Hippotherapy uses the rhythmic three-dimensional movement of a horse as a treatment tool delivered by a licensed therapist. This article explains what hippotherapy is, what the evidence shows for cerebral palsy, what a session looks like, who is a good candidate, how to find a provider, and what costs and insurance look like.
What Hippotherapy Actually Is (and What It Is Not)
Hippotherapy means using the horse’s movement as a treatment tool within a session led by a credentialed physical, occupational, or speech-language therapist. The therapist designs the session around specific functional goals: improving trunk and pelvic control, modulating tone, building postural strength, supporting motor planning, or facilitating speech and communication.
Therapeutic riding is different. It is recreational riding adapted for people with disabilities, taught by a riding instructor, with goals around horsemanship and enjoyment. Both can be valuable, but they are not interchangeable. Hippotherapy is a clinical service; therapeutic riding is a recreational activity. Many programs offer both, sometimes even with the same horse, but the staffing and goals differ.
Why the Horse’s Movement Helps
A walking horse’s pelvis moves in three planes simultaneously: forward and back, side to side, and rotational. This pattern mimics the movement of a human pelvis during walking. For a child with CP whose own walking is limited, this provides a continuous, rhythmic input to the trunk, hips, and pelvis that is hard to replicate any other way. The therapist adjusts the horse’s gait, the rider’s position, the use of props, and the activity (reaching, throwing, communicating) to target specific goals. Sensory input from the horse’s warmth and movement can also support arousal regulation and engagement, which makes hippotherapy useful for some children with sensory or attentional differences alongside CP.
Many CP cases trace back to events during labor and delivery. A free legal review can help clarify whether the injury was preventable and what funding options may be available for ongoing therapy.
What the Evidence Shows
Research on hippotherapy for CP has grown substantially. Findings to date suggest:
- Improvements in gross motor function on standardized assessments (such as the GMFM) compared with controls in some studies.
- Benefits for postural control and balance, particularly in trunk and pelvic stability.
- Possible benefits for spasticity immediately after sessions, with shorter-term effects on tone.
- Benefits for quality of life and engagement reported by parents.
Effect sizes vary across studies, and methodological quality is mixed. Hippotherapy is best understood as a complementary therapy that may add value alongside conventional PT/OT/SLP, not as a replacement. Children most likely to benefit are those with sufficient head and trunk control to safely sit on the horse, who are engaged by the experience, and whose goals align with what the modality offers.
What a Session Looks Like
A typical session lasts 30 to 45 minutes and involves a team:
- The licensed therapist (PT, OT, or SLP) directs goals and activities.
- A horse handler leads the horse and adjusts gait.
- One or two side walkers support the rider physically as needed.
- The horse is specifically selected and trained for therapy work, with a smooth gait and steady temperament.
Activities during the session might include riding in different positions (forward, sideways, backward), reaching for objects, throwing balls, vocalizing, navigating obstacles, or simply riding with the therapist’s facilitation of trunk movement. Sessions are documented like any therapy session and progress is tracked against goals.
Who Is a Good Candidate (and Who Is Not)
Hippotherapy can be appropriate for children with CP who have:
- Sufficient head and trunk control to ride safely (or who can ride with support)
- Goals that align with the modality (trunk control, balance, posture, engagement)
- No major contraindications (severe atlantoaxial instability, uncontrolled seizures, severe behavioral risk, allergies to horses)
- Family ability to attend sessions (often a 30 to 60 minute drive each way)
Children with severe spasticity, limited postural control, or significant medical fragility can sometimes participate with adapted setups. The therapy team evaluates safety and appropriateness in an initial assessment.
Finding a Provider and Paying for It
The American Hippotherapy Association certifies therapists and centers and maintains a directory. Most programs are nonprofits associated with PATH International (Professional Association of Therapeutic Horsemanship). Costs typically range from to per session. Insurance coverage varies: some plans cover sessions billed as PT, OT, or SLP under standard codes; many do not. Medicaid coverage varies by state. Many programs offer scholarships, sliding-scale fees, or fundraising events. Asking the program directly about insurance billing and financial assistance is the practical first step.
Steps to Try Hippotherapy
Use this list to evaluate and start hippotherapy.
Is hippotherapy safe for children with seizures?
Children with well-controlled seizures often participate safely. Centers screen for seizure stability, helmet use is standard, and side walkers add safety. Children with frequent breakthrough seizures or recent uncontrolled events may be advised to wait. Discuss with both your neurologist and the hippotherapy team.
How is hippotherapy different from horse riding lessons?
Riding lessons teach the child to control the horse and develop horsemanship. Hippotherapy uses the horse’s movement to address therapy goals; the child is not learning to ride independently as the primary objective. The therapist directs the session and the horse handler manages the horse. Many children eventually transition from hippotherapy to therapeutic riding for the social and recreational benefits.
We help families across 38 states understand insurance, Medicaid, and other funding for therapies like hippotherapy.
Related reading for parents
- Physical therapy for babies and toddlers with cerebral palsy: what to expect
- Aquatic therapy for balance and movement in CP
- What is the Anat Baniel Method (ABM)?
- CIMT (Constraint-Induced Movement Therapy): is it right for my child?
- Early intervention for cerebral palsy: what therapies actually help
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