Horse power

Hippotherapy can lead to improved balance, strength and flexibility—and to a more positive outlook on life.

by Shara Rutberg

Sitting in her wheelchair, Katie Phemister Kirkham craned her neck to look up at the horse. Way up. “I was terrified,” she says, recalling her first time on a horse, in 1999. “I was so scared I’d fall off. I didn’t think I could do it. I just didn’t see how it could work out.”

But it did. Kirkham, diagnosed with multiple sclerosis in 1983, credits hippotherapy—a type of treatment that uses a horse’s movements to achieve therapeutic goals—with helping her to maintain her balance, flexibility and endurance. And don’t get her started on how happy the sessions make her feel. “It’s huge,” the 52-year-old resident of Fort Collins, Colo., says. “It’s been truly amazing how much it’s helped me.” She’s not alone. For the past 20 years, many people who live with MS have turned to hippotherapy for a range of benefits that make a profound difference in their lives.

Finding deeper strength

As Cinco the horse takes steady steps in an enclosed arena, Kirkham sweats in the saddle as she works to stretch her torso over Cinco’s back and down to the left. She sits on a thick bareback pad instead of a saddle, to have a more direct connection with Cinco’s body as it rocks gently.

As Cinco walks, his movement passively moves Kirkham’s pelvis and hips, mimicking the way a human walks. Each side in turn lifts and tilts forward. When a horse creates this movement, the rider is forced to activate her trunk muscles to compensate; otherwise she would fall over. And because horses don’t step exactly the same way each time, the rider must vary her response, as well, strengthening a greater number of muscles than she would with machine-based exercises.

“Katie is so much stronger now than when she first began working with Cinco more than a year ago,” says Brent Applegate, Kirkham’s physical therapist and the founder of My Heroes Therapy, which provides hippotherapy services in Fort Collins and Atlanta. Kirkham’s posture is straighter too, which in turn improves her breathing and her comfort in a wheelchair.

The balance and postural control developed  on a horse cultivate deeper core strength that translates to other activities. “I’m able to sit up straighter for longer and haven’t been falling off my scooter,” says Alice Hissim, 51, who has secondary-progressive MS and began hippotherapy in 2010 at Freedom Horse in Long Valley, N.J. Hissim, diagnosed in 2004, has worked gradually to build her core muscles on the horse. As her strength and endurance slowly increased, so did her body awareness and stability, which helps her transfer in and out of her scooter and use her walker.

A four-legged treatment tool

Tina Schuh prepares to transfer to a lift that will raise her onto the horse.

Tina Schuh prepares to transfer to a lift that will raise her onto the horse.

Hippotherapy differs from therapeutic or adaptive riding, in which a client learns to control the animal as part of a recreational activity with some therapeutic carryover, explains Debbie Silkwood-Sherer, associate professor in the Central Michigan University graduate program in physical therapy.

In hippotherapy, the horse is used as an actual treatment tool, just as a thera-ball or balance beam would be, and the rider works only to control his or her body, not the horse’s. (The therapists usually have program volunteers helping to lead the horse and offer support to the rider during a session.)

“Some of these movements I could replicate in the clinic with a Swiss ball, for example,” says Silkwood-Sherer, a former president of the American Hippotherapy Association. But in a typical 45-minute hippotherapy session, a horse steps about 2,000 times, she estimates. “There’s no way a person could move her pelvis 2,000 times in a clinic session,” she says. And in hippotherapy, there’s an “added benefit of the person moving through space,” which more closely imitates three-dimensional challenges people encounter in their lives.

It’s not just physical therapists who utilize hippotherapy, however. Occupational therapists use it to work on fine motor control, attention and sensory integration, and speech-language therapists use the sessions to stimulate communication and cognitive skills.

Part of the power of hippotherapy is that it does all of these things at once. “More than any other therapy or activity I’ve tried, this really gets your whole body working as a unit,” says Kirkham, who also skis on adaptive equipment on snow and water.

