This document discusses hippotherapy, which is horse-assisted therapy for people with disabilities. It provides information on who can benefit from hippotherapy, focusing on various medical conditions. It also discusses the important characteristics of therapy horses used for hippotherapy and how the horse's movement and gait can impact patients. Safety is the top priority for ensuring hippotherapy is appropriate for individual patients' needs.

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

3. • 4.1. To whom is hippotherapy recommended
• 4.1.1. Mandatory health conditions
• 4.1.2. Important premises for hippotherapy
• 4.2. Development areas benefitting from hippotherapy
• 4.2.1. Perception
• 4.2.2. Attention
• 4.2.3. Spatial relation/position in space
• 4.2.4. Socialization
• 4.2.5. Capacity to take decisions
• 4.2.6. Speech development
• 4.2.7. Motor skills
• 4.2.8. Control and awareness
• 4.2.9. Organising abilities
• 4.2.10. Behaviour
• 4.2.11. Working memory
• 4.2.12. Motivation

4. • 4.3. Characteristics of therapy horses
• 4.3.1. Selection criteria
• 4.3.1.1. Height
• 4.3.1.2. Movement
• 4.3.1.3. Gender
• 4.3.1.4. Age
• 4.3.1.5. Temper and character
• 4.3.1.6. Flexibility
• 4.3.1.7. Rhythm
• 4.3.1.8. Symmetry
• 4.3.1.9. Posture
• 4.3.1.10. Balance
• 4.3.2 Walking pace - What can be changed?
• 4.3.2.1. Impulse
• 4.3.2.2. Tempo and speed
• 4.3.2.3. Changing direction
• 4.3.2.4. Transition
• 4.3.3. Dressage of therapy horses

5. Patients with following diagnosis can benefit from
hippotherapy:
• Sensory Processing Disorder, Autism Spectrum
Disorder (ASD), Attention Deficit Hyperactivity
Disorder (ADHD), Down Syndrome
• Neuromuscular Diseases
• Difficulties in perception and profound
disability
• Wheel chair users with no gross motor activity
• Epilepsy
• Cerebral palsy
• Head injury
• Scoliosis and other spine problems
• Arthritis
• Amputation
• Post polio syndrome
• Multiple sclerosis
• Hidrocephalus
• Cerebrrovascular accident
• Paraplegia and quadriplegia
• Spina bifida
• Encephalitis
• Muscular dystrophy

6. Patients with a recommendation for hippotherapy must fulfil following mandatory
health conditions:
• minimum recommended age: 2 years
• rider must be in control of her/his head
• it is recommended that s/he can sit upright
• s/he should not have aggressive behaviours that can not be handled

7. • There are situations when certain symptoms might be addressed although the
disease that makes them show up is no suitable for therapy. It usually is related to
the evolution stage of the disease.
• According to the American Hippotherapy Association, following impairments could
mean a risk and could be considered as contraindications
• arthrogryposis,
• heterotopic ossification,
• hip luxation/hip dislocation,
• osteoporosis,
• spinal deformities (instabilities, spinal orthosis, scoliosis, spina bifida).

8. • Safety comes first! This means the safety of the rider during the lesson and the
safety for his long term health.
1. First do no harm! It is the main principle in hippotherapy. For a correct decision risk
versus benefits must be clearly evaluated.
2. The second principle is about the contraindications for hippotherapy and refers to the
diseases or stages of diseases that are not suitable at all for this kind of therapy.
3. The third principle is about choosing the right equipment to be used. It must be chosen
according to diagnostic, age and stage of the disease. The equipment must fit the age of
the rider.

9. • Example: for patients with hydrocephalus that have undergone cranial surgery, the
traditional helmets might be uncomfortable and might not be the right fit.
• In this case the sessions will be postponed until a suitable helmet will be found or is
custom made.
• Patients with high or oscillant (varying) blood pressure should avoid lessons while there
is heat.

10. Absolute contraindications for hippotherapy (according to the American Hippotherapy Association
– AHA )
• Active mental health disorders that would be unsafe (fire setting, suicidal, animal abuse, violent
behaviour, etc.).
• Acute herniated disc with or without nerve root compression.
• Chiari II malformation with neurologic symptoms.
• Atlantoaxial instability (AAI): a displacement of the C1 vertebra in relation to the C2
vertebra as seen on x-ray or computed tomography of significant amount (generally agreed to be
greater than 4 mm for a child) with or without neurologic signs as assessed by a qualified
physician; this condition is seen with diagnoses which have ligamentous laxity such as Down
syndrome or juvenile rheumatoid arthritis.
• Coxa arthrosis: degeneration of the hip joint.The femoral head is flattened and functions like a
hinge joint versus a ball and socket joint. Sitting on the horse puts extreme stress on the joint.

