Hippotherapy
AHA-PATH certification. High patient satisfaction but small effect sizes in RCTs. Beneficial for CP, MS, and ASD in feasibility studies.
Each lens uses its own dimensions and default weights. Scores answer different questions across paths — they aren’t apples-to-apples. How scoring works →
Systematic reviews show small positive effects on balance and motor function; effect sizes modest vs dose-matched alternatives.
Extremely limited by requirement for horse facility and trained animal; applicable only in equine therapy settings.
Very limited coverage; PATH certification required by the few payers that cover; mostly self-pay or disability grants.
PATH International certification; equine-assisted therapy requires horse facility access; significant logistics.
Very limited employer demand; primarily nonprofit equine therapy centers and adaptive sports programs.
Exceptional; children and adults with disabilities report transformative experience. Motivation to attend is unmatched.
Families of pediatric clients with disabilities frequently pay cash or use grants when insurance won't cover equine-assisted therapy.
Scarcity and experiential value support premium per-session pricing, though overhead eats much of the margin.
Highly distinctive — very few clinicians offer it in any given region, creating a near-monopoly niche.
Hard to scale: requires horses, land, certified clinicians, and PATH-credentialed staff — labor and capital intensive.
Parents in special-needs communities actively seek it out, but absolute demand volume is small.
Expensive and slow to implement — facility, livestock, and credentialing costs are substantial relative to revenue.
Niche modality with minimal weight in faculty promotion or hiring outside a few specialized programs.
Some peer-reviewed work exists but the field is small and methodologically limited.
Tangential to core PT/OT curricula; appears at most as a brief elective topic.
Evidence is growing but consists largely of small studies; RCTs are limited and heterogeneous.
Virtually never listed as a desired credential in faculty job postings.
Substantial time and money to credential with little return in academic currency.
- 01Effectiveness of school-based physiotherapy intervention for childrenK. E. Alexander; G. L. Clutterbuck; L. M. Johnston · Disability & Rehabilitation2025Otherdoi:10.1080/09638288.2024.2388260
- 02Equine-Assisted Interventions and Physical Health in Older Adults: A Meta-AnalysisL. Badin; K. Pothier; O. Agli; E. Van Dendaele; G. Guillou; G. Ventalon; N. Bailly · Sage Open Aging2025Meta-analysisdoi:10.1177/23337214241298342
- 03Hippotherapy Improves Gross Motor Function in Children with Cerebral Palsy: Evidence from a Systematic ReviewI. Bernardino; D. F. Borges; J. Casalta-Lopes; J. I. Soares · NeuroRehabilitation2025Systematic reviewdoi:10.1177/10538135251387278
- 04Immediate effects of a 30-min hippotherapy session on center of pressure displacement in children with autism spectrum disorder: A quasi-experimental studyV. de Fátima Coccia; A. L. F. Rodacki; S. L. Pavão · Journal of Bodywork & Movement Therapies2025Otherdoi:10.1016/j.jbmt.2025.05.060
- 05The effect of hippotherapy on people with multiple sclerosis, a systematic reviewI. Giannou; M. Katsina; Z. Dimitriadis; G. Paras; T. Besios · Mult Scler Relat Disord2025Systematic reviewdoi:10.1016/j.msard.2025.106374
- 06The Effect of Hippotherapy Simulator-Assisted Therapy on Motor and Functional Outcomes in Children with Cerebral PalsyC. Günay Yazıcı; F. Özden; O. Çoban; D. Tarakçı; O. Aydoğdu; Z. Sarı · Medicina (Kaunas)2025Otherdoi:10.3390/medicina61101811
