Hippotherapy

Hippotherapy is a recognized treatment of physiotherapy that uses a small horse. During hippotherapy the rhythmical three-dimensional movements of the horse are transferred on the patient and can thus be used therapeutically without the patient actively influencing the horse. Even the transfer itself – mounting and dismounting the horse – forms an essential part of the treatment.

Transfer from the horse into the wheelchair.

Mode of action

The movements of the back of the horse have above all loosening but also strengthening and stimulating effects. The patient sits with his/her legs spread over the back of the horse which is being lead by a horse guide while the gait is walking. This sitting position alone can have a positive influence on the tight muscles of torso and legs. The therapist supports the patient and gives instructions for doing the exercises. Additionally the therapist can stimulate the desired pelvic movements of the patient. This results in a permanent tensing and relaxing of the muscles. Simultaneously balance, posture reactions of the torso and coordination are trained, weak muscles are being strengthened and tension is released.

Hippotherapy can thus be used for various goals, often to decrease pain or to regulate muscle relaxation. In a study about increased muscle tonus (spasticity) in persons with spinal cord injury improvements were noted through hippotherapy (Lechner et al. 2003). Furthermore hippotherapy has a psychologically positive and motivating effect.

During hippotherapy balance and coordination are trained.

The therapist supports the patient while stimulating the desired pelvic movement at the same time.

The individual characteristics and the nature of the horse are very important. Therapy horses are not necessarily a certain breed but are specifically trained and highly sensitive. During the training they learn to get used to wheelchairs and walking aids and to stand next to lifts or ramps and how to deal with the untypical movements of the patients. The goal of training the horse is to "simultaneously use all movement options while granting the highest safety factor during hippotherapy" (Deutsches Kuratorium für Therapeutisches Reiten e.V. (DKThR), translated). With the help of a trusted, people-friendly and obedient horse the behavior and condition of the patient can be influenced positively.

What is required from the horse?

• Mental and emotional suitability for a focused reception and execution of commandos
• Muscle strength and stamina
• Ability to stand quietly and patiently beside a ramp
• Confidence in various therapy material (walking aids, wheelchairs, etc.)
• Ability to be lead on both sides at neck and shoulder levels
• Being insensitive toward spasticity and imbalance of the patient
• Staying calm while surrounded by several people
• Ability to stay calm despite any kind of environmental impacts or noises

Cost coverage and prescription

After finishing the acute phase, hippotherapy can be applied in hospitalized patients as well as during outpatient care. It is usually applied in patients with neurological conditions, e.g. in case of spinal cord injury or stroke. The costs for hippotherapy are partially covered by the health insurance companies or are paid by the disability insurance, in Switzerland for example adults with multiple sclerosis or children with cerebral palsy. For other conditions the financing options need to be investigated by a third party.

In Switzerland the therapy, like any kind of physiotherapy, needs to be prescribed by a physician and can be applied only by a physiotherapist with additional training in hippotherapy. This is usually an advanced training according to Künzle (Hippotherapy-K). In Switzerland only therapeutic treatment by a professional with this specific training is billable to the health insurance. Hospitalized patients with spinal cord injury are covered by the daily hospital allowance.

The therapy team consists of patient, a trained therapy horse, a hippotherapist (physiotherapists with advanced training in Hippotherapy-K) and a horse guide.

Hippotherapy is usually done once a week. It can take place outside or inside. The treatment length depends on the strength and performance of the patient and is 30 minutes on average. The patient is supported by the therapist the whole time. It is not obligatory to wear a helmet (DKThR).

What is required from the patient?

The person needs to be able to sit fairly stable and has a certain amount of control over his/her torso and is able to move the head without support. Whether a patient is able to participate in hippotherapy or not has to be determined by trained staff.

The minimum age for children is four years.

Hippotherapy takes place outdoors.

Further information online (in German and French):

• Schweizer Gruppe Therapeutisches Reiten: http://sg-tr.ch/v2/verein/
• Österreichisches Kuratorium für Therapeutisches Reiten: http://www.oktr.at/
• Deutsche Gruppe für Hippotherapie e. V.: http://www.dgh-ev.com/startseite.html
• Schweizer Gruppe für Hippotherapie-K®: http://www.hippotherapie-k.org/index.php?id=27
• Association Suisse de Thérapie Avec le Cheval: http://www.therapiecheval.ch/
• Institut de Formation en Equithérapie: http://www.ifequitherapie.fr/
• Pferdegestützte Therapie Schweiz / PT-CH: https://pt-ch.ch/
• ESAAT - European Society for Animal Assisted Therapy: http://www.esaat.org/; together with the international organization ISAAT it developed guidelines for the quality assurance of animal-supported interventions in the health system

References:

• Schweizer Paraplegiker-Zentrum: Hippotherapie, Heilpädagogisches und Therapeutisches Reiten. URL: http://www.paraplegiker-zentrum.ch/de/pub/spz/bereiche/physiotherapie/hippotherapie.htm (retrieved July 30, 2015)
• Lechner HE, Feldhaus S, Gudmundsen L, Hegemann D, Michel D, Zäch GA, Knecht H. The short-term effect of hippotherapy on spasticity in patients with spinal cord injury. Spinal Cord. 2003 Sep;41(9):502-5.
• Deutsches Kuratorium für Therapeutisches Reiten e.V. (DKThR): Wie wird Hippotherapie durchgeführt? URL: https://www.dkthr.de/de/therapeutisches-reiten/hippotherapie/wie-wird-hippotherapie-durchgefuehrt/ (retrieved July 30, 2015)
• Abramovic M et al.: Hippotherapie. In: Zäch GA, Koch HG (Hrsg.) (2006): Paraplegie. Ganzheitliche Rehabilitation. Basel: Karger, S. 355f.

About the authors:

• The article was written by the Team of Experts for Hippotherapy, Curative and Therapeutic Horseback Riding at the Department of Physiotherapy of Swiss Paraplegic Center (SPZ) in Nottwil, Switzerland, above all Sabine Grupp, Kathrin Kriesche and Sibille Bühlmann.
• Dr. Andrea Glässel is a physiotherapist and researcher at Swiss Paraplegic Research (SPF) in Nottwil, Switzerland where she has been working since 2007. She is a member of the paraforum team.