improved self-regulation and
behavioural problems.
• Almost half of children with ADHD exhibit poor balance and coordination.

• Children and adolescents with ADHD have decreased gross and fine motor skills
and decreased motor skills.
• Recent neuroimaging studies have also demonstrated that the neural networks
regulating motor functions are dysfunctional in individuals with ADHD.
• The studies proposed that ADHD may be caused by timing deficits associated with
the fronto-striatal-cerebellar network. Another review came to similar conclusions
regarding timing in the left fronto-parieto-cerebellar network during tasks in
individuals with ADHD.
• The studies proposed that cerebellar dysfunction contributes to postural and gait
imbalance in children with ADHD.
https://www.youtube.com/watch?v=SFmkCXkeRp4

• In addition, hippotherapy is effective in the sensorimotor, neuromotor,
psychological, and social domains.
• Because horses provide unique neuromuscular stimulation in a rhythmic motion,
this treatment promotes strength, balance, coordination, and flexibility by motor
learning and sensory integration.
• In the context of ADHD, hippotherapy is expected to improve motor proficiency,
physical activity, and postural balance by stimulating the sensorimotor domain.
• Hippotherapy may improve clinical symptoms, gait balance, and brain connectivity,
the last of which controls gait balance, in children with ADHD.

• Studies show that neurotransmitter activation decreases in children with ADHD
because there is generally lower neurotransmitter activation and increased
activities in the right-dorsal frontal lobes.
• It has been observed that collaboration between the cortexes increased
significantly after hippotherapy.
• It has also been found that hippotherapy causes an increase in decision-making
performance in relation to an increase in brain activity.
• It has been reported in studies that improvement increases as the frequency of
sessions increases.
• It is thought that using hippotherapy with children with ADHD may also be effective
because hippotherapy provides vestibular stimulation.

• Interaction with horses can be an enjoyable experience, leading to higher
motivation to facilitate learning and change behaviour.
• Previous studies have shown that horseback riding enables the rider to experience
full control of direction and speed, developing a sense of autonomy, problem
solving skills and control.

• Children with ADHD commonly have difficulties in social problems, including
social withdrawal, peer rejection, and bullying. The promotion of nonverbal
communication and joint attention in these children would be achieved by
interaction with horses. Therefore, hippotherapy may be a new psychosocial option
to enhance social incompetence in children with ADHD.
• There is some evidence to suggest that improvements in anxiety, irritability,
inattention, and hyperactivity could be achieved by reciprocal interaction with
horses.
• Studies report that there is a significant improvement in social competence and
communication skills.

• Alternatively, it has been demonstrated that horseback riding can improve
functional task performance by decreased reaction time.
• Hippotherapy has recently been used as a specific technique to provide adequate
exercise stimuli to increase functional improvements in patients with
neuromuscular dysfunction.
• During hippotherapy, the therapist targets the rider’s weaknesses to facilitate
sensory-motor and perceptual motor skills by using various postural movements
on the horse.

• There are studies in the literature for hippotherapy, indicating that it increases
walking speed and mobility in the development of static and dynamic balance in
neuromuscular diseases. The reason for this has been reported to be related to the
development of proprioception and early adaptation.
• The current studies provides quantitative evidence that short hippotherapy
improves reaction time, balance, and attention in patients with neuromuscular
dysfunction.

• In mildly affected spinal muscular atrophy (SMA) types, swimming, cycling,
hippotherapy and wheelchair sports can be recommended to increase exercise
function, endurance and participation.
• With hippotherapy: daily stretching, regular aerobic exercises, positioning,
providing cervical and trunk support, providing lower and upper limb range of
motion and increasing mobility.

• Hippotherapy also has effects on autonomic functions, sympathetic and
parasympathetic systems.
• In studies, it is indicated that hippotherapy increases recovery by revealing acute
autonomic responses during treatment and recovery period in neurological
diseases. It has been reported that the heart rate of individuals with neurological
effects applied after hippotherapy sessions improved.
• It strengthens the trunk and upper extremity muscles, reducing the risk of
developing respiratory and heart problems.

• A remarkable improvement in patients’ attention has been observed, suggesting a
quick adaptation in brain function.
• The present data provides evidence that short-term hippotherapy is an effective
treatment strategy in the development of sensory-motor and cognitive skills of
patients with a neuromuscular dysfunction.

