This document discusses how hippotherapy can benefit children with various intellectual, physical, and neurological disabilities. It describes several conditions such as muscular diseases, spinal muscular atrophy, cerebral palsy, Down syndrome, and autism. For each condition, it explains how hippotherapy provides physical, cognitive, and emotional benefits through the repetitive and rhythmic movement of the horse, which can improve areas like balance, mobility, muscle tone, coordination, language skills, and self-confidence. Hippotherapy is presented as an effective rehabilitation treatment that can enhance quality of life for children with disabilities.

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

3. • 5.1.1. Neuromuscular diseases
• 5.1.1.1. Children with Muscular Diseases
• 5.1.1.2. Children with Spinal Muscular Atrophy
• 5.1.2. Neurodevelopmental diseases
• 5.1.2.1. Children at risk
• 5.1.2.2. Children with Cerebral Palsy
• 5.1.2.3. Children with Down Syndrome
• 5.1.2.4. Children with Autism
• 5.1.2.5. Children with Spina Bifida
• 5.1.3. Orthopaedic Diseases
• 5.1.3.1. Children with scoliosis

4. • Neuromuscular disorders affect the nerves, especially those outside the brain and
spinal cord (peripheral nerves). They also affect skeletal muscles, such as those in the
trunk, arms and legs.
• These disorders can be stable and unchanging (static), or can grow worse over time
(progressive).
• Most neuromuscular disorders:
• are present at birth (congenital);
• have a genetic component;
• can affect several generations in a family.

5. There are hundreds of neuromuscular disorders, many with subtypes related to
specific genetic causes. Although some muscle disorders look similar and have
similar treatments, most require unique treatment strategies.
Some types of Neuromuscular Disorders include:
• Muscular Dystrophy, Spinal Muscular Atrophy (SMA), Charcot-Marie-Tooth (CMT)
Disease, Friedreich’s Ataxia (FA), Mitochondrial Myopathies, Metabolic Myopathies
and Juvenile Dermatomyositis (JDM).

6. 5.1.1.1. Children with Muscular Diseases
A child who is diagnosed with muscular dystrophy (MD) gradually loses the ability
to do things like walking, sitting upright, breathing easily, and moving the arms and
hands.This increasing weakness can lead to other health problems.
There are several major forms of MD, which can affect the muscles to varying
degrees. In some cases, MD starts causing muscle problems in infancy; in others,
symptoms don't appear until adulthood.

7. 5.1.1.1. Children with Muscular Diseases
The steady clip clop of a horse’s gait is remarkably similar to a human walking
pattern: rhythmic, consistent and predictable.
The repetitive nature of this movement allows riders to practice and refine their
balance responses.
This can lead to improved core stability and postural control.
This effect can be beneficial in dealing with muscle weakness, which is the main
problem of children with neuromuscular disorders.

8. 5.1.1.1. Children with Muscular Diseases
Hippotherapy provides important effects in children with neuromuscular diseases:
• Gaining strength and confidence
• Social and emotional improvements
• Maximizing mobility

9. 5.1.1.2. Children with Spinal Muscular Atrophy (SMA)
SMA affects nerves as they exit the spinal cord.
Because the nerves lack a gene that helps maintain their function, they eventually
stop carrying signals from the brain to the muscles, which can result in muscle
weakness and loss of muscle mass (known as atrophy).

10. 5.1.1.2. Children with Spinal Muscular Atrophy
• Features of SMA include scoliosis, joint contractures, respiratory muscle weakness
resulting in pneumonia, poor weight gain, paralysis, and even death.
• The horse serves as a base of support, while providing repetitive, rhythmic, and
variable movement interventions. Hippotherapy sessions can help to improve
coordination, response timing, attention, and respiratory control.

