AHA is saddened to inform its members of the death of Barbara Heine, PT on March 30, 2010. Barb had been diagnosed with Mantle Cell Cancer in August 2009 and has been battling the disease since that time.

While living in the United States, Barb served as Executive Director of NCEFT in Woodside, CA.

Barb’s contributions to hippotherapy in the states and in Australia have been numerous. Barb served as education chair for AHA and for 3 years as AHA’s President. For all the therapists and instructors who have taken the AHA courses, you have all been the recipients of the educational tapes that Barb produced while at NCEFT.

Barb was instrumental in putting together the Level II course and the Long Lining course. Barb developed a manual for Australian therapists on hippotherapy and is credited with training, establishing and the credentialing of Australian hippotherapy programs.

The International Scholarship Fund was subsidized by Barb and through her generosity therapists in Russia, China and Mexico have been able to take the Level I AHA course.

Barb was one of the founding members of the American Hippotherapy Certification Board. In honor of Barb’s superior and vast equine skills, AHA had established the Barb Heine Horse of the Year award.

For the hippotherapy community, the loss of Barb will be a void impossible to fill. To Barb’s children we send our deepest condolences.

It is with great sadness that we pass along the news that Barb Glasow, PT, HPCS passed away on May 23, 2009, after a long battle with breast cancer. For those of us that saw Barb at the AHA conference earlier this month, it is hard to believe that she is no longer with us. Barb’s intelligence, wit and foresight, her strength of character and toughness were an inspiration to friends and colleagues.

In an email Pat Sayler, Barb’s partner of 23 years, wrote: “I cannot tell you how much the visit to the Conference meant to Barb; she was on such an upswing, planning her article, excited that people still appreciated her thoughts and insights. She truly missed being involved. She was thrilled to see so many new faces in the membership, knowing that as things evolve the work of AHA and hippotherapy will continue. It was a great 2 weeks for us both and, I, too, am so glad that we made the effort to come.”

Barb will be missed by all whose lives she has touched.

Obituary for Barbara L. Glasow, PT
May 23, 2009

Barbara L. Glasow, 55, passed away on Saturday morning, May 23rd in Pocono Medical Center after a long battle with breast cancer. Born in Rochester, NY she was the daughter of Robert and the late Muriel Glasow.

Barbara was Senior Class Valedictorian at Cardinal Mooney High School in Rochester, NY and graduated Summa Cum Laude in Physical Therapy from Ithaca College, NY.

After graduating college, she lived in Warwick, NY, where she began her private practice. A gifted pediatric physical therapist, she worked with Winslow Therapeutic Riding, LTD and initiated a developmental approach in the use of the movement of the horse to create functional changes in individuals with disabilities. In 1978 she began teaching seminars, and in 1982 traveled to Denmark as the PT with the US NASCP Equestrian Team to compete in the 5th International CP Games. Called the “grandmother of Hippotherapy” by her colleagues, Barbara was instrumental in fostering the creation of the American Hippotherapy Association (AHA) and the furtherance of the use of the horse in treatment by physical, occupational and speech therapists. She was the recipient of the NARHA James Brady Professional Achievement Award and the perpetual Barbara Glasow Award for AHA Therapist of the Year.

Barbara was the PT and a former Board Member for Equi-librium, Inc. Equine Assisted Services. She was a member of Zion United Church of Christ in Stroudsburg, the American Physical Therapy Association, NARHA, and AHA.

She is survived by her partner of 23 years, Patricia J. Sayler, of Effort, PA, her father, Robert A. Glasow, her brother Timothy Glasow and his wife Maryann, her sister Andrea Glasow, her nephew, Jason Glasow and fiance Stephanie Ewert.

A Celebration of Barbara’s life will be held at 2:30pm on Sunday, June 14 at Zion United Church of Christ, 14 North 8th Street, Stroudsburg, PA with fellowship to follow after the service.

In remembrance of Barbara, memorial donations may be made to Equi-librium, Inc., P.O. Box 305, Sciota, PA 18354, Zion United Church of Christ, 14 North 8th Street, Stroudsburg, PA 18360 or American Hippotherapy Association, Inc. 9919 Towne Road Carmel, Indiana 46032. Condolences may be made online at www.poconorecord.com.

Reminiscences of a Early Pioneer
by Barbara L. Glasow, PT

To have the moniker of “grandmother of Hippotherapy” in the US makes a person feel a little old sometimes. For it was only a few years ago . . . .that I was just a college student working on a research report on “Therapeutic Riding.” Back then, in 1973, it was more than a little difficult to do a literature search on a topic that was in its infancy. Virginia Martin of Winslow Unlimited and Borderland Farm in Warwick, NY was one of my chief supporters in this endeavor. What solidified my career-long interest in TR and HPOT was being at the premiere viewing of the Winslow film “Exceptional Equestrians” that was shown at the 1973 NARHA meeting in Washington, DC It was the fact that the film focused on how riding horses could be therapeutic as well as fun that hooked me.