A powerful connection

“I’m still on cloud nine,” says Sandy Huprich, 49, a day after a hippotherapy session at My Heroes’ Atlanta center, near her home in Kennesaw, Ga. While the sessions have definitely helped with her balance and core strength, Huprich, diagnosed with MS in 2012, is most enthusiastic about the psychological benefits. “There’s just something about being able to hear the horse snort, to hold onto his mane,” she says. “It’s the best therapy I’ve ever had.”

The bond between horse and rider can be powerful, but Dr. Adrienne Boissy, a neurologist at the Cleveland Clinic’s Mellen Center for MS, says there’s yet another critical component. She recalls a graduate student patient who was terribly frustrated with her disease and how disconnected she had become from people and the things she’d loved to do. After she began hippotherapy, she developed a deep connection not only with the horse, but also with the therapists, volunteers and other people in the program. “It became a lifeline for her,” says Dr. Boissy. “The change in her was remarkable. She was able to find that emotional connection, a motivation, a social connection through hippotherapy. Those connections were something we couldn’t have offered through traditional medicine and physical therapy alone.”

Risks and fears

Marilyn McDowell practices her balance on an Equicizer, which mimics the movements of a horse.

Marilyn McDowell practices her balance on an Equicizer, which mimics the movements of a horse.

Hippotherapy is no riskier than therapy in a traditional setting, says Jacqueline Tiley, executive director of the American Hippotherapy Association (AHA), pointing to a nearly non-existent incident rate reported in a five-year, industry-wide safety survey. The horses are trained and the rider is surrounded by experienced professionals and volunteers.

At some centers, the riskiest part of hippotherapy—mounting and dismounting—is made even safer with the use of a SureHands Lift, a crane-like machine that hoists the rider from the ground or wheelchair up, over and onto the horse’s back. If people are worried about their ability to sit on a horse, therapists may start them on a device called an Equicizer, a kind of mechanical horse that simulates a real horse’s movements.

Promising research

So far, research on the benefits of hippotherapy has been extremely limited but promising, particularly when it comes to improving balance.

In a small 2005 Swedish study by Ann Hammer and her colleagues at the department of rehabilitation medicine at Orebro University Hospital, 10 of 11 people showed gains—primarily in balance—after weekly hippotherapy sessions conducted over 10 weeks. Some participants also demonstrated improvements in pain relief, muscle tension and ability to perform activities of daily living.

Silkwood-Sherer directed a small 2012 pilot study conducted over 14 weeks in which three people with MS participated in weekly hippotherapy sessions and two with MS received no treatment. Those who rode showed significant improvement when tested in balance and mobility. Research she conducted in 2007 showed that among 15 adults with MS, the nine who underwent weekly hippotherapy treatment for 14 weeks demonstrated a significant improvement in balance versus the control group. She hopes the positive results from these studies will lead to grants for a larger study, which will be important to confirm the findings.

Is it covered?

While physical, occupational and speech-language therapists trained in hippotherapy can be found in nearly every state in the country, one of the larger barriers to accessing hippotherapy is the cost.  Not all insurance companies cover hippotherapy, and many deny claims on the grounds that hippotherapy is “recreational” or “experimental,” decisions that stem from common confusion between hippotherapy and therapeutic riding, Tiley says. AHA’s insurance task force is working with the American Physical Therapy Association and the American Occupational Therapy Association to develop strategies for therapists and people with MS to deal effectively with denials. As insurance companies and the public begin to understand the definition of hippotherapy, the quest for coverage is slowly getting easier.

Financial assistance may be found through scholarships at hippotherapy centers or through local community foundations, says Tiley. The National MS Society may be able to help locate additional financial resources.

Kirkham’s insurance covers her therapy with My Heroes. And if it didn’t, she says, she’d find another way to pay for it. “Somebody once said that the outside of a horse is good for the insides of a man,” she says. “That is so true. It really, really is. I know that it’s truly improved my quality  of life.”

 Shara Rutberg is a freelance writer based in Boulder, Colo.
Spring 2014
Find certified therapists who practice hippotherapy through the American Hippotherapy Association.