- 07Electromyographic analysis of trunk and lower limb activation in children with cerebral palsy during gait and hippotherapy sessionsJ. B. Lage; G. A. N. Nascentes; L. F. Silva; M. C. Borges; I. C. R. Ferreira; L. A. Lombardi; F. S. Silva; A. P. Espindula · J Bodyw Mov Ther2025Otherdoi:10.1016/j.jbmt.2025.04.031
- 08Effectiveness of Equine-Assisted Intervention as a Therapeutic Strategy for Improving Adaptive Behaviour in Children with Autism Spectrum DisorderC. M. Martínez Moreno; J. M. Hernández Garre; P. Echevarría Pérez; I. Morales Moreno; E. Vegue Parra; E. Valero Merlos · Healthcare (2227-9032)2025Otherdoi:10.3390/healthcare13162014
- 09A Randomized Feasibility Study of Rehabilitation Targeting Upper Extremity Function and Participation Using Hippotherapy and the Equine Environment for Children with Cerebral Palsy and Autism Spectrum DisorderJ. Mazzarella; J. C. Heathcock · Journal of Integrative & Complementary Medicine2025RCTdoi:10.1089/jicm.2024.0292
- 10Heart rate and salivary cortisol as indicators of arousal and synchrony in clients, therapy horses and therapist in equine-assisted therapyA. Naber; L. Kreuzer; R. Zink; E. Millesi; R. Palme; K. Hediger; L. M. Glenk · Complementary Therapies in Clinical Practice2025Otherdoi:10.1016/j.ctcp.2025.101937
- 11Effects of Hippotherapy and Horse-Riding Simulators on Gross Motor Function in Children with Cerebral Palsy: A Systematic ReviewA. Ortega-Cruz; V. Sánchez-Silverio; V. Riquelme-Aguado; J. L. Alonso-Perez; V. Abuín-Porras; J. H. Villafañe · J Clin Med2025Systematic reviewdoi:10.3390/jcm14010283
- 12Effects of an Interprofessional Equine Interactive Vaulting Program on Executive Function and Group Participation in Children with DisabilitiesH. Panczykowski · Integrative & Complementary Therapies2025Otherdoi:10.1177/27683192251386180
- 13Impacts of hippotherapy simulation on balance, postural control, and spasticity of thigh adductor muscles in children with spastic bilateral Cerebral Palsy: A single-blind clinical trial studyK. Ramezani; M. kalantari; M. Pashmdarfard; A. A. Baghba; S. Rahmanian; G. Khavari · Iranian Journal of Child Neurology2025Otherdoi:10.22037/ijcn.v19i1.46567
- 14Effects of Equine-Assisted Therapy: A Systematic Review and Meta-AnalysisA. N. Stergiou; A. Ploumis; S. Kamtsios; G. Markozannes; P. Christodoulou; D. N. Varvarousis · J Clin Med2025Meta-analysisdoi:10.3390/jcm14113731
- 15Exploring In-Session Engagement in Equine-Assisted Services for Children and Youth Experiencing Disability: A Scoping ReviewL. M. Aewerdieck; R. A. Martin; F. P. Graham; J. Hay-Smith · J Integr Complement Med2024Systematic reviewdoi:10.1089/jicm.2024.0151
- 16Bibliometric Analysis on Equine-Assisted InterventionsM. Amado-Fuentes; A. Denche-Zamorano; S. Barrios-Fernandez; M. Gozalo · Animals (Basel)2024Otherdoi:10.3390/ani14121776
- 17Equine-assisted service's effect on cartilage and skeletal biomarkers for adults and older adults with arthritis: A pilot studyM. Chrisman; S. White-Lewis; S. Lasiter; S. R. Chesnut; C. L. Russell · Complement Ther Med2024Pilot/feasibilitydoi:10.1016/j.ctim.2024.103047
- 18The Horse Weaves Magic': Parents and Service Providers on the Benefits of Horse-Based Therapies for Autistic Children—an Australian Qualitative StudyM. Cleary; S. West; R. Kornhaber; C. Johnston-Devin; D. K. Thapa; L. McLean; C. Hungerford · Issues in Mental Health Nursing2024Qualitativedoi:10.1080/01612840.2024.2367156