After graduating from Ithaca College in PT, one of my many serendipitous decisions was to live in Warwick, NY and offer my PT services to Winslow as a consultant to the TR program. In those days TR was mostly about finding ways to adapt horseback riding for people with disabilities and trying to make it safe. However, it was not always therapeutic for the most physically involved riders. Within a few years, I had helped Winslow radically change their approach to TR by taking away saddles and reins, using surcingles and pads and using a more developmental approach with a focus on developing balance, symmetry, alignment and postural control in the rider and using progressive movement variations of the horse to challenge the rider before shifting focus back to developing riding skills. This turned into the beginnings of the specialization of TR with the foundations of developmental vaulting, remedial vaulting and HPOT, but without those names.

Virginia Martin was not one to hide anyone’s light under a barrel. She felt we should share this new approach with everyone. By 1978 I was thrust into the “national” limelight and started to teach in one of many seminars offered by Winslow. Anyone attending my early seminars will tell you there were plenty of rough edges. One participant later told me she had counted 150 “ums” during the 3 day course. Nowadays, people tend to have more trouble getting me to be quiet.

By the early 1980’s, I was doing courses in the Eastern US and Canada, having an impact on the quality of programs in the region. By 1982 I had the opportunity to accompany the US NASCP Equestrian Team as the PT with Jan Spink as one of the coaches, to the 5th International CP Games in Greve, Denmark with riding as a demonstration sport. By then, I also knew that the Germans were doing some interesting things with the medical application of the horse, something called “hippotherapy.” The trip to Europe gave me the excuse to stay eight weeks longer after the competition with Jan Spink to visit a variety of German HPOT programs. We ended up at the 4th International Congress on TR in Hamburg, Germany.

How enlightening! The Germans were doing the same thing on the other side of the ocean that I had been doing for the past 6 or 7 years without me knowing it! I must say the German horses might have had a little better quality of movement and training than I had been used to. The long lining was something I definitely wanted to learn. But they used the same progressions of movement (plus a few fancy ones like leg yield, side pass, and shoulder-in). However, I thought the American version, despite our horses, had a few pluses beyond the German approach. I was using more alternative positions than the Germans and had integrated principles of Sensory Integration which made it more available to a wider population of clients. I figured I could take the best of both worlds and end up with a better product.

The 4th International Congress on TR was probably the 1st congress that the Germans ever took any notice of the Americans. Beth Stanford, PT, was one of my early proteges and had started an excellent therapy program for clients with head trauma in Malvern, PA. She had enough gumption to present to this prestigious group. Well, there are head phones to listen to the simultaneous translations, which is a challenge in and of itself. Beth started her presentation with great slides of her adult head trauma clients being backridden backwards on this wonderful, one-of-a-kind horse. (Don’t try to do this in your program!) Within a few minutes the Germans were scrambling for head phones to hear her presentation with a number of questions posed at the end. Thanks to Beth, our American reputation was forever changed in a positive way. Realizing the importance of international exchange, Jan Spink and I composed a “Report on the United States” that was presented with the other country papers. The bonding was established. International relations progressed a bit further.

In 1984, NARHA sponsored Dr. Ingrid Strauss, a neurologist from Germany and a leader in HPOT, to give a 2 day course on HPOT in Amherst, MA. In November 1984, I taught my first 3 day clinical course on HPOT with the content and format that was the precursor to the present day AHA Introduction to HPOT course. The interest grew and a number of past and present AHA Board members took my early HPOT courses including Linda Mitchell, Liz Baker, Claudia Morin, and Marcee Rosenzweig.

By 1986, it was evident that more therapists were needed to be able to teach the basics of HPOT to make an impact and long term difference in the field. Enter Jean Tebay, the “mother of HPOT.” Jean was a great supporter of HPOT and had always been a visionary in TR. We were together at the 1986 NARHA annual awards banquet in Las Vegas when Jean decided to change history. Jean has many talents and is a great organizer. She pulled Jane Copeland (Fitzpatrick), PT, then prominent in the Delta Society, over to the table to confer on the idea that we needed to train a core group of PT’s and OT’s in the fundamentals of HPOT. We needed to keep the group together to develop a standardized curriculum that could be taught all across the country. Since the Germans already had a standardized curriculum in place for their PT’s, it made the most sense to ask them to create a course designed for Americans. On that night, Jean made the commitment to organize a trip to Wildbad, Germany, and Jane and I made the commitment to be part of the adventure.

Within the year, with no money and no sponsoring organization other than Jean’s non-profit Therapeutic Riding Services, Inc., Jean had made arrangements with the Kuratorium fur Therapeutische Reiten to custom tailor a composite 10 day course that combined elements of their two part course. The trio picked a cross section of 17 PT’s and OT’s from dozens who had applied; got Angela Dusenbury, PT, to be our wonderful translator; and, hired with grant money, Loretta Rowley, PhD, to be the Curriculum Development Specialist.

The infamous group from the US and Canada were:

Ellen Adolphson, PT
Liz Baker, PT
Teresa Barnes, PT
Jane Copeland Fitzpatrick, PT
Barbara Engel, OT
Barbara Glasow, PT
Jill Hansen-Byrne, OT
Judy Hillburn, OT
Pippa Hodge, PT
Carolyn Jagielski, PT
Neesa Johnson, OT
Molly Lingua-Mundy, PT
Nancy McGibbon, PT
Linda Mitchell, PT
Claudia Morin, OT
Christine Terry, PT
Colleen Zanin, OT

After the trip, Gertrude Freeman, PT, Teddy Parkinson, PT, Marcee Rosenzweig, PT and Jean Waldron, PT also played early and important roles in the group.

