What is Hippotherapy?


Special thanks to  Maria Hurley at Divinity Farm and Toby Freeman at Horse Talk   and  Jane-Anne Khalid at Miracles-Sudan for permission to use photos. 

 Information on this website should not be construed as medical or therapy advice and is provided only as general information. Please consult your physician and other health professionals for specific advice. All ideas reflect the creative spirit of the author, Barbara Smith OTR/L and bear no relationship to her current employer. 

Hippotherapy should only be performed by trained and  registered occupational, physical and speech therapists.

How can parents help carryover the benefits of hippotherapy after leaving the farm?
Check out this link.
Parent Carryover Activities

hippotherapy standing

Printed with permission from
Austin's Autism Journal

hippotherapy horse and girl one

hippotherapy horse and smiling girl

hippotherapy horse in barn

hippotherapy horse


Hippotherapy Blog- for therapists, instructors, families, riders and others interested in promoting skills using the horse as a treatment tool. Share your stories and expertise.

Can painting a horse be therapeutic?

Click to Enlarge

Learn about how occupational therapists used the horse as an art medium-as well as therapeutic tool at a special needs camp. Advance for OT

Children used water-based, nontoxic, tempera finger paint mixed with horse shampoo. According to Terrie King, LOT, Panola College OTA program faculty member- "We care for our horses very much at camp and consider them a co-therapist deserving of all the rights of any living being."  In fact, "King added, "the horses actually seem to enjoy being painted.

hippotherapy painted horse
Click to Enlarge


What is vaulting?
Vaulting is exercise or gymnastics performed on the back of a moving horse. Someone other than the rider is controlling the horse.

This YouTube video demonstrates vaulting- it is not hippotherapy!

Do therapists use vaulting activities in hippotherapy?
Yes. Vaulting is commonly performed during both therapeutic riding instruction and hippotherapy treatment. It is suitable for riders with mild physical disabilities, sensory processing and motor control deficits, attention deficit disorders, autism and young children with developmental delays.

Vaulting may be used to improve the following skills:
  • Sequencing
  • Memory
  • Strength
  • Motor planning skills
  • Following directions
  • Endurance
  • Balance
  • Postural control
  • bilateral coordination
Vaulting during hippotherapy may involve:
  • Kneeling
  • Holding arms out in extension
  • Holding quadruped position (on hands and knees)
  • Flag and half flag positions
  • Standing on top of the horse
hippotherapy flag position

Photo is property of
Horsetalk  and may not be used without permission.

Flag position involves extension of one leg  and the opposite arm. During half flag the leg is extended and the hands grasp the handle for support.
hippotherapy kneeling arm extension

Photo is property of
Horsetalk  and may not be used without permission
Kneeling may be maintained facing forward, backward or sideways. Extending the arms helps the rider maintain balance.


Performing hand activities while in kneeling further challenges balance and promotes coordination, postural stability and  motor planning skills.

hippotherapy standing on horse

Photo is property of Horsetalk  and may not be used without permission

Standing on top of the horse is a challenge with horse stationary, walking or trotting.

hippotherapy vaulting

Maintaining arms in extension (sometimes called "airplane" position) develops shoulder strength and balance. This is even more challenging as the child sits on the horse's withers facing backwards. Sitting on the withers creates a smaller area for sitting, requiring more balance and the impact of the horse's movement increases sensory stimulation.

hippotherapy quadruped

Positioning in quadruped on hands and knees is a wonderful position to develop strength and coordination.  Putting weight on the hands helps to normalize muscle tone and the trunk muscles work hard to hold this position. Quadruped may be held while facing forwards or backwards.



Some photographs have been altered to protect the identify
of children and facilities

"Hippotherapy"  refers to a medical
strategy using the movement
of the horse to promote neuro-
change. Occupational,
physical and speech therapists use

the horse as a treatment tool to improve posture, strength,
balance, equilibrium reactions, coordination and
communication. It is not a method to teach riding.

hippotherapy brushing  horse
The term "therapeutic riding" encompasses
all aspects
of using the horse with individuals
who have physical
and/or mental disabilities.
This term is all-inclusive and
may involve
activities on or off the horse. The individual
is taught not only specific riding skills,
but also skills performed
off the horse such as grooming
and tacking.

miracles sudan boy with pony
All "equine-assisted" therapies involve a
relationship between
rider and horse. Horses
give unconditional acceptance and
many riders
express their appreciation by hugging, patting or
kissing their ponies.
Occupational therapists may
do both
hippotherapy on the horse and therapeutic activities such
as following
directions to put on a helmet and gait belt before riding.

