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What is Hippotherapy?

Hippotherapy, as defined by the American Hippotherapy Association, is “the incorporation of equine movement by physical therapy, occupational therapy, or speech language pathology professionals in treatment. These professionals use evidence-based practice and clinical reasoning in the purposeful manipulation of equine movement to engage the sensorimotor and neuromotor systems to create functional change in their patient” (“American Hippotherapy Association”). To simplify this definition, it says that these therapists are specially trained to use the movement of horses to help their patients achieve specific goals that have been created for them, so that they may be able to overcome the challenges associated with their impairment. In this blog, I will give a brief historical overview of hippotherapy, talk about the two major organizations that support hippotherapy, differentiate between the two types of hippotherapy, explain the differences between hippotherapy and other traditional therapies, describe how to train a hippotherapy horse, share some personal stories about what it is like volunteering at a hippotherapy facility, and lastly, provide a real testimonial from one of the parents’ of a child who has participated in hippotherapy.

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The history of hippotherapy has two major eras: before 1900 and after 1900. In the era before 1900, there were three main people: Hippocrates, Mercurialis, and Tissot. In his lifetime from 460-377 B.C., Hippocrates of Ancient Greece wrote a chapter in one of his books about natural exercise and mentions horseback riding (“American Hippotherapy Association”). His image is located in the top right corner. I think this ancient statue shows how Hippocrates is a significant contributor to the community of hippotherapy, as he was the first of the three men to describe how riding relates to exercise. The larger image on the left side is of Mercurialis of Italy’s book called the “The Art of Gymnastics,” which he published in 1569 and also mentioned the horse and riding (“American Hippotherapy Association”). Although it is not a picture of Mercurialis himself, it shows that he made a contribution to the history of the hippotherapy community. The last image located in the bottom right corner, is a portrait of Tissot of France. In 1780, Tissot published a book called “Medical and Surgical Gymnastics,” and he mentions how riding at the walk is the most beneficial gait, and he was also the first person to describe the effects of too much riding (“American Hippotherapy Association”).

“Hippocrates.” Wikipedia: The Free Encyclopedia. N.p., 15 Oct. 2015. Web. 26 Oct. 2015.

“Girolamo Mercuriale.” Wikipedia: The Free Encyclopedia. N.p., 2 May 2015. Web. 26 Oct. 2015.

“Joseph Clement Tissot.” Wikipedia: The Free Encyclopedia. N.p., 15 May 2015. Web. 26 Oct. 2015.

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In the era after 1900, there was one prominent figure, and her name was Lis Hartel and she was from Denmark. In 1952, she became the first woman to compete on an Olympic equestrian team and win the silver medal (Olympic Girl Power, para. 1). Why does this matter? At age 23, Lis Hartel contracted the horrible disease of polio and became paralyzed from the knees down. You would think that this would be the end for her, but surprisingly, it was not. She decided to rehabilitate by riding horses, which is something she had loved to do from a young age. Over the years, she suffered many falls learning to ride with such weak muscles, but once she was able to balance on the horse properly again, it was as if she had never stopped riding (Olympic Girl Power, para. 2). In this image, Lis Hartel is being helped on to her horse, Jubilee, by a groom. I strongly believe that this image, and the story of Lis Hartel, is extremely significant to the community of hippotherapy. This is because she never let her disability stop her from accomplishing her goals. That is exactly what hippotherapy does for children with disabilities: it teaches them to never give up, and not let anything, especially their disability, stop them from following their dreams.

Jackson, Lorraine. “Olympic Girl Power: The Incredible Story of Lis Hartel.”Horse Nation 17 Nov. 2014: n. pag. Web. 26 Oct. 2015.

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These are the logos for the two major organizations that support hippotherapy: PATH International and the American Hippotherapy Association. The North American Riding for the Handicapped Association (NARHA), now known as the Professional Association of Therapeutic Horsemanship (PATH) International, which was established in 1969 as a “federally-registered 501(c3) nonprofit organization to promote equine-assisted activities for individuals with special needs” (“PATH International”). PATH not only promotes and supports equine-assisted therapy, they also provide multiple educational workshops, which are available to “help members expand their knowledge, learn new skills, stay up-to-date on industry practices and prepare for instructor certifications.” PATH also hosts eleven regional conferences, and one grand conference annually (“PATH International”). In 1992 and 1993, the American Hippotherapy Association (AHA) was formed and became the first approved section of the NARHA, respectively. The AHA also offers several educational courses taught by faculty members, and hosts a conference every other year (“American Hippotherapy Association”). PATH and the AHA provide these workshops, classes, and conferences to inform people who are interested in becoming a part of the community of hippotherapy, as well as to bring members who are already involved together to share ideas about how to improve old techniques, use new strategies, and celebrate the accomplishments of hippotherapy as a whole (“PATH International” and “American Hippotherapy Association”).

