This document discusses the physical, cognitive, sensory and physiological effects of hippotherapy based on research studies. It summarizes that hippotherapy can improve gross motor skills, trunk strength, extremity control, postural symmetry, muscle tone, respiratory control, attention, focus, orientation, reaction time, tactile sensitivity, proprioception, vestibular function, body awareness, social interaction, self-esteem, motivation and working memory in children with intellectual, emotional, physical and psychomotor disabilities. The document reviews several research studies that demonstrate these benefits of hippotherapy.

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

3. • 8.1 Physical effects
• 8.1.1 Gross motor skills
• 8.1.2 Trunk strength
• 8.1.3 Extremity control
• 8.1.4 Postural symmetry
• 8.1.5 Muscle tone
• 8.1.6 Respiratory control

4. 8.1 Physical effects
• Hippotherapy is a beneficial method to increase functioning in children who need
continuing, varied, and repetitive treatment.
• It provides a new stimulus related to gait and helps the balance and postural
control in children because the pelvic movements of a horse rider are similar to
that of the pelvis during gait.
• After hippotherapy, spatiotemporal parameters, such as gait speed, cadence and
gross motor function, muscle strength and tone improve.

5. 8.1.1 Gross motor skills
• Gross motor abilities require the use of large muscle groups that coordinate body
movements to perform activities such as maintaining running and jumping,
walking, crawling, sitting upright, throwing objects, etc.
• Gross motor skills are essential to make it possible for children to perform
everyday functions.
• Hippotherapy positively affects gross motor function in children. Furthermore, it
maximizes and enhances functional performances, such as playground skills and
sporting skills in daily life.Thus, it becomes easier for children to participate in
daily life activities.

6. 8.1.2 Trunk strength
• Riders adjust the trunk position to the horse’s body position. Repetition of these
adjustments during hippotherapy sessions promotes the strengthening of pelvic,
abdominal, and lumbar muscles, and contributes to an improved trunk strength.
• The child must engage his trunk muscles intensively to maintain a vertical
alignment and react to these postural challenges on the horse.These contractions
increase the trunk strength.

7. 8.1.3 Extremity control
• Maintaining extremity control is necessary for the performance of activities of daily
living in children.
• The horse's movement provides a variety of inputs to the rider, which may be used
to facilitate improved extremity control, contraction, and joint stability in children.
• The upper legs are pushed inwards to stabilize the body and keep the balance in
the middle.This activity increases the activity of the lower extremities and the
lower back muscles as well.

8. 8.1.4 Postural symmetry
• A therapist places the child rider in various positions on the horseback, such as
supine, prone, prone backward, sitting backward, or sitting sideways to facilitate
postural reactions and motor responses.
• The visual, vestibular, and somatosensory systems behave as a multisensory
network that maintains postural symmetry. During the hippotherapy session, the
horse stimulates this system and contributes to the rider's postural symmetry.
• The horse's walking patterns activates a protection movement in the children so as
not to fall.

9. 8.1.5 Muscle tone
• The proper posture during horseback riding is to maintain a 90 degree hip joint
and a 90 degree knee joint. Such posture induces a decrease in the muscle tone
and spasticity (mostly lower extremity muscles such as hip adductors) of the rider
with spinal cord injury.
• The horse’s centre of gravity is displaced three‐dimensionally when walking,
resulting in a very similar movement to that of the human pelvis during walking.
This rhythmic movement, combined with the horse's warmth, decreases
hypertonicity and promotes relaxation in the rider.
• For spastic children, the positioning is essential to relax the stiff muscle groups. For
example, sitting on the horse will relax and stretch the hip adductor muscle groups,
which are affected.
• Children with a weak muscle tone also benefit from hippotherapy by the movement
of the horse, its walking, breathing and perturbation.

10. 8.1.6 Respiratory control
• Respiratory control is essential for speech and produces voice. Hippotherapy
positively affects inspiratory and expiratory respiratory muscle strength.
Respiratory control improves in children with neuromotor disorder by acting on the
diaphragmatic muscle, opening the ring by correcting the position of the trunk.

11. • 8.2 Cognitive effects
• 8.2.1 Attention and focus
• 8.2.2 Orientation
• 8.2.3 Speed reaction for the task

12. 8.2 Cognitive effects
• An increase in physical activity has a positive effect on the perceptions and
cognitive development, while the physical experience promotes intellectual
development. Hippotherapy improves cognitive abilities.
• Children with intellectual disabilities lack the willingness to participate in an
exercise, and their disabilities make it difficult to carry out physical activity.
Therefore, interventions that utilize interaction with the horse are more beneficial
for these children.

13. 8.2.1 Attention and focus
• Brain injury does not only affect the motor system, it often also affects the
neurocognitive and sensory systems. Attention and focus are essential while doing
the task, such as carrying a box, walking, and climbing because they affect the
task's quality.
• During ambulation, the horse provides a rhythmic movement and dynamic
environment for the rider.
• Therefore hippotherapy positively affects attention and focus in children with have
neuromotor disorders.