- 19The effects of mechanical hippotherapy riding on postural control, balance, and quality of life (QoL) in patients with strokeO. Çoban; F. Mutluay · Disability & Rehabilitation2024Otherdoi:10.1080/09638288.2023.2221458
- 20Comparison of the effects of mechanical hippotherapy and Cawthorne-Cooksey exercises in patients with multiple sclerosis: Randomized trialA. Kabuk; Ö. Şevgin · Mult Scler Relat Disord2024RCTdoi:10.1016/j.msard.2024.105697
- 21HORSE POWER: HOW A THERAPEUTIC EQUINE HELPED A TODDLER WITH SPINA BIFIDAC. Lent · Exceptional Parent2024OtherPMID 177312833
- 22Interaction during equine-facilitated rehabilitation from the rehabilitees' perspective - A phenomenological studyM. Mattila; S. Honkanen; T. Sjögren; A. Piirainen; E. Aartolahti · Taylor & Francis Ltd2024Narrative reviewdoi:999-1010
- 23Development and pilot of equine facilitated physical therapy outcome measure tool for chronic low back pain patientsS. Mattila-Rautiainen; M. Venojärvi; A. Sobolev; H. Tikkanen; A. Keski-Valkama · Journal of Bodywork & Movement Therapies2024Otherdoi:10.1016/j.jbmt.2024.01.005
- 24Efficacy of hippotherapy simulator exercise program in patients with stroke: a randomized single-blind clinical trialS. ÖZtÜRk; O. AydoĞDu; Z. Sari · Topics in Stroke Rehabilitation2024RCTdoi:10.1080/10749357.2024.2310425
- 25Effects of hippotherapy on motor function of children with cerebral palsy: a systematic review studyP. Plotas; A. Papadopoulos; E. M. Apostolelli; E. Vlachou; F. Gazou; I. Zogopoulou; I. Katsaidoni; I. Panagiotopoulou; S. P. Paparouna; N. Silavou; K. Fragkiadaki; E. Tsiamaki; S. Fouzas; X. Sinopidis; N. Trimmis · Ital J Pediatr2024Systematic reviewdoi:10.1186/s13052-024-01715-9
- 26Multispecies Occupations Involving Equines: An Action-Oriented Inquiry to Inform Occupational Therapy PractitionersH. K. Pugh; K. S. Heatwole Shank · OTJR: Occupational Therapy Journal of Research2024Otherdoi:10.1177/15394492231203724
- 27Multiple Equine Therapies for the Treatment of Gross Motor Function in Children with Cerebral Palsy: A Systematic ReviewZ. Qin; Z. Guo; J. Wang · Journal of Community Health Nursing2024Systematic reviewdoi:10.1080/07370016.2024.2304825
- 28Clinical effects of equine-assisted therapeutic exercises in static and dynamic balance of children with cerebral palsyA. N. Stergiou; D. N. Varvarousis; S. Mattila-Rautiainen; M. Tzoufi; S. Doulgeri; A. Ploumis · Rehabilitación2024Otherdoi:10.1016/j.rh.2024.100841
- 29Hippotherapy in the management of hypermobile Ehlers-Danlos syndromeH. Viruega; C. Loriette; M. Quignon; M. Gaviria · BMJ Case Reports2024Otherdoi:10.1136/bcr-2024-261605
- 30Improving trunk posture control in children with CP through a cable-driven robotic hippotherapy: A randomized controlled feasibility studyM. Wu; J. Kim; D. Gaebler-Spira · Gait Posture2024RCTdoi:10.1016/j.gaitpost.2024.06.020
- 31Analysis of strength and electromyographic activity of lower limbs of individuals with down syndrome assisted in physiotherapy and hippotherapyD. E. Bevilacqua Junior; E. C. d. Mello; J. B. Lage; M. F. Ribeiro; A. A. Ferreira; V. d. P. A. Teixeira; A. P. Espindula · Journal of Bodywork & Movement Therapies2023Otherdoi:10.1016/j.jbmt.2023.05.009
- 32Clinical application and feasibility of utilizing the PEDI-CAT to assess activity and participation among children receiving physical therapy incorporating hippotherapyS. Conroy; T. Evans; D. Butler-Moburg; R. Beuttler; J. Robinson; M. Huebert; E. O Mahony; M. Grant-Beuttler · Taylor & Francis Ltd2023Pilot/feasibilitydoi:2300-2313
