Even inside the barn at Southlands Foundation, just outside Rhinebeck, it was cold enough that humans and horses alike could see their breath. Nancy King, an occupational therapist and director of A Horse Connection, gave T.J. short verbal cues—“gentle touch” and “quiet hands”—as they readied Skarloey. During the preparations, T.J.’s attention scattered easily. He repeated the word “chocolate,” which, in the veiled world of autism, could mean he wanted chocolate, or that he was just hooked on repeating the word—a behavior known as perseveration. Another time, T.J. took out his grooming tools to brush Skarloey’s mane, but got distracted.
Skarloey, through it all, remained stoic, showing no signs of the layperson’s perception of equine impatience: tail flicking, snorting, pawing. When Skarloey and T.J. both were ready, Nancy led them to an indoor ring for a hippotherapy session.
Hippotherapy literally means “treatment with the help of the horse” (hippo- taken from the Greek word for horse). The idea of seeking aid for human ailments from horses began (in modern times) in Germany, Switzerland, and Austria in the 1960s—at that time as an adjunct to physical therapy. By the 1970s, interest had spread to the US and other countries, and over the next two decades standardized curricula were developed in the US for teaching therapists this specialty. The American Hippotherapy Association (AHA) was established in 1992; by 1999, the American Hippotherapy Certification Board was in place.
Today, a hippotherapy clinical specialist (a term preferred by the AHA over “hippotherapist,” ingrained though it is, given the current medical/insurance reimbursement milieu) must be a licensed physical therapist, occupational therapist, or speech-language pathologist who has additionally trained and earned certification in the use of horses as a tool to achieve treatment goals. Clients often come through physician referrals.
Specific riding skills are not taught in hippotherapy; that is the domain of therapeutic riding, which teaches riding skills to people with special physical, cognitive, emotional, or social needs. That approach does not require a therapist’s degree but practitioners need special training as a therapeutic riding instructor. Other therapeutic forms that use horses may focus on grooming, leading, feeding, and other tasks, or on the nature of the human-horse interaction (as is equine-facilitated psychotherapy).
Elizabeth, a teacher from T.J.’s residential school, said his coordination had noticeably improved because of these sessions. “He couldn’t buckle [the saddle] at all, and now he can. He needs a little help, but he can do it.”
King, who holds a master’s degree in occupational therapy, clarifies that the “occupation” in occupational therapy “refers to the way in which we spend time and energy. A lot of people hear ‘occupational therapy’ and think ‘jobs.’ But it means the occupation of everyday life. The way we occupy time. If I have a problem that interrupts my ability to be all that I am, I may be helped with occupational therapy to get back on track or become independent.”
And independence is relative. It may mean being able to sit up longer in a dentist’s chair, or it may mean becoming more verbal, as in T.J.’s case. “For a lot of occupational therapists,” King continues, “working with certain populations, we are very challenged. What can we do to engage a person? The horse sets up instantaneous engagement. Once T.J. was involved in his tasks on the horse, the perseveration got put aside awhile. For him, that’s big.”
Hippotherapy, as explained by the AHA, works like this: “In the controlled hippotherapy environment, the therapist modifies the horse’s movement and carefully grades sensory input. A foundation is established to improve neurological function and sensory processing. This foundation can be generalized to a wide range of daily activities. The movement of the horse, as the tool, can be compared to other therapy tools such as balls, scooters, or swings. The variability of the horse’s movement, the rhythm, dimensionality, regularity, and the ability of the therapist to modify these movement qualities, is where the horse, as a tool, supersedes the others.”
Improvements in muscle tone, balance, posture, coordination, and motor and cognitive development—as well as emotional well-being—are all proven benefits for a variety of conditions and impairments. There is also that special, unquantifiable human-horse bond.