How the use of Horses in Treatment can Help People with
a Variety of Diagnoses and Disabilities
Attention Deficit Hyperactive Disorder
Diagnoses:
Attention Deficit Hyperactive Disorder
Autism
Cerebral Palsy
Down Syndrome
Intellectual Disability
Multiple Sclerosis
Neurological Disorders/ Impairments
Older Adults
Spinal Cord Injury
Stroke
Veterans
Attention Deficit Hyperactive Disorder (ADHD) is a common disorder among children and can impact many areas of their lives (18). They often fall behind their peers developmentally (18). Along with attention, children with ADHD often struggle with their functional motor performance, social problems, low self-esteem, anxiety, and academic problems (18). Research supports the use of horses in treatment to be beneficial for children with ADHD. The rhythmic stride of the horse challenges the balance and postural control of the client, improving their motor and postural control (18). This treatment strategy combines both motor learning and sensory integration techniques to improve function and participation in the daily lives of the clients (18). Due to the repetitive rhythmic movement of the horse’s gait the client’s vestibular system is constantly being challenged. Research has shown that both motor planning and intellectual abilities are positively stimulated through stimulation of the vestibular system (18). Along with varied challenging activities the client participates in during a session, Using horses in treatment can benefit the cognitive development of children with ADHD. Studies have also shown that physiological effects from the rhythmic movement of the horse’s gait and the surrounding environment can have a positive impact on the psychological well-being decreasing depressed and anxiety (18). This can lead to an increase in self-esteem for clients participating in this type of therapy sessions. It can be a beneficial treatment strategy for children with ADHD increasing their participation in daily activities and improving their overall well-being.
Autism
Autism spectrum disorder (ASD) is a common neurodevelopmental disorder that often impacts social skills, language development and can include cognitive and sensory processing deficits and repetitive and stereotypical behaviors (11). The horse and the environment of a hippotherapy session is a multi-sensory environment that often calms the sensory systems of clients with ASD and encourages communication and social participation (12). During the treatment session the client participates in activities with the therapist and other members of the treatment team that promote communication, social participation, and increased attention (13). Hippotherapy is a form of animal-assisted therapy that has been shown to reduce problem behaviors in children with ASD (14). The connection formed from the human-equine interaction often creates a calming effect decreasing anxiety in many individuals (14). Between 80% and 90% of people diagnosed with ASD also have motor impairments (11). Many also have problems with their postural control and motor coordination due to a lack of body awareness (11). The movement of the horse challenges the client’s postural control, balance, and motor control while they are mounted on the horse (11). There are many different ways that hippotherapy can help to improve participation in many daily activities for both children and adults with ASD
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Cerebral Palsy
Cerebral palsy (CP) occurs in 1 to 3 out of 1,000 births (7). The injury that occurs before, during, or shortly after birth can lead to many deficits such as abnormalities in muscle tone, reflexes, and righting movements, as well as impaired motor development, balance, and control, and possible complications with vision, cognition, and social development (7). These complications make it challenging for people with CP to participate in many daily activities. In hippotherapy, it is the movement of the horse that improves balance, strength, posture, motor control, and function (7). The warmth and movement the rider experiences from the horse will reduce tone and often relaxes patients with spastic CP (10). Clients with CP will often participate in various activities during intensive rhythmic equine movement experiences while mounted and moving through space, further challenging postural control as the horse changes direction, halts, starts, and changes speed during the treatment session. This further improves their gross and fine motor skills. The improvement in the client's strength and balance helps to increase their function in daily tasks (2). It is also a very fun and motivating activity that clients enjoy while they are experiencing such an intense form of exercise and intervention (2).
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Down Syndrome
Children born with Down Syndrome (DS) often show developmental delays in many areas including walking, motor skills, functional activities, communication, and cognitive development (17). These children often show clumsiness, slower movements, and slower reaction time that often persist into adulthood (17). They also often struggle with balance and postural deficits (17). These motor delays often make it more challenging for children with DS to participate in many activities that are important to them and their development. Hippotherapy can benefit children with DS in many different ways. The horse challenges the client’s balance, posture, strength, and motor control (10). There are many different activities that can be used during a hippotherapy treatment session to help children with DS improve their motor control, strength, and motor planning. There are also activities that can be used to help children with their cognitive and linguistic development. Children with DS can benefit from hippotherapy in many ways.
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Intellectual Disability
Individuals with intellectual disabilities (ID) struggle with learning new cognitive skills, memory, and attention (21). Their intellectual disability may lead to emotional problems including anxiety, and impact their ability to live independently and participate in desired daily activities. An individual may be diagnosed with ID or it may co-occur with another diagnosis such as autism, cerebral palsy, stroke, and Down syndrome. These individuals oftentimes also struggle with their social skills and motor control (21). Motor control relies on the ability to maintain stability through sequencing controlled movements (21). Individuals with ID often struggle with this as well as needing more time to initiate and respond to movements (21). One reason for this suggests that they don’t process incoming visual and vestibular information as efficiently (21). Research has shown hippotherapy to be very beneficial for individuals with ID (21). The multi-sensory environment of a hippotherapy session provides input that strengthens the sensory processing system (21). This often makes it easier to attend to and work through different motor and cognitive tasks. Hippotherapy also benefits client’s balance, motor control, and cognitive abilities.