11. 5.1.1.2. Children with Spinal Muscular Atrophy
Hippotherapy has the capacity to enhance quality of life for those incorporating it as
part of a proactive treatment strategy, targeted to help maintain strength, postural
control, and range of motion in children with SMA.
Moreover, hippotherapy has several unique features provided by this therapeutic
treatment strategy, emphasizing the rich, complex, and positive emotional, social,
and physical experiences not readily available in traditional settings.

12. Hippotherapy can be beneficial and provide an effective contribution for the
rehabilitation of patients with disabilities attributable to neurological disorders.
The psychological, cognitive and relational areas could benefit from the animal-child
interaction to promote child autonomy, self-esteem, self-efficacy and openness to
others. Physical, motor and psychosocial benefits were found in children with
anxiety and/or depression disorders, in autism spectrum disorders, dyspraxia, as
well as in infantile cerebral palsy and attention deficit hyperactivity disorder.

13. • A child who may experience neurological problems during pregnancy, delivery or during the
newborn period due to environmental or biological effects is called a “baby at risk”.
• Biologic risk factors:
• Prematurity, hypoxic ischemic encephalopathy (type of brain dysfunction that occurs when the brain doesn't
receive enough oxygen or blood flow for a period of time), intrauterine growth retardation (less than 10% of
predicted foetal weight for gestational age), chronic lung disease, microcephaly (baby's head is smaller
than expected when compared to babies of the same sex and age), exposure to drugs, and central nervous
system infections.
• Environmental risk factors:
• Early exposure to heavy metals including lead, mercury and arsenic, poverty, and mental illness.

14. • Children at risk should receive physiotherapy treatment as early as possible.
• The main reason is to take advantage of the plasticity of the central nervous system and to
train physiological movement patterns.
• Hippotherapy is a physiotherapy method working on a neurophysiological basis.
Therapists can utilize treatment with the horse, starting from an early age of the
child.
• The success of the hippotherapy treatment depends on the expertise and
involvement of the therapist as well as a a properly trained horse.

15. In children at risk, hippotherapy :
• supports the normal motor development;
• decreases sensory integration problems;
• strengthens weak posture muscles;
• supports language development;
• reduces behavioural and psychosocial problems.

16. • Cerebral Palsy (CP) is the most common motor disability in childhood.
• CP is caused by
• a brain injury or problem that occurs during pregnancy or birth or within the first 2 to 3 years
of a child's life.
• abnormal brain development or damage to the developing brain that affects a person's ability
to control his or her muscles.
• This can be caused by:
• Problems from being born too early (premature birth),
• Not getting enough blood, oxygen, or other nutrients before or during birth.

17. Hippotherapy can help children and adults with cerebral palsy on many levels. It contributes to a
rider's physical, psychological, and emotional wellbeing.
Some of the physical impairments that may be improved by hippotherapy are:
• abnormal tone
• impaired coordination
• impaired communication
• decreased mobility
• poor posture
• impaired balance
• impaired limbic system function

18. Hippotherapy provides improvements in balance, mobility, posture, the activity of
the adductor muscle (any of the muscles that draw a part of the body toward its
median line or toward the axis of an extremity), balance of the trunk, functionality,
muscle symmetry, pelvic movement, gait, walking speed and length of stride,
psychosocial parameters and patients’ overall quality of life.
Improvement in these areas can lead to improvement in gross motor skills (walking,
standing, sitting, etc.), speech, comprehension, and behaviour, including motivation,
attention, and arousal.

19. • Hippotherapy is also very emotionally rewarding for children and their families.
• 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 increase self-confidence and encourage a child's
success.

20. • Down syndrome is a genetic condition that happens when a child is born with an
extra chromosome. The extra chromosome affects the way the child's brain and
body develop, leading to developmental delays, intellectual disability and an
increased risk for certain medical issues.
• Some characteristics of Down Syndrome include low muscle tone and weakness in
trunk and limbs, impulsive behaviour, short attention span, impaired social skills,
and slower learning.

