The term hippotherapy refers to how occupational therapy, physical therapy, and speech-language pathology professionals use evidence-based practice and clinical reasoning in the purposeful manipulation of equine movement as a therapy tool to engage sensory, neuromotor, and cognitive systems to promote functional outcomes.

Best practice dictates that occupational therapy, physical therapy, and speech-language pathology professionals integrate hippotherapy into the patient’s plan of care, along with other therapy tools.

Simply put, hippotherapy refers to the use of equine movement (the movement of the horse) as a treatment tool within occupational therapy, physical therapy, or speech-language pathology treatment.

The term hippotherapy originates from the Greek word “hippos” meaning horse (or equine), and roughly translates as “treatment with the help of the horse”.

When including hippotherapy in treatment, therapists carefully select horses for their clients based on their temperament, movement, and conformation. The movement of the horse is then carefully and purposefully manipulated to impact the client. In addition, skilled and licensed healthcare professionals use various developmental positions to further enhance this movement. Hippotherapy is combined with other standard therapy tools in an intervention plan designed to address the treatment needs of the client.

To use hippotherapy in treatment, one must be a licensed therapist who has completed continuing education in the inclusion of horses and equine movement (hippotherapy) in treatment.  Licensed occupational therapy, physical therapy, and speech-language pathology professionals may include equines and/or hippotherapy in treatment when working within their scope of practice. This has long been recognized by the American Occupational Therapy Association, the American Physical Therapy Association, and the American Speech-Language-Hearing Association.

Licensed therapy professionals in occupational therapy, physical therapy, and speech-language pathology are legally bound to follow the mandates of their state licensure, their codes of ethics, and their practice acts. They are required to obtain professional continuing education, such as that offered by the American Hippotherapy Association, Inc.

Therapists can seek training in how to safely and effectively include hippotherapy within their practice through continuing education. Therapists may then choose to pursue board certification in the inclusion of hippotherapy in treatment from the American Hippotherapy Certification Board.

The American Hippotherapy Association published Best Practice Statements for healthcare professionals who include hippotherapy in treatment in 2015, with the document most recently updated in 2023.

Horseback riding is a recreational activity with the rider controlling the horse. When referring to horseback riding lessons for individuals with special needs, AHA, Inc. recommends the use of the term adaptive riding in place of therapeutic riding. This term more accurately describes the activity, being consistent with other activities such as adaptive skiing, adaptive basketball, and adaptive swimming. Adaptive riding is a riding lesson adapted for individuals with special needs, taught by horseback riding instructors. This activity is recreationally based, and goals may address leisure, education, socialization, competition in the sport, and fitness. It is not the goal of the instructor to rehabilitate, but rather to improve riding skills and quality of life through participation in an enjoyable activity.

Therapy with a licensed occupational therapy, physical therapy, or speech-language pathology professional that incorporates equines and/or hippotherapy differs greatly from riding lessons for individuals with special needs.  Therapy services require medical necessity and are highly regulated. The therapist may choose to include hippotherapy in treatment based on their clinical reasoning/experience, the best available research, and client or patient values.  The purpose of including hippotherapy in treatment varies depending on the therapist and treatment goals.

• Hippotherapist (or related terms such as equine therapist, horse therapist, etc.)

• Equine therapy/equine therapist/horse therapy/horse therapist (refer to the type of therapy that is happening instead, based on the therapist’s license, i.e., physical therapy incorporating hippotherapy)

• Terms that refer to hippotherapy as “magic” (the inclusion of hippotherapy in treatment supported by research and is an evidence-based practice when utilized within occupational therapy, physical therapy, and speech-language pathology services)

• Alternative therapy/treatment (hippotherapy is not an alternative treatment. It is a treatment tool that can be utilized by occupational therapy, physical therapy, and speech-language pathology professionals)

• Rider (when an individual is receiving therapy on or off a horse, they are referred to as a patient or client. Since hippotherapy is not a riding lesson, and the client is not learning horseback riding skills, the term “rider” is not accurate

• Hippotherapy is not a separate type of therapy.  Patients are receiving occupational, physical, or speech-language pathology services (depending on the licensed professional who they are seen by). They are working on functional therapy goals, not horseback riding skills. The outcome measure for the patient is a change in functional independence across environments.

• Clients who receive occupational therapy, physical therapy, or speech-language pathology services must demonstrate medical necessity- therapy is not a recreational activity.

• Healthcare services incorporating horses are highly regulated. This differs from therapeutic or adaptive riding lessons, which have little to no oversight or regulation and are not provided by licensed therapists.

• The use of hippotherapy in occupational therapy, physical therapy, or speech-language pathology treatment is well supported within the research and falls within evidence-based practice.

• Occupational therapy, physical therapy, and speech-language pathology services incorporating hippotherapy is a medical treatment and may be billed to third parties for reimbursement. Therapy is commonly covered within health insurance plans. A small number of private insurers have exclusion policies related to the inclusion of animals or hippotherapy within treatment.

• Horses selected for use in occupational therapy, physical therapy, or speech-language pathology services must meet specific selection criteria regarding movement quality, temperament, and training. The health, wellness, soundness, and temperament of the horse are critical components.

•  Skilled handling of the horse is critical.

For your additional references, you may wish to reference the following documents and websites:

• American Hippotherapy Certification Board

• Research related to hippotherapy: Bibliography

• Position on the use of hippotherapy in treatment in the U.S.

• AHA RecommendedTerminology document (includes definitions as well as terms to avoid)

• Letter from American Physical Therapy Association (APTA) about hippotherapy

• Letter from American Occupational Therapy Association (AOTA) about hippotherapy

• Letter from American Speech-language Hearing Association (ASHA) about hippotherapy

• Issue Brief – “Therapeutic Riding”

• Issue Brief – Clarification on Hippotherapy and Adaptive Riding/Therapeutic Riding