Hippotherapy and Equine-Assisted Therapy for Children

What is Hippotherapy & Equine Therapy?

A horse's walk moves a rider's pelvis in a rhythmic, three-dimensional pattern similar to human walking. In hippotherapy, the therapist uses that movement on purpose, adjusting the horse's speed, direction, and the child's position to work on trunk control, balance, strength, sensory processing, attention, or speech. A horse handler and one or two side walkers usually help keep your child safe.

The American Hippotherapy Association states that hippotherapy is provided within standard occupational therapy, physical therapy, and speech-language therapy services and is not a separate service or program.

'Equine therapy' is a loose term that can mean many things. Therapeutic or adaptive riding teaches a child with a disability to ride and is led by a certified riding instructor, not a therapist. Equine-assisted learning and equine-facilitated psychotherapy are other distinct services.

Who is it for?

Who provides it?

Hippotherapy must be provided by a licensed PT, OT, or SLP working within their scope of practice, alongside a trained horse handler and horse. In Illinois, confirm the therapist's license with IDFPR. The American Hippotherapy Certification Board (AHCB) offers two voluntary credentials: 'Hippotherapy Certified' for basic knowledge and 'Hippotherapy Clinical Specialist' (HPCS) for advanced knowledge, which requires at least three years of practice and 100 hours of direct hippotherapy treatment. Therapeutic riding instructors, often certified through PATH International, are not licensed therapists.

What do families and practitioners report?

Families often describe hippotherapy as the therapy their child looks forward to most. Parents report better sitting balance, stronger core muscles, more words or vocalizing on the horse, and improved confidence. Therapists value that the horse's movement provides many repetitions of balance challenges in a motivating setting that is hard to recreate in a clinic.

Does it work? What the research says

For cerebral palsy, a 2020 systematic overview of CP interventions in Current Neurology and Neuroscience Reports (Novak and colleagues) rated hippotherapy 'green' (effective) for improving body symmetry, and recent systematic reviews continue to report gross motor benefits, although many trials are small.

For autism, the strongest single study is of therapeutic horseback riding rather than hippotherapy. A 2015 randomized trial in the Journal of the American Academy of Child and Adolescent Psychiatry (Gabriels and colleagues, 127 youth ages 6 to 16) compared 10 weeks of riding with a barn activity without horses and found improvements in irritability, hyperactivity, social cognition, social communication, and number of words spoken. Replication by other groups is still needed.

Is it covered by insurance in Illinois?

Some insurers cover hippotherapy when a licensed PT, OT, or SLP bills it as part of standard therapy, while others exclude it. Coverage by Illinois Medicaid/All Kids and commercial plans varies by plan and medical necessity. Therapeutic riding is recreation and is usually not covered by insurance, though some programs offer scholarships. Hippotherapy is rarely provided through Early Intervention or school IEPs because of cost and location, but you can ask.

What to consider and ask

• Confirm the session is run by a licensed PT, OT, or SLP, not only a riding instructor.
• Ask about safety practices: helmets, side walkers, horse selection, and emergency plans.
• Get medical clearance from your child's doctor before starting.
• Set clear therapy goals and ask how they connect to your child's daily life.
• Ask about weather cancellations, seasonal breaks, and travel time to the barn.
• Check costs and coverage in advance, since many families pay out of pocket.