21. 5.1.2.3. Children with down syndrome
• In general, most individuals with Down Syndrome have muscle hypotonia, caused
by decreased segmental excitability of motor neurons and by impaired stretch
reflex, generating a decreased sensorimotor control. This causes a slow or
ineffective muscle contraction.
• Postural changes in Down Syndrome may occur due to the difficulty of perception
of postural responses, which impairs the feeling of the movement correctly.

22. • The rhythmic sway of the horse spine stimulates postural reflexes of the
hippotherapy patient/practitioner, resulting in balance training and postural and
motor improvements.
• Hippotherapy is an effective tool for treating Down Syndrome because it provides
sensory stimulation to the muscles and joints, improves balance, body awareness,
and postural control.

23. 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; the vestibular–cerebellar system could
promote changes in the central nervous system that transfers to linguistic patterns.
Thanks to the rhythmic and repetitive movements of the horse, the child with Down
syndrome can improve balance and coordination as well as language and
communication skills.

24. It can help with cognitive, behavioural, and communication skills as the kids are
taught to appropriately interact and relate to the horse. This interaction helps to
develop memory, communication, self control, and self confidence.
The relationship that develops between the kids and their horse during a
hippotherapy session is not only emotionally rewarding, but motivating and
encourages greater success.

25. • The autism spectrum disorder 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.
• Some children may have difficulty concentrating on tasks, making and maintaining
eye contact, completing basic skills such as eating, dressing, brushing their teeth
or bathing.

26. • The researchers found that the children became more socially motivated and
improved their sensory seeking and sensitivity.
• Most children with autism are unable to integrate their sense and understand how
their bodies relate to the external world.
• Hippotherapy is a great way to help a child gain a sense of body-awareness while
improving sensory integration.

27. • Some may wonder how hippotherapy can be used to encourage speech in a child.
However during a typical session, the rider is motivated to communicate with both
the therapist and the horse.
• It has been noted that non-verbal autistic children suddenly begin to speak when
they are prompted to use the horse’s name or are asked to get the horse moving.

28. • Hippotherapy gives children with autism a sense of themselves and their bodies
while increasing their contact and interaction with the surrounding world.
• A child’s self confidence will increase once they have formed a sense of
competence by learning how to interact and work with their horse.

29. The sensory nature of riding a horse, including graded proprioceptive, vestibular,
and tactile input, promotes the self-regulation of children with autism
This graded sensory input for children with ASD can improve academic responding
behaviours,on-task behaviours,and stereotypic behaviours (Escalona et al. 2001;
Koenig et al. 2012;Van Rie and Heflin 2009).

30. Gabriels et al. (2012) stated:
“Horses may help organize or provide input to the ASD child’s sensory system.This
factor may contribute to helping the child feel calm” (p. 586).

31. • Some other benefits of Hippotherapy with autistic population include (Aspen, 2011):
• Relaxing tight muscles
• Building muscle strength
• Improving fine motor coordination
• Sharpening hand/eye coordination
• Improving posture & flexibility
• Improving communication (improving one’s ability to breathe makes it easier for a person to
speak)
• Gaining self-control
• Gaining self-confidence
• Improving concentration (especially for those who have difficulty staying on task with activities)
• Improving socialization

32. • Spina bifida is a condition that affects the spine and is usually apparent at birth.
• It is a type of neural tube defect.
• Spina bifida can happen anywhere along the spine if the neural tube does not close
all the way.

33. • Spina bifida is usually both an indication and a precaution to hippotherapy.
• Some of the physical and developmental problems associated with spina bifida are
very likely to improve through therapeutic riding.
• For example, a child or adult with spina bifida may have decreased independent sitting
balance. A well-planned hippotherapy program can develop the sitting balance. It can
improve off-the-horse functional daily living activities, such as sitting or walking.

