Hippotherapy Vs. Therapeutic Riding
Hippotherapy vs. Therapeutic RidingWhat is the difference? And how do I know which one is most appropriate for my child?HippotherapyTherapeutic RidingPhysical, Occupational or Speech Therapy. The movement of the horse is a treatment tool.Adapted recreational horseback riding lessonsHippotherapy is not a horseback riding lesson. It is physical,occupational or speech therapy, which is approved by aphysician and implemented by a team that includes alicensed, credentialed therapist.Therapeutic riding is recreational horseback riding lessonsadapted to individuals with disabilities.Hippotherapy is implemented by a professional therapist(occupational therapist, physical therapist or speech language pathologist) in conjunction with a competent horsehandler and a specially screened and trained therapy horse.Therapeutic riding is completed by a certified therapeutichorseback riding instructor in conjunction with volunteers.There is direct hands-on participation by the therapist atall times.In therapeutic riding, the individual is often taught riding lessons in a group format, which runs in “sessions”. The instructor must respond to the group as a whole, in addition to fostering individual success.The horse’s movement is essential to assist in meeting therapy goals.There is occasional hands-on assistance by the riding instructor and/or volunteers, but the instructor usually teaches fromthe center of the arena.The goal of hippotherapy is to improve neurological functioning in cognition, body movement, organization, and attention levels to improve function off the horse.Horses used for therapeutic riding instruction have beenscreened to make sure they have the appropriate temperament for this job.Hippotherapy is a one-on-one treatment and generally occurs until the client meets discharge criteria.In therapeutic riding, the emphasis is on proper riding positionand reining skills, not functional therapeutic goals.In hippotherapy, the treating therapist continually assesses andmodifies therapy based on the client’s responses.Because therapeutic riding is an adaptive/recreational/sportactivity, NOT therapy, it is not covered by insurance.Physical, occupational or speech therapy in which hippotherapy is utilized, is reimbursable by medical insurance(third party).created 12/20109 9 1 9 To w n e R o a d C a r m e l , I n d i a n a 4 6 0 3 2 P h o n e : ( 8 7 7 ) 8 5 1 - 4 5 9 2 F a x : ( 3 1 7 ) 8 7 2 - 3 2 3 4w w w. a m e r i c a n h i p p o t h e r a p y a s s o c i a t i o n . o r gThis fact sheet was created by AHA volunteers and students from Central Michigan University for the use by AHA members for the purpose of educatingothers about Hippotherapy. AHA grants permission for this use by our members and facilities. Any altering of this material is not endorsed by AHA.
AHA, INC. TERMINOLOGYIn the interest of clarity and consistency, AHA, Inc. has adopted the following suggested glossary to describe thetherapy team and the setting in which AHA, Inc. members work, we have included terms related to the field of equineassisted activities and therapies as a whole as well to help with clarification. Using this terminology accurately inall communications will facilitate greater understanding throughout the equine and medical communities. Pleasereview these terms and use them when describing hippotherapy (equine movement/related activities), equine assistedtherapy, equine facilitated mental health, as it relates to PT, OT and SLP practices.ADAPTIVE RIDING (AR)Mounted activities, including traditional riding disciplines (i.e. English, Western) where instruction and/or equipment may bemodified by a specially trained riding instructor for a person with a disability to ensure successful progression of equestrian skills.COMPETITIONIndividual or team sports at the local, regional, national, or international level. Integrated or specialized competition can be breedor activity based.EDUCATORAn educator/teacher licensed or sanctioned by the state, school district, department of education or equivalent designation.EQUINEA general description inclusive of horses, ponies, mules, donkeys, or miniatures. Of special note: the equine is not inanimate,therefore, we refrain from phrases such as ‘using the horse’ or ‘a pony is used’. We might ‘use’ the movement of the horse, or wemay ‘use’ examples of equine behaviors, we do not ‘use’ the animal. Consider phrases such as: work with the horse, incorporatingthe equine, the horse assisting the therapist, or the pony facilitating the therapy.EQUINE ASSISTED ACTIVITIES (EAA)Any activity within an equine environment, mounted or un-mounted, where the goal is not therapy but activity driven, i.e.adaptive riding, grooming, horsemanship, stable management, shows, parades, demonstrations, etc., for pleasure and/orrecreation. EAA are supervised by a PATH certified instructors at all PATH member centers.EQUINE-ASSISTED THERAPY (EAT)A goal directed intervention in which a specially trained equine is an integral part of the treatment process. EAT is directed