Danielle Champagne, Claude Dugas
Physiotherapy Theory and Practice (2010) 

Description 
The purpose of this case report is to describe the impact of an 11-week hippotherapy program on the gross motor functions of two children (respectively 28 and 37 months old) diagnosed with Down syndrome. Hippotherapy is a strategy that uses the horse's motion to stimulate and enhance muscle contraction and postural control.

Conclusion
The hippotherapy intervention for these two children with Down syndrome improved their motor performances in fundamental motor skills (walking, running, and jumping), as revealed by the GMFM results

Valéria Sovat de Freitas Costa, Hudday Mendes da Silva, Elioenai Dornelles Alves, Patrick Ramon Stafin Coquerel, André Ribeiro da Silva, Jônatas de França Barros
Fisioter. (2015) 

Description 
Individuals with Down syndrome may have decreased respiratory muscle strength due to hypotonia, a common characteristic in this population. 

Results 
Individuals who practiced hippotherapy showed improvements in both inspiratory and expiratory respiratory muscle strength, although no significant difference was demonstrated.

Conclusion
This study demonstrates that hippotherapy benefits respiratory muscle strength in individuals with Down syndrome, and that the youngest subjects had the best results.

Voznesenskiy, Rivera-Quinatoa, Bonilla-Yacelga, Cedeno-Zamora
Procedia - Social and Behavioral Sciences (2016) 

Description 
A study was conducted to assess the effect of an equine-assisted physical activity and an adaptive horseback riding program in comparison with conventional adapted physical education designed to develop gross motor skills measured by the Gross Motor Function Measure (GMFM-88) in children with Down syndrome in a special education institution. 

Results
According to the fitted ordinary least squares and robust regression models, the equine-assisted activities program had, on average, a large positive effect on children's gross motor development in comparison to the conventional physical education in the control group for 3 months.

Conclusion
Evidence is provided with regard to the short-term improvement of the gross motor function in children with Down syndrome participating in equine-assisted activities, in comparison to regular adapted physical education, in a special education institution. Further research is needed to assess medium and long term effects of equine-assisted activities on gross motor development in children with Down syndrome.

Ribeiro, Espindula, Ferreira, Ferraz, Sande de Souza, Diniz, Teixeira
Physiotherapy (2015) 

Description 
Hippotherapy is a therapeutic method that uses the horse’s movement to achieve functional results in practitioners with Down syndrome (DS), who present motor and neurophysiological changes that affect the musculoskeletal system. Evaluating the motor behavior related to the control and the improvement of muscle activation in practitioners with Down syndrome subjected to hippotherapy. 10 practitioners were divided into two groups: Down Group (DG) - practitioners with DS, and Healthy Group (HG) - practitioners with no physical impairment.

Conclusion
Practitioners with DS presented satisfactory changes in muscle activation pattern, in learning and in motor behavior during hippotherapy sessions.