For some, the term “hippotherapy” can be confusing. When people first hear about hippotherapy, some common questions are: “Is that some kind of therapy for hippos?”, “Do hippotherapists provide it?”, “Is this some kind of ‘miracle cure’?”, “Is that an alternative therapy?”, “Isn’t that experimental?” The answer is “No!” to all of these questions.
The Top 10 Hippotherapy Myths and Misconceptions:
“Hippotherapy is a type of therapy/type of horse therapy/type of equine therapy.”: Despite the sound of it’s name, hippotherapy is NOT a “type of therapy” at all. It is more accurate to describe it as a tool or strategy that is incorporated into an OT/PT/SLP plan of care to address specific functional skills. Because it is not a type of therapy, it is also inappropriate to refer to hippotherapy as a “treatment” , “service” or “procedure”.
Most importantly, hippotherapy is not a type of “equine therapy” or “horse therapy”. It is not provided by “equine therapists”. These terms should not be used in this context, as “equine therapy” is actually therapy FOR horses.
“Therapeutic riding and hippotherapy are basically the same thing.”: “Therapeutic Riding” and therapy sessions incorporating horses differ in many ways, the most critical being:
- OT, PT, and SLP services fall within the healthcare industry. They are provided within a highly regulated medical model. Therapists receive years of schooling and clinical supervision and pass board exams before receiving their license. They then complete additional continuing education before incorporating horses into therapy. The focus is on habilitation/rehabilitation.
- Riding lessons for individuals with special needs (often called “therapeutic” or “adaptive” riding) fall under the adaptive sports industry. They are offered within a recreational model, with little to no regulation or requirement for education, training, competency or licensing. Claims about the focus and “benefits” of this activity vary widely.
Misrepresentation of “therapeutic riding” and other activities involving horses, as a “form of therapy” and claims of “therapeutic benefits” by non-licensed professionals are problematic. It is frustrating and concerning to therapists, however riding instructors also have concern about this, as seen in this recent post, on the term “therapeutic riding” from “Hoof Falls and Footfalls”, titled “The ‘T’ Word”.
This also impacts licensed mental health professionals who incorporate equines in treatment. It can result in a negative public perspective, as seen on the John Oliver Show on 5/20/18 (Warning: NSFW). Things like this episode highlight the need for separation and clarity, as pointed out in this response to the John Oliver Show by Leif Hallberg.
Riding lessons and other activities involving equines, that are not provided by licensed therapists, should never be advertised as “therapy” or as a way to provide habilitation or rehabilitation. There are legal and ethical implications surrounding this and clarity in advertising is needed. Check out this ad from APTA about misrepresentation of healthcare services, which sums up this problem:
“Hippotherapy is a program/practice.”: Use of the terms “hippotherapy program” and “hippotherapy practice” are incorrect. They further perpetuate the misconception that hippotherapy is a separate service from OT, PT or SLP. The term “hippotherapy program” is often seen at riding centers. The more accurate way market this would be to market the actual service being provided (i.e. “Physical therapy”, “Occupational therapy” or “Speech therapy”). Lastly, therapists don’t “practice hippotherapy”. They practice OT/PT/SLP, under their license (see myth 10).
“The horses provide/facilitate the therapy. Horses have magical healing powers!”: This one is closely related to myth 2. As with other therapy tools, such as swings, bikes, balls and trampolines, the skills of the licensed therapist are what is critical. Not the tools themselves. While appropriate horse selection is a crucial part of therapy incorporating equines (see myth 6), it is important to note that horses do not provide or facilitate the therapy- the therapists do!
Just like being on a bike or swing is not in itself “therapy”, neither is being on a horse. A horse does not make improvements to a client on its own. It is the skilled intervention of the therapist that makes the difference.
Licensed therapists evaluate the client, and then develop a treatment plan. Next, they select a horse based on it’s temperament, conformation and movement. They select various developmental positions for the client. The therapist uses a variety of other tools, strategies, techniques, activities, tasks and approaches within their scope, in conjunction with and in addition to hippotherapy, under their professional license. They use their clinical experience to direct the horse’s movement (direction, speed, tempo and rhythm), in order to achieve specific outcomes, and lastly they use their clinical expertise to make changes to treatment plans as needed. That is what makes the difference.
Successful treatment incorporating equines is the result of skilled therapy from a licensed and trained professional. Not from some sort of “magic” that happens from being on or near a horse. Therapy, from an OT/PT/SLP who incorporates horses, is far more skilled and scientific than that. Therefore, if the service sounds like it is “magic”, or “facilitated by a horse”, be wary. Therapists don’t rely on magic. They rely on their education, training, clinical experience and science.