- 33Hippotherapy concepts: A scoping review to inform transdisciplinary practice guidelinesN. du Plessis; K. Uys; T. Buys · Scandinavian Journal of Occupational Therapy2023Systematic reviewdoi:10.1080/11038128.2023.2231562
- 34Effect of hippotherapy on balance, functional mobility, and functional independence in children with Down syndrome: randomized controlled trialY. Kaya; S. Saka; D. Tuncer · Eur J Pediatr2023RCTdoi:10.1007/s00431-023-04959-5
- 35Evaluating the efficacy of hippotherapy: a promising intervention in rheumatology, pain medicine, and geriatricsB. F. Kocyigit; E. Adilbekov; S. Zharmenov; A. Akyol; M. Yessirkepov · Rheumatol Int2023Otherdoi:10.1007/s00296-023-05451-x
- 36Equine-Assisted Therapy in Post-Traumatic-Stress Disorder: A Systematic Review and Meta-AnalysisN. Palomar-Ciria; H. J. Bello · J Equine Vet Sci2023Meta-analysisdoi:10.1016/j.jevs.2023.104871
- 37Effects of Hippotherapy on Postural Control in Children With Cerebral Palsy: A Systematic ReviewF. Peia; N. C. Veiga; A. P. Gomes; B. N. D. Santos; N. M. S. Marques; I. Glória; J. B. Goulardins · Pediatr Phys Ther2023Systematic reviewdoi:10.1097/pep.0000000000000999
- 38Evaluation of stress markers in horses during hippotherapy sessions in comparison to being ridden by beginnersJ. F. Potier; V. Louzier · Anim Welf2023Otherdoi:10.1017/awf.2023.6
- 39The effectiveness of hippotherapy simulation exercises for muscle strength, disease activity and quality of life in sedentary adults with ankylosing spondylitisE. Salbaş; A. Y. Karahan · Ann Med2023Otherdoi:10.1080/07853890.2023.2249822
- 40The efficacy of Equine Assisted Therapy intervention in gross motor function, performance, and spasticity in children with Cerebral PalsyA. N. Stergiou; S. Mattila-Rautiainen; D. N. Varvarousis; M. Tzoufi; P. Plyta; A. Beris; A. Ploumis · Front Vet Sci2023Otherdoi:10.3389/fvets.2023.1203481
- 41Breast Cancer: How Hippotherapy Bridges the Gap between Healing and Recovery—A Randomized Controlled Clinical TrialH. Viruega; C. Galy; C. Loriette; S. Jacquot; J. L. Houpeau; M. Gaviria · Cancers2023RCTdoi:10.3390/cancers15041317
- 42Pulmonary Function and Aerobic Capacity Responses to Equine Assisted Therapy in Adolescents with Idiopathic Scoliosis: A Randomized Controlled TrialM. A. Abdel Ghafar; O. R. Abdelraouf; A. A. Abdel-Aziem; T. E. Elnegamy; M. E. Mohamed; A. M. Yehia; G. S. Mousa · J Rehabil Med2022RCTdoi:10.2340/jrm.v54.1085
- 43A 10-Week Program of Combined Hippotherapy and Scroth's Exercises Improves Balance and Postural Asymmetries in Adolescence Idiopathic Scoliosis: A Randomized Controlled StudyA. A. Abdel-aziem; O. R. Abdelraouf; S. A. Ghally; H. A. Dahlawi; R. E. Radwan · Children2022RCTdoi:10.3390/children9010023
- 44Effects of equine-assisted interventions on older adults' health: A systematic reviewL. Badin; É. Alibran; K. Pothier; N. Bailly · Int J Nurs Sci2022Systematic reviewdoi:10.1016/j.ijnss.2022.09.008
- 45Perception of hippotherapy professionals about their practice with the elderlyJ. Barbosa Matarazo; E. Rezende Freitas · Fisioterapia em Movimento2022Otherdoi:10.1590/fm.2022.35147
- 46Analysis of Trunk Neuromuscular Activation During Equine-Assisted Therapy in Older AdultsE. C. de Mello; L. H. Diniz; J. B. Lage; M. F. Ribeiro; D. E. Bevilacqua Junior; R. C. Rosa; F. A. G. Cardoso; A. A. Ferreira; M. L. F. Ferraz; V. d. P. A. Teixeira; A. P. Espindula · Perceptual & Motor Skills2022Otherdoi:10.1177/00315125221112249
- 47Equine-Assisted Therapies for Children With Cerebral Palsy: A Meta-analysisN. Heussen; M. Häusler · Pediatrics2022Meta-analysisdoi:10.1542/peds.2021-055229