14. 8.2.2 Orientation
• Children with neuromotor disorders have difficulties with control of the body
position and have trouble keeping the body's balance.Therefore they have spatial
orientation deficits.
• Hippotherapy induces vestibular and proprioceptive stimulation and improves
spatial orientation.
8.2.3 Speed reaction for the task
• Hippotherapy improves the executive functioning and reduces planning, thus a
shorter reaction time in problem-solving situations.

15. • 8.3 Sensory Effects
• 8.3.1 Tactile
• 8.3.2 Proprioceptive
• 8.3.3 Vestibular
• 8.3.4 Postural schema

16. • Sensory inputs are necessary for efficient motor planning. Hippotherapy provides
many sensory stimulations for the rider through the movement of the horse.
• The horse and its movement give tactile, proprioceptive and vestibular input.This
motion experience affects the body image awareness in children with neuromotor
disabilities.

17. 8.3.1 Tactile
• Clients use many positions such as sitting and lying prone on the horse.
• The horse offers tactile input to the child in these positions.The client reaches the
horse's side and offers tactile input while working on the dissociation of the upper
and lower trunk and balance.
• Tactile inputs improve trunk stability, posture, gait and balance in children with
cerebral palsy.
https://www.dreamstime.com/photos-images/hippotherapy.html

18. • Hippotherapy, as a treatment strategy, is linked to the sensory integration theory
because the movement of the horse offers a multisensory experience.
• Riding bareback may help the rider receive the maximum proprioceptive input
possible from the horse. As an alternative approach, stirrups (used with a saddle or
bareback pad) can help the rider receive proprioceptive input by weight-bearing
into the hard surface.These inputs increase body awareness.

19. • The vestibular system (inner ear balance mechanism) works with the visual system
(eyes), muscle, and joints to maintain balance.They also help to keep awareness of
daily living activities.
• The horse's movement, with changes in direction and speed, stimulates the
vestibular region of the brain.
• The horse's slow swinging stimulates the vestibular system and may help stimulate
the production of speech sounds.

20. 8.3.4 Postural schema
• The postural schema is the position and movement of the body. It is derived from
the proprioceptive and kinaesthetic afferent impulses.
• Hippotherapy has positive effects on the position and function of individual parts of
the body, making it possible for children with special needs to improve posture
and maintain balance in daily living activities.

21. • 8.4 Physiological Effects
• 8.4.1 Interaction with horse
• 8.4.2 Social ınteraction
• 8.4.3 Self-esteem
• 8.4.4 Motivation
• 8.4.5 Working memory

22. 8.4 Physiological effects
• Hippotherapy increases the ability to recover from disease, reduces depression
and sense of loneliness. It affects psychological variables such as anxiety,
motivation and ensures maintained social support in children.Therefore,
hippotherapy is widely used as an effective intervention.
https://www.dreamstime.com/photos-images/hippotherapy.html

23. 8.4.1 Interaction with horse
• The bonding process connecting a human with a horse starts with the physical
contact. Body contact constitutes an emotional connecting channel between
interactants and results in substantial behavioural and physiological variation.
• Hippotherapy is a potent source for providing accurate, effective social and
psychological feedback.
• Interaction with horses offers various benefits that may improve quality of life, such
as increased confidence, lower stress, and an increase in caloric output.

24. 8.4.2 Social interaction
• Horses can work as facilitators of social interaction in children.The presence of
horses makes the therapeutic environment seem more friendly and the therapy
itself less threatening. Also, horses make children feel more open and comfortable.

25. 8.4.3 Self-esteem
• Humans need self-esteem to exist beyond survival.
Adequate self-esteem is essential to our survival
because it is a motivator and it inspires behaviour.
• The sense of achievement experienced while
riding can increase self-esteem.The horse is a self-
esteem booster, partly because having successfully
commanded a horse, a very large animal, makes
the patients very proud of themselves and
improves self-esteem.
https://www.zarebasystems.com

26. 8.4.4 Motivation
• Involvement with horses is a strong motivation for many people.
• Group riding sessions are a safe and fun way to motivate people to maintain their
physical, mental, emotional and social skills.
• Children's motivation to be with the horses and their preference for being
outdoors, as opposed to being inside the school, helps children with physical
aspects in addition to learning and social skills.

27. 8.4.5 Working memory
• The brain works on autopilot in familiar situations and saves energy by thinking
and doing what we have always done in similar cases. Novel situations require
conscious thinking and working memory and they activate the prefrontal cortex.
Learning and creativity become possible.
• Hippotherapy can be a treatment option because it is an unconventional
experience. It helps patients gain sensory input from their environment, the horse,
and their own body to help improve their working memory and create a lasting
change.

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30. 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.
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