“Therapists ‘provide’ hippotherapy.”: Stay with me here. Yes it is true, that only OT/PT/SLP professionals can use hippotherapy in treatment, however the wording is important. Therapists do NOT “provide hippotherapy”, “provide hippotherapy sessions”, “provide hippotherapy services” or “provide hippotherapy lessons”. Adding hippotherapy into an OT/PT/SLP treatment plan doesn’t change what the therapy is, or what the therapist is licensed to do. Another way to word this is: “provide OT/PT/SLP services incorporating hippotherapy”. While it is slightly more wordy, it is the accurate way to describe therapy services that incorporate hippotherapy. Related to this point- Therapists who use hippotherapy in treatment are not “hippotherapy providers”. They are OT, PT, or SLP providers (see myth 10).
“Hippotherapy is a good ‘retirement’ job for older or unsound horses.”: This myth couldn’t be further from the truth. While hippotherapy is a great career option for healthy horses with the right temperament, it is not a good option for horses who are unsound for other work. Not only can this be considered unfair to the horse, it is also poor practice, as the horse will not able able to produce the best movement for the therapy session.
While horses are typically only asked to walk in a therapy session, they still must be sound in all gaits. Therapists consider a variety of factors when selecting a horse to use in treatment including age, health, conformation, conditioning, training and temperament. When OT/PT/SLP professionals use hippotherapy in treatment, the movement that the horse produces is used to affect change in the client. If the horse is unsound, unfit, stiff, arthritic, or reluctant to move forward the movement produced will be asymmetrical or of poor quality for therapy. Just as a therapy practice shouldn’t use broken or rundown equipment, the equines they work with should also be in good condition and well cared for.
“Hippotherapy is new and experimental.”: There is a large body of research related to the use of hippotherapy in treatment. There are 8 systematic reviews, 86 peer reviewed articles, and 10 peer reviewed case studies that show support for the use of equine movement in treatment on The American Hippotherapy Association bibliography. Further, there is a significantly larger body of evidence on motor learning, postural control, sensory, dynamic systems and other areas that apply to the use of hippotherapy in treatment for occupational, physical and speech therapy. Finally, it is important to remember that “evidence-based practice” is the integration of the best evidence in the research, combined with clinical expertise and patient values. To learn more about what makes something an evidence based practice click here for information from The American Speech-Language and Hearing Association.
In addition, hippotherapy is NOT new: It originated in Germany, Switzerland, and Austria in the 1960s, and came to the United States in the 1970s. Educational opportunities, research and support surrounding the use of hippotherapy in treatment has continued to improve and grow over the past 50 years.
“Hippotherapy is a costly procedure.”: While hippotherapy can be used by a therapist during the provision of a variety of billable therapy procedures, it is not in itself a procedure. Therapists should bill using the most representative code for the procedures they provide. The fees for these procedures are the same, whether hippotherapy is part of the session or not. Some common procedures billed by OT, PT and SLP professionals are:
97535–Self Care Management Training
92507–Speech-language therapy, individual
92526–Treatment of swallowing dysfunction and/or oral function for feeding
97127–Therapeutic intervention for cognitive function.
“Hippotherapy is an alternative treatment.”: Hippotherapy is NOT an “alternative treatment”. In fact, it is not “a treatment” at all (see myth 1). Again, it is a tool or strategy, that falls within the scope of occupational therapy, physical therapy or speech language pathology professionals. None of these are alternative. OT, PT and SLP services are quite standard and common place in the healthcare industry. Hippotherapy may be used during OT/PT/SLP treatment, just as a ball, swing, trampoline and other tools may be used during these services.
“The person who provides therapy incorporating horses is called a hippotherapist.”: Therapists who provide services incorporating hippotherapy are OT/PT/SLP professionals. These professionals work within a scope of practice, under their professional license. There is no such thing as a “hippotherapist” in the U.S.
What other hippotherapy myths and misconceptions have you seen? How do you think the hippotherapy myths and misconceptions listed here impact clients and therapists? Let me know in the comments!
*Edited to add: Many of the issues pointed out in this post are very well known to those working in the therapy, education and adaptive sports fields. The leaders at the American Hippotherapy Association are working with AOTA, APTA and ASHA to address some of these challenges. In addition, leaders in the therapy and “non-therapy” fields are working to address challenges related to unclear terminology, as seen in this statement from PATH International.
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© 2018, Tina M. Rocco, M.A. CCC-SLP, HPCS. All rights reserved.