Quantitative (not qualitative) studies were sought investigating whether horseback riding used as therapy improves gross motor function in children with cerebral palsy (CP). Eleven published studies on instructor-directed, recreational horseback riding therapy (HBRT) and licensedtherapist-directed hippotherapy were identified, reviewed, and summarized for research design, methodological quality, therapy regimen, internal/external validity, results, and authors’ conclusions. Methodological quality was moderate to good for all studies; some studies were limited by small sample size or lack of non-riding controls. HBRT improved gross motor function in five of six studies (one study was inconclusive); hippotherapy improved gross motor function in all five studies. The studies found that during HBRT and hippotherapy: (1) the three-dimensional, reciprocal movement of the walking horse produced normalized pelvic movement in the rider, closely resembling pelvic movement during ambulation in individuals without disability; (2) the sensation of smooth, rhythmical movements made by the horse improved co-contraction, joint stability, and weight shift, as well as postural and equilibrium responses; and (3) that HBRT and hippotherapy improved dynamic postural stabilization, recovery from perturbations, and anticipatory and feedback postural control. The evidence suggests that HBRT and hippotherapy are individually efficacious, and are both medically indicated as therapy for gross motor rehabilitation in children with CP.
There is a growing body of knowledge demonstrating the efficacy of horseback riding used as therapy in either HBRT or hippotherapy to improve gross motor function in children with CP.
Physiological mechanisms reported for HBRT and hippotherapy for improving gross motor function are related to the rider responding to the three-dimensional, reciprocal movement of the walking horse. Both HBRT and hippotherapy produce pelvic movements in the rider which closely resemble pelvic movements during ambulation in able-bodied individuals with no gross motor disability.
In conclusion, research evidence suggests that clinicians and therapists can recommend either instructor-directed HBRT or therapist-directed hippotherapy as efficacious, medicallyindicated therapy for gross motor rehabilitation of children with CP. Further studies with larger samples, blinded assessment, and non-riding controls are needed to conclusively evaluate and compare instructor-directed HBRT and therapist-directed hippotherapy.