Animal-assisted therapy has been used for years to promote human well-being, and has been shown to improve outcomes for people with Autism-spectrum disorders, illnesses, behavioral problems, and poor emotional well-being (Nimer & Lundahl, 2007). Equine-assisted therapies, the use of horses to promote development of skills and behaviors, are used internationally to complement medical intervention for individuals with many disabling conditions such as autism, cerebral palsy, spinal cord injury, emotional disabilities and multiple sclerosis (American Hippotherapy Association, 2007; Debuse, Chandler, & Gibb, 2005; Hammer et al., 2005; North American Riding for the Handicapped Association, 2008; Pichon Riviere, Augustovski, & Colantonio, 2006; Riding for the Disabled Association, 2008; Riding for the Disabled Association of Australia, 2008). The recent film and book, The Horse Boy by Rupert Isaacson (2009) brings this approach into the public eye. Isaacson highlighted his son's affinity with horses and their potential to help him learn to make sense of his world as the family traveled to Mongolia to find help for Rowan's autism.
Horseback riding and related activities using horses are believed to help people develop motor skills, balance, and muscle control; improve social, communication, and self-help skills; and improve psychological constructs such as self-esteem and well being (Brock, 1989; Casady & Nichols-Larsen, 2004; Macauley & Guterriez, 2004). The unique experience of working with a large animal can assist children and adults to work through fear, develop empathy, cooperate with others, and to develop self-confidence (Frewin & Gardiner, 2005). Although evidence is emerging to support these benefits, rigor in research addressing outcomes for children and adults has been lacking. As a result, many insurance companies in the United States consider equine-assisted activities experimental and will not fund them as interventions for individuals with disabilities (Aetna, 2008; Pichon Riviere et al., 2006).
This paper explains the history and terminology around the therapeutic use of horses for people with disabilities as well as reviews research evidence of its effectiveness in promoting positive outcomes in children and adults. First, we will describe different types of equine-assisted therapies, the populations served, and the geographical scope of these interventions. Then we will review the literature on outcomes and effectiveness for different population groups. Finally, we will summarize the evidence, point out limitations in the research to date, discuss why equine-assisted therapies are so popular, and identify needs for future research. This information is necessary to evaluate equine-assisted therapy programs and assess outcomes in light of established costs and benefits.
Context of horseback riding programs
The history of horseback riding for therapeutic benefit dates as far back as the second century, however, it resurfaced in medical literature around the time of the polio epidemic in Scandinavia in the mid-1940's (Sterba, 2007). Liz Hartel of Denmark is credited with inspiring the beginning of the organized movement of therapeutic horseback riding. Hartel won the silver medal for Grand Prix dressage at the 1952 Helsinki Olympics despite a physical disability caused by polio (North American Riding for the Handicapped Association, 2008). The first two therapeutic riding centers were founded in Denmark and Norway, and the geographic range of therapeutic riding has since included Europe, Canada, South America, Asia, Australia, New Zealand and the United States (Debuse, Chandler & Gibb, 2005; Hammer, Nilsagard, Forsberg, Pepa, Skargren & Oberg, 2005). Therapeutic intervention using horses has expanded from horseback riding to include hippotherapy, dressage, carriage driving, vaulting, and other human-horse collaborations that are thought to improve motor, emotional, and behavioral outcomes for children and adults. …