Further interest in HPOT was fueled in the US in June 1987, with a 6 day course taught by Frau Ursula Stamm, PT, from the Wildbad Clinic in Germany, at the National Center for Equine Facilitated Therapy in Woodside, CA, which I was fortunate enough to attend. Then, the momentous day arrived and “the group” flew from various parts of the country, and met, some for the first time, in Wildbad, for the American HPOT course of October 1987.

After long days of lessons, riding, and practicums presented by the Germans . . . the real work started. That’s when Jean Tebay and Loretta Rawley got to lead us through the DACUM (Developing a Curriculum) process. DACUM is a formal group process of curriculum development that uses workers involved in the field; identifies the duties and tasks that are used in the field; and from that, develops objectives for each task and determines the education and training needed to achieve the objectives. There we were, sitting in a classroom, tired and brain dead, being cajoled to come up with the duties and tasks of a therapist doing HPOT, writing our brilliant ideas on pieces of paper taped up all around the room. Other than our fearless leaders, we had no idea where this was going to lead.

The trip to Wildbad over, the commitment to the project continued as the National Hippotherapy Curriculum Development Committee. In the next 2 years, 4 major meetings were held in Tucson, Toronto, San Francisco, and Warwick. By November 1989, pilot test copies of 3 core curricula were presented to the Delta Society (the sponsoring organization for grants) at its annual meeting in Parsippany, NJ. The curricula developed became the basis for the present AHA courses.

From 1990 to 1992, the group began to change and evolve and its purpose shifted. An average of 2 major meetings per year continued to be held in various parts of the country. The focus shifted to fleshing out the curricula and developing audiovisuals and materials to go with each course.

Participants in the courses being taught were responding positively. More and more people attending the courses were asking for more than just the course information. They wanted networking; information on topics outside of the courses; an intermediate level course; and assistance with research ideas.

It became obvious that a more formal and permanent organization needed to be formed. The field of TR was in transition. Many of the people that were more connected with health professions and academia had been attracted to the Delta Society and its tract for TR. Delta had been supportive of our group and welcomed the possibility of a more formal affiliation with us. NARHA was struggling over a variety of issues including the direction the organization should take. There were a number of elements within the NARHA membership that were pulling the organization in several directions.

Our group had many long and serious talks about what to do. We discussed becoming a separate organization, affiliating with the Delta Society; becoming a section of the APTA, AOTA or ASHA; developing a section under NARHA; or becoming a separate, non-profit, independent organization. None of us wanted the headaches of fund raising , or the responsibility of maintaining non-profit status. Section status within APTA or AOTA could develop into several separate professional organizations, potentially splintering the group. Questions arose concerning how we could maintain consistency among several groups; how we could foster quality across disciplines; how we could encourage teaming or transdisciplinary treatments. We kept coming back to either Delta Society or NARHA, which had the ability to house all the disciplines within one organization. Delta Society had the professionalism and the setting of standards that we wanted to foster. Though, TR was only one small aspect of it’s focus. NARHA, on the other hand, was the organization that most people looked to as the national organization for TR. It housed all the various people and groups that HPOT included. And, there was a part of NARHA that was very supportive of our group and liked the direction we were taking.

By 1991, the group had developed a Mission statement, Philosophy statement and Vision and had worked on an in depth strategic plan and analysis of options. The analysis included: trends and events impacting HPOT; needs of people interested in HPOT; needs of the HPOT group as an organization; strengths and weaknesses of the group and strengths and weaknesses of Delta and NARHA. Based on this analysis, we decided to approach NARHA with the idea of developing a professional section with separate bylaws, finances and Board of Directors. The idea of a section had been researched based on the structures of APTA, AOTA, the NDTA and SII (Sensory Integration International). A meeting was held on July 21,1991 with NARHA with encouragement to have the proposal formally presented to the NARHA Board. It was a momentous meeting that I was pleased to be a part of.

On February 28, 1992, the national HPOT Curriculum Development Committee formally met in Sarasota, FL with myself as the Chair. At that meeting the Mission Statement, Vision and philosophy were formally approved. Jane Copeland (Fitzpatrick) made the motion to “form an organization that promotes professional growth among physical and occupational therapists and others interested in utilizing the horse in a treatment approach based on principles of HPOT and to have the first meeting of the organization.” The motion was adopted unanimously. An additional motion made by Nancy McGibbon was that “this organization proceed as an independent organization pending the approval of Section status by the NARHA Board of Directors.” Founding member status was established as “those nationally registered and/or state licensed physical or occupational therapists who have been involved in the National HPOT Curriculum Development Committee the entire time since its inception in 1987.”

