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Hippotherapy is a form of physical, occupational and speech therapy in which a therapist uses the characteristic movements of a horse to provide carefully graded motor and sensory input. A foundation is established to improve neurological function and sensory processing, which can be generalized to a wide range of daily activities. Unlike therapeutic horseback riding (where specific riding skills are taught), the movement of the horse is a means to a treatment goal when utilizing hippotherapy as a treatment strategy.
Derived from the Greek hippos (horse), "hippotherapy" literally refers to treatment or therapy aided by a horse. The concept of hippotherapy finds its earliest recorded mention in the ancient Greek writings of Hippocrates. However, hippotherapy as a formalized discipline was not developed until the 1960s, when it began to be used in Germany, Austria, and Switzerland as an adjunct to traditional physical therapy. In Germany hippotherapy was treatment by a physiotherapist, a specially trained horse, and a horse handler. The theories of physiotherapy practice were applied; the physiotherapist gave directives to the horse handler as to the gait, tempo, cadence, and direction for the horse to perform. The movement of the horse was carefully modulated to influence neuromuscular changes in the patient. The first standardized hippotherapy curriculum would be formulated in the late 1980s by a group of Canadian and American therapists who traveled to Germany to learn about hippotherapy and would bring the new discipline back to North America upon their return. The discipline was formalized in the United States in 1992 with the formation of the American Hippotherapy Association (AHA). Since its inception, the AHA has established official standards of practice and formalized therapist educational curriculum processes for occupational, physical and speech therapists in the United States.
Equine-assisted therapy is an umbrella term for therapy incorporating the equine environment into a treatment session within the scope of a therapist's practice and professional designation.Physical and occupational therapists, physical and occupational therapy assistants, and speech and language pathologists practicing hippotherapy incorporate the horse's movement into the total care plan for their patients.
In the mental-health field, social workers, psychologists and mental-health providers may incorporate equine-assisted psychotherapy into their treatment sessions. This is different from hippotherapy, where the movement of the horse influences or facilitates an adaptive response in the patient. Forms of equine assisted psychotherapy may have the patient on or off the horse, and the treatment is not focused on a set of specific movements for the horse to produce an adaptive response in the patient.
In the United States, the American Hippotherapy Association (AHA) offers education to therapists, promotes research in equine assisted therapy and provides continuing education courses.
The role of the horse
The horse's pelvis has a similar three-dimensional movement to the human's pelvis at the walk. The horse's movement is carefully graded at the walk in each treatment for the patient. This movement provides physical and sensory input which is variable, rhythmic and repetitive. The variability of the horse's gait enables the therapist to grade the degree of input to the patient and use this movement in combination with other treatment strategies to achieve desired therapy goals or functional outcomes. In addition, the three-dimensional movement of the horse's pelvis leads to a movement response in the patient's pelvis which is similar to the movement patterns of human walking. A foundation is established to improve neurological function and sensory processing, which can be generalized to a wide range of daily activities and address functional outcomes and therapy goals.
Hippotherapy has been used to treat patients with neurological or other disabilities, such as autism, cerebral palsy, arthritis, multiple sclerosis, head injury, stroke, spinal cord injury, behavioral disorders and psychiatric disorders. The effectiveness of hippotherapy for many of these indications is unclear, and more research has been recommended. There is a lack of scientific evidence regarding the effectiveness of hippotherapy in the treatment of autism. The Argentine Institute for Clinical Effectiveness and Health Policy concluded, in a study of the evidence for the efficacy of hippotherapy, that there were generally significant problems in terms of study design and/or methodology. "The efficacy of this therapy does not seem to have been sufficiently proven for any specific indication. Its recreational role and impact on the quality of life of these patients have not been sufficiently analyzed."
Use in physical, occupational, speech and language therapies
Physical therapists who have had training in hippotherapy may incorporate the multi-dimensional movement of the horse to achieve gait training, balance, postural/core control, strengthening and range of motion goals. Improvement in gross motor skills and functional activities for developing children with disabilities has been reported. Impairments are addressed through the variability of the horse's movement by modifying the rhythm, tempo and cadence of the horses movement.
Occupational therapists providing hippotherapy utilize the movement of the horse to improve motor control, coordination, balance, attention, sensory processing and performance in daily tasks. The reciprocal multi-dimensional movement of the horse helps with the development of fine motor skills, visual motor skills, bilateral control and cognition as well. Sensory processing via hippotherapy simultaneously addresses the vestibular, proprioceptive, tactile, visual and auditory systems. The occupational therapist incorporates the movement of the horse, hippotherapy, to modulate the sensory system in preparation for a therapy or treatment goal that leads to a functional activity.
Hippotherapy has also seen use in speech and language pathology. Hippotherapy uses a horse to accomplish traditional speech, language, cognitive, and swallowing goals. Using hippotherapy, appropriate sensory processing strategies have been integrated into the treatment to facilitate successful communication.
The American Hippotherapy Association offers certification qualifications for working as a hippotherapist. Hippotherapy Clinical Specialty (HPCS) Certification is a designation indicating board certification for therapists who have advanced knowledge and experience in hippotherapy. Physical therapists, occupational therapists, and speech-language pathologists in practice for at least three years (6,000 hours) and have 100 hours of hippotherapy practice within the prior three years are permitted to take the Hippotherapy Clinical Specialty Certification Examination through the American Hippotherapy Certification Board. Those who pass are board-certified in hippotherapy, and entitled to use the HPCS designation after their name. HPCS certification is for five years. After five years the therapist can either retake the exam or show written evidence of 120 hours of continuing education distributed over the five years. Continuing education must include 50% (60 hours) in education related to equine subject matter: psychology, training, riding skills and so on; 25% (30 hours) in education related to direct service in the professional discipline and 25% (30 hours) in any other subject related to hippotherapy. An alternative is to provide written evidence of scholarly activity appropriate to the field of hippotherapy. Acceptable scholarly activity may include graduate education in hippotherapy, publication of articles on hippotherapy in juried publications, scientific research related to hippotherapy, the teaching or development of hippotherapy, or acting as AHA-approved course faculty. AHA, Inc now recognizes two different AHCB credentials: AHCB Certified Therapist and AHCB Certified Hippotherapy Clinical Specialist. 
Professional Association of Therapeutic Horsemanship (PATH) International, offers similar licensing and certification processes, for the center hosting hippotherapeutic activities. Accreditation is a voluntary process that recognizes PATH Intl. Centers that have met established industry standards. The accreditation process is a peer review system in which trained volunteers visit and review centers in accordance with PATH Intl. standards. A center that meets the accreditation requirements based on the administrative, facility, program and applicable special interest standards becomes a PATH Intl. Premier Accredited Center for a period of five years. There are more than 850 Professional Association of Therapeutic Horsemanship International (PATH Intl.) Centers in the United States and around the world providing equine-assisted activities and therapies. These member centers range from small, one-person programs to large operations with several certified instructors and licensed therapists. In addition to therapeutic equitation, a center may offer any number of equine-assisted activities and therapies, including Hippotherapy, equine facilitated mental health, driving, vaulting, trail riding, competition, ground work or stable management. 
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American Hippotherapy Association
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