and/or provided by a human/health service professional with specific expertise and within the scope of their practice.EQUINE-FACILITATED MENTAL HEALTH (EFMH)Inclusive of equine-assisted activities and therapies with a focus on mental health issues. (EFL and EFP)EQUINE-FACILITATED PSYCHOTHERAPY (EFP)Experiential psychotherapy that includes equine(s). It may include, but is not limited to, a number of equine activities suchas handling, grooming, lunging, riding, driving, and vaulting. EFP is facilitated by a licensed/ credentialed mental healthprofessional working with and/or as an appropriately credentialed equine professional/ instructor.HIPPOTHERAPY (HPOT)Hippotherapy is a physical, occupational or speech therapy treatment strategy that utilizes equine movement. This strategy is usedas part of an integrated treatment program to achieve functional outcomes. www.americanhippotherapyassociation.orgRevised March 2013American Hippotherapy Association, Inc. (AHA, Inc.)PO BOX 577, Lafayette, CO 80026 (877) 851-4592 FAX: (877) 700-3498 info@americanhippotherapyassociation.org americanhippotherapyassociation.org1
AHCB HIPPOTHERAPY CERTIFIED THERAPIST– ENTRY LEVELAn entry level exam which licensed therapist (PT, PTA, OT, COTA, SLP, and SLPA) who have attended both the AHA, Inc. LevelI and II courses may take. Successful completion of this national board written exam shows a baseline level of competency inequine movement/related activities as a treatment strategy.AHCB HIPPOTHERAPY CLINICAL SPECIALIST (HPCS)An experienced, licensed therapist (PT, OT, SLP) who has demonstrated an advanced level of knowledge in using equinemovement/related activities as a treatment strategy by successfully completing a national board written examination.HORSE HANDLER/LEADERIndicates the individual preparing and handling the equine during a treatment sessions.MENTAL HEALTH PROFESSIONALA licensed and/or credentialed medical professional who specializes in the treatment of individuals with psychiatric,psychological, emotional or behavioral diagnoses.PARTICIPANTAn individual who participates in a research project. Although subject is used in some venues, participant is preferredterminology.PATH Intl.Professional Association of Therapeutic Horsemanship InternationalPATH Intl. CENTERA center that has established membership with PATH Intl. and agrees to comply with the PATH Intl. standards by signing anannual compliance form.PATH Intl. CERTIFIED INSTRUCTORA riding instructor certified by PATH Intl. at the registered, advanced, master level or specialty, i.e. driving, interactive vaulting,who holds an approved certification in the specific equine activity they teach.PATH Intl. PREMIER ACCREDITED CENTERA member center that has been successfully evaluated to be in compliance with PATH Intl. standards. A PATH Intl. PremiereAccredited Center may use the PATH Intl. PAC logo and present itself as a PATH Intl. Premier Accredited Center.PATIENT/CLIENTA general description of the person who takes part in equine assisted therapies. There will be varied usage depending on thediscipline and setting. For instance, in a therapy setting, it is appropriate to use patient or client; in a school setting, one may referto therapy patients/clients as “students”. Use of terminology related to persons with disabilities will follow the common usageby the World Health Organization (WHO) that is ‘people first, disability or diagnosis second’. Preferred statement: ‘patient withcerebral palsy.’ Incorrect: ‘CP patient.’TANDEM HIPPOTHERAPY (T-HPOT)A treatment strategy in which the patient is handled by the therapist or skilled designee who is mounted on the horse behindthe patient.THERAPEUTICAn activity is therapeutic if a participant benefits, shows improvement or feels better once engaged. An activity can be therapeuticwithout being considered as therapy. In general, EAA’ s may be described as therapeutic, but they are not therapy or are notconsidered treatment without fulfilling specific requirements. (See Therapy, defined below)Revised March 2013American Hippotherapy Association, Inc. (AHA, Inc.)PO BOX 577, Lafayette, CO 80026 (877) 851-4592 FAX: (877) 700-3498 info@americanhippotherapyassociation.org americanhippotherapyassociation.org2
THERAPYMay only be done only by a licensed/credentialed professional such as a PT, OT, SLP, (and licensed assistants), psychologist, socialworker, MD, among others.TREATMENTServices in which therapy is provided. This is generally thought of in a medical model. (See Therapy)VOCATIONAL REHABILITATIONEquine related activities that may include work hardening, work re-entry or vocational exploration. Participants are young adultsor adults. May be considered equine assisted therapy if integrated by the therapist as part of a medical treatment plan.TERMS TO AVOIDCLASSIC OR CLASSICAL HIPPOTHERAPYThese terms were used at one time by the American Hippotherapy Association (AHA) to differentiate types of hippotherapypracticed. It is no longer necessary to make this distinction and the term Hippotherapy is inclusive of all