Founding members are:

Elizabeth Baker, PT
Terri Barnes, PT
Jane Copeland (Fitzpatrick), PT
Gertrude Freeman, PT
Barbara Glasow, PT
Pippa Hodge, PT
Carolyn Jagielski, PT
Linda Mitchell, PT
Molly Lingua-Mundy, PT
Nancy McGibbon, PT
Claudia Morin, OT
Marcee Rosenzweig, PT

The first meeting of the Board of Directors of the American Hippotherapy Association (AHA) was held the very next day. By the end of the meeting, Nancy McGibbon was elected as the first President, the bylaws were passed, and committee structures and goals were established. I got the role of continuing officially in the capacity of Secretary. The financial structure would be managed through support of a pass through fund working in liaison with Mary Nastan, PT and her therapeutic riding program, Suncoast Therapeutic Equestrian Program in Florida.

In the following months, a letter inviting AHA Charter membership was sent out with an invitation to get involved on the ground floor. On November 11, 1992, the first annual meeting of the membership of the AHA was held at Tyson’s Corner, VA at the same time that the NARHA annual conference was held. During the NARHA annual conference, NARHA member signatures were gathered to support a petition for Section status within NARHA. At the January 30, 1993 NARHA Board of Directors meeting, a unanimous vote was cast to accept the proposal of AHA to become the first special interest Section of NARHA. It was a landmark occasion, soon to be followed by the acceptance of additional sections within NARHA. The AHA is forever grateful to former NARHA President, Marion May, for helping it to occur.

So where are we now? I stayed on the AHA Board until 1997 and then rotated off due to health and family issues. However, in this day of e-mail it seems I have almost as many AHA projects on my plate as in the past. Now, in its 7th year as a Section, AHA is operating under its 4th President. Out of the present 15 on the Board, only 3 are original Founding Members which is where we hoped we would be by now. It gives me great pleasure to see a vision come into being and have it be as much or more than the original vision. We have achieved many of the original goals and many are in process. There are 3 established curricula that are in constant change when needed. There is a registration process, and now, a well thought out certification process. We developed competencies and then standards. HPOT is now part of the NARHA accreditation process. There is still more to do but it feels good that I no longer need to worry about whether HPOT will die out if I am no longer active in the field. It has been a long road and the road still extends far into the future with research to be done and efficacy studies to be completed. At times I feel like the “grandmother of hippotherapy” but also as a proud one, with many children and grandchildren that any grandmother would be proud of to call part of the family.

By Barbara L. Glasow, PT

An exuberant therapist recently thought . . .”I just learned about the most wonderful new treatment that I have ever been involved with since becoming a therapist. It’s called hippotherapy!! The movement of the horse is almost magical with the results that can be achieved! I’m hooked! I’m going to stop using most of the other treatment approaches that I’ve used for 10 years and I going to become a hippotherapist and devote myself to learning everything I can about it. Then, I’m going to open a clinic devoted exclusively to the practice of hippotherapy and achieve amazing results. And then, we’ll need to do research to prove to everyone that this modality is the best treatment around for any patient with movement dysfunction. Where was this treatment when I needed inspiration in my career a few years ago?”

Enthusiasm and exuberance is wonderful. The energy we derive from something that excites us can carry us through some pretty rough times of rapid change in health care, increasing documentation demands, decreasing health insurance coverage and increasing scrutiny by managed care. Those of us who include hippotherapy in our practice would tend to agree that it is a very valuable treatment strategy and assists us in achieving functional outcomes sometimes more efficiently than with other means.

However, in these same times of increasing managed care, decreasing coverage and increasing scrutiny it is of critical importance that all therapists accurately state clearly what they are providing patients within their treatment plans and neither under nor overstate what is being done or why. Many of us have made hippotherapy out to be more than it really is and the word itself has not been helpful to us in gaining the recognition and reimbursement that we want for it.

Hippotherapy, from the word “hippos”, the Greek word for horse, was created by the Germans who use all kinds of compounds words in their language. Hippotherapy is a very logical word for them to create. It means “treatment with the help of the horse.” Physical therapists there get trained and certified and can say they are “hippotherapists”, physical therapists that treat with the horse, in the same manner as they have “hippologists”, people who train horses. As Americans, we have chosen to retain the use of the word, “hippotherapy”, thinking that it would be internationally easier to communicate with other professional colleagues around the world. Presently, over 24 countries are doing some type of medical treatment with the use of the horse and most are calling it hippotherapy.

In the United States, however, the use of the word “hippotherapy” is a very confusing term to physicians, researchers and third party payers. To them, the word hippotherapy implies that it is a unique and distinctly different treatment approach from what has ever been done before. In their eyes, it needs to be proven through research that it is effective; improves functional outcomes; and is as good as or better than other treatments. Until then they view hippotherapy as a new, emerging and investigational technology and so therefore it does not qualify for reimbursement at the present time.

When we argue that hippotherapy is a treatment strategy and not a modality or distinct treatment method it is argued back that other treatment tools don’t have the word “therapy” in it. An easy reply is that “Swiss therapy balls” are used in a wide variety of treatment procedures and are clearly treatment tools. But this does not make our lives any easier. Unfortunately, we have done such a good job of spreading the word about hippotherapy that we are probably stuck with the word for better or worse. So, all we can do is to take care in what we say about it.