11. • Grand mal seizures (generalized tonic-clonic seizure): uncontrolled by medications.
• Haemophilia with a recent history of bleeding episodes.
• Indwelling urethral catheters.
• Medical conditions during acute exacerbations (rheumatoid arthritis, herniated nucleus pulposis,
multiple sclerosis, diabetes, etc.).
• Open wounds on weight-bearing surface.
• Pathologic fractures without successful treatment of the underlying pathology (e.g. severe
osteoporosis, osteogenesis imperfecta, bone tumour, etc.).
• Tethered cord with symptoms.
• Unstable spine or joints including unstable internal hardware.

12.  Horse assisted therapy incorporates all the activities that have a therapeutic
objective, and are practiced by specialized professionals working with people with
disabilities and using the horse as a therapy tool.
 Hippotherapy has proven to be one of the most effective therapies used for better
balance, posture and an improved mobility in people with motor dysfunctions.

13. • Horse assisted therapy has a significant role on the perception. It brings changes
on the visual level.
• Changes in perception bring changes in cognition by stimulating the cognitive
mechanism.
• Moreover, the movement of the horse causes a movement of his own body, warms
and relaxes the joints, an aspect that helps the child to obtain a state of well-being,
relaxation, peace.

14. • Perception is directly influenced by the sensorial development.
• Its core aim is to obtain a functional answer to outside stimuli. The functional
answer is a correct reaction to stimuli from the environment.
• Modulation allows filtering of irrelevant stimuli. It thus helps maintain an optimal
level of excitement which facilitates attention to the requirements of the
environment and allows responses according to stimuli - functional answers.
• To obtain modulation, activities that stimulate the vestibular and proprioceptive
system will be chosen.
• When children with sensory difficulties succeed in obtaining modulation, this will
positively influence attention and will help her/him to interact with the world.
• Activities stimulating the proprioceptive system include counter gravity
movements: standing in stirrups.

15. • In Horse Assisted Therapy the pace and walking style of the horse has a direct
influence on the vestibular system.This will help with the sensory modulation too.This
means that choosing a slow pace and calm walking style will result in calming effects
on the patient while using trot or an alert pace will energise the patient.
(Stimularea vestibulara în timpul mersului calare, Terapia cu Ajutorul Calului, A. Bilba,
2019, p. 88, ISBN 978-973-732-218-0)

16. • The rider is on the horse. S/he is above
ground, on the back of an animal. An
animal that has his own reflexes and
reactions.
• For a child, this is an unknown situation,
whereby s/he has not yet built any
behavioural schema about. S/he has to
adapt, to find out and to apply new
behaviours, finding out in a direct way, if
and how they work.

17. • Stimulating attention: in order to stimulate attention we will organise activities around
the working field.The duration and difficulty of each game will be increased. Also, as
the attention span gets better, new games will be added.
• Children must listen to requirements and do what they are asked to.They must also
maintain balance on the horse. All this requires a great amount of attention.

18. • Circles, balls, cones will be used to
organise games.
• The aim is that the child follows with
attention and does what is required
from her/him.

19. • This type of therapy means constant
movement, and attention and
coordination skills are both used.

20. • Each working phase has one or more therapeutic objectives:
• maintaining balance
• correct posture
• spatial orientation
• recognizing items
• coordination eye - mouth
• decision taking
• maintain focus
• stimulating attention
• modulating the rhythm of the execution of the requirement
• fine and gross motor skills
• acknowledging own corporality
• stimulating intrinsic muscular system

21. • The space where lesson take place,
walking direction, working on more
than one plan (up - down) influence
the capacity to create spatial relations.

22. • It has been observed that children will easily interact
with 3 to 4 persons while riding.
• Group exercises are part of the hippotherapy
sessions.
• By its nature, the hippotherapy lessons mean contact
with more people.
• Children have contact with other children
• They learn to socialize
• They learn to observe social rules
• They learn to take turn
• They develop creativity and learn about competitive
play

23. • Children will receive vestibular and proprioceptive stimulation by the movement
of the horse. This will increase the attention and concentration and will boost their
self esteem.
• The child will be asked to take a decision according to the horses movement and
acting.