• Literature say that hippotherapy is an exercise therapy that can have positive
physical effects on coordination, muscle tone, postural alignment,
stiffness/flexibility, endurance, and strength, correcting abnormal movement
patterns and improving gait.
• The repeated motion in hippotherapy induces continuous sensory stimuli in
subjects to create cognitive responses, and provides learning effects such as
sensory integration, movement planning, discrimination of the left and the right,
and spatial senses.

• While hippotherapy initially began for people with physical disabilities, more
evidence is supporting the effectiveness of speech language pathology therapy
with hippotherapy.
• These findings suggest that improved physical activity with hippotherapy has
positive effects on physical abilities and psychological functioning in various
populations.

• Cognitive and motor advances in neuromuscular diseases provide psychological
well-being.
• Hippotherapy increases the quality of life.

Definition Effect of hippotherapy
Cerebral
palsy (CP)
CP is a persistent
neurological disorder,
caused by damage or
abnormalities in the
immature brain that
impair the brain's
ability to control
movement, posture, and
balance.
Motor Cognitive Psychological
 Regulation of muscle tone
o Increasing muscle tone in
the trunk and neck area
o Decreasing muscle tone in
the lower extremities
 Pelvic mobilization/stabilization
 Reinforces the appearance of
righting mechanisms and trunk
control
 Improves the equilibrium
reactions (especially in relation
to changes of pace and
direction)
 Reduces involuntary
movements
 Improve gross and fine motor
function
 Provides sensorimotor
stimulation
 Reduces fatigue
 Improves the quality of life
 Improves walking speed, stride
length, independent sitting
ability, jumping, ascending and
descending stairs
 Improves speech,
language,
cognitive, and
masticatory
functions
 Improves visual
perception
 Improves speech
 Improves active
communication,
 Decreases
anxiety
 Development of
the ability to plan
task-oriented
work
 Positive
psychosomatic
influences such as
increased self-
esteem and
motivation
 Enhances self-
esteem
 Enhances the
ability to recover
from disease,
 Reduces
depression and
sense of
loneliness
 Increases
interpersonal
communication

Down
seyndrome
(DS)
DS is a condition in
which a child is born
with an extra copy of
their 21st chromosome
— hence its other
name, trisomy 21.This
causes physical and
mental developmental
delays and disabilities.
 Provides sensory inputs to
the joints and muscles
 Muscle distension and body
relaxation
 Improves dynamic and
static balance reactions
 Regulates muscle tone
 Improves balance
 Increases muscle strength
 Improves gross and fine
motor function
 Strengthens the trunk and
upper extremity muscles,
reducing the risk of
developing respiratory and
heart problems
 Adjusts lung capacity and
volume
 Provides speech
development
 Modification and
rearrangement of the
nervous system
 Improves
concentration
 Improves sequencing
and planning in the
activity
 Activates mental
processes
 Improves auditory-
motor and visual-
motor coordination
 Improves memory
 Improves body
awareness
 Improves
communication
skills
 Increases self-
confidence
 Positive effects on
quality of life and
self-esteem
 Increases eye
contact

Definition EFFECT OF hippotherapy
Autism
spectrum
disorder
(ASD)
ASD is a condition
related to brain
development that
impacts how a person
perceives and socializes
with others, causing
problems in social
interaction and
communication.The
disorder also includes
limited and repetitive
patterns of behaviour.
 Improves postural
stability
 Improves gross and fine
motor function
 Increases upper
extremity skills
 Increases the person's
participation in
performance and daily
life activities
 Improves
communication ability
 Improves performance
in coping with problems
and daily activities
 Improves the ability to
regulate sensory inputs
 Increases language,
social engagement,
gaming skills and
academic abilities
 Better time at school
 Interacts more with
their peers
 Improves the ability
to pay attention to the
consequences of
behaviour
 Improves social
maturity
 Reduces
hyperactivity
 Increases motivation
 Improves learning
ability
 Makes you feel better
psychologically
 Decreases social isolation in
children and their families
 Improves the ability to cope
with anxiety and emotional
difficulties in children and
their families
 Increases the willingness to
participate in daily activities
 Causes positive changes in
irritability, hyperactivity,
social and communicative
behaviour
 Increases all adaptive
behaviour (communication,
imitation), self-care, light
activities and social
interaction
 Reduces irritability,
stereotype movements,
hyperactivity and aggressive
behaviour
 Balances the progesterone
hormone and increases the
cortisol hormone

