Classic hippotherapy reflects the German model of hippotherapy practiced widely throughout Europe since the 1960's. Since it is purely the horse's movement and the client's responses that constitute the treatment, classic hippotherapy should only be carried out by a PT, OT, or a speech language pathologist with a certificate of clinical competence (SLP/CCC), who has focused training in the following areas:
* Development of body systems and interaction with the development of movement.
* Effect of neuromuscular, musculoskeletal and cardiopulmonary dysfunction on growth and development, motor development and function.
In classic hippotherapy, it is purely the horse's movement that influences the client. The client may be positioned astride the horse facing forward, backward, prone or supine. The client passively interacts with, and responds to, the horse's movement. The therapist's responsibility is to constantly analyze the client's movement. The therapist must constantly analyze the client's responses and adjust accordingly the manner in which the horse is moving. This assumes that the therapist has sufficient understanding of the movement of the horse to direct the horse handler/instructor to alter the tempo and direction of the horse as indicated by the client's responses.
The primary focus of classic hippotherapy is the rider's posture and movement responses. However, other effects may occur in respiration, cognition and speech production. For example, if the treating therapist is a PT whose goal is to strengthen the trunk muscles and positively affect the client's posture, respiration and speech will improve due to the increased trunk strength. That is the beauty of the horse as a treatment tool -- these "other" changes occur even though you are not focusing on them.
Hippotherapy, on the other hand, is a treatment approach that uses the movement of the horse based on the methodology of classic hippotherapy with the addition of the treatment principles that apply to the particular profession of the therapist providing the service. The unique combination of the horse, the horse's movement and a non-clinical environment produces an extraordinary effort on all the systems of the body. Therefore, although hippotherapy is frequently used to achieve physical goals, it also affects psychological, cognitive, social, behavioral and communication outcomes. Hippotherapy is truly a multidisciplinary form of treatment and can be applied by a PT, OT, SLP/CCC, psychologist or psychotherapist.
It is a treatment approach that uses activities on the horse that are meaningful to the client and specifically address the individual's goals. Hippotherapy provides a controlled environment and graded sensory input designed to elicit appropriate adaptive responses from the client. It does not teach specific skills associated with being on a horse -- rather, it provides a foundation of improved neuromotor function and sensory processing that can be generalized to a wide variety of activities outside treatment. In other words, the client's adaptive responses to the environment and the horse's movement ultimately bring about improvements in function.
An example of a meaningful activity in which multiple systems of the body are affected could be the following: A young client may be asked to move from facing forward to facing backward and then to quadruped (on all fours). In this position, he may be asked to reach one hand down to pat the horse. This activity (the transition, the quadruped position and the reaching activity), is overlaid on the constant rhythmical 3-dimensional movement of the horse. Therefore, in addition to the facilitation of automatic postural responses and stimulation of trunk muscles, there are increases in sensory input to the following systems of the body:
* Vestibular -- because the client is facing backward while the horse is moving forward.
* Proprioceptive -- heavy touch pressure through the hip, knee, wrist, elbow and shoulder joints in the quadruped position.
* Tactile -- touching the soft warm coat of the horse.
* Cognitive -- higher level motor planning skills required to execute the transition.
* Motor (physical) -- stability of hips and pelvis required to maintain position while reaching forward with one hand.
This is a meaningful activity for any client who exhibits trunk weakness, poor pelvic control, decreased gross motor skills, poor motor planning and a diminished ability to process sensory information.