24. • Vestibular stimulation promotes visual contact with objects and people around her/him and
facilitates communication with them.
• Typical exercises will involve training of the diaphragm and will make pronunciation easier, as
well as length, intensity and rhythm of the sound.These will influence the tone of voice.
• Speech development is enhanced as new words must be learned in order to communicate with
the horse.
• A greater number of non-verbal communication is used.
• The relation between child and therapist gets better, children learn to communicate more fluently.
• The tone of voice becomes more firm.
• Affects part of the communication process and becomes part of life.
• Following hippotherapy sessions, Dismuke (1984) discovered important progress in speech
ability, vocabulary, bilateral motor coordination, visual perception and right/left discrimination.

25. • While walking, the horse has a 3D type of
movement. This is extremely similar to the
natural human movement style. The three
movement types are:
• Antero-posterior
• Lateral
• Sagittal
• By changing the walking pace of the horse,
different impulses will be sent (vestibular,
proprioceptive, rotation movement,
anteroposterior and lateral ones).

26. • Some of the physical benefits
are:
• better posture,
• greater force in muscles,
• better balance while seating,
• better walking,
• better motor control,
• and a better general
mobility.

27. • Contact with a big animal has
an emotional impact on the
child.
• Besides emotional
experience, there are also a
lot of sensorial experiences.

28. • Eye-mouth coordination

29. • In order to sit on the horse, you need a good control of your body.
• The rider has to get a better control of his own body. The rhythm and
communication is consistent and the relation is permanently ongoing. This brings a
better self image and a boost of self esteem.
• The immediate answer of the horse is a continuous reward.

30. • Organising abilities: development of ones capacity to self regulate is an important
feature of individual growth.
• Children with ADHD are very sensitive to any stimuli from the environment when
bored or frustrated.
• Behavioural inhibition is the centre of attention deficit (R.A. BARKLEY, ”Behavioral
inhibition, sustained attention, and executive functions: constructing a unifying
theory of ADHD”, Psychol Bull, 121(1), Jan 1997, pp. :65-94).

31. • Executive functioning means the ability to plan, organise and use information to
solve problems.
• Self control: children with motor disabilities do not have enough self control in
order to modify their responses in an efficient way.
• Example: when solving a problem that involves the reaction time, they can not slow
down enough to check for mistakes (M. SEMRUD-CLIKEMAN, S. PLISZKA , M.
LIOTTI, ”Executive functioning in children with attention-deficit/hyperactivity
disorder: combined type with and without a stimulant medication history”,
Neuropsychology, 22(3), May 2008, pp. 329-40).

32. • The working memory keeps an information active whilst the child is working with
another one. Thus, the child will work simultaneously with two sets of information.
• The capacity of the working memory is equal to the executive attention. A better
working memory will mean a better performance to avoid distractions.
• A limited working memory is associated with a low capability to maintain focus, to
self regulate and a weak reaction capacity in prompted actions. All of these are
therapeutic objectives.
• To stimulate the working memory, a child needs to maintain his focus while
working. Children with psychomotoric disabilities have a problematic perception
of information, have difficulty in maintaining focus and have struggles to
discriminate stimuli.

33. • While relaxing or while doing actions that do not need a lot of attention, the
capacity to focus recovers. The theory suggest that while out in the fields, the
mental effort is not as high.
• To help regain the focus during hippotherapy sessions, a walk can be taken, with
no specific task in mind, just relaxing.
• For a few minutes the patient will be asked to relax and just enjoy nature.
• It will usually take 2 minutes and as soon as the patient seems more relaxed, the
activity will start again.

34. • Motivation is the process that initiates, guides, and maintains goal-oriented
behaviours.We have intrinsic and extrinsic motivation:
• Intrinsic motivation
• This is done for internal reasons. It is aligning with own values or simply
having pleasure in doing something. The role of the intrinsic motivation is
important in the cognitive and social development.
• Active participation of the child in therapy is very important. Therefore,
activities that bring them pleasure and keep them interested must be
chosen.
• Most if not all children are attracted by animals. They built a strong and
long-lasting relationship, that is usually easy to build.
• This is part of the possible intrinsic motivation in HAT.

35. • Extrinsic motivation
• Main objectives of the therapy must be to gain and improve abilities that
will help him to get a better form of integration and quality of life.
• This is where extrinsic motivation steps in.
• Rewards might make the activity appealing, even if it does not show like
this from the beginning.
• This can be used by the therapist to teach daily life skills. Once these have
been mastered the extrinsic motivation is not necessary anymore.

