Hippotherapy is a form of physical, occupational or speech therapy. The movement of the horse affects a rider's posture, balance, coordination, strength and sensorimotor systems. It is thought that the warmth and shape of the animal and its rhythmic, three-dimensional movement along with the rider's interactions with the horse and responses to the circulation of the horse can improve the flexibility, posture, balance and mobility of the rider. It differs from therapeutic horseback riding, because the work is one-on-one, and the rider does not direct the horse; rather, licensed health professionals such as physical therapists, occupational therapists, or speech-language pathologists guide the rider's posture and actions while the horse is controlled by assistants at the direction of the therapist. The therapist guides both the rider and horse to encourage specific motor and sensory inputs. Therapists develop plans to address specific limitations and disabilities such as neuromuscular disorders, walking ability, or general motor function.

Equine-assisted psychotherapy

Equine-assisted psychotherapy (EAP) or Equine Facilitated Psychotherapy (EFP) is the use of equines to treat human psychological problems in and around an equestrian facility. It is not the same as therapeutic riding or hippotherapy. Though different organizations may prefer one term over the other for various reasons, in practice, the two words are used interchangeably. Other terms commonly used, especially in Canada, include Equine Facilitated Wellness (EFW), Equine Facilitated Counselling (EFC) and Equine Facilitated Mental Health (EFMH).

While some mental health therapies may incorporate vaulting and riding, most utilize ground work with horses.Some programs only use ground-based work. There are also differences between programs over whether the animal is viewed as a co-facilitator, or simply as a tool.

The field of equine-assisted psychotherapy did not publicly become a part of the equine-assisted therapy world until the 1990s, although individuals had been experimenting with the concept before that time. The first national group in the United States, the Equine-Facilitated Mental Health Association (EFMHA), now a part of PATH International, formed in 1996. The mental health area of equine-assisted therapy became subject to a major rift when a second group, the Equine Growth and Learning Association (EAGALA) formed in 1999, splitting from EFMHA (now PATH) over differences of opinion about safety protocols. Since that time, additional differences have arisen between the two groups over safety orientation, the therapeutic models used, training programs for practitioners, and the role of riding. EAGALA itself had a further split between its founders in 2006 due to legal issues, with yet another new organization formed.

As a result, although PATH and EAGALA remain the two most important certification organizations in the United States, there has been a significant amount of misunderstanding amongst practitioners, client, and within the scientific literature. To resolve these differences, an independent organization, the Certification Board for Equine Interaction Professionals (CBEIP) formed, beginning in 2007, to promote professional credibility in the field. However, the world of equine-assisted psychotherapy remains disorganized and has not standardized its requirements for education or credentialing.

In Canada Equine Facilitated Wellness-Canada provides certification and training standards in the field of Equine Facilitated Wellness. They very clearly view the horse as a partner rather than a tool; Equine-Facilitated Counseling also sees the horse as sentient being and partner.

Therapeutic horseback riding

Therapeutic riding is used by physically challenged individuals who ride horses to relax, and to develop muscle tone, coordination, confidence, and well-being.

Therapeutic horseback riding is considered recreational therapy where a person is taught by a non-therapist riding instructor how to control a horse actively while riding.  It is used as an exercise to improve sensory and motor skills for coordination, balance, and posture.

Most research has focused on the physical benefit of therapeutic work with horses, with the most rigorous studies being subject to systematic review since about 2007. Claims made as to the efficacy of equine therapies for mental health purposes have been criticized as lacking proper medical evidence due in large part to poor study design and lack of quantitative data. Ethical questions relating to its expense and its continued promotion has been  raised in light of this lack of evidence. While such therapies do not appear to cause harm, it has been recommended they not be used as a mental treatment at this time unless future evidence shows a benefit for treating specific disorders.

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