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The Horse as a Therapeutic Tool for ASD

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The Horse as a Therapeutic Tool for ASD

By Barbara Smith, MS, OTR/L

Autism Asperger’s Digest | July/August 2012


What Is Hippotherapy?

Horses provide an ideal therapeutic tool for occupational, physical, and speech language pathologists who work with children on the spectrum. There are several types of Equine-Assisted Therapies (EAT) that involve horses, but hippotherapy is the only one that must be performed by registered therapists or assistants to address treatment goals, such as improving manipulation skills or decreasing sensory sensitivities. There are different levels of training and certification involved in hippotherapy, although all practitioners must be licensed occupational or physical therapists, or speech language pathologists. Other types of EAT usually focus on teaching individuals with disabilities riding skills, possibly with the goal of entering the Special Olympics.

By participating in hippotherapy children are often highly motivated by the novel, exciting sensory-based activities that might frighten some horses. The horse must be carefully desensitized and familiar with materials and the movements involved well in advance. The ideal hippotherapy horse has had many years of experience working with unpredictable children and sensory materials.

As an occupational therapist (OT), I work on the same functional goals I might address in other clinical settings. However, the horse provides unique opportunities to promote skills such as emotional empathy; communication using words, gestures, or pictures (related to making the horse go, stop, or turn); sensory modulation produced by horse movement and motor activities; body awareness and postural control required to ride; and visual, perceptual, and fine-motor skills to perform equine-related tasks on or off the horse (e.g., putting away equipment, brushing horse, finding hidden objects on trail).

Because OTs look at the whole person, strategies that promote communication skills and social/emotional health as well as improve sensorimotor skills are included in hippotherapy. This all begins with the child-horse relationship.

The Child-Horse Bond and Empathy

TempleGrandin, the renowned author, lecturer, and animal behavior expert, has written extensively about her autism and ability to understand animals. I developed an interest in hippotherapy after attending one of her presentations and quickly realized the potential benefits to children who have behavioral and sensory challenges.

A properly trained therapy horse (chosen for having the right temperament, anatomy, and gait) is a forgiving friend who provides unconditional acceptance even if the client is making odd sounds, rocks back and forth, or pats the mane with too much force. At the same time the child is taught how to be considerate. For example, the child is encouraged to be gentle while patting the mane and not to kick while turning around to face backward. Developing empathy with the horse is a stepping stone to caring human interactions, and the child-horse bond is a powerful motivator to communicate.

Developing Communication Skills

Hippotherapy involves one person leading the horse (while holding the lead line) with the therapist positioned on one side of the horse and the third person, the side walker (often a volunteer), on the other side. As the child is prompted to communicate basic directions, such as “go” or “whoa,” the leader responds accordingly. Children learn to steer at junctions and choose activities such as sit-ups or trotting. Children are highly motivated to make the horse move, and they learn that ignoring the therapist’s requests to communicate or follow directions may result in the horse’s stopping.  Movement after compliance creates a natural reinforcement.

Following directions and imitation are encouraged when I sing, “If You’re Happy and You Know It,” substituting requests in the lyrics (e.g., pat the mane, touch the tail, blow a kiss, nay like a horse). If children do not participate, the horse is stopped so that they can process the directions (sometimes with physical assistance). Horse movement after engagement again provides reinforcement, and the frequent transition between stop and go provides sensory input that helps children focus.

Sensory Modulation

Where else can a child receive the sensory stimulation his brain seeks while at the same time being confined to a small working surface to perform less preferred activities? The therapist chooses the type and intensity of sensory stimulation according to the child’s needs. Vestibular stimulation (movement that impacts balance) varies according to the following:

  • the horse’s speed
  • whether walking in straight lines versus curves
  • the child’s position, such as facing sideways, kneeling, standing on top of the horse, or posting (i.e., alternating sitting and standing with feet in stirrups), and
  • use of inclines.

The horse’s movement provides proprioceptive (deep pressure) stimulation to joints and muscles, especially when the child hugs the horse or bears weight on forearms or hands. Tactile stimulation to hands is provided throughout the session with the goal of decreasing touch sensitivities in preparation for hand use. Facing backward enables the rider to feel the rhythm of the horse’s hind leg movement with his hands.

Promoting Body Awareness and Motor Planning

Children on the spectrum often have low muscle tone (i.e., they feel floppy). Simply being on a horse increases muscle tone and makes a child more aware of where his arms and legs are and how they are moving. I often find myself saying, “You’re sliding into my arms. Don’t make me catch you!” Learning to keep feet in the stirrups, grasp the reins, and look straight ahead at the same time develops coordination between the right and left sides of the body as well as body awareness.

Motor planning is a term that describes planning and performing unfamiliar motor tasks. Children with poor motor-planning skills look clumsy. Hippotherapy activities that promote motor-planning skills include touching right hand to left foot, sit-ups, arm circles, pulling reins to stop at a named destination, and steering with reins to weave around cones on the ground.

Many parents are surprised when they see their children standing on top of the stationary or walking horse. I might encourage the child to balance by extending his arms like a circus tightrope walker. Sometimes I provide a familiar fine-motor activity to perform while balancing. I have found that nothing makes a child more aware of what his body is doing than when standing on top of a horse!

Many children learn to maintain challenging positions, first while stationary and then during the walk. The following positions promote body awareness, motor control, and strength:

  • quadruped position (placing weight on knees and hands, while grasping handle or placing hands on horse)
  • kneeling with arms extended
  • prone (on belly) over horse’s barrel with arms and legs extended like “Superman,” and
  • standing on horse while reaching for objects, then squatting to place object in container.

Adapting Activities for Hippotherapy

When the child is on the horse, the therapist has an ideal opportunity to work on visual perceptual and fine-motor skills with individuals who might otherwise run away at the sight of a lacing board or crayon! Incorporating a sensory component such as lights, weighted materials, vibration, or fun textures may help some children with autism focus and engage in hand activities. For example, you can use heavy bean bags or fill socks with sand to place into containers, or use toys that light up and make funny sounds. I adapt activities to promote success for the child and to make them easier for me to manage while working with a child on a horse. The following are a few of my favorites:

  • Lace a horse-themed board with only 4–5 large holes (using thick cord).
  • String large donut shapes with thick cord, which is much easier than learning how to string beads. The cord is attached to a mesh bag, making it easier to manage.
  • Complete a puzzle that requires reaching for pieces attached with Velcro to a box lid. The puzzle board is placed inside a flat box. The therapist doesn’t need to hold the pieces; the child works on visual skills to transition between vertical and horizontal planes (a skill needed to copy from the board at school). Positioning the child facing backward enables the horse’s rear to be used as a table.
  • Remove toys attached with Velcro and place them in a bottle. The child stabilizes the bottle with one hand while inserting the toys inside.

I have found that performing hippotherapy is not only fun but also an effective treatment tool when used with children on the spectrum. These children often experience new successes, build confidence, and learn functional skills that will affect their everyday home and school lives. Equine friends help children with autism in countless ways!


Barbara Smith, MS, OTR/L, is the author of The Recycling Therapist and From Rattles to Writing: A Parent’s Guide to Hand Skills. Please visit her website, www.RecyclingOT.com, for more information about hippotherapy.

Copyright © Autism Asperger’s Digest. 2012. All Rights Reserved. Distribution via print means prohibited without written permission of publisher.


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