34. • However, spina bifida is a precaution to riding because that same impaired sitting
balance makes a fall more likely.
• Furthermore, the patients is likely to have a decreased sensation in the legs and
seat area, making pressure sores and skin irritation a possibility.
• Therefore, care should be taken when choosing children with spina bifida for
hippotherapy.

35. 5.1.3.1. Children with scoliosis
• Scoliosis is a sideways curvature of the spine that occurs most often during the growth
spurt just before puberty.
• According to the SRS (Scoliosis Research Society), a curve has to have a Cobb angle
(measurement of the degree of side-to-side spinal curvature) of more than 10 degrees.
• While scoliosis can be caused by conditions such as cerebral palsy and muscular
dystrophy, the cause of most scoliosis is unknown.

36. 5.1.3.1. Children with scoliosis
• Asymmetric muscle activity is considered to be one of the main problems in
scoliosis.
• Symmetric muscle activity can be achieved in children with scoliosis through the
rhythmic movements of the horse in the hippotherapy session.
• Structural scoliosis greater than 30 degrees is contraindicated for hippotherapy.

37. 5.1.3.1. Children with scoliosis
There are very few studies showing the effect of hippotherapy in people with
scoliosis.
• In the case series, it was reported that riding in 3 cases reduced the Cobb angle.
(Masahiro Ihara et. all, 2012)
• More studies are needed to clarify whether hippotherapy is effective in treating
scoliosis.

38. • As with any treatment modality, there are contraindications and precautions for
hippotherapy.
• Some take on special significance when taking into account the fact that the patient
must be able to sit astride the horse.

39. Seizures are changes in the brain’s electrical activity.These changes can cause
dramatic, noticeable symptoms, or in other cases no symptoms at all.
The symptoms of a severe seizure include violent shaking and a loss of control.
However, mild seizures can also be a sign of a significant medical problem.
Recognizing them is therefore important.
For safety reasons, children with uncontrolled seizures are contraindicated for
hippotherapy.

40. Aware impaired
Awareness
Focal Onset Generalized Onset Unknown Onset
Motor Onset
• automatisms
• atonic1
• clonic
• epileptic spasms1
• hyperkinetic
• myoclonic
• tonic
Non-Motor Onset
• autonomic
• behaviour arrest
• cognitive
• emotional
• sensory
Motor
• tonic-clonic
• clonic
• tonic
• myoclonic
• myoclonic-tonic-clonic
• myoclonic-atonic
• atonic
• epileptic spasms1
Non-Motor (absence)
• typical
• atypical
• myoclonic
• eyelid myoclonia
Motor
• tonic-clonic
• epileptic spasms
Non-Motor
• behaviour arrest
Unclassified2
focal to bilateral tonic-clonic
1 These could be focal or generalized, with or
without alteration of awareness.
2 Due to inadequate information or inability to place
in other categories.
• 5.2.1.1.Types of seizures
The international classification of epileptic seizures is summarized in the table below.

41. 5.2.1.2. Medication in Seizures
Many medications are used in the treatment of epilepsy and seizures, including:
• Carbamazepine (Carbatrol,Tegretol, others)
• Phenytoin (Dilantin, Phenytek)
• Valproic acid (Depakene)
• Oxcarbazepine (Oxtellar,Trileptal)
• Lamotrigine (Lamictal)
• Gabapentin (Gralise, Neurontin)
• Topiramate (Topamax)
• Phenobarbital

42. 5.2.1.3. Risks for the child with seizures
• Seizures in childhood can be very dangerous
• Seizures, especially in early infancy, can be catastrophic to cognitive and
motor development.
• Drug-resistant seizures can cause cognitive decline and memory impairment.
• Seizures can cause psychiatric dysfunction.
• Prolonged seizures can cause brain damage, organ failure, and death.
• Seizures, especially in childhood, may cause autism.
• Seizures can cause Sudden Unexplained Death due to EPilepsy (SUDEP).

