The significance of the human-animal relationship has been recognized for centuries. Evidence of its existence in ancient times is found in various petroglyphs across the globe. Konrad Lorenz and Boris Levinson were among the first pioneers to inspire interest in the examination of the human-animal bond (HAB), which in turn, served as a catalyst for its therapeutic use (Hines 2003). Organizations devoted to investigation of the HAB evolved in the 1960s and 1970s.  Among these, were the Delta foundation, established in 1977, and the North American Riding for the Handicapped Association (NARHA), founded in 1969. 

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The Delta Foundation has since been renamed, Pet Partners.  Currently the leading international resource for the HAB, this non-profit organization is dedicated to “ human health and well-being through the human-animal bond.” The canine is the primary species involved in public services provided by the Delta Society. In contrast, NARHA is an organization with equine emphasis. 

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NARHA’s mission is to “change and enrich lives by promoting excellence in equine assisted activities.”  Since its formation in 1969, this organization has provided therapy for physically and cognitively disabled populations.  In 1996 NARHA developed the Equine Facilitated Mental Health Association (EFMHA) section, expanding their focus to include populations with psychological and/or mental concerns. EFMHA specializes in equine-facilitated psychotherapy (EFP) and was developed as a therapy approach geared towards individuals who suffer from anxiety, depression, and autism.  In 2011 NARHA was renamed the Professional Association of Therapeutic Horsemanship International (PATH International.)

 

Animal Assisted Therapy (AAT) is an intervention approach that utilizes the human-animal bond as an integral component to achieve a specific therapy goal (Chandler 2005).  The human-animal bond offers a relationship in the absence of conditional limitations, such as fear of rejection, judgment or consequence, elements that are commonly found in human-human relationships. Several animal species, including small and large breeds, have been used in AAT. For example, therapy dogs are used in the Reading Education Assistance Dogs (R.E.A.D) program to facilitate improved reading and communication skills among children. 

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WHY HORSES?

Currently there are three primary therapy approaches that utilize a horse to assist in achieving specific therapeutic goals: equine assisted therapy, hippotherapy, and equine facilitated psychotherapy. Equine Assisted Therapy (EAT) refers to treatment that incorporates equine activities and/or the equine environment.  Rehabilitative goals are related to the patient’s needs and the medical professional’s standards of practice.

 

​Therapeutic Riding (TR) is a NOT a form of therapy but rather a recreational activity that may offer therapeutic benefit. TR involves mounted activities including traditional riding disciplines or adaptive riding activities conducted by a NARHA certified instructor. Hippotherapy (HPOT) is a physical, occupational or speech therapy treatment strategy that utilizes equine movement as part of an integrated treatment program to achieve functional outcomes. Equine Facilitated Psychotherapy (EFP), as defined by EFMHA, is psychotherapy facilitated by a licensed/credentialed mental health professional working with a horse and NARHA certified equine professional. EFP activities may include any of the following equine activities: handling, grooming, lunging, riding, driving, and vaulting (NARHA, 2008).

The use of AAT may help to facilitate improved communication for individual’s who are less responsive to traditional therapy (Triebenbacher, 2000), a trait that is common among children with Autism Spectrum Disorder (ASD) due to deficits in social communication. Children with impaired social communication are often deprived of the natural benefits involved in a communicative exchange. The inability to express one’s ideas, needs, and desires, creates an environment in which full potential cannot be achieved.  In turn, future success in the academic and professional realms is either unattainable, or difficult to achieve without direct intervention.

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In 2003, American Hippotherapy Association, Inc (AHA). separated from NARHA to incorporate as a separate 501(c)3 organization. Since it’s beginning, AHA, Inc. has been an organization dedicated to improve lives by advancing education, best practices, and resources for licensed healthcare professionals who incorporate horses in skilled therapy services.. 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 as a therapy tool to engage sensory, neuromotor and cognitive systems to promote functional outcomes.

 

​HIPPOTHERAPY 

Hippotherapy is a physical, occupational, and speech-language therapy treatment strategy that utilizes equine movement as part of an integrated intervention program to achieve functional outcomes. Equine movement provides multidimensional movement, which is variable, rhythmic, and repetitive. The horse provides a dynamic base of support, making it an excellent tool for increasing trunk strength and control, balance, building overall postural strength and endurance, addressing weight-bearing, and motor planning. The equine movement offers sensory input to the vestibular, proprioceptive, tactile, and visual systems.

 

Social Communication - Pragmatics 

Effective social communication is essential to building and maintaining relationships. Impairment in this area of an individual’s life can influence self perception, as well as the impressions made on others, ultimately defining the individual and their role in society (Milligan et al, 2007). Successful communication enables the positive aspects of interrelationships, while improving self-esteem, self-worth, self-confidence and overall quality of life, all of which may be compromised in the lives of individuals with social communication impairments (Brinton & Fujiki, 1993).  AAT, combined with traditional intervention approaches used by Speech Language Pathologists, may provide an effective means to improve communication among the Autism Spectrum Disorder (ASD) population and others in need of assistance.

 

Animals can serve as catalysts to initiate social interaction between human observers.  They can serve as an agent to focus and sustain attention (Martin & Farnum, 2002), as well as provide an item of interest to promote and encourage social interaction, engagement and communication. They may also serve as a model that promotes appropriate human social behaviors (Bardill & Hutchinson 1997). For example, although animal language is far less complex than that of humans, they shy away from inappropriate social behaviors such as yelling and/or violent outbursts (kicking, punching, etc) yet are attracted to humans who present with calm, welcoming dispositions that are conveyed through an individual’s vocal volume and body language.