36. • To be used in therapy, the horses must have special characteristics.
• When choosing a therapy horse, the person must know the horses and also have
knowledge about the special needs of people with disabilities.
• The most important aspect is the character.
• Some horse breeds are more suitable for this kind of activity, but this is not
everything that matters.
• The most important characteristic of a therapy horse is curiosity.
• A curios horse will be always attentive, will react to the leader’s requests and will
become predictable with the time.
• Ponies are not recommended.

37. • In therapeutic equine activities, the horse is a therapy tool as well as a member of
the team.
• It is very important that the horse is well prepared. This will ensure the best
possible results.
• To be utilised in HAT, horses must have special characteristics.

38. • When selecting a HAT horse, structure, length and width of the back must be taken
into consideration.
• The height must be adapted to the needs of the rider as well as those of the
therapist.
• The structure and physical appearance is correlated with his movement, the length
of his steps, the balance of the back and all these influence the impulses send by
the horse.

39. • Movement of the horse must be a healthy one and the sequence of the steps must
be a clear one.
• The different walking paces of a horse are:
• long, distanced walk (the horse sets the back foot in front of the first hoof print),
• small step (the horse sets the back foot behind the first hoof print),
• a regular, rhythmic movement during all the three paces (walk, trot, gallop).

40. • Neutered (castrated) horses are preferred as they are the most balanced
characters.
• Mares can be also used but it must be taken into consideration that during oestrus
(when the mare is sexually receptive ("in heat")), they can become more difficult to
control.
• Stallions have an unpredictable character and can thus not be used.

41. • Horses younger than 5 years are not suitable for therapy. They are playful, very
active and sometimes shy.
• Usually a good age for a horse to step into therapy is 15 years of age.
• Younger horses can become therapy horses but their character will play a
significant role in the decision. It also recommended to know them for at least 3
years before they become therapy horses.

42.  The horse must be easy to lead. He has to follow instructions with pleasure and content,
and be patient during mounting and dismounting
 An unstable and nervous horse, or one that bites is not suitable for therapy. He might
endanger the therapeutic process.
 When choosing a horse, it is advisable that the horse is observed in his stable. Than we
should focus on his reaction to people. Than he will be groomed, cleaned and you will
mount on him. It is also advised that he is being observed in relation to other horses,
when possible.
 Other useful information can be taken from:
 his behaviour while on the lead rope, when the saddle is on his back or during dressage;
 readiness to become a therapy horse;
 his obedient/submissive answer to riders and/or therapist request;
 any negative behaviour that shows up.

43. • By flexibility we understand the ability of the horse to easily balance from one feet
to another.
• A rigid horse will produce a rigid movement, will have a slow answer and will have
a too low rhythm.
• The abovementioned are not wished for in therapy.

44. • By rhythm we mean the walking pace of the horse (how he naturally sets the feet
one after another).
• The rhythm is a fundamental characteristic in the human movement. It has input for
the sensory processing, the muscular tonus and is influenced by time and
coordination.
• Thus the rhythm must be sustained and constant on the front feet.

45. • Symmetry means that the movement is similar on both sides of the horse. The
length of his step is equal on both sides. The pressure he puts in the step is the
same on the right as well as on the left.
• Healthy horses have a symmetric movement typology. This will be transmitted to
the rider.
• If the horse lacks symmetry (due to an accident or a birth defect), the rider will
feel himself this unusual pace.
• A horse with a symmetric movement will ensure a symmetric posture to the rider.

46. • Posture: parallel to the ground.
• It is essential that the body alignment is parallel to the ground. It enhances
symmetry and is a guarantee that the horse is well balanced.
• It is important for flexibility, rhythm, pace and transition movements.
• Almost always when the horse lacks one of this characteristics he will not be able
to walk correctly. A horse with no flexibility will not have a correct walking pace,
his walking will not be symmetric and balanced.

47. • Balance is the ability of a horse to remain balanced and flexible while moving. This
also influences rhythm and walking pace.
• These characteristics are similar to those of the human walk. This is a validating
fact that the horse should be used as a therapy tool.
• The walking pace induces a 3D type of movement on the pelvis, in the exact same
way as the human walk. The pelvis moves sagital, vertical and frontal. It induces
antero - posterior, vertical and lateral movement. (S.E. Harris, Horses Gaits,
Balance, and Movement, Macmillan, New York, 1993; Classical Training of the Horse,
United States Dressage Federation, 1998)

48. • While walking the following characteristics can be modified in order to obtain the
movement wished by the therapist:
• Impulse
• Tempo and speed
• Change of direction
• Transition
• The horse does this with no effort as this are routine movements for him.