43. 5.2.1. Seizures
• During a seizure, involuntary muscle contractions and uncontrolled joint movements often
occur.
• Also, some seizures can lead to head traumas and or muscular and/or bony injuries.
• It is risky for safety if the child with a seizure is on a horse. Therefore, seizures are
contraindicated for hippotherapy.

44. 5.2.2.1. Fractures
• The fracture must be well fixed in the healing process. Bones that are not properly fixed can delay healing or
cause malunion (a fracture that has healed, but in less than an optimal position). Therefore, hippotherapy is
contraindicated.
5.2.2.2. Malunion
• A malunion is when a fractured bone doesn’t heal properly. Some ways that it shows is by having the bone
being twisted, shorter, or bent. Malunions can occur by having the bones improperly aligned when
immobilized, having the cast taken off too early, or never seeking medical treatment after breaking it.
Malunions are painful and commonly produce swelling around the area, possible immobilization,
and deterioration of the bone and tissue.

45. 5.2.2.3. Hyperlaxity
• If you have hypermobile joints, you're able to extend them easily and painlessly
beyond the normal range of motion.
• Hypermobility of the joints occurs when the tissues holding a joint together, mainly
ligaments and the joint capsule, are too loose.
• Often, weak muscles around the joint also contribute to hypermobility. In particular,
hyperlaxicity in the hip joint can cause hip subluxation /dislocation.

46. 5.2.2.4. Muscle tone problems
• Excessive lower extremity spasticity can restrain the amount of hip abduction
necessary to straddle the horse.
• If excessive tone is accompanied by hip subluxation / dislocation in hip adductor
muscles and internal rotator muscles, hippotherapy is contraindicated.
• Trunk control and head control must also be carefully assessed. The inability to sit
independently and lack of head control are also a contraindication.

47. 5.2.3.1.What is osteoporosis
Osteoporosis is a disease in which the density and quality of bones are reduced.
As bones become more porous and fragile, the risk of fracture is greatly increased.
The loss of bone occurs silently and progressively.

48. 5.2.3.2. Risks of osteoporosis
In addition to making you more susceptible to breaks and fractures, osteoporosis can lead to other
complications:
• Osteoporosis can be disabling and limit your physical activity. A loss of activity can cause you to
gain weight. It can also increase stress on your bones, in particular your knees and hips. Gaining
weight can also increase your risk of other problems, such as heart disease and diabetes.
• Less physical activity can lead to a loss of independence and isolation. Activities you once
enjoyed may be too painful now. This loss, added to the possible fear of fractures, can bring
on depression.
• Fractures caused by osteoporosis can be severely painful and debilitating.

49. 5.2.3.3. Hippotherapy and a child with osteoporosis
• Hippotherapy carries minor risks, such as falling or sudden movements of the
horse.These risks can cause fractures in a child with osteoporosis.
• In addition, some fractures can occur even without a fall in osteoporosis.
• Therefore, osteoporosis is contraindicated for hippotherapy.

50. Hippotherapy is contraindicated for children using these drugs.
5.2.4.1. Steroids
• Steroids (short for corticosteroids) are synthetic drugs that closely resemble
cortisol, a hormone that your body produces naturally.
• Steroids work by decreasing inflammation and reducing the activity of the immune
system.
• They are used to treat a variety of inflammatory diseases and conditions.

51. 5.2.4.1. Steroids
• Corticosteroids induced Osteoporosis is one of the well-known and devastating
adverse effects of long-term use of corticosteroids.
• Up to 40% of patients on long-term corticosteroids develop bone loss leading to
fractures.
• In the hippotherapy session, although rare, situations such as falling and sudden
movements of the horse may pose a risk.
• Therefore, using steroids is contraindicated for hippotherapy.

52. 5.2.4.2. Anti-epileptics
• Anti-epileptics are a class of drugs that try and prevent rapid, repetitive,
stimulation of the brain that causes seizure activity such as in epilepsy.
• Some seizures may not be controlled with anti-epilectics.
• Hippotherapy is contraindicated in children using anti-epilectic as these seizures
pose a safety risk.