- 48The Short-term Effects of Hippotherapy and Therapeutic Horseback Riding on Spasticity in Children With Cerebral Palsy: A Meta-analysisC. Hyun; K. Kim; S. Lee; N. Ko; I. S. Lee; S. E. Koh · Pediatr Phys Ther2022Meta-analysisdoi:10.1097/pep.0000000000000880
- 49Hippotherapy in neurodevelopmental disorders: a narrative review focusing on cognitive and behavioral outcomesG. Maresca; S. Portaro; A. Naro; R. Crisafulli; A. Raffa; I. Scarcella; B. Aliberti; G. Gemelli; R. S. Calabrò · Appl Neuropsychol Child2022Narrative reviewdoi:10.1080/21622965.2020.1852084
- 50Effectiveness of Mechanical Horse-Riding Simulator-Based Interventions in Patients with Cerebral Palsy-A Systematic Review and Meta-AnalysisE. Obrero-Gaitán; D. Montoro-Cárdenas; I. Cortés-Pérez; M. C. Osuna-Pérez · Bioengineering (Basel)2022Meta-analysisdoi:10.3390/bioengineering9120790
- 51Does Hippotherapy Improve the Functions in Children with Cerebral Palsy? Systematic Review Based on the International Classification of FunctioningE. Pantera; P. Froment; D. Vernay · Journal of Integrative & Complementary Medicine2022Systematic reviewdoi:10.1089/jicm.2021.0417
- 52Preliminary Efficacy of Occupational Therapy in an Equine Environment for Youth with Autism Spectrum DisorderB. C. Peters; W. Wood; S. Hepburn; E. J. Moody · Journal of Autism & Developmental Disorders2022Otherdoi:10.1007/s10803-021-05278-0
- 53Impact of hippotherapy on the life habits of children with disabilities: a systematic reviewA. Potvin-Bélanger; C. Vincent; A. Freeman; V. H. Flamand · Disability & Rehabilitation2022Systematic reviewdoi:10.1080/09638288.2021.2012847
- 54Effects of equine-assisted therapy on the functionality of individuals with disabilities: systematic review and meta-analysisA. Prieto; K. Martins Almeida Ayupe; L. Nemetala Gomes; A. C. Saúde; P. Gutierres Filho · Physiother Theory Pract2022Meta-analysisdoi:10.1080/09593985.2020.1836694
- 55The influence of equine-assisted services on the balance of a participant with visual impairment and autism characteristicsM. M. Ramos; M. Nabeiro · Journal of Bodywork & Movement Therapies2022Otherdoi:10.1016/j.jbmt.2022.03.007
- 56Effects of hippotherapy simulation exercise vs. conventional home exercises on muscle strength and balance in people with multiple sclerosis: A randomized controlled trialE. Salbaş; A. Y. Karahan · Mult Scler Relat Disord2022RCTdoi:10.1016/j.msard.2022.104111
- 57Physical therapy with hippotherapy compared to physical therapy alone in children with cerebral palsy: systematic review and meta‐analysisG. Santos de Assis; T. Schlichting; B. Rodrigues Mateus; A. Gomes Lemos; A. N. dos Santos · Developmental Medicine & Child Neurology2022Systematic reviewdoi:10.1111/dmcn.15042
- 58Can hippotherapy make a difference in the quality of life of children with cerebral palsy? A pragmatic studyD. J. Silkwood-Sherer; N. H. McGibbon · Taylor & Francis Ltd2022Otherdoi:390-400
- 59Effect of Equine-Assisted Activities and Therapies on Cardiorespiratory Fitness in Children with Cerebral Palsy: A Randomized Controlled TrialM. H. Suk; J. Y. Kwon · J Integr Complement Med2022RCTdoi:10.1089/jicm.2021.0158
- 60Effects of equine-assisted activities on attention and quality of life in children with cerebral palsy in a randomized trial: examining the comorbidity with attention-deficit/hyperactivity disorderB. Ahn; Y. S. Joung; J. Y. Kwon; D. I. Lee; S. Oh; B. U. Kim; J. Y. Cha; J. H. Kim; J. Y. Lee; H. Y. Shin; Y. S. Seo · BMC Pediatr2021RCTdoi:10.1186/s12887-021-02597-0
