Sometimes when reading information or when speaking to professionals (both therapists and instructors) related to Equine Assisted Therapies and Activities, I am shocked to hear how often inaccurate terminology is used when talking about things like hippotherapy and adaptive riding! For example, terms like “horse therapy”, “horseback therapy”, “therapeutic riding”. Is it therapy or not? I often also see people frequently making claims about the benefits of riding lessons, and eluding to riding lessons being a type of “therapy”. It is illegal to practice without a license, and making claims like this is unethical. On the PATH international website, they write that “Therapeutic Riding provides benefits in the areas of THERAPY, education sport and recreation & leisure.” There are several things that are concerning here. To claim that the riding lesson is providing “therapy” benefits really crosses the line and is misleading. Professional organizations like AOTA, APTA and ASHA often tackle issues such as this in order to protect therapists, and may need to begin to take a look at this issue.
As both a therapist and a PATH Registered Instructor, that it was important to share some information about terminology and the differences between therapy and riding lessons. While this post is long, the information it is very important for both therapists and instructors to understand.
Here are a few facts about hippotherapy, adaptive riding and the related terminology:
- Hippotherapy is not therapy for hippopotami . Nor is it therapy done by or with the help of a hippopotamus . The Greek word “hippos” translates to “horse”. Hippotherapy, is loosely translated as treatment with the help of a horse. The term “hippotherapy” more accurately is referring to the movement of the horse as a therapy treatment strategy. When a patient is receiving occupational, physical or speech therapy incorporating the movement of the horse we call this hippotherapy. The American Hippotherapy Association says: “The term hippotherapy refers to how occupational therapy, physical therapy, and speech-language pathology professionals use evidence-based practice and clinical reasoning in the purposeful manipulation of equine movement to engage sensory, neuromotor, and cognitive systems to achieve functional outcomes. In conjunction with the affordances of the equine environment and other treatment strategies, hippotherapy is part of a patient’s integrated plan of care.” Hippotherapy is not a “form of therapy” it is a treatment strategy or tool used within OT/PT/ST.
- When horses and the horse’s environment are used as part of an occupational, physical or speech therapy session but the patient is not on the horse we call this equine assisted (occupational/physical/speech) therapy. There are many goals and objectives that the occupational, physical or speech therapist can work on around the horses and in the horses environment.
- Hippotherapy is not the same as nor is it a form of “adaptive” or “therapeutic” horseback riding. They differ in many ways, the biggest being that in hippotherapy the patient is working on therapy goals and in adaptive/therapeutic riding the rider is working on learning how to ride a horse. Hippotherapy is a treatment strategy which can be provided by a licensed Physical Therapist, Occupational Therapist or Speech Language Pathologist as part of a patients total plan of care. When used correctly, the use of Hippotherapy may enhance traditional therapy and helps patients to meet their therapy goals and objectives. Hippotherapy is never provided by riding instructors.
- The American Hippotherapy Association (AHA) refers to riding lessons for individuals with special needs as “Adaptive Riding” as it is believed that the term “Therapeutic Horseback riding” is misleading and confusing for people. It implies that the adaptive riding lessons are “therapy” and this terminology is misleading for people. PATH International continues to use the term “Therapeutic Riding”. It confuses people and insurance companies, resulting in denied claims for people who actually are receiving therapy.
- It is true that adaptive riding has many benefits as a recreational activity. In addition to being a speech language pathologist, I am also a registered riding instructor with PATH and I teach Adaptive Horseback riding lessons. I also, up until recently, managed a horse show series for riders with disabilities called “The Long Island Horse Show Series for Riders with Disabilities”. There are many people who are looking to participate in an enjoyable sport rather than therapy. Being a good Adaptive Riding instructor is a skill. Adapting a horseback riding lesson and teaching someone to overcome their limitations is amazing. It is great for self esteem and growth. I am not sure why many riding instructors insist on trying to “stake a claim on therapy” when the work they are doing is amazing in itself. I personally love teaching riding lessons and I really love preparing riders with special needs to be successful in the sport and in the world of equestrian competition. When I work as an instructor, my riders learn things like equitation, competition rules, horse anatomy, parts of the tack, and how to groom and tack their horses. Some of them go to horse shows. Some just have fun. They learn a lot about the sport of riding. They learn important lessons on sportsmanship and on winning and losing. They feel better about themselves at the end of the day, and might be stronger, more balanced and more physically fit from this wonderful form of exercise. All great secondary benefits, but still not therapy! When I provide speech therapy using hippotherapy my session looks VERY different than when I am teaching a riding lesson. Having the patient learn to ride is not the goal of my session when I am using the horses movement to work on speech.