Is treatment different when the therapist is
an occupational, physical or speech

hippotherapy boy holding hoop
Physical and occupational therapists both
use the horse to
achieve biomechanical
goals such as increasing trunk
normalizing muscle tone, independent
improving balance, posture,
equilibrium reactions
(to not fall over
when the center of gravity changes)

Holding a hoop helps this child to open up the chest
and breath deeply. This contributes to postural
control and  speech.

miracles sudan boy with ballOccupational therapists focus on
goals related to sensory processing.
The horse provides strong tactile (touch),
vestibular (movement) and proprioceptive
(deep pressure to joints and muscles)
stimulation that organizes the child's
sensory system.

The child above is receiving sensory input from the horse's
movement as well as touch from the ball and deep
pressure to joints as he holds it on his head while moving.
The therapist is promoting bilateral hand use and motor
planning as he moves the ball in different ways. 

two hands
Occupational therapists focus on using
motor activities that develop postural
control and eye-hand coordination.
this child cannot hold onto the handle
support while placing rings on the stack

she must use
her trunk muscles to maintain her posture
and balance. 

Read more: Hand Activities and Hippotherapy

Reaching for the ring on her pony's ear
promotes balance, range of motion and

pins on mane
Occupational therapists also use fine-motor
activities such as attaching clothespins
to the mane to strengthen hands and
develop dexterity.



hugging hippotherapy pony
Children receive tactile (touch)
input when hugging
the pony facing forward,
backwards or
while lying over the horse's barrel.

Toys such as puff balls that are fun to squeeze
and pull provide great tactile and proprioceptive
sensory input to the hands.

hippotherapy meadow fingerfacingleft fingerpointingright hippotherapy riding ring

Occupational and speech therapists often have objectives
related to following directions and communicating with either
gestures, verbalization, signs, pointing to pictures  or a
combination. The hippotherapy situation often motivates
the child to communicate "go" and "whoa" and choose
which direction to ride the horse. The above pictures can
be used by a child to communicate that she wants to go
left to the meadow or go right to  see the horses in the arena.
Children can also communicate these choices by
approximating the word sounds, steering with the reins,
pointing or looking in the chosen direction.

hoopballs  velcrobottle  hippotherapy cones
basketball   puzzle  matchingpictures

Children can make a choice by pointing to a picture of a
desired activity or be asked to follow directions to
remove a specific picture before performing the task.
Occupational therapists use activities to help the child
improve attention to tasks and cognitive awareness.
Activities to work on these skills include:

Looking at a picture of flowers and then
finding them on the trail

hippotherapy water bottlesHolding arms out to the side in "airplane"
position. This girl is holding plastic bottles
filled with water. They are not only fun, but
help make the child more aware of where
arms are and how they are moving.
sequencingexercisesRemembering an exercise sequence such as
"make arm circles,
touch the mane and touch
the tail."

hippotherapy girl with dollIdentifying body parts on a doll or picture

Photo is property of Horsetalk  and may not be
used without permission

How does the movement of the horse help the
therapist achieve therapeutic goals?

The multi-dimensional movement of the horse
produces pelvis and spinal movement
in the rider that is similar to the
movement required in human gait.

The pelvis moves forward and backward,
side to side and in rotation.These
movements not only allow non-ambulatory
riders to experience sensations similar

to walking but also helps children to develop the balance,
postural control and sensory integration that typical children
develop through everyday play and other movement activities.

What is Muscle Tone?

Muscle tone refers to the amount of resistance to passive
stretch or movement.  Muscles may have low tone and
move very easily or high tone which is less easy to stretch.

How does hippotherapy affect muscle tone?

Horse movements that are rhythmic, smooth and regular
relax muscles much the way a cradle rocks a baby to sleep.
These movements may also be preferred by children who
are easily overstimulated.

Horse movements that are jerky, of irregular speed and
involve frequent "stop and go" movements increase
muscle tone and raise the child's arousal level much the
way jumping on trampoline or  bouncing on a Hippity Hop
ball does.

Why do therapists place the child in different
positions such as side-sitting, facing backwards
or lying down?

hippotherapy backwards
Photo is property of Horsetalk  and may
not be used without permission

Different position vary the sensory input,
hip range of motion, pelvic tilt and muscles
being strengthened. Facing backwards

provides a bigger stretch to the legs. Putting weight on
the hands helps children to tolerate touch and improve
hand use.

Some children can perform push-ups while facing backwards
to strengthen trunk and upper extremities.

hippotherapy peg boardFacing backwards also provides a large
surface for upper extremity
bearing or an activity such as a puzzle.

Sitting while facing sideways facilitates side to side weight
shifts and increases balance

squat to stand
Performing squat to stand repetitions strengthens trunk and
leg muscles and improves postural control and balance.

prone over horse

Positioning the child prone (on the
belly) over the horse's barrel
relaxes spastic muscles and
provides strong sensory input.

The supine position (lying down on the back) with
head on horse's rump also provides total weight -
bearing to the body, facilitates equilibrium responses,
elongates the rib cage and provides strong sensory
stimulation. Some children can perform sit-ups in this
position, strengthening belly muscles.

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    ©2008 Barbara Smith