Attention deficit
hyperactivity
disorder (ADHD)
ADHD is a
neurodevelopmental
disorder characterized
by developmental
disorder symptoms of
inattention,
hyperactivity, and
impulsivity.
These features may
lead to academic
failure, decreased
motor performance,
and social
relationships in
children with ADHD.
 Contributes to
postural and gait
imbalance
 Promotes strength,
balance,
coordination, and
flexibility by motor
learning and sensory
integration
 Improves motor
proficiency, physical
activity, gait speed
and postural balance
 Increases decision-
making performance
 Makes learning easier
 Increases motivation
 The development of
the ability to control
 Increases sense of
autonomy
 Develops problem
solving skills
 Decrease in social
disability
 Improves anxiety,
irritability and inattention
and hyperactivity
 Provides the development
of communication skills
 Improves social
competence and
communication skills

Neuromuscular
diseases
Neuromuscular
diseases affect the
function of muscles
due to problems with
the nerves and
muscles in the body.
The most common
symptom of these
diseases is muscle
weakness.
 Improves static and
dynamic balance
 Increases walking
speed and mobility
 Provides early
adaptation to
movement
 Improves reaction time,
balance and attention
 Increases exercise
function and endurance
 Provides daily
stretching, positioning,
aerobic exercise effects
 Provides lower and
upper extremities’
range of motion
 Strengthens the trunk
and upper extremity
muscles, reducing the
risk of developing
respiratory and heart
problems
 Improves sensory
integration, motion
planning,
separation of left
and right
 Increases language,
social engagement,
gaming skills and
academic abilities
 Improves
concentration
 Improves
sequencing and
planning in the
activity
 Cognitive and motor
advances in neuromuscular
diseases provide
psychological well-being.
 Increases the quality of life
 Positive effect on physical
abilities and psychological
functioning

• Sterba, J. A. (2007). Does horseback riding therapy or therapist‐directed hippotherapy rehabilitate children with cerebral
palsy?. Developmental medicine & child neurology, 49(1), 68-73.
• Haehl, V., Giuliani, C., & Lewis, C. (1999). influence of hippotherapy on the kinematics and functional performance of two children with
cerebral palsy. Pediatric Physical Therapy, 11(2), 89-101.
• Lechner, H. E., Kakebeeke, T. H., Hegemann, D., & Baumberger, M. (2007). The effect of hippotherapy on spasticity and on mental well-being
of persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 88(10), 1241-1248.
• Leidig, M. (2018). An Examination of Hippotherapy as a Tool to Deliver Physical, Occupational, and Speech Therapy.
• Wollenweber, V., Drache, M., Schickendantz, S., Gerber-Grote, A., Schiller, P., & Pöhlau, D. (2016). Study of the effectiveness of hippotherapy
on the symptoms of multiple sclerosis–Outline of a randomised controlled multicentre study (MS-HIPPO). Contemporary clinical trials
communications, 3, 6-11.
• Shurtleff, T. L., Standeven, J. W., & Engsberg, J. R. (2009). Changes in dynamic trunk/head stability and functional reach after
hippotherapy. Archives of physical medicine and rehabilitation, 90(7), 1185-1195.
• Moraes, A. G., Copetti, F., Angelo, V. R., Chiavoloni, L. L., & David, A. C. (2016). The effects of hippotherapy on postural balance and
functional ability in children with cerebral palsy. Journal of physical therapy science, 28(8), 2220-2226.
• Kwon, J. Y., Chang, H. J., Yi, S. H., Lee, J. Y., Shin, H. Y., & Kim, Y. H. (2015). Effect of hippotherapy on gross motor function in children with
cerebral palsy: a randomized controlled trial. The Journal of Alternative and Complementary Medicine, 21(1), 15-21.
• Kwon, J. Y., Chang, H. J., Lee, J. Y., Ha, Y., Lee, P. K., & Kim, Y. H. (2011). Effects of hippotherapy on gait parameters in children with bilateral
spastic cerebral palsy. Archives of physical medicine and rehabilitation, 92(5), 774-779.