- Because hippotherapy is provided by a therapist as part of an occupational, physical or speech therapy treatment plan, the cost may covered by insurance depending on your coverage for occupational, physical or speech therapy services. Your coverage will also vary depending upon if the therapist if “in network” or “out of network” with your insurance company. Therapeutic or adaptive riding is considered recreational and is NOT covered by insurance.
- This one is one of my biggest pet peeves: There is no such thing as a “hippotherapist”! In addition, hippotherapy is NOT a type of therapy or a form of therapy (as speech therapy is). This is a little confusing, because of the name “hippotherapy” but it is important to understand. There is no separate license for hippotherapy in the U.S. Hippotherapy is simply a treatment strategy that is utilized by occupational, physical and speech language pathology professionals. When a speech therapist uses hippotherapy as part of a patient’s treatment we are still providing speech therapy (when an occupational therapist uses hippotherapy it is still occupational therapy, same is true for physical therapy). Just like when you go to an occupational therapy session and the treatment strategy is the use of a therapy swing for the day, the session is billed as occupational therapy, NOT swing therapy. The therapist does not suddenly turn into a “swing therapist”. This is an important differentiation to make. Insurance companies pay for speech therapy (and occupational/physical therapy), not for hippotherapy (they also don’t pay for swing therapy)! This is because they pay for therapy, not specific treatment tools or strategies. When we do not use the right terms it confuses patients and the public as well as insurance companies.
- Since we are talking about insurance companies, let’s talk about the “S-Code” for hippotherapy. The American Hippotherapy Association advises against using the “S-Code” for hippotherapy. Stick with your traditional OT, PT and Speech codes. You are providing occupational therapy, physical therapy or speech therapy. Just because you are using a horse, you are not suddenly doing a different type of therapy. Remember that hippotherapy is not form of therapy (see number 7). It is a treatment strategy. For more on this, visit the American Hippotherapy Association website to access their billing document.
- When a person is riding a horse in a riding lesson we call them a “rider“. When a person is receiving occupational, physical or speech therapy on a horse we refer to the person as a “patient” or “client“. When teaching someone to ride we call it a lesson. When giving someone therapy we call it a treatment or therapy session.
- A horse is a horse of course of course, but in a therapy session when we are talking about using the correct terminology, the horse is a “treatment tool“, and the horse’s movement is the “treatment strategy“. We modify the horses movement (our treatment strategy) as needed many times throughout a therapy session that incorporates hippotherapy to get desired responses from the patient. Therapists are trained to use and modify the movement of the horse and a variety of developmental positions while on the horse to improve function.
- When documenting therapy sessions which incorporate hippotherapy as a strategy it is important to stay away from horseback riding terms like “rider”, “trotted”, “posting”, “walk/halt transitions” etc. If you are a therapist, think and speak like a therapist! The person you are treating is a patient/client. So they didn’t “post”. Think about it in therapy terms. It is a “modified sit to stand’. They didn’t “trot”. You “provided them with increased proprioceptive and vestibular input”. You didn’t do “walk/halt transitions”. You worked on “righting responses and increasing arousal”.
- If you are a therapist, lead with the therapy. Therapists need to stop saying things like “hippotherapy program” and “hippotherapy session”. You don’t have a ‘hippotherapy program” Hippotherapy is not a program. It is a treatment strategy. If you are a physical therapist, you have a physical therapy practice that incorporates or specializes in the us of hippotherapy in treatment. You are not providing a “hippotherapy session”, you are providing physical therapy sessions incorporating hippotherapy. The same applies for occupational therapists and speech language pathologists. As a therapist, you have a responsibility to work within your scope of practice and to be clear about this.