53. 5.2.4.3. Antidepresants
• Antidepressant is the term used for psychiatric medication, nutrients or herbal substances used to relieve
conditions such as depression or dysthymia (serious state of chronic depression, which persists for at least
two years).
• Drug groups such as monoamine oxidase inhibitor, tricyclic antidepressant and selective serotonin reuptake
inhibitor are known as antidepressant drug groups.
• People using antidepressants may experience side effects such as fatigue, drowsiness, blurred vision and
insomnia.
• These side effects may be a safety risk for hippotherapy. Therefore this medications are contraindicated for
hippotherapy.

54. 5.2.4.4. Anticoagulative agents
• Anticoagulant drugs are used to reduce the ability of the blood to
clot. Examples of anticoagulants include aspirin, heparin and warfarin.
• The main side effect seen with anticoagulant medicine is bleeding.
• Bleeding or haemorrhage (bleeding within the body) can occur in any part of the
body. Bleeding-related issues are risky for hippotherapy.
• Because of all these risks, hippotherapy is contraindicated in children and adolescents
using anticoagulant agents.

55. • The other contraindications and precautions for hippotherapy
Medical Orthopaedic General
• Acute arthritis
• Multiple sclerosis (during period
of exacerbation)
• Complete quadriplegia
secondary to spinal injury
• Open wounds on weight bearing
surfaces
• CVA secondary to unclipped
aneurysm
• Severe allergies
• Recent surgery
• Treatment principles/
Documentation/ reimbursement
• Acute herniated disc
• Atlanto-axial instability
• Severe osteoporosis
• Spondylolisthesis
• Structural scoliosis greater than
30 degrees
• Severe anxiety
• Grossly disruptive behaviour
• Abnormal fatigue

56. Definition Effects of hippotherapy
Neuromuscular
diseases
Neuromuscular
diseases affect the
function of muscles
due to problems
with the nerves and
muscles in your
body.
The most common
symptom of these
diseases is muscle
weakness.
Motor Cognitive Psychological
• 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 effect
• Providing lower and
upper extremity’s 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

57. Definition Effects of hippotherapy
Children at risk
In babies at risk,
developmental delay,
weakness in the
posture muscles,
delay in language
development, sensory
integration problems,
behavioural problems
and psychosocial
problems can be
seen.
Motor Cognitive Psychological
• Supports normal
development
• Strengthens muscles
• Improves static and
dynamic balance
• Provides early
adaptation to
movement
• Improves reaction
time, balance and
attention
• Improves sensory
integration, motion
planning, separation
of left and right
• Increases language,
social engagement,
gaming skills and
academic abilities
• Improve
concentration
• Improves
sequencing and
planning in the
activity
• Increases the quality of life
• Positive effect on physical
abilities and psychological
functioning
• Decreases behavioural
problem and psychosocial
problem
• Decreases sensory
processing problems

58. Definition Effects of hippotherapy
Cerebral
palsy
Cerebral palsy (CP) is a
persistent neurological
disorder caused by
damage or abnormalities
in the immature brain
that impairs the brain's
ability to control
movement, posture, and
balance.
Motor Cognitive Psychological
• Regulation of muscle tone
• Increases muscle tone in the
trunk and neck area
• Decreases muscle tone in the
lower extremities
• Pelvic mobilization/stabilization
• Reinforcement or the appearance
of righting mechanisms and trunk
control
• Improves the equilibrium
reactions (especially in relation to
changes of pace and direction)
• Reduces involuntary movements
• Improves 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
• Improvement in
speech, language,
cognitive, and
masticatory
functions
• Improved visual
perception
• Improves speech
• Improves active
communication,
• Decreased anxiety,
• Development of
the ability to plan
task-oriented work
•
• Positive
psychosomatic
influences such as
increased self-
esteem and
motivation
• Enhancing self-
esteem
• Enhances the
ability to recover
from disease
• Reduces
depression and
sense of loneliness
• Increase in
interpersonal
communication