• Hession, C. E., Eastwood, B., Watterson, D., Lehane, C. M., Oxley, N., & Murphy, B. A. (2014). Therapeutic horse riding improves cognition, mood arousal, and
ambulation in children with dyspraxia. The Journal of Alternative and Complementary Medicine, 20(1), 19-23.
• Jang, C. H., Joo, M. C., Noh, S. E., Lee, S. Y., Lee, D. B., Lee, S. H., ... & Park, H. I. (2016). Effects of hippotherapy on psychosocial aspects in children with cerebral
palsy and their caregivers: a pilot study. Annals of rehabilitation medicine, 40(2), 230.
• Bae, M. S., Yun, C. K., & Han, Y. G. (2017). The Effects of Hippotherapy for Physical, Cognitive and Psychological Factors in Children with Intellectual
Disabilities. Korean Society of Physical Medicine, 12(3), 119-130.
• Portaro, S., Bramanti, P., Cacciola, A., Cavallaro, F., & Milardi, D. (2016). Why do we apply hippotherapy in neurological diseases? A brief overview and future
perspectives. Int J Phys Med Rehabil, 4(3), 4-5.
• Silkwood-Sherer DJ, Killian CB, Long TM, Martin KS (2012) Hippotherapy--an intervention to habilitate balance deficits in children with movement disorders: a clinical
trial. Phys Ther 92: 707-717.
• Ward SC, Whalon K, Rusnak K, Wendell K, Paschall N (2013) The association between therapeutic horseback riding and the social communication and sensory
reactions of children with autism. J Autism Dev Disord 43: 2190-2198.
• Shurtleff TL, Standeven JW, Engsberg JR (2009) Changes in dynamic trunk/head stability and functional reach after hippotherapy. Arch Phys Med Rehab 90: 1185-
1195.
• Champagne, D., & Dugas, C. (2010). Improving gross motor function and postural control with hippotherapy in children with Down syndrome. Physiotherapy Theory
and Practice, 26(8), 564-571.
• Costa, V. S. D. F., Silva, H. M. D., Alves, E. D., Coquerel, P. R. S., Silva, A. R. D., & Barros, J. D. F. (2015). Hippotherapy and respiratory muscle strength in children and
adolescents with Down syndrome. Fisioterapia em Movimento, 28(2), 373-381.
• Costa, V. S. D. F., Silva, H. M. D., Alves, E. D., Coquerel, P. R. S., Silva, A. R. D., & Barros, J. D. F. (2015). Hippotherapy and respiratory muscle strength in children and
adolescents with Down syndrome. Fisioterapia em Movimento, 28(2), 373-381.
• Uyanik, M., & Kayihan, H. (2010). Down syndrome: sensory integration, vestibular stimulation and neurodevelopmental therapy approaches for children. Stone JH,
Blouin M. International Encyclopedia of Rehabilitation, 9.
• Gabriels, R. L., Pan, Z., Dechant, B., Agnew, J. A., Brim, N., & Mesibov, G. (2015). Randomized controlled trial of therapeutic horseback riding in children and
adolescents with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 54(7), 541-549.
• Tabares, C., Vicente, F., Sánchez, S., Aparicio, A., Alejo, S., & Cubero, J. (2012). Quantification of hormonal changes by effects of hippotherapy in the autistic
population. Neurochemical Journal, 6(4), 311-316.
• Jackson-Maldonado, D. (2019). Hippotherapy and the Communicative Abilities of Children With Down Syndrome: A Preliminary Study. Communication Disorders
Quarterly, 1525740119870769.
• Koca, T. T., & Ataseven, H. (2015). What is hippotherapy? The indications and effectiveness of hippotherapy. Northern clinics of Istanbul, 2(3), 247.

