Update: AHA, Inc. Hippotherapy Conceptual Framework

Hippotherapy, the use of medical-quality equine movement in occupational therapy (OT), physical therapy (PT), and speech-language therapy (SLP), has been incorporated into treatment for 47 years in the US. The American Hippotherapy Association, Inc. developed a Conceptual Framework (HCF) based on established treatment theories in 1997 to support research, treatment paradigms, and quality horse training/handling in therapy. This framework is presented in the AHA Foundation Course, Hippotherapy Treatment Principles Part II, and was extensively updated in 2024/2025.

 The Conceptual Framework aligns with other frameworks within these therapy disciplines, focusing on the effects of equine movement on human neurophysiology while emphasizing the necessity of high-quality equine input.  The nine identified tenets mix theoretical and observable phenomena to explain how quality equine movement can effectively improve patient function in their preferred environment. In the teaching of the Framework, AHA Faculty bring the tenets into the treatment practicums to promote the clinical reasoning expected of the therapist using this tool.   

The underlying principle of the HCF is Neuroplasticity, recognizing that modification of impairments requires changes within the central nervous system. Motor Learning, Dynamic Systems and Sensory Integration® theories are the source of the nine tenets, which are not hierarchical but do influence each other. Rhythmicity, often elusive for patients with sensorimotor impairments, can be provided with well-executed equine movement, leading to integrated rhythmic responses. Motivation and Arousal are inextricably linked and may be influenced by the equine movement experience and the environment. Therapist modified equine movement affects a patient’s arousal levels through collaboration with skilled horse handlers and engaged horses.

The therapist relies on Entrainment of the patient within the dynamic triad made up of therapist facilitation, equine movement, and specific horse handling to shift patient behavior. Identified Control Parameters facilitate replication of functional shifts observed during treatment. Treatment objectives encompass aspects of Postural Control resulting from manipulating quality equine movement input through skilled handling of the well-trained horse.

Use of equine movement facilitates the patient’s experience of varied sensorimotor challenges, promoting Adaptability in their behavioral responses and leading to Generalization in the patient’s own environment. Generalization promotes the opportunity for Self-Organization, the ultimate patient outcome. 

The AHA, Inc intends that this updated Framework reflects current thinking in our fields, and with practical implementation, becomes a useful clinical reasoning guide in practice, or a theoretical foundation for research questions. Whether hearing about the HCF for the first time or getting a fresh perspective on previously learned concepts, the AHA, Inc’s HCF provides the guiding structure for the American model of hippotherapy as a tool in treatment.