We have all been guilty in misrepresenting what hippotherapy is or is not from NARHA to AHA to myself who wrote an article in 1984 “Hippotherapy – The Horse as a Therapeutic Modality”. Many clinicians casually use the terms “treatment tool” and “modality” interchangeably. As innocent as that is, the two terms mean very different things. Therapists use a wide variety of treatment tools (any instrument or device necessary to one’s profession or occupation) including gymnastic balls, scooters, balance beams, weights within the different treatment procedures of neuromuscular reeducation, therapeutic exercise or therapeutic activities. We expect to be reimbursed for the treatment procedure we provide NOT the treatment tool that is used. Modalities (“Any physical agent applied to produce therapeutic changes to biologic tissue; includes but not limited to thermal, acoustic, light, mechanical, or electric energy.”) are very different from procedures and each require their own CPT code for reimbursement. Modalities must also be FDA approved and go through the investigational technology review of insurance carriers. It is very clear, when carefully thought about, that the horse is not a modality, yet how often have we referred to hippotherapy as such?

Many of us feel that we are able to achieve quicker and better functional outcomes with the use of the horse, and in the future, hopefully sufficient research will support this conclusion. In the meantime though, we need to be educating others that hippotherapy is an inclusive term that refers to all the ways the horse can be used as a treatment strategy. Hippotherapy is NOT one separate new treatment method. Instead, therapists use the horse in a variety of treatment approaches that been used in the therapy field for years, including the neurodevelopmental treatment approach, sensory integration, motor learning, motor control, psycholinguistics. The way the horse is used for each patient depends on the needs of the specific patient, the expertise of the therapist and the training of the horse.

When we refer to using the horse or equine movement as a treatment strategy within a therapeutic procedure it is then very appropriate to bill for units of service depending on how the strategy is used. APTA and AOTA have both agreed that use of the CPT codes 97110 (therapeutic exercise), 97112 (neuromuscular education), 97530 (therapeutic activities) or 97770 (sensory integrative activities) could all be appropriate codes depending on how the tool of the horse is used by a therapist within a treatment procedure. However, when therapists call the reimbursement department of APTA to inquire how the treatment approach of “hippotherapy” should be coded, APTA has been reluctantly but correctly recommending recently (since the Korokti administrative insurance hearing occurred) that therapists use the code 97799 (for unlisted therapeutic procedure) which then requires that additional documentation be submitted in order to be reviewed for reimbursement. In this case, the therapist has presented hippotherapy as a unique treatment and since it does not have its own code number, the unlisted procedure code should be used. If instead, the therapist inquires how to code a treatment session in which neuromuscular reeducation is used in order to improve the patient’s postural control, balance and body awareness and the horse is used as a treatment tool to assist in that process, APTA would concur that use of the code 97112 for neuromuscular reeducation would be appropriate. I think you begin to see the importance of how we state what we are doing.

Many of us state that we have hippotherapy practices or that we are hippotherapists. We offer hippotherapy programs and we often market hippotherapy as a unique treatment approach to potential patients. We probably all have stated something to that effect in the past. This is great from a marketing perspective but has helped in creating the insurance backlash that we are currently facing. How might we state more clearly and correctly what we are doing?

When we are trained in hippotherapy we do not become hippotherapists but remain therapists (physical therapists, occupational therapists, speech-language pathologists) that include hippotherapy in their practice.

We offer physical therapy services (or OT, SLP) that include:

• hippotherapy
• hippotherapy as a treatment strategy
• the use of the horse in treatment
• the movement of the horse in treatment
• equine movement in treatment. Hippotherapy can be a strategy of choice used by therapists within their treatments. The new definition of hippotherapy very succinctly states what it is and what it is used for. The hippotherapy certification exam, if passed, allows therapists to state that they are a hippotherapy clinical specialist, (a clinician that includes hippotherapy in their practice and has a high level of knowledge in hippotherapy). When we obtain prescriptions for treatment the prescriptions state PT, OT, or SLP not hippotherapy since the prescription needs to state the service that is being requested. (It may state “. . . that includes hippotherapy.”)

When we use semantics correctly it sometimes seems that it takes a lot spontaneity out of life. Is it really that important to be politically correct all the time? That’s a hard question. Many of us speak more casually when explaining to a lay person what treatment they will be getting and what it will do for them in less technical terms. However, if we want to get reimbursed for the treatment we need to document what we do in much more technical and medical terms. It seems that we need to clearly make the same distinction in semantics when we speak about hippotherapy. It may require a little reflection on our part to become aware of what we are saying and in doing so we may become better educators of others in what hippotherapy is really all about.

Summary of the Do’s & Don’t of Hippotherapy Semantics

• Hippotherapy is a treatment strategy NOT a modality, unique treatment approach, form of therapy or treatment.
• Hippotherapy is NOT new. It’s been used for over 20 years in the U.S. in treatment.
• Therapists are NOT hippotherapists nor do they practice hippotherapy or have a hippotherapy practice.
• Therapists DO include hippotherapy in their practice; use the horse as a treatment tool; use the horse in treatment; use the movement of the horse in treatment or use equine movement in treatment.
• Hippotherapy can be considered a “strategy of choice.”
• Hippotherapy can be considered an inclusive term that refers to all the ways the horse can be used as a treatment strategy by PT’s, OT’s and SLP’s.

When certified by the American Hippotherapy Certification Board the therapist is a hippotherapy clinical specialist.