• Jackson-Maldonado, D. (2019). Hippotherapy and the Communicative Abilities of Children With Down Syndrome: A Preliminary Study. Communication Disorders
Quarterly, 1525740119870769.
• Espindula, A. P., Ribeiro, M. F., Souza, L. A. P. S. D., Ferreira, A. A., Ferraz, M. L. D. F., & Teixeira, V. D. P. A. (2016). Effects of hippotherapy on posture in individuals
with Down Syndrome. Fisioterapia em Movimento, 29(3), 497-506.
• Costa, V. S. D. F., Silva, H. M. D., Azevêdo, M. D., Silva, A. R. D., Cabral, L. L. P., & Barros, J. D. F. (2017). Effect of hippotherapy in the global motor coordination in
individuals with Down Syndrome. Fisioterapia em Movimento, 30, 229-240.
• Bashmakova, S. B., Lapteva, N. V., Matantseva, T. N., Khmelkova, E. V., Tsvetkova, N. V., & Sheshukova, N. N. (2018). Correction Of The Sensory-Perspective Sphere In
Children With DownS Syndrome By Means Of Hippotherapy. www. mjltm. com info@ mjltm. org, 363.
• Ajzenman, H. F., Standeven, J. W., & Shurtleff, T. L. (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(6), 653-663.
• Peters, B. C. M., & Wood, W. (2017). Autism and equine-assisted interventions: A systematic mapping review. Journal of autism and developmental disorders, 47(10),
3220-3242.
• Ajzenman, H. F., Standeven, J. W., & Shurtleff, T. L. (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(6), 653-663.
• Hyun, G. J., Jung, T. W., Park, J. H., Kang, K. D., Kim, S. M., Son, Y. D., ... & Han, D. H. (2016). Changes in gait balance and brain connectivity in response to equine-
assisted activity and training in children with attention deficit hyperactivity disorder. The Journal of Alternative and Complementary Medicine, 22(4), 286-293.
• Lee, N., Park, S., & Kim, J. (2017). Hippotherapy and neurofeedback training effect on the brain function and serum brain-derived neurotrophic factor level changes in
children with attention-deficit or/and hyperactivity disorder. Journal of exercise nutrition & biochemistry, 21(3), 35.
• Oh, Y., Joung, Y. S., Jang, B., Yoo, J. H., Song, J., Kim, J., ... & Kwon, J. Y. (2018). Efficacy of Hippotherapy versus pharmacotherapy in Attention-Deficit/Hyperactivity
Disorder: A randomized clinical trial. The Journal of Alternative and Complementary Medicine, 24(5), 463-471.
• Stergiou, A., Tzoufi, M., Ntzani, E., Varvarousis, D., Beris, A., & Ploumis, A. (2017). Therapeutic effects of horseback riding interventions: a systematic review and meta-
analysis. American journal of physical medicine & rehabilitation, 96(10), 717-725.
• Bae, M. S., Yun, C. K., & Han, Y. G. (2017). The Effects of Hippotherapy for Physical, Cognitive and Psychological Factors in Children with Intellectual
Disabilities. Korean Society of Physical Medicine, 12(3), 119-130.
• Tabares, C., Vicente, F., Sánchez, S., Aparicio, A., Alejo, S., & Cubero, J. (2012). Quantification of hormonal changes by effects of hippotherapy in the autistic
population. Neurochemical Journal, 6(4), 311-316.
• Paganoni, S. (2018). Evidence-based physiatry: pediatric neuromuscular rehabilitation in the era of precision medicine. American journal of physical medicine &
rehabilitation, 97(12), 920.
• Taylor, R. R., Kielhofner, G., Smith, C., Butler, S., Cahill, S. M., Ciukaj, M. D., & Gehman, M. (2009). Volitional change in children with autism: A single-case design
study of the impact of hippotherapy on motivation. Occupational Therapy in Mental Health, 25(2), 192-200.

The European Commission's support for the production of this publication does not
constitute an endorsement of the contents, which reflect the views only of the
authors, and the Commission cannot be held responsible for any use which may be
made of the information contained therein.
https://www.hippotherapy-training.eu/
https://www.facebook.com/HippotherapyProject/
https://www.hippotherapy-training.eu/elearning/?lang=en
https://play.google.com/store/apps/details?id=com.hippotherapy.mobile
https://apps.apple.com/app/id1526453884

Hippotherapy module 10 EN

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Hippotherapy module 10 EN

Similar to Hippotherapy module 10 EN (20)

More from Karel Van Isacker

More from Karel Van Isacker (20)

Recently uploaded

Recently uploaded (20)

Hippotherapy module 10 EN