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Multiple Sclerosis
Multiple Sclerosis (MS) is a chronic progressive disease resulting from demyelination and loss of axons in the central nervous system (25). Common symptoms involved in MS are loss of functional activity, strength, balance, postural control, coordination, motor control, and sensation (25, 26). By using the rhythmic movement of the horse, hippotherapy can help clients with MS improve in many of these areas leading to an increase in participation in daily tasks (25). hippotherapy is a multisystem integrative therapeutic approach that can strengthen many systems at the same time due to the horse and the surrounding environment (26). Many clients with MS who participate in EAT also receive psychosocial benefits from the atmosphere and the environment of the treatment sessions (25).
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Neurological Disorders/ Impairments
Many different neurological disabilities can occur in both childhood and adulthood, resulting in a variety of impairments and symptoms. They can occur developmentally or from an illness. Some injuries can also result in traumatic brain injuries. Often with neurological impairments, there are both cognitive and physical impairments, as well as social and psychological deficits. Hippotherapy is an integrative treatment strategy that can benefit clients in multiple ways during treatment sessions. For individuals with neurological impairments or brain disorders, research provides compelling evidence that hippotherapy can be used to help improve the client’s balance, posture, flexibility, gait function, and emotional well-being (27, 16). The horse and the surrounding environment can also help stimulate and benefit the client’s vestibular, visual, and other sensory systems (16). There are many activities that clients can participate in during a hippotherapy treatment session to help improve both their motor control and their cognitive abilities. By participating in hippotherapy treatment sessions, children and adults with neurological impairments can improve their participation in meaningful daily activities.
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Older Adults
In adults over the age of 65, falls are the leading cause of injury and death (28). This is often due to a decline in balance, strength, and sensory systems that is part of the natural aging process (28). Fear of falling in older adults is very common and often leads to a decrease in independence and participation in meaningful activities leading to social isolation (28). A decline in balance can also lead to slower reaction speeds and a decrease in motor control (28). Balance is essential for both. In hippotherapy, the movement of the horse during the treatment session is used to improve their balance, muscle strength, postural control, motor control, and coordination for older adults (28). In addition to physical benefits, hippotherapy can offer clients sensory and psychosocial benefits (28). There are also many activities that clients can participate in during the treatment session to improve their memory and cognitive skills. This treatment can improve independence and activity participation in older adults.
Spinal Cord Injury
Spinal cord injuries (SCI) can range in severity and impairments depending on where on the spine the
the injury occurred and the severity of the injury. Often balance is a struggle for individuals with SCI due to motor control and sensory deficits in their lower limbs and trunk. Hippotherapy is a beneficial intervention strategy for improving balance and motor control (22). By improving these symptoms, individuals will be able to participate in important tasks with more ease. Spasticity is also a common symptom of SCI (22). Spasticity consists of uncontrollable muscle spasms producing high muscle tone (22). It can make daily tasks more challenging. By improving motor control through the rhythmic stride of the horse, hippotherapy can help improve spasticity by regulating muscle tone (22). Individuals with SCI often go through a life-altering event and may experience anxiety or depression when adjusting to their new lifestyle. Research has shown that hippotherapy can also improve the mental well-being of individuals with SCI (22). Many of the symptoms and struggles experienced by individuals with a SCI can be addressed through hippotherapy.
Stroke
Stroke is a common injury to the brain due to a disturbance in the blood supply to the brain, resulting in impairments and disabilities that vary from person to person (15). Symptoms resulting from a stroke can vary from problems with balance, gait, and motor control to deficits in cognitive skills, speech, and memory. Physical, psychological, social, and cognitive impairments resulting from stroke can lead to a decrease in function and quality of life (15). In hippotherapy, the use of the horse, its movement, and environmental opportunities as therapeutic tools allow for the biopsychosocial development of skills for individuals with motor impairments (15). The horse can be used during the intervention to strengthen the client's balance and stability as well as their motor control. Hippotherapy also provides an experience that leads to an interaction of the sensory, vestibular, tactile, visual and postural senses, strengthening each one (16). The movement of the horse and the stimulating environment present during a hippotherapy treatment session leads to improvement in function and quality of life for patients who have suffered from a stroke (15).
Veterans
Hippotherapy has been used as an intervention to help many veterans who have come home from war and have suffered many injuries, both physical and psychological. It has benefited many individuals who have lost their limbs in battle (24). Participating in hippotherapy treatment sessions improved their balance, posture, flexibility, strength, and self-esteem (24). Veterans with various disabilities have used hippotherapy intervention to reduce pain, improve walking, improve core strength, decrease spasticity, improve body image and self-concept, and improve sensory and motor planning skills and coordination (23, 24). Through participating in hippotherapy, these clients often experience psychological benefits, including improved social skills, self-esteem, life satisfaction, decreased anxiety, and overall wellness (23, 24). Veterans often struggle with adjusting to their lives after returning home due to physical and psychological impairments. hippotherapy can be a beneficial intervention to help them with this adjustment and to improve their overall well-being.