Equine -Assisted Occupational Therapy

(AKA "Hippotherapy")

fine/visual motor skills
balance and crossing midline

First, it is important to understand that this is NOT a separate service.  It is merely a specialization and one tool (of many) in our occupational therapist's toolbox.  The reason it has a separate section for discussion is because there are many misconceptions associated, and the goal here is to clear those up.  In order to allow for public understanding, continued medical acceptance, and insurance reimbursement in the future, we must all understand the following information:


Medical professionals using equine movement include physical therapists, occupational therapists, and speech language pathologists. The use of hippotherapy is one of many treatment strategies possible within an integrated treatment plan to achieve functional outcomes for children and adults.


When equine movement is part of treatment, the client engages in activities specifically designed to challenge their motor and sensory systems.  Improved balance, mobility, integration of sensory information, and communication help the client to function more successfully.  The skilled therapist directs the horse’s movement and carefully grades the sensory input in a controlled natural environment.  Whether PT, OT, or Speech treatment, the client benefits from a foundation, which is established through the movement of the horse to improve neurological function and sensory processing.  This foundation will be generalized to a wide range of functional skills.  In addition to utilizing the horse, the therapist uses specific interventions to target deficit areas in order to improve fine & gross motor skills, social skills, communication, and cognition.  


Therapists in the United States have used the movement of the horse for treatment since the 1970’s and it is currently utilized in more than 24 countries. The American Physical Therapy Association (APTA), the American Occupational Therapy Association (AOTA), and the American Speech-Language and Hearing Association (ASHA) recognize hippotherapy as within the scope of therapy practice.  Because of this, the use of hippotherapy is (and rightly should be) reimbursable through many insurance companies across the nation.  Unfortunately however, in the state of Montana, there are still exclusions present that make reimbursement through Medicaid and insurance not a viable option.  Because of this limitation, the portion of treatment conducted with the horse must be paid for privately, which can be a significant challenge to many of our clients, potentially standing in the way of them being able to participate in the equine-assisted portion.  Fortunately, we are blessed to pair with a local non-profit organization called Human Therapy on Horseback (HTH), that provides scholarship funding (when available) that helps to cover the cost of the equine-assisted portion of the treatment. 

To learn more about HTH, click on their tab above.  To contact HTH directly to help with fundraising or to make a donation to support one of our clients, please visit their website: 

So, what is the difference between "therapeutic horseback riding", "adaptive riding", "horse therapy" and "hippotherapy"?

"Therapeutic horseback riding" is more appropriately called "adaptive riding".  It is conducted by an equine specialist (NOT usually a therapist) and uses equine-assisted activities for the purpose of contributing positively to the physical, emotional and social well-being of people with a variety of challenges.  The focus is to provide recreation & leisure opportunities to individuals who may not be able to participate in standard horseback riding lessons.  If not completed by a licensed therapist, it should not be deemed "therapeutic", due to the fact that a riding instructor is not trained, certified and/or licensed to be appropriately and/or safely addressing cognitive, physical, emotional or social limitations.


Whereas occupational therapy (integrating hippotherapy) is considered a medical treatment and is sometimes reimbursable, adaptive riding is not a medical treatment and is not reimbursable.  Although it is not considered medical treatment, the rider will still benefit from the leisure and recreational aspects as well as the conditioning that typically comes along with participation in physical activities. 

In the same sense that "therapeutic horseback riding" is misleading, so is the terminology "horse therapy".  It does not accurately describe any actual service, and is often used as a generic term for describing some type of therapeutic activity involving a horse.  This term should be avoided whenever possible as it is confusing, misleading, and can contribute to the difficulties when billing insurance companies for therapy services conducted by licensed healthcare professionals.

Occupational therapy (integrating hippotherapy), on the other hand, provides an individualized therapy plan and specific interventions targeting goals.  The therapist is trained to direct and utilize the horse's rhythmic motion to normalize movement as well as to help improve muscle tone, flexibility, balance, posture, and coordination.  The motion and warmth of the horse's body improves the rider's blood circulation and reflexes while exercising the rider's spinal column, joints and muscles.  In addition to the neurological and physiological benefits, the integration of the horse into treatment contributes to mental and emotional well-being.