variations as long as thediscipline fits the definition as outlined by AHA, Inc. (See Hippotherapy)HIPPOTHERAPIST/EQUINE THERAPIST/EQUINE-ASSISTED PSYCHOTHERAPISTThese terms (and other similar terms) are never to be used, as there are no such professions, professional education or licensing inNorth America. An appropriate description would be the therapist first (recognized profession) with the equine-assisted therapyfollowing (i.e. PT using HPOT, clinical psychologist doing EFP).MODALITY/TOOLThe use of the movement of the horse is defined as an treatment strategy rather than a modality. Legally, hippotherapy or the useof the movement of the horse is not a modality, and the term modality should not be used. Additionally, the equine is not the tool;the movement and/or the behavior of the horse is the facilitator for change. (See Equine)RIDERThis refers to the individual who participates in a therapeutic riding lesson or an able bodied riding lesson.USING THE HORSE/THE HORSE IS USEDThe equine is a sentient being and participates in EAAT by facilitating or assisting in the provision of services. Humane treatmentis quintessential, including respectful verbiage in discussing the equine’s participation.“THERAPY”Laws differ by state. If non-licensed/credentialed personnel claim to be doing therapy or providing treatment, this is oftenconsidered fraudulent and practicing without a license. Marketing strategies (brochures, website) must utilize appropriateterminology. A therapist must be present in order to represent an individual or an organization as offering “therapy”.Revised March 2013American Hippotherapy Association, Inc. (AHA, Inc.)PO BOX 577, Lafayette, CO 80026 (877) 851-4592 FAX: (877) 700-3498 info@americanhippotherapyassociation.org americanhippotherapyassociation.org3
December 15, 2011Jacqueline Tiley, Executive DirectorAmerican Hippotherapy AssociationDear Ms. Tiley:The American Occupational Therapy Association, Inc. (AOTA) recognizes the use of themovement of the horse (hippotherapy) as one of many interventions that may be used byoccupational therapy practitioners, as long as it is based on an appropriate occupational therapyevaluation, and integrated into a broader occupational therapy program and plan of care with theoverall goal of supporting engagement in daily activities and occupational performance.Documentation should be explicit in linking the occupational therapy intervention to the clientgoals and outcomes.Selection of an appropriate intervention is dependent on the medical diagnosis (e.g. neurological,muscular, psychosocial) and the specific client’s performance goals (e.g. improvement inmobility, balance, or sensory responses), for occupational therapy (OT). Therapeutic horsebackriding in which the goal is to achieve the skill of riding would not be considered occupationaltherapy. For example, an occupational therapy goal might be to work on dynamic balance, askill involved in the performance of various daily activities e.g. completing morning dressing,playing on playground, etc.In addition, from both an ethical and reimbursement perspective, it is incumbent upon theoccupational therapist to provide documentation which objectively supports the rationale forthis choice of intervention, how and why it is appropriate to meet the specific goals and needs ofthe client.As per the Code and Ethics Standards of the profession, the occupational therapy practitionerusing this approach must be competent to provide this intervention, which will likely requirereceipt of special training to work in this area.Sincerely,Maureen Freda Peterson, MS, OT/L, FAOTAChief Professional Affairs OfficerAmerican Hippotherapy Association, Inc. (AHA, Inc.)PO BOX 577, Lafayette, CO 80026 (877) 851-4592 FAX: (877) 700-3498 info@americanhippotherapyassociation.org americanhippotherapyassociation.org
American Hippotherapy Association, Inc. (AHA, Inc.)PO BOX 577, Lafayette, CO 80026 (877) 851-4592 FAX: (877) 700-3498 info@americanhippotherapyassociation.org americanhippotherapyassociation.org
May 5, 2012Debbie Silkwood-Sherer PT, DHS, HPCSPresident, American Hippotherapy AssociationP.O. Box 2014Fort Collins, CO 80522-2014Dear Dr. Silkwood-Sherer:On behalf of the American Physical Therapy Association’s (APTA) more than80,000 member physical therapists, physical therapist assistants, and students ofphysical therapy, I am happy to provide a letter to the American HippotherapyAssociation on the use of a hippotherapy as a treatment strategy that is an appropriatepart of physical therapy practice. Physical therapists’ practice in a wide variety ofsettings and perform evidenced-based screening and evaluation for individuals withneuromuscular, cardiovascular, integumentary, and musculoskeletal conditions andprovide interventions that focus on mobility and function to enable an individual’sparticipation and improving their quality of life.The physical therapy plan of care is based upon an individualized examination andevaluation of the patient to address impairments and functional and participationlimitations