59. Definition Effects of hippotherapy
Down
syndrome
Down syndrome 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.
Motor Cognitive Psychological
• 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
• Adjusting 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

60. Definition Effects of hippotherapy
Autism
spectrum
disorder
Autism spectrum
disorder 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.
Motor Cognitive Psychological
• 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
• Interact 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 in all adaptive
behaviour (communication,
imitation), self-care, light
activities and social
interaction
• Reduces irritability,
stereotype movements,
hyperactivity and aggressive
behaviour
• Imbalance in the progesterone
hormone and an increase in
cortisol hormone

61. Definition Effect of hippotherapy
Spina bifida
Spina bifida is a
condition that affects
the spine and is
usually apparent at
birth.
It is a type of neural
tube defect.
Motor Cognitive Psychological
• Improves static and
dynamic sitting
balance
• Increases mobility
• Improves reaction
time, balance and
attention
• Provides daily
stretching, positioning,
aerobic exercise effect
• Provides lower and
upper extremity’s
range of motion
• Strengthens the trunk
and upper extremity
muscles
• 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
• Improves socialization
• Improves functional daily
living activities
• Increases the quality of life
• Positive effect on physical
abilities and psychological
functioning

62. For general information about hippotherapy:
• https://www.youtube.com/watch?v=r-ZvCWdA2yQ
• https://www.youtube.com/watch?v=n5ay7isqXGs
• https://www.youtube.com/watch?time_continue=140&v=HaKjglrlmQs&feature=emb_logo
• https://www.americanhippotherapyassociation.org/assets/docs/Final-2017-Best-Practice-1.pdf
for children with Autism: https://www.youtube.com/watch?v=PsSGqPJi54g
for children with Down syndrome: https://www.youtube.com/watch?v=QvpYjjN70W8
for children with Cerebral Palsy: https://www.youtube.com/watch?v=S1R4_HrnHkc

63.  https://www.sciencedirect.com/science/article/pii/S0003999309002044?casa_token=
D3MXwTdyXoYAAAAA:LVgmFz9b9PH82ROxKvOaFBZ1mjkMt1uoNw1nJtMwRbWKFUO
vabNHT_YlBkAWCJ2ZJ_6cgk86
 https://www.liebertpub.com/doi/abs/10.1089/acm.2014.0021
 https://ajot.aota.org/article.aspx?articleid=1863078
 https://www.tandfonline.com/doi/full/10.3109/09593981003623659?casa_token=DfVIq
Bc2MIAAAAAA%3ABPpERrHZVeJ3F729jKQi5trRvenZGkl8GVqWkQsj7snVcXmFx2itfeK
KK_sep0nWS-WZn7lcIMx85Q
 https://www.scielo.br/scielo.php?pid=S0103-51502016000300497&script=sci_arttext
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175116/

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• 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.
• Lemke, D., Rothwell, E., Newcomb, T. M., & Swoboda, K. J. (2014). Perceptions of equine assisted activities
and therapies by parents and children with spinal muscular atrophy. Pediatric physical therapy: the
official publication of the Section on Pediatrics of the American Physical Therapy Association, 26(2), 237.
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cerebral palsy: A narrative review. European Journal of Paediatric Neurology, 22(6), 1150-1160.
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review. Journal of autism and developmental disorders, 47(10), 3220-3242.
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activities-in-autism-spectrum-disorder
• Escalona, A., Field, T., Singer-Strunck, R., Cullen, C., & Hartshorn, K. (2001). Brief report: Improvements in
the behavior of children with autism following massage therapy. Journal of Autism and Developmental
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among children with autism spectrum disorders: A pretest–posttest control group design. American
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67. 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/
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https://apps.apple.com/app/id1526453884