AHA 2000 Hippotherapy is a term that refers to the use of the movement of the horse as a strategy by Physical Therapists, Occupational Therapists, and Speech-Language Pathologists to address impairments, functional limitations, and disabilities in patients with neuromusculoskeletal dysfunction. This strategy is used as part of an integrated treatment program to achieve functional outcomes.

Physical therapists, occupational therapists and speech-language pathologists have used the movement of the horse in therapy in the United States since the 1970’s. Internationally, physical therapists have been using hippotherapy for over 30 years. Recent review has shown that hippotherapy is currently used in 24 countries. In order to provide a forum of education, communication and research among health professionals using the movement of the horse in treatment, the American Hippotherapy Association (AHA) was formed in 1992. It became an official section of the North American Riding for the Handicapped Association (NARHA) in 1993. The AHA membership is composed primarily of physical therapists, occupational therapists, and speech-language pathologists interested in the use of the horse in treatment.

The American Hippotherapy Association created a conceptual framework for the use of equine movement as a treatment strategy. The conceptual framework is based on dynamic systems theory, integrated with principles of motor learning, sensory integration, and psycholinguistics. The framework was developed to (a) provide therapists with a theoretical basis for the use of equine movement in an integrated treatment program, (b) promote effective clinical problem-solving, and (c) aid the generation of hypotheses for scientific research.

Therapists who use equine movement as a treatment strategy are encouraged to pursue specialized training in this area. AHA has developed two approved 3-day courses: Introduction to Hippotherapy – Principles and Applications and Intermediate Hippotherapy – Clinical Problem Solving. Clinicians in the United States have offered a number of continuing education programs directly related to hippotherapy since 1984. The American Hippotherapy Association published Hippotherapy Standards for use in the NARHA accreditation process for operating centers where licensed health professionals use equine movement as part of a patient’s treatment plan. Through the Standards committee, AHA sponsors therapist registration which acknowledges that a therapist has met specific education and practice requirements in hippotherapy. The American Hippotherapy Certification Board (AHCB), in collaboration with an independent testing organization, established a certification process to recognize a higher level of hippotherapy knowledge and experience. The first candidates for the Hippotherapy Clinical Specialist (HPCS) designation sat for the exam in 1999.

Hippotherapy is used as one part of a patient’s integrated treatment plan. The treatment program is based on the therapist’s evaluation and the functional goals of the patient. The therapist may choose the horse’s movement as a strategy to be used in the treatment plan if hippotherapy is the most effective and efficient means for the patient to achieve positive functional outcomes. This decision is reflective of the therapist’s own profession and theoretical model of treatment. The therapist may use the horse in a variety of ways depending on the needs of the patient. Equine movement is continually modified during a treatment session and over a period of time in response to patient changes. The therapist provides hippotherapy most often in a one-on-one treatment, but sometimes in small groups. Standard documentation reflects progress of treatment, and follows the guidelines of the therapists’ profession. Current Procedural Terminology (CPT) codes used for billing are chosen based on how this strategy is used to address specific goals of treatment.

The use of hippotherapy is consistent with standard practice for Physical Therapy, Occupational Therapy and Speech-Language Pathology as the activity is experiential, functional and in a natural environment. The movement of the horse, as the tool, can be compared to other therapy tools such as balls, scooters or swings. The variability of the horse’s movement, the rhythm, dimensionality, regularity, and the ability of the therapist to modify these movement qualities, is where the horse, as a tool, supersedes the others.

Horses used for patient treatment must meet specific selection criteria regarding movement quality, temperament and training. Even when an ideal horse is used, the treatment quality and results are based on the specialized hippotherapy training of the therapist, their clinical experience and expertise, and how well they integrate the use of the horse into a comprehensive treatment program.

There is widespread acceptance of hippotherapy within the medical/professional and educational communities. The American Physical Therapy Association (APTA), American Occupational Therapy Association (AOTA) and the American Speech and Hearing Association (ASHA) recognize hippotherapy. There are a number of universities that request placement of their health professional students in affiliations that include hippotherapy. A number of school districts pay for school based therapy that includes hippotherapy in a treatment plan because it produces educationally relevant functional outcomes. Major third party payers throughout the country reimburse for treatment that includes the movement of the horse as a treatment strategy. Continuing Education Units (CEU’s) are routinely granted for AHA approved and other courses taught by clinicians with recognized expertise in hippotherapy. Articles on the use of the horse in treatment are published in peer reviewed journals such as Physical Therapy, Physical and Occupational Therapy in Pediatrics, and Developmental Medicine and Child Neurology in addition to numerous articles in clinical publications. Presentations on hippotherapy are given at many Regional, National and International professional conferences.

Hippotherapy, the use of equine movement as a treatment strategy, has evolved over 30 years. Through education and clinical experience, therapists will continue to refine the use of hippotherapy in treatment. Using the movement of the horse as the strategy of choice has resulted in improved functional outcomes for a wide variety of patients. These positive results ensure that hippotherapy will continue to be used in treatment for many years to come.

Prepared by the American Hippotherapy Association Practice Committee
April 2000 – May be reproduced in its entirety.

