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Therapeutic Horseback Riding (THR) is a therapeutic program that provides equine assisted activities for individuals with disabilities in order to improve their physical, emotional, and mental well-being. This is done through an adaptive riding program that focuses not only on riding skills but also on the development of a relationship between the horse and rider. The program can include work both on the ground such as grooming, leading, or directing a horse, and activities on horseback.
Therapeutic riding activities are conducted by certified therapeutic riding instructors in conjunction with trained volunteers. During riding activities a new rider or an individual with physical limitations is generality assisted by two side-walkers who walk alongside the horse, as well as a horse leader. These individuals are volunteers that have been trained to assist the instructor in the conduct of the therapeutic program.
Therapeutic riding differs from hippo-therapy, one form of equine assisted therapy, in that in hippo-therapy a physical or occupational therapist uses only the movement of the horse to improve an individual's sensory and motor skills. The therapist does not teach riding skills or seek to develop a relationship between the horse and rider. The primary goal of hippo-therapy is to improve the individual's balance, posture, function, and mobility. Therapeutic riding is a broader program of therapy that can include multiple therapeutic elements simultaneously.
Therapeutic riding combines the physical aspect of riding in improving balance, posture and mobility and adds the mental, emotional and cognitive skills required to ride a horse and develop a positive working relationship with the horse. This expansion of therapy beyond just the physical aspects involved in riding a horse can improve an individual's emotional control, behavioral self-regulation and cognitive functioning and help them function more productively and effectively in society.
Therapeutic riding centers and their instructors are certified by the Professional Association of Therapeutic Horsemanship International and therapy is conducted as part of an overall treatment plan developed in conjunction with a medical health professional. Safety is a paramount concern and therapeutic riding is not appropriate for individuals with certain disabilities. Instructors work with the health care provider to plan for the individual's needs, appropriate supervision, and ensure rider safety.
There are a wide range of physical, mental, and emotional disabilities that can benefit from the use of therapeutic riding. Some of the many individuals who research has proven can benefit from therapeutic horseback riding include those with attention deficit disorder, autism, amputations, brain injuries, stroke, cerebral palsy, downs syndrome, multiple sclerosis, spinal cord injuries, and a wide variety of emotional, cognitive, or mental disabilities.
For those with physical limitations experiencing the rhythmic motion of a horse can be very beneficial to improve muscle function and control. Riding a horse moves the rider's body in a manner similar to the human gait, so riders with physical needs often show improvement in flexibility, balance and muscle strength. For individuals with mental and emotional challenges, the unique relationship formed with the horse can lead to increased confidence, patience and self-esteem
There have been numerous studies that have shown evidence of the benefits of therapeutic riding. Individuals with cognitive disabilities such as autism or Downs Syndrome have shown demonstrated benefits from THR. Bass, Duchowny, and Llabre (2008) found that children with autism who participated in a therapeutic horseback riding program improved in sensory integration and directed attention as compared to the control group. While Biery and Kaufman (1989) showed that significant improvement was seen on standing and quadruped balance after the therapeutic riding program for individuals with Downs Syndrome
It is clear from the research and from the responses of individual participants that therapeutic riding is a physical activity that can provide significant benefits to individuals with physical, emotional, or mental challenges. It requires an individual to control and exercise a wide range of muscles, while simultaneously having the individual exercise emotional and cognitive skills required to maintain control of the horse. Like any physical activity it provides benefits beyond those to the muscular skeletal and cardiovascular systems. There are boosts to cognitive skills as well as to emotional well-being. The interaction with the horse adds an additional element to the equation in that the individual can establish a relationship or connection with their equine partner. Therapeutic riding is a beneficial physical activity has demonstrated the ability to change and benefit the lives of numerous individuals and assist them to live a healthier, more active, and more productive life.
Biery, Martha, Kaufmann, Nancy, 1989, "The Effects of Therapeutic Horseback Riding on Balance." Adaptive Physical Activity Quarterly, Volume 6, Issue 3, pgs 221-229.
Crothers, G. (1994). "Learning disability: Riding to success." Nursing Standard, 8, 16-18.
Emory, D. (1992). "Effects of therapeutic horsemanship on the self-concepts and behavior of asocial adolescents." Dissertation Abstracts International, DAI-B 53/05, 561.
Kaiser, L., Smith, K., Heleski, C., & Spence, L. (2006). "Effects of a therapeutic riding program on at-risk and special needs children." Journal of the American Veterinary Medical Association, 228, 46-52.
Learn About Therapeutic Riding. PATH International, November 3, 2015.
Miller, John, Alston, Dr. Antoine J, "Therapeutic Riding: An Educational Tool for Children with Disabilities as Viewed by Parents", Journal of Southern Agricultural Education Research, 2004, Volume 54, Number 1, pgs 113-123.