“PATH International.” PATH International: Professional Association of Therapeutic Horsemanship International. N.p., 7 June 2011. Web. 1 Oct. 2015.

“Welcome to the Cheff Center!” Cheff Therapeutic Riding Center. Kelly White Design, 2015. Web. 10 Nov. 2015. 

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The next two images are representations of the two types of hippotherapy: classic hippotherapy and modern hippotherapy. Why is hippotherapy categorized? What makes the two types different? The image above shows classic hippotherapy. Classic hippotherapy is when “a therapist uses the horse’s three-dimensional movement to manipulate the passive body of the patient and the patient may ride in different positions” (Granados and Agis, para. 3). This image depicts a child with a disability during her hippotherapy session. She is sitting sideways on the horse performing the exercise of holding her arms out, which is something that might be difficult for children with disabilities. You can see that the therapist is facing towards the girl and is giving her instructions, while the sidewalker is supporting the child to ensure that she does not fall off of the horse. It is a very simple picture with a distinct angle because it is trying to show you the child’s body and what she is doing during her therapy session, while still including the therapist and the sidewalker, but making the child the focal point of the photo. This picture is important because it accomplishes the purpose of showing you what goes on during a classic hippotherapy session, so that you will be able to notice a difference when you see a picture of modern hippotherapy.

“Hippotherapy.” Quest Therapeutic Services. Message Agency. Website. 8 October 2015.

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The second type of hippotherapy, seen in this picture, is called modern hippotherapy. Modern hippotherapy is “an approach that uses the equine movement of classic hippotherapy, but adds the component of psychological intervention” (Granados and Agis, para. 4). It is different from classic hippotherapy because “by adding that psychological component, modern hippotherapy is able to help children with autism, cerebral palsy, Down syndrome, and multiple sclerosis.” In contrast, classic hippotherapy helps children with “neuromuscular, musculoskeletal, and cardiopulmonary dysfunctions” (Granados and Agis, para. 3 and 4). In this image, there is a young girl with special needs performing an activity during her hippotherapy session. She looks focused on putting that ring on the pole, but the smile on her face shows how much fun she is having. This image is a little more complex, because there is more color and it is taken from a different angle. The angle is looking forwards, but on a diagonal, so that you can see the therapist and leader of the pony. It helps you notice that while the therapist is watching and holding on to the girl to make sure she is safe, that the girl is quite independent in the completion of the activity, which is what modern hippotherapy is all about: completing a physical activity while also strengthening mental and social skills.

Quest Therapeutics Services Inc. “Finley.” Facebook. N.p., 17 Sept. 2015. Web. 28 Oct. 2015.

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Hippotherapy vs. Traditional Therapies

There are three very significant reasons why hippotherapy, as a whole, is different from other traditional therapies. The first reason is “a patient can be stimulated multi-dimensionally by the tilting, rotating, and moving through space of the horse’s gait, which is almost impossible to replicate in a clinical setting” (Is hippotherapy better than other forms of physical, occupational, or speech therapy?, para. 3). In addition, “the excitement of working with the horse makes the child more willing to participate. Disabled children who have had negative experiences with other forms of therapy, usually do not associate those previously negative feelings with hippotherapy” (Is hippotherapy better than other forms of physical, occupational, or speech therapy?, para. 3). Secondly, there is a study that was done with children who were diagnosed with spastic cerebral palsy. It concluded that “eight minutes of hippotherapy resulted in improved muscle symmetry, which suggests that the movement of the horse rather than passive stretching accounts for more improvement in these children” (Benda, William, Nancy H. Mcgibbon, and Kathryn L. Grant, para. abstract). Finally, another study discovered that hippotherapy helps children with autism because it gives them special social and emotional connections with the horse, that they do not normally feel with other humans (Dingman, para. 3).

