Kinesiological Description of Hippotherapy as a Treatment Modality

Document Type: Original Article


1 Biomedical Engineering Faculty, Amirkabir University of Technology, Tehran, Iran

2 Chartered Physiotherapists in Therapeutic Riding and Hippotherapy, Riding for Disabled Association, United Kingdom


Hippotherapy as a treatment modality relies on patient-equine dynamic interaction to enhance physical abilities in a range of neuromuscular diseases. The modality takes advantage of external stimulations in the form of kinetic and kinematic inputs to patient’s upper body. Current practices and procedures could be greatly enhanced by an objective approach to session planning based on a predictive neuromuscular model. Individualization of the treatment program is both subject-specific and equine-specific.To this effect, kinesiological aspects of the three main upper body flexor-extensor muscles which are directly affected by this treatment modality are presented in a biomechanical model. Events and phases of this dynamic interaction are identified and described using a phase plane analysis. Physical interpretations of coefficients in the movement differential equation illustrates that the proposed approach and mathematical modeling have the potential to be tailored for various musculoskeletal or neuromuscular disorders. Validation results show that the model has the ability to simulate kinematic response and muscle forces of the patient upper body during a hippotherapy session. This predictive ability could provide the therapist with a tool to estimate the effects prior to therapy sessions and choose the most suitable combination of horse and exercises.