Scheidhacker, M., Bender, W., and Vaitel, P. (1991). "The effectiveness of therapeutic horseback riding in the treatment of chronic schizophrenic patients. Experimental results and clinical experiences." Nervenarzt, 62, 283-287.
Shambo, Leigh, Seely, Susan K., Voderfecht, Heather R. "A Pilot Study on Equine Facilitated Psychotherapy for Trauma Related Disorders", 2010,
Stickney, Margaret Ann, "A Qualitative Study of the Perceived Health Benefits of a Therapeutic Riding Program for Children with Autism Spectrum Disorders", 2010, University of Kentucky Doctoral Dissertations. Paper 40.
Zadnikar Monika, Kastrin Andrej, "Effects of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: a meta-analysis", August 2011, Developmental Medicine & Child Neurology, Volume 53, Issue 8, pages 684-691.
Therapeutic Horseback Riding for Veterans
Horseback riding simulators are intended to allow people to gain the benefits of therapeutic horseback riding or to gain skill and conditioning for equestrian activity while diminishing the issues of surrounding cost, availability, and individual comfort level around horses. Horseback therapy has been used by many types of therapists (ie: physical, occupational, and speech therapists) to advance their physical, mental, emotional, and social skills.
Simulators used for therapeutic purposes can be used anywhere (ie: clinic or a patient home), do not take up much space, and can be programmed to achieve the type of therapy desired. Additionally, difficulty level can be set by the therapist and increased gradually in subsequent sessions to reflect the patient’s progress and abilities. Some people use these simulators as personal exercise machines to tone core muscles in an easy and low-impact manner.
Products that attempt to accurately imitate the movement of a real horse and are sometimes used for therapeutic purposes as well as for developing equestrian skills or conditioning are the Equicizer, an American-developed mechanical product that resembles the body of a horse, imitates the movement of a race horse, and can be used at slower speeds for therapeutic and rehabilitation purposes. Another product that resembles and moves like a real horse is the line of Racewood Equestrian Simulators, with 13 models to imitate actual movement of horses in various disciplines, including a simple walk and trot model.
Simulators that do not resemble horses but imitate certain aspects of equine motion are popular in some Asian countries such as Japan and South Korea, in part because land for keeping actual horses is quite limited. One such commercial product is the Joba, created in Japan by rehabilitation doctor Testuhiko Kimura and the Matsushita Electric Industrial Company. The Joba does not resemble a horse, but rather just looks like a saddle, with plastic handle and stirrups, attached to a base that allows it to pitch and roll, exercising core muscles. A similar product manufactured in the US is a stool-like device called the iGallop, which was commercially available in the mid 2000s and moves in a side-to-side and circular motion with various speed settings. However, it was criticized for not delivering the results claimed.
There has been increased research regarding use of horseback riding simulators compared to conventional therapy methods. One 2011 study by Borges et al. compared children with cerebral palsy and postural issues who received conventional therapy to similar children who received therapy involving a riding simulator. The results from this study showed that children who received riding simulator therapy exhibited a statistically significant improvement regarding postural control in the sitting position, specifically regarding the maximal displacement in the mediolateral and anteroposterior directions. Parents of these children noted that their children executed activities of daily living that demanded greater mobility and postural control better than before. In a 2014 study by Lee et. al, 26 children with cerebral palsy were divided into two groups: a hippotherapy group and a horseback riding simulator group. The children in each group underwent the same kind of therapy for the same amount of time using either a real horse or the simulator. Conventional physical therapy sessions were attended before each hippotherapy or horseback riding simulator session. It was found that both static and dynamic balance improved for the children in both groups following their 12-week-long programs and there was not a statistically significant difference between the results from the two groups. This indicates that using a horseback riding simulator can be as effective as hippotherapy for improving balance in children with cerebral palsy.
Another area of research involves horseback riding simulation with stroke patients. Trunk balance and gait were assessed before and after the stroke patients were treated using a horseback riding simulator. Because stroke patients are not able to keep both feet on the floor and weight distributed equally between them, it is very easy for them to lose trunk muscle strength and control of the trunk on one or both sides. In a 2014 study, 20 non-traumatic, unilateral stroke patients underwent therapy using a horseback riding simulator. Their therapy included six 30-minute sessions a week for five weeks. The Trunk Impairment Scale (TIS) used to assess the patients before and after their therapy showed that they had better trunk control in a seated position following their sessions. Upon gait analysis, improvements in the areas of velocity, cadence, and stride length of the affected and non-affected sides were all observed. Additionally, the percentage of time spent in the double support phase was decreased. More research studies in which more subjects are tested for longer amounts of time are currently being investigated.