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Barbara Smith, MS, OTR/L

July 1, 2018



Why should we utilize hippotherapy?


The horse provides multidimensional movement that is variable, rhythmic, and repetitive. This is similar to the human gait. There are other animals that people can ride for therapy, like elephants, but a horse's gait and pace is similar to a human's. The pelvis moves in an anterior/superior and lateral direction, and there is pelvic rotation. All these movements give the rider the experience of walking. Riders, who have abnormal gait, get to experience what a normal gait feels like.

It is important that your horse have a good gait. During the hippotherapy session, we also had a volunteer who was in control of the horse and led it with a rope. The therapist would tell the volunteer when to go and stop. There was one volunteer who had an uneven gait. He dragged one leg when leading the horse. He had good control of the horse, but he was not appropriate to use during hippotherapy sessions. We needed volunteers who had normal gait as well as the horses. 

The horse's gait is special because the horse walks at a rate of 110-120 beats per minute, providing over 3,000 opportunities for a child to accommodate his or her pelvis during a 30-minute therapy session. Typically, my sessions were 30 minutes. There were a couple of situations where I worked with children who had spasticity, and it took me about 15 minutes of slow walking just to have their spasticity be reduced enough so that the child could open up his hips and straddle the horse. Those sessions might have run longer.

The horses would work for about two hours, and then they would be switched for a new horse. Often it was hard to find the ideal horse for every client. Some horses have a more narrow body, which is beneficial for someone who has limited range of motion and spasticity. A horse, who is ready to move and loves to trot, would be great for a child with autism, but maybe not with a client with cerebral palsy. For clients with cerebral palsy, we want a horse with a very smooth, even, and calm gait to reduce muscle tone. We used horses that had a better temperament and a desirable gait as mentioned before. Horses would move up to the hippotherapy program if they proved that they were reliable and had all the aforementioned characteristics. These horses almost never reacted to what was going on in the environment which was desirable.  

In the sessions, the child could straddle the horse and face frontward or backwards, or sit sideways and face me. The child would be constantly responding to the pull of gravity and other forces. The forces were constantly changing as there was a lot of variety in the environment. I liked to use a gait belt as it is safer for me to hold on to the child.


  • Builds strength
  • Develops balance
  • Normalizes muscle tone
  • Increases range of motion
  • Allows for weight bearing

Hippotherapy helps to increase body awareness and engagement: 

  • Right/left side coordination
  • Motor planning - sequencing and rhythm
  • Respiratory control
  • Sensory integration
  • Attention/focus
  • Persistence at tasks
  • Endurance

Hippotherapy promotes the following:

  • Visual perceptual skills
  • Daily living skills
  • Eye-hand coordination
  • Decrease sensory defensiveness
  • Communication skills
  • Social/emotional health
  • Self-esteem


barbara smith

Barbara Smith, MS, OTR/L

Barbara A. Smith, M.S., OTR/L has worked for over 30 years in a variety of settings including public schools, special education collaboratives, early intervention programs,  state institutions, community residences, adult day services and hippotherapy facilities.  She is the author of The Recycling Occupational Therapist, From Rattles to Writing: A Parent’s Guide to Hand Skills and From Flapping to Function: A Parent’s Guide to Autism and Hand Skills. Barbara’s newest book explains the developmental challenges that impact fine-motor skills and the many creative, easy to implement and inexpensive strategies to help children learn. Naturally many activities are made from or adapted using recycled materials!

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