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Training a Hippotherapy Horse

Training a hippotherapy horse is not as difficult as it may sound. Of course, the person training the horse needs to have the knowledge and experience of training horses to work in hippotherapy. The video above accurately depicts a trainer, named Samuel Brown, performing some hippotherapy training exercises. I’m sure it seems odd what he is doing, but all of these exercises help to desensitize the horse. Desensitizing a horse means “continually using a signal or stimulus until all response has been eliminated” (Sutor, para. 2). As you can see in the video, Mr. Brown performs each exercise several times, until the horse has no response to the object. By desensitizing a horse, you are teaching it not to respond to strange or scary objects, movements, and noises. This is crucial for a horse to be used in hippotherapy, because the child will be performing exercises, such as playing catch or sitting backwards, on the horse and it would not be safe for the child, therapist, sidewalker, or leader if the horse were to spook at every little movement that is made during the session. Not only does the training teach the horse not to spook, it also teaches the horse to trust people more easily. This is important in hippotherapy since each horse is ridden by a different child in each session. With that said, training only goes so far, because you cannot control if a horse spooks at something not happening in the session, like thunder, a bush, or a squirrel in a tree. Now, I would like to give you a glimpse of the hippotherapy center in my hometown, and what it’s like to be a volunteer. 

Samuel Brown. Training of the Hippotherapy Horse. N.p., 22 Jan. 2009. Web. 5 Dec. 2015.

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Quest Therapeutic Services, Inc.

Quest Therapeutic Services is an equine-assisted therapy facility located in my hometown of West Chester, Pennsylvania that I had the privilege to volunteer at, for a year and half. Quest mainly specializes in hippotherapy, but they also have an early intervention program and a school-based therapy program. In their early intervention program, one of the specially trained therapists will come to the home of child that may be too young to participate in hippotherapy, to begin treatment at a young age in preparation for hippotherapy. For their school-based therapy program, Quest provides therapy for children in grades K-12 at the child’s school that he or she currently attends, or brings children who are home or cyber-schooled into a school environment to receive therapy (“Quest Therapeutic Services”). Although these two programs are important at Quest, their hippotherapy program is the one that a majority of their patients participate in. All of the therapists that are a part of the hippotherapy program, are not only professionals in their field of occupational, physical, or speech language pathology therapy, but they are also specially trained in hippotherapy as well. I have met most all of the therapists and they are some of the nicest people I have met. One can tell that they really love what they do. In addition to an incredible staff, Quest is home to a wonderful group of 10 specially trained therapy ponies. I have loved getting to know each one of the ponies, and it truly is amazing to see how much they love their job helping these children.  

QuestTherapeutic. Quest Therapeutic Video. YouTube. N.p., 21 May 2010. Web. 10 Nov. 2015.

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Compared to other hippotherapy facilities, Quest is definitely on the smaller side. So in order to get the word out about their program, they attend different community events. The picture to the left is from when Quest walked in the Mushroom Festival, in one of the nearby towns. They asked a few volunteers to join them and they also brought one of the ponies named, Chloe, and had one their patients ride her as a demonstration to the public. The picture to the right is of the tent that Quest had set up at the Willowdale Steeplechase, which is one their major supporters and partners. Each year they set up a tent, bring one the ponies and a patient to do a demonstration, and they also have stick horse races for all the kids that come to the event with their families. By participating in these local community events, Quest is not only spreading the word about their services, but also possibly gaining future volunteers, therapists, and patients.  

Quest Therapeutics Services Inc. “Mushroom Festival." Facebook. N.p., 11 Sept. 2015. Web. 5 Dec. 2015.

Quest Therapeutics Services Inc. "Willowdale Steeplechase." Facebook. N.p., 11 May 2015. Web. 5 Dec. 2015.

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You are probably wondering why a picture of this sign would be important to Quest. This sign hangs on their front door, and what it is saying could not be truer. I first heard about Quest my junior year of high school, through a friend of my mom’s, and I was immediately intrigued. I had heard of hippotherapy before, but I had no idea that there was a center ten minutes from my house. Before we graduated from high school, we had to complete a senior project, where you could either choose to write a research paper or do community service. I knew that I wanted to do volunteer work, but I had no idea where to volunteer. As soon as I heard about Quest, I knew right away that this is where I wanted to volunteer for my senior project. During my first visit to Quest, I took a tour of the building with my mom’s friend, and her daughter. After my first visit, I knew I wanted to go back. So, I had my mom go back with me and we talked to the lady who, at the time, was the volunteer coordinator and the barn manager. She gave me the forms to fill out, and I scheduled what day I would go out to volunteer during the week. Once I completed my training session, I could start actually doing barn work and helping out in therapy sessions. Even after I completed my senior project, I continued to volunteer at Quest, and last summer I even got to help exercise the ponies before sessions to help keep them fit. The point of sharing this story is to prove that I was a complete stranger when I first walked into Quest and now, every time I leave, I know that I am not just a volunteer, but a friend. This sign also applies to new patients and their families because it puts them at ease knowing that they are in a safe place.