Before 1900

• 460-377 B.C. – Hippocrates in ancient Greece wrote a chapter on ‘Natural Exercise’ and mentions riding
• 1569 – Merkurialis of Italy wrote on ‘The Art of Gymnastics’ mentioning the horse and riding
• 1780 – Tissot of France in his book ‘Medical and Surgical Gymnastics’ regarded riding at the walk as the most beneficial gait. He was also the first to describe the effects of too much riding as well as contraindications.

Since 1900

• In 1952 at the Helsinki Olympics, Liz Hartel won a silver medal in equestrian sports and told the world how riding had helped her recover from polio.
• In the 1960’s therapeutic riding centers developed throughout Europe, Canada and the US.
• In the 1960’s the horse began to be viewed as an adjunct to physical therapy in Germany, Switzerland, and Austria. This endeavor was called ‘hippotherapy’.
• In 1969 the North American Riding for the Handicapped Association (NARHA) was established in the United States.
• In the 1970’s physical therapists in the United States began to develop treatment uses for the movement of the horse.
• In 1987 a group of 18 American and Canadian therapists went to Germany to study hippotherapy and began development of a standardized hippotherapy curriculum.
• 1988-1992 – Further development of standardized curricula on hippotherapy by the National hippotherapy curriculum Development Committee.
• 1992 – Formation of the American Hippotherapy Association.
• 1993 – The American Hippotherapy Association was approved as the first Section of NARHA.
• 1994 – AHA Inc. established therapist registration and set standards of practice for hippotherapy. 1999 – American Hippotherapy Certification Board was established. The first Hippotherapy Clinical Specialists (HPCS) examination w

Founding Members: These nationally registered and/or state licensed physical or occupational therapists have been involved in the National Hippotherapy Curriculum Development Committee the entire time since its inception in 1987.

• Elizabeth Baker
• Terri Barnes
• Jane Copeland Fitzpatrick
• Gertrude Freeman
• Barbara Glasow
• Pippa Hodge
• Carolyn Jagielski
• Linda Mitchell
• Molly Lingua
• Nancy McGibbon
• Claudia Morin
• Marcee Rosenzweig

Joann Benjamin, PT, HPCS
PT Advance – Summer 2000

With an ever-increasing number of people seeking treatment in community, non-clinical settings, it comes as no surprise that hippotherapy is as popular as it is effective. Many patients, parents and doctors are requesting hippotherapy as part of a rehabilitation program. Therapists who integrate hippotherapy have found increasing demand for their services. Across the country, more and more therapists are learning about hippotherapy, and are including it in their practice.

Hippotherapy literally means treatment with the help of a horse, from the Greek word hippos meaning horse. The American Hippotherapy Association (AHA) has defined hippotherapy as “a term that refers to the use of the movement of the horse as a strategy by Physical Therapists, Occupational Therapists, and Speech-Language Pathologists to address impairments, functional limitations, and disabilities in patients with neuromusculoskeletal dysfunction. This strategy is used as part of an integrated treatment program to achieve functional outcomes.”(AHA, 2000)

Current concepts of Hippotherapy have developed from earlier principles, developed in Germany and practiced widely throughout Europe since the 1960’s. This model formed the basis of the first curriculum established for Hippotherapy in the U.S. in 1987.

The movement of the horse is the strategy that a therapist uses to improve a patient’s neuromotor function. The patient may be positioned astride the horse facing forward or backward, sitting sideways, lying prone or supine. The patient interacts with, and actively responds to, the horse’s movement. The therapist’s responsibility is to continuously analyze the patient’s responses and adjust accordingly the manner in which the horse is moving. For this reason the therapist must have sufficient understanding of the movement of the horse to direct the experienced horse handler/therapeutic riding instructor to alter the tempo and direction of the horse as indicated by the patient’s responses.

Often, the primary focus of a PT treatment is the patient’s postural and motor responses. Positive effects from the movement of the horse can be seen in motor coordination, muscle tone, postural alignment, stiffness/flexibility and strength. Other effects on body systems can and do occur as well. Changes are often seen in the respiratory, cognitive, sensory processing, balance, affective, arousal and speech/language production functions. These changes may be a consequence of the postural and motor changes. For instance, the patient’s respiration and speech will improve as a result of improvements in trunk alignment and motor coordination. Many times, however, the system changes are a direct result of the horse’s movement. The focus of PT may not be to achieve changes in speech production, but it can often occur. That is the beauty of using the horse’s movement as a treatment strategy and also why the varied disciplines of PT, OT and Speech can use hippotherapy so successfully as a part of their treatment programs.

The therapist will use activities on the horse that are meaningful to the patient and will specifically address the particular functional goals of that patient. Goals are function oriented, and would not include specific skills associated with being on a horse, such as riding. The movement of the horse provides a foundation of improved neuromotor function and sensory processing that can be generalized to a wide variety of activities outside the treatment setting. In other words, the patient’s adaptive responses to the horse’s movement ultimately bring about improvements in function. Because the environment is a natural one, often the challenges associated with being in a non-clinical setting add additional opportunities to make the hippotherapy portion of treatment beneficial for the patient’s community integration.