49. • Impulse: the movement of the horse’s pelvis and back feet to the front will change
the position of the horse and the movement of his body.
• The front feet is followed by the back ones.The back ones will step on the exact
foot prints of the front feet or in front of them.
• A stronger impulse will mean that the horse will step with the back feet over the
foot print of the front feet.

50. • Tempo means the number of steps per minute. Speed means the time the horse
needs to walk a certain distance.
• A pony has a much faster tempo than a horse.
• The tempo must remain constant.
• The speed can be changed while modifying the length of the step but also by
modifying the tempo.

51. • The most used types of walking:
• In a straight line
• Changing direction
• Serpentine
• Circles
• When the horse changes direction, the arching of the horse will change.

52. • Transition means:
• changing speed while walking,
• changing the way of walking,
• speeding,
• slowing.

53. • For an optimal training of a horse for therapy, it is necessary to have in mind
qualities of the trainer.
• Dressage of therapy horses is different than that of horse riding.
• The therapy horse must undergo desensitization training in order not to obey any
commends from the rider.
• The horse trainer must have some qualities and knowledge regarding interaction
with horses.

54. • Any dressage method must have in the centre the preparation of the horse: it must
be a balance between physical exercise and training. It must not be forgotten that
the physical and psychic development of the horse depends on the variable laws
of nature.
• The mental profile of the horse plays also a very important role in dressage.
• The memory of the horse is very helpful for dressage, when this is made in a
correct, respectful way. The memory becomes dangerous when the dressage is an
incorrect one. As the horse will keep in mind all the wrong things that have been
done to him and all stereotypes he has come in contact with.

55.  The horse does not have opinions and can not understand the sense of his own
actions. Instead, he can be guided through positive or negative strengthened
behaviours. Frequently repeated these become automatic behaviours or habits.
 A nervous horse, with a mean character, which bites and is unsubordinated, is
without any exception a sick horse and has an organic deficiency. Taking care of
him is an absolute priority. Dressage is less important.

56. • The horse has limited patience.
• The rider or the leader must do his best to know the mental, physical and psychical
limit of his horse.
• The method combines principles and procedures with the order in which they
should be used.
• Methods and principles will be chosen according to objectives and environment.
• Before beginning dressage, it is mandatory to observe the horse, his temper and
his appearance.Than the best practices to achieve objectives will be used.

57. • Any dressage method rely on the law of association.
• In order to learn a new movement an old, already acquired information will be
used.To this old information the new one will be attached.
• Conditioned reflex continues to be a used method. For this work, the horse must be
attentive.
• The goal of the learning process is to form new, positive, helpful habits.

58. • Following the initial dressage, the therapy horses must undergo also a specific
training.
• While learning, repetition and confirmation are important, ritualising is a safety
guarantee for the horses.
• Therapy horses must stay patient for a longer time while being mounted,
dismounted, grooming, even if this isn’t always a pleasure.
• He has to get used to different types of mounting and also with tools used when
doing so.

59. • These horses must get used to different leading ways:
• dressage rope
• using the bridle
• lead rope
• long bridles
• double lead rope
• the horse must learn to obey the leader.

60. • Therapy horses must work very well on the lead rope, especially when we talk
about riding during therapy hours. He must react immediately to the reactions sent
by the leader with the aid of the rope or the whip as the therapist will communicate
with the child and not with the horse.
• Horses must be trained to accept more rigid postures of the rider, as children with
physical disabilities might also be very spastic.
• During the training the horses must get accustomed with all the instruments, toys,
equipment used in therapy. As well as with the environment, the visual, acoustic,
tactile stimuli that might appear during therapy (movements, screams, uncontrolled
movement of body parts) and with a lot of people around them.

61. • Natural Horsemanship is recommended. (Parelli and Tellington method)
• Therapy horses need rest and need to relax. It is important to learn and read the
signs of stress, burn out, overwork.
• Being a therapy horse is intense for horses, especially from the psychic point of
view.

62. • If a horse is overworked, then these following signs of exhaustion can be seen:
• he will frequently bend his ears to the back during activities and mounting, dismounting,
• he refuses to leave his box,
• runs away or shies away.
• As much as possible a horse must live in a environment similar to his natural
habitat.
• The horse loves to live with other horses and to have access to a free field.
• A horse that is only kept inside will be less focused and more tensed.

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