- 61Effectiveness of hippotherapy and therapeutic horseback riding on balance in hemiparetic patients after strokeS. B. Carlos Azevedo Silva; A. C. Corrêa Bicca Hruschka; A. Gomes Moraes; J. Cerqueira Leal; M. Lucena da Silva; L. Petrus da Silva Paz · Fisioterapia em Movimento2021Otherdoi:10.1590/fm.2021.34201
- 62Equine-Assisted Services for Children with Attention-Deficit/Hyperactivity Disorder: A Systematic ReviewA. Helmer; T. Wechsler; Y. Gilboa · Journal of Alternative & Complementary Medicine2021Systematic reviewdoi:10.1089/acm.2020.0482
- 63Physical therapy treatments incorporating equine movement: a pilot study exploring interactions between children with cerebral palsy and the horseP. Lightsey; Y. Lee; N. Krenek; P. Hur · Journal of NeuroEngineering & Rehabilitation (JNER)2021Pilot/feasibilitydoi:10.1186/s12984-021-00929-w
- 64Role and Effects of Hippotherapy in the Treatment of Children with Cerebral Palsy: A Systematic Review of the LiteratureM. J. Menor-Rodríguez; M. Sevilla Martín; J. C. Sánchez-García; M. Montiel-Troya; J. Cortés-Martín; R. Rodríguez-Blanque · J Clin Med2021Systematic reviewdoi:10.3390/jcm10122589
- 65Effects of hippotherapy on postural balance, functional mobility, self-perceived fatigue, and quality of life in people with relapsing-remitting multiple sclerosis: Secondary results of an exploratory clinical trialA. G. Moraes; S. G. R. Neri; R. W. Motl; C. B. Tauil; F. von Glehn; C. Corrêa É; A. C. de David · Mult Scler Relat Disord2021Otherdoi:10.1016/j.msard.2021.102948
- 66Facilitating new movement strategies: Equine assisted physiotherapy for children with cerebral palsyB. C. Norrud; M. Råheim; T. T. Sudmann; M. Håkanson · Journal of Bodywork & Movement Therapies2021Otherdoi:10.1016/j.jbmt.2020.12.022
- 67Equine spinal kinematics derived from different riding positions during asymmetrical bareback ridingN. Nuchprayoon; P. Ritruechai; K. Watchararat; W. Limroongruengrat; T. Wongtawan; N. Arya · J Equine Sci2021Otherdoi:10.1294/jes.32.81
- 68Effect of Equine-Assisted Activities on Cardiac Autonomic Function in Children with Cerebral Palsy: A Pilot Randomized-Controlled TrialI. K. Park; J. Y. Lee; M. H. Suk; S. Yoo; Y. G. Seo; J. K. Oh; J. Y. Kwon · J Altern Complement Med2021RCTdoi:10.1089/acm.2020.0346
- 69Hippotherapy and life habits with children with motor deficit and neurodevelopmental impairment: A pilot survey of parentsA. Potvin-Bélanger; A. Freeman; C. Vincent · Journal of Pediatric Rehabilitation Medicine2021Cross-sectionaldoi:10.3233/PRM-190641
- 70Effectiveness of equine-assisted therapies for improving health outcomes in people with multiple sclerosis: A systematic review and meta-analysisD. Suárez-Iglesias; I. Bidaurrazaga-Letona; M. A. Sanchez-Lastra; S. M. Gil; C. Ayán · Mult Scler Relat Disord2021Meta-analysisdoi:10.1016/j.msard.2021.103161
- 71Optimal Terminology for Services in the United States That Incorporate Horses to Benefit People: A Consensus DocumentW. Wood; K. Alm; J. Benjamin; L. Thomas; D. Anderson; L. Pohl; M. Kane · Journal of Alternative & Complementary Medicine2021Otherdoi:10.1089/acm.2020.0415
- 72Hippotherapy: a systematic mapping review of peer-reviewed research, 1980 to 2018W. H. Wood; B. E. Fields · Disability & Rehabilitation2021Otherdoi:10.1080/09638288.2019.1653997
- 73Effectiveness of Equine-Assisted Activities and Therapies for Improving Adaptive Behavior and Motor Function in Autism Spectrum DisorderL. Zoccante; M. Marconi; M. L. Ciceri; S. Gagliardoni; L. A. Gozzi; S. Sabaini; G. Di Gennaro; M. Colizzi · J Clin Med2021Otherdoi:10.3390/jcm10081726