1.     Rigby, B. R., and Grandjean, P. W. “The Efficacy of Equine-Assisted Activities and Therapies on Improving Physical Function.” The Journal of Alternative and Complementary Medicine, Vol. 22, No. 1, (2016), 9–24.
2.     Uchiyama, H., Ohtani, N., and Ohta, M. “Three-dimensional analysis of horse and human gaits in therapeutic riding.” Applied Animal Behaviour Science, Vol. 135, No. 4, (2011), 271–276.
3.     Champagne, D., Corriveau, H., and Dugas, C. “Effect of Hippotherapy on Motor Proficiency and Function in Children with Cerebral Palsy Who Walk.” Physical & Occupational Therapy In Pediatrics, Vol. 37, No. 1, (2017), 51–63.
4.     Kwon, J.-Y., Chang, H. J., Yi, S.-H., Lee, J. Y., Shin, H.-Y., and Kim, Y.-H. “Effect of Hippotherapy on Gross Motor Function in Children with Cerebral Palsy: A Randomized Controlled Trial.” The Journal of Alternative and Complementary Medicine, Vol. 21, No. 1, (2015), 15–21.
5.     Lee, C.-W., Kim, S. G., and Na, S. S. “The Effects of Hippotherapy and a Horse Riding Simulator on the Balance of Children with Cerebral Palsy.” Journal of Physical Therapy Science, Vol. 26, No. 3, (2014), 423–425.
6.     Moraes, A. G., Copetti, F., Angelo, V. R., Chiavoloni, L. L., and David, A. C. “The effects of hippotherapy on postural balance and functional ability in children with cerebral palsy.” Journal of Physical Therapy Science, Vol. 28, No. 8, (2016), 2220–2226.
7.     Garner, B. A., and Rigby, B. R. “Human pelvis motions when walking and when riding a therapeutic horse.” Human Movement Science, Vol. 39, (2015), 121–137.
8.     Goldmann, T., and Vilimek, M. “Kinematics of human spine during hippotherapy.” Computer Methods in Biomechanics and Biomedical Engineering, Vol. 15, No. sup1, (2012), 203–205.
9.     Debuse, D., Chandler, C., and Gibb, C. “An exploration of German and British physiotherapists’ views on the effects of hippotherapy and their measurement.” Physiotherapy Theory and Practice, Vol. 21, No. 4, (2005), 219–242.
10.   Meregillano, G. “Hippotherapy.” Physical Medicine and Rehabilitation Clinics of North America, Vol. 15, No. 4, (2004), 843–854.
11.   Heine, B. “Hippotherapy. A multisystem approach to the treatment of neuromuscular disorders.” Australian Journal of Physiotherapy, Vol. 43, No. 2, (1997), 145–149.
12.   Rigby, B. R., Gloeckner, A. R., Sessums, S., Lanning, B. A., and Grandjean, P. W. “Changes in Cardiorespiratory Responses and Kinematics With Hippotherapy in Youth With and Without Cerebral Palsy.” Research Quarterly for Exercise and Sport, Vol. 88, No. 1, (2017), 26–35.
13.   Strashko, Y., Kapustianska, A. A., and Bobyrova, L. E. “Experience of using hippotherapy in complex effects on muscle spirals in children with spastic forms of cerebral palsy.” Wiadomosci Lekarkie, Vol. 69, (2016), 527–529.
14.   Aranda-García, S., Iricibar, A., Planas, A., Prat-Subirana, J. A., and Angulo-Barroso, R. M. “Comparative Effects of Horse Exercise Versus Traditional Exercise Programs on Gait, Muscle Strength, and Body Balance in Healthy Older Adults.” Journal of Aging and Physical Activity, Vol. 23, No. 1, (2015), 78–89.
15.   Borgi, M., Loliva, D., Cerino, S., Chiarotti, F., Venerosi, A., Bramini, M., Nonnis, E., Marcelli, M., Vinti, C., De Santis, C., … Cirulli, F. “Effectiveness of a Standardized Equine-Assisted Therapy Program for Children with Autism Spectrum Disorder.” Journal of Autism and Developmental Disorders, Vol. 46, No. 1, (2016), 1–9.
16.   Bronson, C., Brewerton, K., Ong, J., Palanca, C., and Sullivan, S. J. “Does hippotherapy improve balance in persons with multiple sclerosis: a systematic review.” European Journal of Physical and Rehabilitation Medicine, Vol. 46, No. 3, (2010), 347–353. Retrieved from europa-medicophysica/article.php?cod=R33Y2010N03A0347
17.   Champagne, D., and Dugas, C. “Improving gross motor function and postural control with hippotherapy in children with Down syndrome: Case reports.” Physiotherapy Theory and Practice, Vol. 26, No. 8, (2010), 564–571.
18.   Steiner, H., and Kertesz, Z. “Effects of therapeutic horse riding on gait cycle parameters and some aspects of behavior of children with autism.” Acta Physiologica Hungarica, Vol. 102, No. 3, (2015), 324–335.
19.   Hasan, C. Z., Jailani, R., Tahir, N. M., and Desa, H. M. “Vertical Ground Reaction Force Gait Patterns During Walking in Children with Autism Spectrum Disorders.” International Journal of Engineering - Transaction B: Applications, Vol. 31, No. 5, (2018), 705–711.
20.   Cha, Y. J., Stanley, M., Shurtleff, T., and You, J. (Sung) H. “Long-term effects of robotic hippotherapy on dynamic postural stability in cerebral palsy.” Computer Assisted Surgery, Vol. 21, No. sup1, (2016), 111–115.
21.   Zhang, K. “The Design and Realization of a Gait Rehabilitation Training Robot with Body Supporting Mechanism.” International Journal of Engineering - Transaction C: Aspects, Vol. 29, No. 9, (2016), 1314–1318.
22.   Saadat, M., and Garmsiri, N. “A New Intelligent Approach to Patient-cooperative Control of Rehabilitation Robots.” International Journal of Engineering  - Transaction C: Aspects, Vol. 27, No. 3, (2014), 467–474.
23.   Park, J.-H., and You, J. S. H. “Innovative robotic hippotherapy improves postural muscle size and postural stability during the quiet stance and gait initiation in a child with cerebral palsy: A single case study.” NeuroRehabilitation, Vol. 42, No. 2, (2018), 247–253.
24.   Ranciaro, M., Santos, E. L., Vara, M. F. F., Strasse, W. A. D., Franzo, D., Nogueira-Neto, G. N., Manffra, E. F., and Nohama, P. “Kinematic analysis of the evaluation of equine therapy patients with actimeter.” In 2018 Global Medical Engineering Physics Exchanges/Pan American Health Care Exchanges (GMEPE/PAHCE), IEEE, 1–5.
25.   Navvab Motlagh, F., and Arshi, A. R. “Symmetry comparison between sacrum and center of mass during walking.” Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, Vol. 230, No. 7, (2016), 682–689.
26.   Antunes, F. N., Pinho, A. S. do, Kleiner, A. F. R., Salazar, A. P., Eltz, G. D., de Oliveira Junior, A. A., Cechetti, F., Galli, M., and Pagnussat, A. S. “Different horse’s paces during hippotherapy on spatio-temporal parameters of gait in children with bilateral spastic cerebral palsy: A feasibility study.” Research in Developmental Disabilities, Vol. 59, (2016), 65–72.
27.   Ribeiro, M. F., Espindula, A. P., Bevilacqua Júnior, D. E., Tolentino, J. A., Silva, C. F. R. da, Araújo, M. F., Ferreira, A. A., and Teixeira, V. de P. A. “Activation of lower limb muscles with different types of mount in hippotherapy.” Journal of Bodywork and Movement Therapies, Vol. 22, No. 1, (2018), 52–56.
28.   Esser, P., Dawes, H., Collett, J., and Howells, K. “IMU: Inertial sensing of vertical CoM movement.” Journal of Biomechanics, Vol. 42, No. 10, (2009), 1578–1581.
29.   Pfau, T., Ferrari, M., Parsons, K., and Wilson, A. “A hidden Markov model-based stride segmentation technique applied to equine inertial sensor trunk movement data.” Journal of Biomechanics, Vol. 41, No. 1, (2008), 216–220.
30.           Szpala, A., Rutkowska-Kucharska, A., Drapała, J., and Brzostowski, K. “Choosing the Right Body Position for Assessing Trunk Flexors and Extensors Torque Output.” Human Movement, Vol. 12, No. 1, (2011), 57–64.