and environmental barriers. The plan of care consists of thepatient’s/client’s goals and intended outcomes and the treatment strategies andinterventions directed to achieve a functional outcome. Hippotherapy is atreatment strategy that when incorporated into the physical therapist plan of careutilizes the equine movement as part of an integrated program to achieve outcomessuch as improved balance, strength and flexibility. In cases where a physicaltherapist treatment plan utilize hippotherapy, the services rendered by that physicaltherapist, in such a context, should be recognized as physical therapy interventionsand not the specific treatment strategy, device, equipment or adjunct used to deliverthese interventions. In contrast, therapeutic horseback riding in which the goal is toachieve the skill of riding or other equine-related activities is not consideredphysical therapy intervention due to it not being a component of the individuals’physical therapy plan of care.While the 2003 Guide to Physical Therapist Practice does not specificallymentioned hippotherapy, it is considered a treatment strategy consistent withinterventions of therapeutic exercise. The Guide states that therapeutic exercisemay include “balance and coordination training; motor function training orretraining; neuromuscular education or re-education; neuromuscular relaxation,inhibition and facilitation; perceptual training; posture awareness training; andsensory training or retraining”.American Hippotherapy Association, Inc. (AHA, Inc.)PO BOX 577, Lafayette, CO 80026 (877) 851-4592 FAX: (877) 700-3498 info@americanhippotherapyassociation.org americanhippotherapyassociation.org
When an individual’s physical therapy plan of care includes hippotherapy as a treatmentstrategy it is appropriate for services to be billed as neuromuscular education, therapeuticexercise, therapeutic activities or sensory integration, depending the intent of the intervention,the patient goals, and assuming all other payer requirements are met.Thank you and if you need any further information, please feel free to contact APTA’sClinical Practice and Research Department at practice@apta.orgSincerely,R. Scott Ward, PT, PhDPresidentRSW/jm/mfd2American Hippotherapy Association, Inc. (AHA, Inc.)PO BOX 577, Lafayette, CO 80026 (877) 851-4592 FAX: (877) 700-3498 info@americanhippotherapyassociation.org americanhippotherapyassociation.org
American Hippotherapy Association, Inc. (AHA, Inc.)PO BOX 577, Lafayette, CO 80026 (877) 851-4592 FAX: (877) 700-3498 info@americanhippotherapyassociation.org americanhippotherapyassociation.org
AHA, INC. BIBLIOGRAPHY AND REFERENCE LISTPEERED REVIEWED HIPPOTHERAPY RESEARCH ARTICLESThis section includes articles that use scientific research and inquiry methods that include more than one researchparticipant. Although some articles use the term “therapeutic riding”, “riding therapy”, “horse therapy”, or “equineassisted therapy” in their title or text, the description of the actual methods is consistent with current AHA definitionof hippotherapy and are therefore included in this category. Many of these are older articles or were conducted incountries where terminology differs slightly from current AHA definitions.Benda, W., McGibbon, N.H., Grant, K.L. (2003). Improvements in muscle symmetry in children with cerebal palsy after equineassisted therapy (hippotherapy). The Journal of Alternative and Complementary Medicine,9(6), :817-825.Bronson C, Brewerton K, Ong J, Palanca C, Sullivan SJ. (2010) Does hippotherapy improve balance in persons with multiplesclerosis: a systematic review. European Journal of Physical and Rehabilitation Medicine. 46:347-353.Casady, R.L., Nichols-Larsen, D.S. (2004). The effect of hippotherapy on ten children with cerebral palsy. Pediatric PhysicalTherapy, 16(3): 165-172.Champagne D, Dugas C. (2010) Improving gross motor function and postural control with hippotherapy in children with Downsyndrome: case reports. Physiotherapy Theory and Practice. 8:564-571.DeBuse D, Gibb C, Chandler C. Effects of hippotherapy on people with cerebral palsy from a users’ perspective: a qualitativestudy. Physiotherapy Theory and Practice, 2009;25(30):174-192Dirienzo LN, Dirienzo LT, Baceski DA. (2007). Heart Rate Response to Therapeutic Riding in Children with CP: An explorationstudy. Pediatric Phys Therapy, 19:160-165.Debuse, D., Chandler, C., Gibb, C. (2005). An exploration of German and British physiotherapists views on the effects ofhippotherapy and their measurement. Physiotherapy Theory and Practice, 21(4): 219-242.Dirienzo LN, Dirienzo LT, Baceski DA. (2007). Heart Rate Response to Therapeutic Riding in Children with C
A riding instructor certified by PATH Intl. at the registered, advanced, master level or specialty, i.e. driving, interactive vaulting, who holds an approved certification in the specific equine activity they teach. PATH Intl. PREMIER ACCREDITED CENTER A member center that has been successfully evaluated to be in compliance with PATH Intl .
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