Hippotherapy is part of a complete treatment program. It can be used as a preparatory activity such as using the movement of the horse to facilitate increased arousal and postural tone for a patient who is hypotonic, prior to gait training. It can be used to mobilize the spine and pelvis to allow for participation in developmental positions on the floor. Hippotherapy can be used as a primary strategy, leading to improved function off of the horse. Just a few examples might be the achievement of midline orientation, reciprocal weight bearing through the pelvis as is needed for gait or unilateral reaching, or improved sequencing/motor planning when asked to do activities on the horse. The movement of the horse may be used as a follow up to other PT procedures done off of the horse, to reinforce the input from the therapist and improve generalizability of a task. The possibilities of using the strategy are endless, as the input from the movement of the horse is so strong, and provides such a variety of sensory-motor experiences.

The Therapist’s Role in Hippotherapy

There are guidelines as to the qualifications, responsibilities and training requirements of therapists wishing to practice Hippotherapy that have been established by the American Hippotherapy Association and approved by the North American Riding for the Handicapped Association (NARHA). Keep in mind, the use of the horse’s movement as a treatment strategy does not mean that a therapist is a ‘hippotherapist’ any more than a physical therapist using the principles of NDT is a neurodevelopmental therapist, or a PT using a pool is an aquatherapist.

Any therapist providing direct treatment services in a Hippotherapy program should meet the following qualifications:

• Is licensed or registered to practice PT, OT, or SLP
• Has received training in the principles of Hippotherapy, equine movement and equine psychology. One way that this can be achieved is through attendance at an AHA approved 3-4 day course “Introduction to Hippotherapy”.
• Is the equivalent of a NARHA registered instructor (minimum level) and, if not, has a NARHA registered instructor assisting with the horse at all treatment sessions, assuring that the horse is handled effectively, humanely and with utmost safety.
• Maintains current professional and general liability insurance.

Because hippotherapy is part of the integrated treatment plan, the initial evaluation, documentation, discharge criteria, and billing will all follow the structure consistent with the profession of the therapist who is using the movement of the horse as a treatment strategy. Long and short term goals are established which are functional, measurable and relevant to the patient’s needs.

Therapists who have completed an introductory hippotherapy course and have basic hippotherapy experience can become registered with the AHA. Registration is required for a therapist who uses hippotherapy at a NARHA accredited program and indicates a basic level of knowledge of hippotherapy. Once a therapist has achieved extensive clinical experience using hippotherapy as part of their professional practice, they are eligible to take the Hippotherapy Clinical Specialist Examination administered by the Professional Testing Corporation (PTC). A therapist who passes this advanced exam is a Hippotherapy Clinical Specialist (HPCS). There are currently fewer than 50 clinical specialists in the US, though this number is growing.

Additional Roles for Therapists

Therapists have much to offer any therapeutic riding program and may become involved in roles other than in hippotherapy or direct patient service. These can include:

• Consultation
• Staff and volunteer training in body mechanics, physical and cognitive impairments, basic handling/transfer skills, precautions and contraindications
• Community education regarding benefits of the horse in rehabilitation
• Liaison with the medical community
• Recruitment of additional health care professional
• Referral of patients/clients
• Competitive rider classification at the National and International levels

By helping in this way, a therapist has an opportunity to observe the innumerable qualities of the horse. This can often be such an enlightening experience that the therapist will be motivated to gain the additional skills and training necessary to provide direct service.

Hippotherapy offers the therapist a unique opportunity. The input that the movement of the horse provides to the patient is natural, rhythmical, multi-dimensional, and rich in sensory input. The therapist can use the tool in many ways to create a neuromotor experience unequal to any other tool the therapist has. It is no wonder hippotherapy continues to be requested by therapists, doctors and patients – as a part of a treatment program that will help therapists help their patients achieve their goals.



Would you like to contact a Hippotherapy Clinical Specialist® or AHA Inc. Member Therapist in your area to find out more about hippotherapy? Or perhaps you would like a speaker at your next professional meeting?
(US Therapists | Foreign Therapists)

HPCS – A therapist who carries the AHCB Board Certification in Hippotherapy. Hippotherapy Clinical Specialists names are followed by ‘HPCS’ on this list.

Level II  – A therapist who has completed both Level I and II AHA Approved Courses who demonstrates clinical problem solving with respect to clinical reasoning, the Hippotherapy Conceptual Framework and application of the Disablement Model. They have clinical application of NDT, SI and Motor Learning within the hippotherapy treatment strategy.

Level I  – A therapist who has completed the AHA Approved Level I Course who has gained the basic knowledge of the horse’s movement and its application to patients with neuromuscular disorders. They have also gained knowledge of horse and patient selection, evaluation, treatment planning and business aspects.

** NARHA Registered Therapist

AHA Inc. Member Therapists: Want to be included on this list? If so, please send your contact information along with your participation details of the AHA Approved Courses you have completed to info@americanhippotherapyassociation.org today! New members must request their name be added. It will not be done automatically.

AHA Inc. does not endorse, nor certify clinical competence of therapists. Each therapist is bound by their own national and state practice acts, dependent upon their area of practice (physical, occupational or speech). It is always a good idea to speak at length with, and interview your clinical practitioner.

The following Hippotherapy Clinical Specialists® (HPCS) and AHA member therapists may be able to assist you:

Find A Therapist In the United States

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