O’Connell Betsy. “Door sign.” 21 October 2015. Personal Photograph.

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These are some pictures taken by Sam, the volunteer coordinator, during this past summer when myself and few other girls, who volunteer and ride horses outside of Quest, helped exercise the therapy ponies. Exercising the ponies is very important, because even though they do a lot of walking during the therapy sessions, they still need to be ridden to stay in shape, so that they are engaging their hind end properly, which allows for the children to feel the full movement of their walk. The large picture on the left is of me riding Tobin, and not to be biased, but he is probably my favorite pony at Quest. The top right picture is of all of us after we went on a trail ride. The bottom right picture is a picture of us actually on a trail ride. Exercising the ponies with all these girls was one of the highlights of my summer, and I am looking forward to going back over winter break to continue volunteering and riding these incredible ponies.  

Sam (Volunteer Coordinator at Quest). “Meredith and Tobin.” Summer 2015. Personal Photograph.

Sam (Volunteer Coordinator at Quest). “Post Trail Ride.” Summer 2015. Personal Photograph.

Sam (Volunteer Coordinator at Quest). “Trail Riding Fun.” Summer 2015. Personal Photograph.

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The next few posts are collages of pictures from Quest, and with them, I intend to show you what it is like to be a volunteer there and what happens during the therapy sessions. However, I would like you to keep in mind that this is how Quest is run and this may not be the way that other hippotherapy facilities operate. When I first arrive at Quest to start working, I set my things down in the cubby area they have set aside for the volunteers’ belongings and I check the therapy session board, which is the image in top right corner. It shows you what time the sessions are and how many sessions are happening at once. It is difficult to see, but in each block on the board there is a specific order. The yellow squares have the therapists’ name, the pink squares have the child’s name, the green squares tell you which horse to use. Then, the first name under that is leader of the horse, and the second name is the sidewalker. I always make sure to check the board so that I know which therapist and child I am assisting. I also check each session to see if I will be a leader or a sidewalker. A leader is the person in charge of leading the horse around the ring and controlling the speed of the horse. A sidewalker stands on the side of the horse opposite the therapist, and their job is to provide extra support for the child and do activities with the child, too. The next job I do as a volunteer, is to groom and tack-up the ponies. The bigger image on the left side is a picture of the different brushes that are used to groom the ponies, and make sure they are clean for sessions. The last image in the bottom right corner is of one of the ponies at Quest, and his name is Mocha. He is a very sweet pony that is loved by many of the children. The purpose of this image is to show you what a one of the ponies’ looks like all tacked up and ready for sessions. Once all these tasks have been completed, I usually go sit in the waiting area, and wait for the children to arrive for sessions.

O’Connell Betsy. “Therapy Session Board.” 21 October 2015. Personal Photograph.

O’Connell Betsy. “Grooming Bucket.” 21 October 2015. Personal Photograph.

O’Connell Betsy. “Mocha.” 21 October 2015. Personal Photograph.

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In the previous collage, you saw a picture of Mocha, one of the Quest ponies, wearing his therapy pad. This picture is a close-up of the therapy pad, and the purpose of it is to point out the three differences between a therapy pad and a regular saddle used for horseback riding. First, it is flat and not big and bulky. This is important because it gives the child the freedom to perform exercises and play games on the horse. In addition, the freedom of the therapy pad allows for the child to experience all of the movements of the horse’s body. Second, it has a handle on the front, and that is there for the kids to hold on to if they feel uncomfortable about riding at first, which is common. As time passes, most children do not use the handle because they become comfortable with riding and doing exercises without holding on. Lastly, there are stirrups on either side. Most children will not use them when they first begin therapy, because they are not quite strong enough to stand while the horse is walking. Once their muscles become stronger, the children will use the stirrups to stand up when the horse is walking and to do other exercises or games simultaneously.

O’Connell Betsy. “Therapy Pad.” 21 October 2015. Personal Photograph.