- Hippotherapy is supposed to be part of a total plan of care. This means that hippotherapy should not be the only approach that you use with any of your patients as a therapist. You should have access to a clinical space, and work with your clients both on and off of the horse to facilitate carryover and generalization of skills and to effectively complete ongoing clinical assessment of how the client is functioning both on and off of the horse.
- If you are a riding instructor who develops goals for your riders, the goals should be related to horsemanship and riding. For example, “Johnny will steer his horse through 3 cones”, “Johnny will keep his horse trotting for 2 laps around the arena”, “Johnny will independently tack up his horse”. The goals should not be related to improving function, as instructors do not have training to do this. Even riding instructors who are certified by organizations such as PATH International do not receive training to assess or improve function as an occupational, physical or speech therapist would. Riding instructors are trained to adapt the lesson they teach to help facilitate success. In addition they often have training in precautions and contraindications for riding lessons for people with special needs, and basic training in working with people with special needs. It is important to understand that while some riding instructors may have additional training in special education or other related fields, in order to become a PATH International registered instructor, you only need to be 18. No other degrees or training are required. There generally are no requirements in the U.S. related to training for riding instructors for people with or without disabilities, and the task of finding a qualified instructor falls on the consumer.
- Good instructors are able to select an appropriate horse to match their rider’s skill level, adapt riding equipment as needed, and adapt how they teach in order to help individuals with physical or cognitive disabilities ride successfully. They put things in place to keep their riders safe. It is incredibly hard to be a good rider, harder to be a good instructor, and even more difficult to be a good instructor for a person with special needs. Good riding instructors for individuals with special needs are hard to find, and are incredibly skilled equestrians and instructors. If you are one of them be proud!
- As mentioned above, there may be some secondary benefits of riding lessons, however these benefits apply to all people who participate in the sport or activity of horseback riding, not just individuals with special needs. A rider may be more physically fit after participating in lessons, they might have improved self esteem, they might have an increased quality of life, they might have more opportunities for socialization. They get to spend time with others who share a common interest. Riding is a wonderful activity with all of the benefits associated with becoming an equestrian athlete. Riders have the joy of spending time with wonderful animals in a natural environment. They may overcome obstacles and will learn a new sport. These benefits are great, however they are because of participation in a wonderful recreational activity. Some may argue that riding a horse is “therapeutic”. We just must remember though, that it is NOT the same as receiving therapy.
- The research issue: Terminology varies widely in research articles related to adaptive/therapeutic riding lessons and therapy sessions. It is so important that we move toward consistent and clear terminology related to equine assisted activities and therapies. I hope in the near future organizations like PATH International and The American Hippotherapy Association Inc. can work together to develop this.
Riding lessons for people with special needs and therapy sessions incorporating Hippotherapy both have very different but important purposes and goals. They are both incredibly valuable, however they are very different things.
We must be clear when explaining what adaptive (or if you must say: “therapeutic”) riding is. Adaptive riding is valuable and needed as a recreational activity and a sport for individuals with special needs. It is important, just as other adaptive sports are. Using the term “therapeutic riding lessons” to describe this activity confuses people. It is misleading (sometimes intentionally) by instructors and centers, and this is very unfortunate for all.
In addition, therapists need to be clear when talking about hippotherapy. Hippotherapy is as a valuable treatment strategy for patients receiving occupational, physical and speech therapy. Therapists utilizing hippotherapy as a treatment strategy must work hard to educate patients and insurance companies. Using the right terminology is crucial. In face, it is your responsibility under the “Best Practice Statements” from the American Hippotherapy Association, which are available here. That site also provides a list of terms and their definitions as they relate to equine assisted activities and therapy as well as a variety of other resources.
I leave you with these final thoughts. If researchers, therapists and riding instructors don’t use correct and clear terms about what it is we do, how can we expect the patients, clients, riders, insurance companies, medical community and general public to understand? When you talk about what you do, are you part of the problem or part of the solution?