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The simplicity found in animal communication enables ease in message interpretation and translation; as such exposure to animals may be beneficial for individuals with impaired social communication.  Introduction of an animal into therapy may better enable clinicians to meet the client at their current level of functioning. Activities involving social interaction with a therapy animal can provide an environment in which the client is able to engage and communicate without the stress and anxiety that some communication impaired individuals may experience when interacting with their peers.  Through this experience, one can develop foundational communication skills that might generalize to interactions with other humans.

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In addition, Hippotherapy has been used to treat behaviors associated with sensory integration deficits that hinder successful social communication. The movement of the horse provides vestibular information when the client is facing backward while the horse is moving forward. Proprioceptive input is delivered each time the horse takes a step regardless of the position of the rider, but can be enhanced if the client sits in a quadruped position as this delivers heavy touch pressure through multiple points within the body simultaneously (hip, knee, wrist, elbow and shoulder joints) and touching the soft warm coat of the horse provides tactile information (Heine, 1997).

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Several physiological and psychosocial benefits to incorporating AAT into the practice of various disciplines have been identified.  Research has shown that it is an effective means to decrease blood pressure (Odendaal, J. S., 2000), alleviate depression and anxiety (Prothmann, A., Bienert, M., & Ettrich, C. 2006),  increase attention and improve social communication (MacKinnon, J. R., Noh, S., Lariviere, J., MacPhail, A., Allan, D. E. & Laliberte, D., 1995; Martin, F. & Farnum, J., 2002; and Prothmann, A., Bienert, M & Ettrich, C., 2006), improve self esteem and sense of responsibility (Kogan, L. R., Granger, B. P., Fitchett, J. A., Helmer, K. A., & Young, K. J., 1999) and literacy in children (Newlin, 2004).  In addition to the above, equine-related AAT has served to improve motor control, mobility, balance, flexibility and posture (MacKinnon et al 1995).

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Personal testimonies reporting the positive impact of AAT can be found at the NARHA, Delta Society and other AAT organization websites. Positive outcomes associated with AAT have also been formally documented in various case studies. Lehrman, J., & Ross, D. B. (2001) conducted a case study investigating the general benefits of Therapeutic Riding (TR) on a female, age 10, with impaired vision and multiple disabilities. TR was implemented over the course of 10 weeks. Post therapy changes in performance were noted as follows: increase in verbal productions, newly acquired ability to stand independently, walk up a ramp using handrail, and rotate in a sitting position independently. An increase in visual attention span and fixation time was also observed. Additional case studies have demonstrated that AAT can serve to facilitate improved self esteem and sense of responsibility (Kogan, L. R., Granger, B. P., Fitchett, J. A., Helmer, K. A., & Young, K. J., 1999) and literacy in children (Newlin, 2004).

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Along with public interest in AAT, recognition in the need for research that provides stronger evidence to support efficacy in its use continues to rise.  Odendaal (2000) conducted a within-subject, pretest-posttest study design, and found that individuals showed a significant decrease in blood pressure following exposure to a therapy dog. The results of Prothmann, Bienert, and Ettrich’s (2006) quasi-experimental control trial showed that exposure to a therapy dog served to alleviate depression and anxiety. 

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Glazer, H. R., Clark, M. D., & Stein, D. S. (2004) conducted a cohort study investigating the impact of Equine Facilitated Psychotherapy (EFP) on grieving children.  Participants included 5 children, ages 4 to 14, mourning the death of a family member. All children participated in a EFP program for 6 weeks. Following each EFP session, the children and their parents were asked to provide feedback on the experience, and a volunteer associated with each child reported on the child’s progress. Results of the study showed an increase in self-confidence, self-esteem, trust and communication skills for all children.  Additional measures, provided by parent report, indicated that the children were able to generalize learned behaviors to home environments.

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MacKinnon et al (1995) conducted an experimental controlled trial involving 19 participants, ages 4-12 years, with cerebral palsy.  All children participated in a 6 month Therapeutic Riding (TR) program to develop functional riding skills, knowledge of horses and their care, and skill at games on horseback. Each child showed improvements in physical and psychosocial abilities.  Most common areas of improvement were in attention span, social interaction, confidence, trunk and hand control, posture, and pelvic mobility.

 

Although improvements in communication, language and speech associated with AAT have been reported in the literature, few experimental studies have investigated the effects on social communication directly. Among these were Martin and Farnum (2002) and Redefer and Goodman (1989) and Sams, Fortney and Willenbring, S. (2006).

 

Martin and Farnum (2002) conducted an experiment using a within-subject, repeated-measures design. Participants included 10 children diagnosed with pervasive developmental disorders (PDD), age 3 to 13 years. Each child participated in 45 sessions across fifteen weeks, in which they were presented with a ball, stuffed dog or a live dog. Children’s interactions were recorded as behavior or verbal. Results indicated that the highest level of verbal expression and greatest duration of attention occurred within the condition involving the live dog.  In addition, children were more socially engaged and appeared happier in the presence of the live dog.

 

Redefer and Goodman (1989) conducted a single-subject design experiment to investigate the changes in social behavior of children with Autism during and after their exposure to intervention facilitated by a therapy dog. Participants included 12 children, ages 5 to 10 years, all exhibiting autistic-like social behaviors and attending a center for Autistic children. Researchers found that children diagnosed with Autism demonstrated fewer stereotyped behaviors and increased socially appropriate behaviors in when a therapy dog was introduced into therapy.  

 

Sams, Fortney and Willenbring (2006) conducted a single-subject design pilot study investigating language use and social interaction in children with autism when receiving two forms of occupational therapy: occupational therapy using standard techniques, and occupational therapy incorporating animals. Participants included twenty-two children, ages 7 to 13, all of whom received both forms of therapy. Results of the study indicated that the children established significantly greater use of language and significantly greater social interaction in sessions incorporating animals when compared to sessions involving solely standard occupational therapy techniques.