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This collage of pictures shows you what the kids do before they begin their therapy sessions. The large image on the left side is a picture of the therapy mat. When the kids come outside with their therapists, they usually sit here to do a few exercises to warm up before actually getting on the pony. There are other structures, such as a small balancing beam and trampoline, in the therapy area of the barn, for the kids to perform warm-up exercises. Another fun thing that the kids like to do is ride the bikes, which are seen in the image in the top right corner. Each bike is a different level of difficulty, and the child’s therapist will choose which bike for them to ride based on their strength and assistance levels. The kids will either ride the bikes down the aisle of the barn or outside, if the weather is nice. The last image in the bottom right corner depicts the helmet and therapy belt cubby. Once the kids have done some warm-up exercises, they come back to sit on therapy mat, which is right next to the cubby. Here, the therapist chooses the proper helmet size for the child to wear while riding the pony. Next, the therapist chooses which therapy belt fits the child best. A therapy belt velcros around the child’s body/trunk, and has handles on it for the therapist to hold on to and to keep the child safe on the pony. When the child has on their helmet and belt, he or she is ready to get on their pony.  

O’Connell Betsy. “Therapy Mat.” 21 October 2015. Personal Photograph.

O’Connell Betsy. “Bicycles.” 21 October 2015. Personal Photograph.

O’Connell Betsy. “Helmet and Belt Cubby.” 21 October 2015. Personal Photograph.

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This image shows you what the mounting area, which is where the kids get on the ponies, looks like at Quest. When the therapist is ready to start the session, the leader for that session gets the correct pony and leads it into the arena. Usually, the leader is waiting in the arena before the child, therapist, and sidewalker come in so that the session can start right away. So, when the child and therapist come in, they walk up the ramp together and wait at the top on the platform. The sidewalker walks over to the smaller platform on the right side, and stands on the top waiting to help the therapist put the child on the pony. The leader then leads the pony through the small chute in between the ramp, and the cones, and has it stop between the two platforms. Next, the therapist and sidewalker help the child mount the pony the way that is easiest for them, but most children will straddle the therapy pad as if one would to ride a horse in regular saddle. Once the child is on the horse and the therapist and sidewalker have made sure they are safe, the therapist will typically ask the child to tell the pony to walk on, which is the cue for the leader to lead the pony out of the mounting area and in to the arena. One thing I would like to point out is that the orange cones are placed there so that the leaders know not to walk through the mounting area in the middle of a therapy session.

O’Connell Betsy. “Mounting Area.” 21 October 2015. Personal Photograph.

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These pictures depict what the indoor arena and outdoor area look like at Quest. Most all sessions take place inside, unless the weather is nice or the therapist feels the child is comfortable riding outside. The larger image on the left side is of the indoor arena. It is much, much bigger in person, and there is enough room for four to five therapy sessions to occur at one time. One thing I would like to point out in particular are the poles with tennis balls on top lined up in the middle of arena. Those can be used for the leader to weave the pony through or the pony can be stopped at one pole and the child can play a game with the rings that are resting at the bottom of each pole. The image on the top left of the square is of a basketball net that is located in one of the corners of the arena, where the pony is stopped in front of it, so that the child can shoot some baskets with help from the therapist or sidewalker. The arena also has many other activities, such as a puzzle and book corner, a white board, a fishing game, and other balls to play catch with. The remaining three images are all from the outdoor space that Quest has for therapy sessions to take place outside. In the image located in the top right of the square, you can see that there are lots of trees and grass for the ponies the walk on comfortably. The image in the bottom left of the square shows these raised wooden steps that are located in the middle of the space. These are used for the pony to walk over, and each one is a different height. When the pony walks over them, it helps to improve the child’s trunk strength, so that they can balance themselves to sit up straight while walking over an uneven surface. The last image in the bottom right corner of the square shows what everyone calls the “car wash” at Quest. These pool noodles hang up in the spring and summer and during sessions, the leader walks the pony through them for the child to have a little fun. As you can see, Quest has a very beautiful property and an awesome indoor arena so that they can provide their hippotherapy services.  

O’Connell Betsy. “Indoor Arena.” 21 October 2015. Personal Photograph.

O’Connell Betsy. “Basketball Net.” 21 October 2015. Personal Photograph.

O’Connell Betsy. “Outdoor Space.” 21 October 2015. Personal Photograph.

O’Connell Betsy. “Raised Steps.” 21 October 2015. Personal Photograph.

O’Connell Betsy. “Car Wash.” 21 October 2015. Personal Photograph.